The attribution of lung cancer to asbestos

Our plain-English summary of The attribution of lung cancer to asbestos, by W. Weiss (Chest, 1993).

The study

• Author: W. Weiss
• Journal: Chest
• Published: 1993;103(2):654-5
• Type of article: Comment, Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor, not a new study. Weiss responded to a 1992 Chest article by Kishimoto on asbestos bodies in autopsy lung tissue in Kure, a Japanese shipbuilding city. The letter restated Kishimoto's figures. Concentrations of 500 or more asbestos bodies per 5 g of wet lung tissue were found in 89 percent of 19 mesothelioma cases, 38 percent of 104 lung cancer cases, 37 percent of 62 gastric cancer cases and 28 percent of 45 colon cancer cases. The figure was 10.5 percent of 200 control autopsies from 1984 to 1989. The author called Kishimoto's mesothelioma conclusion probably correct in a shipbuilding area. The author argued that the claim that about 40 percent of lung cancers were related to asbestos was in error. The reasons given were missing information on how cases and controls were selected, on age and sex, on smoking, and on asbestosis, and that association alone does not establish cause. Using a relative risk of 1.11 from a study of U.S. shipyard counties by Blot and colleagues, the author calculated that 9.9 percent of lung cancer deaths there were attributable to asbestos, at least in part. A partial reply from Kishimoto followed.

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 commenting on another author's published autopsy study, followed by part of that author's reply
• Who was studied: No new population. The letter discusses Kishimoto's autopsy series from one hospital in Kure, Japan, a shipbuilding center. That series had 19 mesothelioma, 104 lung cancer, 62 gastric cancer and 45 colon cancer cases, plus 200 control autopsies, from 1984 to 1989.
• Exposure: Asbestos bodies in lung tissue (500 or more per 5 g of wet lung tissue) in a shipbuilding area. Fiber types are not specified.
• Main results:
  • Kishimoto's figures as restated in the letter: 500 or more asbestos bodies per 5 g of wet lung tissue were found in 89 percent of 19 mesothelioma cases, 38 percent of 104 lung cancer cases, 37 percent of 62 gastric cancer cases, 28 percent of 45 colon cancer cases, and 10.5 percent of 200 control autopsies.
  • The author considered Kishimoto's conclusion about mesothelioma probably correct in a shipbuilding area.
  • The author argued there was no information on whether cases and controls were representative, on matching or adjustment for age and sex, or on what proportion of deaths were autopsied.
  • The author argued there was no information on smoking, the primary confounding agent for lung cancer, or on the frequency of asbestosis in the groups.
  • The author argued that association alone does not establish a causal relationship.
  • Using Blot and colleagues' relative risk of 1.11 for lung cancer in U.S. shipyard counties from 1950 to 1969, the author calculated that 9.9 percent of those lung cancer deaths were attributable to asbestos, at least in part.
  • The author stated that Kishimoto misrepresented Kannerstein and Churg. According to the letter, those authors found lung cancer more common in the lower lobes among exposed cases, but no difference in cell type or in peripheral versus central position.
  • In the partial reply, Kishimoto stated that 18 of the lung cancer cases in the original article were asbestosis and five had evidence of pleural plaques.
  • In the partial reply, Kishimoto stated that about 40 percent of lung adenocarcinomas occurred in nonsmokers or patients who were not heavy smokers.
• The authors' conclusion: The author concluded that elevated asbestos body concentrations in lung tissue are only estimates of exposure and cannot establish a causal relationship with a disease as common as lung cancer.

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: Attribution, Lung Cancer.

Related studies

• Causal attribution and life-threatening disease — C. Mumma, R. McCorkle (1982)
• Asbestos, asbestosis, and cancer: The Helsinki criteria for diagnosis and attribution. Critical need for revision of the 2014 update — X. Baur, H.J. Woitowitz, et al. (2017)
• The attribution of lung cancers to asbestos exposure: a pathologic study of 924 unselected cases — F. Mollo, C. Magnani, et al. (2002)
• The diagnosis and attribution of asbestos-related diseases in an Australian context: report of the Adelaide Workshop on Asbestos-Related Diseases. October 6-7, 2000 — D.W. Henderson, M.L. Jones, et al. (2004)
• Estimating past inhalation exposure to asbestos: A tool for risk attribution and disease screening — J.W. Cherrie, D. McElvenny, et al. (2018)
• Asbestos, smoking, and lung cancer: interaction and attribution — B.W. Case (2006)

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