Pulmonary fibrosis in asbestos insulation workers with lung cancer

Our plain-English summary of Pulmonary fibrosis in asbestos insulation workers with lung cancer, by W. Weiss (British Journal of Industrial Medicine, 1989).

The study

• Author: W. Weiss
• Journal: British Journal of Industrial Medicine
• Published: 1989;46(6):430
• Type of article: Comment, Letter
• Cited by: 1 article, 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. 000178).

In plain English

This is a letter to the editor, not a new study. The author criticised the design of an earlier paper by Kipen et al, which had reviewed 138 histologically confirmed lung cancer cases from the United States-Canadian insulator cohort. The author argued that Kipen et al treated all interstitial fibrosis as asbestosis, even with rare or no asbestos bodies. The author also argued that they had no unexposed control groups with blind evaluation of x ray films or tissue samples. Using data from a separate paper by Selikoff et al, the author calculated a relative risk of lung cancer of 4.23 among these insulators 20 or more years after first exposure. From that figure, the author estimated that 23.6% of the lung cancers would have occurred without asbestos exposure. The author compared this with the 18% of Kipen et al's cases reported as having no radiographic signs of asbestosis. The author concluded that Kipen et al's conclusion was not warranted by their study design. The author called for adequately designed studies to settle the question.

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: Letter to the editor (correspondence) criticising the design of an earlier study by Kipen et al (1987); no new data were collected
• Who was studied: No population of its own. The letter discusses the 138 histologically confirmed lung cancer cases (out of 450 diagnosed) in the United States-Canadian insulator cohort reviewed by Kipen et al
• Exposure: Asbestos exposure in insulation workers of the United States-Canadian insulator cohort; no fiber types are named
• Main results:
  • The author argued that Kipen et al assumed all interstitial fibrosis was asbestosis, even when asbestos bodies were rare or absent
  • The author argued that Kipen et al had no unexposed control groups with blind evaluation of x ray films or tissue specimens, and considered this the most serious defect
  • Using data from Selikoff et al based on death certificates, the author calculated a relative risk of lung cancer of 4.23 among the insulators 20 or more years after onset of exposure
  • From that relative risk, the author estimated that 23.6% of the lung cancers (one in every 4.23) would have occurred in this population without asbestos exposure
  • The author based the calculation on 20 or more years from first exposure because 134 of Kipen et al's 138 cases occurred in that interval
  • The author noted that the 23.6% figure approximated the 18% of Kipen et al's 138 cases reported as having no radiographic signs of asbestosis in the lung tissue
• The authors' conclusion: The author concluded that Kipen et al's conclusion was not warranted by their study design. In the author's view, the most parsimonious interpretation was that the lung cancers without x ray evidence of asbestosis were the number expected without asbestos exposure. The author called for adequately designed studies to settle the issue.
• Limitations the authors state:
  • The author said it was open to question whether the 138 cases were representative of all cases, but assumed for the argument that they were
  • The author acknowledged potential for error in the methods used when comparing the 23.6% and 18% figures

Topics

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

Medical terms in this study, explained in our Lexicon: Pulmonary Fibrosis, Insulator, Lung Cancer.

Related studies

• Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation — H.M. Kipen, R. Lilis, et al. (1987)
• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Serum type III procollagen peptide: indicator for pulmonary fibrosis: II. Application in 80 asbestos insulation workers — I. Okazaki, K. Maruyama, et al. (1987)
• Pulmonary fibrosis in asbestos insulation workers with lung cancer — Y. Suzuki, H. Kipen, et al. (1987)
• Idiopathic pulmonary fibrosis in asbestos-exposed workers — E.A. Gaensler, P.J. Jederlinic, et al. (1991)
• Frequency of HLA antigen in asbestos workers with and without pulmonary fibrosis — C.C. Evans, H.C. Lewinsöhn, et al. (1977)

Browse more research in British Journal of Industrial Medicine, or return to medical research.