Projection of asbestos related diseases in the United States, 1985-2009. I. Cancer

Our plain-English summary of Projection of asbestos related diseases in the United States, 1985-2009. I. Cancer, by D.E. Lilienfeld, J.S. Mandel, P. Coin, et al (British Journal of Industrial Medicine, 1988).

The study

• Authors: D.E. Lilienfeld, J.S. Mandel, P. Coin, L.M. Schuman
• Journal: British Journal of Industrial Medicine
• Published: 1988;45(5):283-91
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000246).

Abstract

Projections of asbestos associated cancer mortality in the United States during the 25 year period 1985-2009 were made based on previously published estimates. These estimates were reviewed for malignant mesothelioma, lung cancer, and gastrointestinal cancers. Particular attention was given to the assumptions used in the original derivation of the estimates. For malignant mesothelioma mortality, previous estimates ranged from 15,500 to 300,000. Using recently published data from the Surveillance, Epidemiology, and End Results project, coupled with the previously published estimates, projected asbestos related malignant mesothelioma mortality in the United States for the period 1985-2009 was estimated to be 21,500. For lung cancer, previous estimates were reviewed, particularly with regard to the ratio of deaths from lung cancer to deaths from malignant mesothelioma. Using these ratios, a range of projected deaths was established and a median of those estimates used as a project, which was 76,700 such deaths in the United States between 1985 and 2009. Gastrointestinal cancer mortality has been projected by only three investigators. A median of those estimates (33,000) was used. In conclusion it is estimated that 131,200 deaths from asbestos associated cancer will occur in the United States between 1985 and 2009.

In plain English

This paper reviewed earlier projections of asbestos-related cancer deaths in the United States for 1985 to 2009 and made its own. Earlier mesothelioma estimates ranged from 15,500 to 300,000, though the authors' table dates the 300,000 estimate to 1980 to 2010. The authors judged both ends unreasonable and considered 20,000 to 23,000 deaths a fair assessment. As a check, they used registry data analysed by Spirtas et al to project about 35,000 mesothelioma cases among white people. Assuming 10% overdiagnosis and 25% non-asbestos cases, they reduced this to 23,625, which they called close. For lung cancer, a ratio of 3.3 to 3.8 lung cancer deaths per mesothelioma death gave 66,000 to 87,400, with a midpoint of about 76,700. For digestive system cancers, whose link to asbestos the authors called controversial, they used about 33,000, from three earlier estimates clustering between 30,000 and 35,000. The authors concluded that about 131,200 cancer deaths, including about 21,500 from mesothelioma, would result from past occupational asbestos exposure. They noted that precise data are unavailable and that lung cancer projections may not adequately account for smoking.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of previously published and unpublished projections, used to derive the authors' own projections of asbestos-related cancer deaths
• Who was studied: Projected asbestos-related cancer deaths (malignant mesothelioma, lung cancer, gastrointestinal cancers) in the United States for the 25 years 1985 to 2009
• Exposure: Past occupational exposure to asbestos. The authors' projections do not specify fiber types; the authors note that the influence of fiber type on risk is not clear.
• Main results:
  • In the text, earlier projections of asbestos-related malignant mesothelioma deaths ranged from 15,500 (Walker) to 300,000 (Bridbord), and the authors judged neither figure reasonable. The text places this range in 1985 to 2009, but table 2 lists the Bridbord estimate for 1980 to 2010.
  • Table 2 lists the unpublished Bridbord et al estimate of 300,000 mesothelioma deaths for the years 1980 to 2010
  • The authors considered 20,000 to 23,000 deaths a fair assessment of asbestos-related malignant mesothelioma over 1985 to 2009
  • From incidence data analysed by Spirtas et al, and assuming the increase continued into the early 1990s and then diminished, the authors projected about 35,000 cases of malignant mesothelioma among whites in the United States between 1985 and 2009
  • Applying assumed overdiagnosis of 10% and 25% of cases not due to asbestos to that projection for whites, the authors obtained 23,625 future asbestos-related mesotheliomas, which they described as close to their estimate
  • Using 20,000 to 23,000 mesothelioma deaths and a ratio of 3.3 to 3.8 lung cancer deaths per mesothelioma death, projected asbestos-related lung cancer deaths were 66,000 to 87,400
  • The average of that range gave about 76,700 asbestos-associated lung cancer deaths for 1985 to 2009
  • The authors called the relation of asbestos to digestive system cancers controversial. Three earlier estimates of asbestos-related digestive system cancers (not including peritoneal mesothelioma) clustered between 30,000 and 35,000, and the authors used about 33,000.
• The authors' conclusion: The authors concluded that about 131,200 cancer deaths would occur in the United States from 1985 to the end of 2009 as a result of past occupational asbestos exposure: about 21,500 from malignant mesothelioma, 76,700 from lung cancer, and 33,000 from gastrointestinal cancers
• Limitations the authors state:
  • The data needed for precise calculations of asbestos-related cancer and asbestosis are not, and never will be, available
  • The authors described any precise number of future mesothelioma deaths as tenuous
  • Mortality data on mesothelioma are inadequate because there is no specific ICD code for the disease
  • Projections of lung cancer deaths may not adequately take cigarette smoking into account
  • How fiber type affects relative risk estimates is not clear
  • The relation of asbestos to digestive system cancers is controversial

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Lung Cancer, Epidemiology.

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