The asbestos disease epidemic: here today, here tomorrow

Our plain-English summary of The asbestos disease epidemic: here today, here tomorrow, by P. Cullinan, N. Pearce (Thorax, 2012).

The study

• Authors: P. Cullinan, N. Pearce
• Journal: Thorax
• Published: 2012;67(2):98-9
• Type of article: Editorial, Comment
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this commissioned editorial, the authors discussed the continuing worldwide use of asbestos and commented on a 37-year retrospective cohort study of employees of the Chongqing asbestos plant in China, published in the same issue of Thorax. They noted that total bans were in place in 52 countries, but that elsewhere production and use continued and even increased. In India, use had doubled in the last decade to about 300 000 tonnes a year. Almost all of the estimated 2 million tonnes mined each year was chrysotile. The Chongqing plant had used only chrysotile from Sichuan mines, and a limited analysis of ore samples in 2000 had not detected tremolite. A reference group of electronics factory workers in the same city was followed for the same period. The study found a more than threefold increase in the risk of death from lung cancer, and from non-malignant respiratory disease, among the asbestos workers after statistical control for smoking. It showed an exposure-response relationship in both non-smokers and smokers, and there were two mesothelioma deaths. The authors noted limitations: the absence of tremolite was unverified, earlier or other exposures were possible, and a quarter of the electronics workers could not be traced. They concluded that the study gave further evidence against the 'amphibole hypothesis'. They also concluded that claims that asbestos is safe if used safely are disingenuous at best, and that the asbestos disease epidemic had not ended but had moved.

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 is a commissioned editorial, not an original study. The authors commented on a separate study in the same issue of Thorax by researchers from Hong Kong and Sichuan. That study was a 37-year retrospective cohort study of employees of the Chongqing asbestos plant in China, compared with workers at an electronics factory in the same city. The editorial says the plant used only chrysotile asbestos mined in Sichuan. As the editorial describes it, the study found a more than threefold increase in the risk of death from lung cancer, and also from non-malignant respiratory disease, among the asbestos workers after statistical control for smoking. It found an exposure-response relationship in both non-smokers and smokers, and two mesothelioma deaths in the asbestos cohort. The editorial authors noted several limitations. The tremolite-free claim could not be verified. Workers may have had earlier asbestos exposure or other workplace carcinogens. A quarter of the electronics workers could not be traced. The authors concluded that the study adds evidence against the 'amphibole hypothesis' and that the asbestos disease epidemic has moved rather than ended.

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: Commissioned editorial commenting on a retrospective cohort study (Wang et al., Thorax 2012;67:106-10) published in the same issue; not original research
• Who was studied: The editorial discusses another study's cohort: employees of the Chongqing asbestos plant in China, followed for 37 years, with a reference group of electronics factory workers in the same city followed for the same period. No numbers of workers are given in the editorial.
• Exposure: Chrysotile asbestos, which the editorial says was the only type used at the plant, from mines in Sichuan. The plant used up to 6000 tonnes of raw asbestos a year to make textiles, asbestos cement products, rubber products, and friction and heat-resistant materials. A limited analysis of ore samples in 2000, reported in an earlier study, did not detect tremolite contamination.
• Main results:
  • As reported by the editorial about the Wang et al. study, the asbestos workers had a more than threefold increase in the risk of death from lung cancer, and also from non-malignant respiratory disease, after statistical control for smoking. The editorial gives no exact risk ratios or confidence intervals.
  • According to the editorial, the Wang et al. study showed an exposure-response relationship in both non-smokers and smokers.
  • According to the editorial, there were two deaths from mesothelioma in the asbestos cohort. The editorial suggests these were presumably the same two reported in an earlier 25-year follow-up of the same cohort.
• The authors' conclusion: The editorial authors concluded that this study of pure or near-pure chrysotile provides further evidence against the 'amphibole hypothesis'. They also concluded that the asbestos disease epidemic is not over but has moved to rapidly developing economies.
• Limitations the authors state:
  • The study's authors could not verify the claim that the factory only ever used tremolite-free chrysotile.
  • The asbestos factory employees may have had previous asbestos exposure elsewhere, or there may have been other, unidentified carcinogens in the workplace.
  • Follow-up of the asbestos cohort was virtually complete, but a quarter of the electronics workers in the reference group could not be traced.

Topics

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

Medical terms in this study, explained in our Lexicon: Cohort Study, Thorax, Chrysotile, Tremolite, Lung Cancer, Mesothelioma, amphibole hypothesis.

Related studies

• Occupational lung diseases: from old and novel exposures to effective preventive strategies — P. Cullinan, X. Muñoz, et al. (2017)
• Exposing the "myth" of ABC, "anything but chrysotile": a critique of the Canadian asbestos mining industry and McGill University chrysotile studies — D. Egilman, C. Fehnel, et al. (2003)
• A 37-year observation of mortality in Chinese chrysotile asbestos workers — X. Wang, E. Yano, et al. (2012)
• Occupational respiratory disease in mining — M.H. Ross, J. Murray (2004)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)
• Dose-response associations of silica with nonmalignant respiratory disease and lung cancer mortality in the diatomaceous earth industry — H. Checkoway, N.J. Heyer, et al. (1997)

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