Risk factors in asbestos exposure

Our plain-English summary of Risk factors in asbestos exposure, by P.C. Elmes (Journal of the Royal Society of Medicine, 1978).

The study

• Author: P.C. Elmes
• Journal: Journal of the Royal Society of Medicine
• Published: 1978;71(12):914-6
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002118).

Summary of the article

This symposium paper, read to the Royal Society of Medicine's Section of Occupational Medicine on 27 October 1977, discussed the medicolegal aspects of asbestosis, lung cancer and mesothelioma by level of asbestos exposure. Under high exposure, as in factories before the 1933 regulations, asbestosis sometimes caused death after 10 to 15 years. In heavy smokers with asbestosis the lung cancer risk was stated as between 70 and 100%, so that all their lung cancers could be considered occupational. Under controlled (moderate) exposure, averaging 5-15 fibres/cc until about 1960 and later falling to the 2 fibres/cc standard, disabling asbestosis was described as rare before retiring age. Lung cancer risk in this group was given as about four-fold raised in non-smokers (80% attributable) and ten- to twenty-fold raised in heavy smokers (90-95%). Mesothelioma risk ranged from very high in insulation workers to very low with exclusively chrysotile exposure. The author regarded all cases with a history of occupational exposure as 100% attributable, and smoking as unimportant. For low continuous or occasional high exposure, the last 10 years were regarded as irrelevant for lung cancer and mesothelioma, but past short exposures were always relevant for mesothelioma. The author concluded that mesothelioma presented the main medicolegal problem in individual cases. He called identifying sources of exposure an urgent matter, both for individual claims and to prevent future cases.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This 1978 symposium paper gave the author's views on medicolegal questions in asbestos disease; it reported no new study. The author grouped British asbestos workers by exposure level. The author discussed a moderately exposed worker (factory exposure was often 5-15 fibres/cc until about 1960) aged 55 or 60 with diagnosable asbestosis but no serious disability. For such a worker, the author stated, lung cancer risk was raised about four-fold above general-population non-smokers in a non-smoker, and ten- to twenty-fold above people with the same smoking habit in a heavy smoker. The author wrote that mesothelioma risk ranged from very high in insulation workers to very low in factory workers exposed only to chrysotile. Because the idiopathic disease is so rare, the author considered all cases with a history of occupational exposure 100% attributable. The author's working rule treated the most recent 10 years as irrelevant for lung cancer and mesothelioma, while past short exposures were always relevant for mesothelioma. Discussing low continuous or occasional high exposure, the author concluded that mesothelioma presents the main medicolegal problem in the individual case, as it usually arises without asbestosis or pleural plaques. The author also concluded that identifying exposure sources is urgent.

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: Symposium paper giving the author's expert opinion (narrative commentary drawing on other published work; no new data)
• Who was studied: No study population; the author discussed asbestos-exposed workers in Britain, classified by level of exposure (high, controlled/moderate, low continuous or occasional high)
• Exposure: Occupational asbestos exposure at different levels: very dusty factory conditions before the 1933 regulations; average 5-15 fibres/cc in regulated factories until about 1960, falling to the 2 fibres/cc standard; low continuous or occasional high exposure. Mixed fiber exposure and exclusively chrysotile exposure were mentioned.
• Main results:
  • The author stated that for a heavily exposed worker with diagnosed asbestosis who is a heavy smoker, the lung cancer risk is between 70 and 100%, so all lung cancers can be considered occupational
  • For a moderately exposed worker aged 55 or 60 with diagnosable asbestosis but no serious disability, the author stated that a non-smoker's lung cancer risk is raised about four-fold above that of non-smokers in the general population
  • For the same kind of worker (moderately exposed, aged 55 or 60, diagnosable asbestosis but no serious disability), the author stated that a heavy smoker has a ten- to twenty-fold increased lung cancer risk compared with the general public with the same smoking habit
  • The author stated that mesothelioma risk in the moderately exposed group ranges from very high in insulation workers (reaching 50% of the lung cancer rate in that group) to very low in factory workers with exclusively chrysotile exposure
  • The author stated that, because idiopathic mesothelioma is so rare, all mesothelioma cases with a history of occupational exposure are 100% attributable
  • The author stated that exposure is usually not enough to cause asbestosis in pleural mesothelioma cases but usually has been enough in peritoneal mesothelioma cases
  • The author proposed as a working rule that the most recent 10 years be regarded as irrelevant for lung cancer and mesothelioma, while short periods of exposure in the past are always relevant for mesothelioma
  • The author stated that in the low exposure group lung cancer is probably not a significant risk
• The authors' conclusion: In the section on low continuous or occasional high exposure, the author concluded that mesothelioma presents the main medicolegal problem in the individual case, because it usually arises with no evidence of asbestosis or pleural plaques; the author also concluded that identifying sources of exposure leading to mesothelioma is urgent, both for individual cases and to prevent future cases

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer, Mesothelioma, Insulator, Chrysotile, Occupational Exposure.

Related studies

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• Anxious and depressive symptoms in the French Asbestos-Related Diseases Cohort: risk factors and self-perception of risk — I. Mounchetrou Njoya, C. Paris, et al. (2017)
• Risk factors associated with asbestos-related diseases: a community-based case-control study — M.I. Rosell-Murphy, R. Abós-Herràndiz, et al. (2013)
• Talc-coated rice as a risk factor for stomach cancer — G.N. Stemmermann, L.N. Kolonel (1978)
• Occupational risk factors for lung cancer in women: results of a case-control study in Germany — I. Jahn, W. Ahrens, et al. (1999)

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