Relation between exposure to asbestos and mesothelioma

Our plain-English summary of Relation between exposure to asbestos and mesothelioma, by I.J. Selikoff, J. Churg, E.C. Hammond (The New England Journal of Medicine, 1965).

The study

• Authors: I.J. Selikoff, J. Churg, E.C. Hammond
• Journal: The New England Journal of Medicine
• Published: 1965;272:560-5
• Cited by: 329 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001540).

In plain English

This 1965 study asked whether mesothelioma of the pleura (the lining of the chest) and of the peritoneum (the lining of the abdomen) was linked to asbestos exposure in the United States. The authors used three approaches. In 2,500 consecutive autopsies (1953-1964), 26 cases had asbestosis. Among those 26 were 4 pleural and 3 peritoneal mesotheliomas, and no mesothelioma was found without asbestosis in that series. Among 45 mesothelioma cases from the Armed Forces Institute of Pathology with lung tissue, asbestos bodies were found in 12. Among 307 consecutive deaths (1943-1964) of 1,522 New York and Newark, New Jersey, asbestos insulation workers, 10 were from mesothelioma (4 pleural, 6 peritoneal) and 53 from lung cancer. For comparison, an American Cancer Society general-population study recorded only 3 deaths from pleural mesothelioma among 31,652 deaths. Among the 10 workers who died of mesothelioma, none developed it less than 32 years after exposure began. The authors concluded that mesothelioma must be added to the cancer risks of asbestos inhalation. They cautioned that the numbers were small and that their figures may underestimate the true incidence.

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: Three-part investigation: a review of an autopsy series for mesothelioma among cases with asbestosis, a review of pathology-institute mesothelioma cases for asbestos bodies in lung tissue, and a study of causes of death among a union group of asbestos-insulation workers
• Who was studied: Three groups. (1) 2500 consecutive autopsies from 1953 to 1964 (including 1020 adult males), of which 26 had asbestosis. (2) 45 cases of pleural and peritoneal mesothelioma from the Armed Forces Institute of Pathology files that had lung tissue available. (3) 1522 members of the asbestos insulation workers' union locals in New York City (Local 12) and Newark, New Jersey (Local 32), who were members at any time from December 31, 1942, to December 31, 1962, and among whom 307 deaths occurred from January 1, 1943, to August 31, 1964.
• Exposure: Insulation workers in building, powerhouse and shipyard construction, with what the authors describe as relatively light, intermittent exposure to asbestos-containing insulation materials. Some of these materials contained 10 to 15 per cent asbestos. Most of the men with mesothelioma in the autopsy series had worked in asbestos factories.
• Main results:
  • Among the 26 autopsies with asbestosis, there were 4 pleural mesotheliomas (15 per cent), 3 peritoneal mesotheliomas and 7 bronchogenic carcinomas.
  • In this autopsy series, no case of mesothelioma was found in the absence of asbestosis.
  • Among the 45 Armed Forces Institute of Pathology mesothelioma cases, asbestos bodies were found in 12: in 5 of 19 pleural and 7 of 26 peritoneal mesotheliomas.
  • In 10 of these 12 cases, the asbestos bodies were first noticed in the present review.
  • Among the 307 deaths of insulation workers, 10 were from mesothelioma: 4 of the pleura and 6 of the peritoneum. The authors describe this as more than 3 per cent of deaths.
  • Among the 307 deaths of insulation workers, 53 were from lung cancer.
  • Among the 307 deaths of insulation workers, 34 were from cancer of the stomach and colon.
  • For comparison, in an American Cancer Society prospective study of the general population, 1,018,183 men and women aged thirty to eighty-nine were traced through September 30, 1962. Of these, 31,652 died: only 3 from pleural mesothelioma and none from peritoneal mesothelioma.
  • Among the 10 insulation workers who died of mesothelioma, age at death ranged from fifty to seventy-five years (average fifty-nine).
  • Among these 10 workers, exposure lasted fifteen to forty-three years. In none did the tumor develop less than thirty-two years from the onset of exposure (average thirty-eight and five tenths years).
  • The authors found no evident correlation between the occurrence of mesothelioma and the severity of asbestosis.
  • Six of the 7 men with mesothelioma in the autopsy series had histories of prolonged employment in the asbestos industry, in asbestos-factory work rather than insulation work.
  • The seventh man with mesothelioma in the autopsy series was a carpenter who denied ever having seen, used or handled any asbestos product. At post-mortem examination, asbestos bodies and fibers were found in his lung.
• The authors' conclusion: The authors concluded that mesothelioma must be added to the cancer risks of asbestos inhalation. In their view it joins lung cancer, and probably cancer of the stomach and colon, as a significant complication of industrial asbestos exposure in the United States. They also stated that mesothelioma may not be entirely a problem of crocidolite alone and is not limited to South Africa. They raised the question of whether mesothelioma may also be a community problem.
• Limitations the authors state:
  • Only small numbers of mesothelioma cases were available, so the findings may be due to chance.
  • Autopsy series are selected, so the 7 mesotheliomas among 26 asbestosis autopsies cannot necessarily be taken as the true incidence.
  • In the pathology-institute cases, very little lung tissue was available, and the part of the lung sampled was unknown. Only tissue sections could be checked for asbestos bodies, so asbestos may have been under-detected.
  • Asbestos bodies are occasionally found in 'normal' lungs without asbestosis, so their importance could be overemphasized.
  • Only 110 of the 297 non-mesothelioma deaths among the workers had histologic confirmation. Mesothelioma incidence among the workers may therefore be underestimated.

Topics

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

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

Related studies

• Diffuse mesothelioma and exposure to asbestos dust in the Merseyside area — W.G. Owen (1964)
• Exposure to asbestos and mesothelioma of the pleura — P.B. Fowler, J.C. Sloper, et al. (1964)
• Association of asbestos and bronchogenic carcinoma in a population with low asbestos exposure — M.L. Warnock, A.M. Churg (1975)
• Asbestos exposure, smoking, and neoplasia — I.J. Selikoff, E.C. Hammond, et al. (1968)
• Epidemiology of gastrointestinal cancer — I.J. Selikoff (1974)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)

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