Sailors and the Risk of Asbestos-Related Cancer

Our plain-English summary of Sailors and the Risk of Asbestos-Related Cancer, by R.A. Lemen, P.J. Landrigan (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: R.A. Lemen, P.J. Landrigan
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(16)
• Type of article: Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sailors have long been known to experience high rates of injury, disease, and premature death. Many studies have shown asbestos-related diseases among shipyard workers, but few have examined the epidemiology of asbestos-related disease and death among asbestos-exposed sailors serving on ships at sea. Chrysotile and amphibole asbestos were used extensively in ship construction for insulation, joiner bulkhead systems, pipe coverings, boilers, machinery parts, bulkhead panels, and many other uses, and asbestos-containing ships are still in service. Sailors are at high risk of exposure to shipboard asbestos, because unlike shipyard workers and other occupationally exposed groups, sailors both work and live at their worksite, making asbestos standards and permissible exposure limits (PELs). based on an 8-h workday inadequate to protect their health elevated risks of mesothelioma and other asbestos-related cancers have been observed among sailors through epidemiologic studies. We review these studies here.

In plain English

This article was a review, not a new study. The authors searched PubMed and NIOSHTIC-2 for epidemiologic studies, case reports and case series on asbestos-related disease in sailors. They noted that chrysotile and amphibole asbestos were used widely in ship insulation, bulkheads, pipe coverings, boilers and machinery. They argued that 8-hour exposure limits do not fit sailors, who live as well as work aboard. Among the studies reviewed, a 2020 study of Nordic seafarers reported an excess of mesothelioma (SIR = 2.17; 95% CI: 1.83–2.56). A study of the Royal Norwegian Navy reported excess mesothelioma in engine room crews (SIR = 6.23; 95% CI: 2.51–12.8). A Finnish study found lung cancer in male deck crew slightly elevated but not significantly (SIR = 1.2; 95% CI: 0.9–1.6). The authors also cited a study funded by defense law firms that found the evidence did not allow definitive conclusions. The authors concluded there can be no doubt of a causal relationship between sailors' asbestos exposure and increased asbestos-related disease. They acknowledged that some cited studies differ in methods and cannot always reconstruct sailors' precise past exposure.

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 published epidemiologic studies, case reports and case series
• Who was studied: Published studies of sailors (merchant seamen, naval crews, marine engineers) found by searching PubMed and NIOSHTIC-2 and by checking reference lists
• Exposure: Shipboard asbestos, chrysotile and amphibole, in insulation, joiner bulkhead systems, pipe coverings, boilers, machinery parts and bulkhead panels
• Main results:
  • The authors argued that air measurements on ships at sea cannot be judged against limits based on an 8-hour workday, because sailors live and work aboard
  • Reviewed study (2020, five Nordic countries, 81,741 seafarers and 66,926 fishermen, 1961–2005): only seafarers had a significant excess of mesothelioma, SIR = 2.17 (95% CI: 1.83–2.56)
  • Reviewed study of 28,300 Royal Norwegian Navy servicemen: significant excess of mesothelioma in engine room crews, SIR = 6.23 (95% CI: 2.51–12.8)
  • Reviewed study of 3324 long-term U.S. merchant marine seamen (X-rays 1985–1987): asbestos-related X-ray changes were most common in the engine department, 391 of 920 (42.5%)
  • Reviewed Italian cohort of seamen: excess lung cancer only in those with at least one sailing experience, SMR = 1.71 (95% CI: 1.15–2.44)
  • Reviewed Finnish study: lung cancer in male deck crew was slightly elevated but not statistically significant, SIR = 1.2 (95% CI: 0.9–1.6)
  • The review cited a study funded by law firms representing asbestos defendants, which concluded that study limitations and mostly unremarkable shipboard air measurements preclude definitive conclusions
• The authors' conclusion: The authors concluded that virtually all published studies of sailors report elevated asbestos-related disease, and that there can be no doubt of a causal relationship between sailors' asbestos exposure and increased risk of asbestos-related diseases
• Limitations the authors state:
  • Some of the cited studies differ in methods and cannot always reconstruct sailors' precise past exposure to asbestos

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Chrysotile, Amphibole Asbestos, Pipe Covering, Permissible Exposure Limit (PEL), Mesothelioma.

Related studies

• An exposure study of bystanders and workers during the installation and removal of asbestos gaskets and packing — C. Mangold, K. Clark, et al. (2006)
• Asbestos-related cancers among 28,300 military servicemen in the Royal Norwegian Navy — L.A. Strand, J.I. Martinsen, et al. (2010)
• Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM) — L. Vimercati, D. Cavone, et al. (2023)
• Mortality among shipyard Coast Guard workers: a retrospective cohort study — S. Krstev, P. Stewart, et al. (2007)
• Use of asbestos in the Israeli Defense Forces — Z. Schlezinger (1986)
• Correlation between fibre content of the lungs and disease in naval dockyard workers — J.C. Wagner, C.B. Moncrieff, et al. (1986)

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