The biomedical and epidemiological characteristics of asbestos-related diseases: a review

Our plain-English summary of The biomedical and epidemiological characteristics of asbestos-related diseases: a review, by M. Huncharek (The Yale Journal of Biology and Medicine, 1986).

The study

• Author: M. Huncharek
• Journal: The Yale Journal of Biology and Medicine
• Published: 1986;59(4):435-51
• Type of article: Historical article, Review
• Cited by: 17 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. 000404).

Abstract

The purpose of this paper is to provide the reader with an overview of the biomedical and epidemiological characteristics of asbestos-related disease based upon currently available information. Epidemiological and experimental data developed over the past 20 years have greatly added to our knowledge of the biological effects of asbestos, particularly in relation to clinical disease. This information has substantially strengthened the evidence linking asbestos to specific health effects. Lung cancer and mesothelioma are clearly the most important asbestos-related causes of death among exposed individuals, although the accumulated data is suggestive of the existence of an excess risk of gastrointestinal and a variety of other neoplasms. Animal studies confirm the human epidemiological results and indicate that all commercially available fiber types are capable of producing lung cancer and mesothelioma. Experimental implantation and injection studies also show that the carcinogenicity of mineral fibers (including asbestos) is directly related to their dimensionality and not their chemical composition. Although the asbestos-related medical and scientific literature is voluminous, many issues related to the biological activity of asbestos fibers are as yet unresolved. Due to experimental and analytical limitations, questions concerning risk at low-level exposure, dose-response relationships, and individual susceptibility remain problematic.

In plain English

This 1986 article was a narrative review, not a new study. The author, at the Yale Department of Epidemiology and Public Health, summarized published human and animal research on asbestos-related disease. It covered history, fiber types (chrysotile and the amphiboles crocidolite, amosite, actinolite, anthophyllite and tremolite), asbestosis, pleural changes, lung cancer, mesothelioma and gastrointestinal cancer. The author described lung cancer and mesothelioma as the most important asbestos-related causes of death and called the occupational association with gastrointestinal cancer weak. Among the studies reviewed, a 1955 study by Doll found 11 lung cancer deaths where 0.8 were expected among men who had worked at least 20 years in an English asbestos textile factory. A 1978 study by McDonald and colleagues found mesothelioma some 60 times more frequent in a crocidolite-exposed group than in a Quebec chrysotile mining and milling cohort. The review reported that animal studies produced mesothelioma and lung cancer with all major commercial fiber types. It also reported that mesothelioma usually appeared 35 years or more after first exposure. The author concluded that risk at low exposure levels, dose-response relationships and individual susceptibility remained unresolved.

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: Narrative review of published epidemiological, clinical and experimental (animal) literature on asbestos-related disease
• Who was studied: No new subjects were studied; the review drew on published occupational cohort, case-control, clinical and animal studies, mostly from the preceding 20 years
• Exposure: Asbestos in general and its fiber types: chrysotile (serpentine group) and the amphiboles crocidolite, amosite, actinolite, anthophyllite and tremolite, in jobs including mining and milling, textile, asbestos-cement, insulation and factory work
• Main results:
  • The author described lung cancer and mesothelioma as the most important asbestos-related causes of death among exposed individuals.
  • In Doll's 1955 study, reviewed here, men who had worked at least 20 years in an asbestos textile factory in northern England had 11 observed lung cancer deaths compared with 0.8 expected.
  • In a 1968 report by Selikoff, Hammond and Churg, reviewed here, asbestos workers who smoked had eight times the lung cancer risk of all other smokers.
  • In a 1978 study by McDonald et al., reviewed here, mesothelioma was some 60 times more frequent in a cohort exposed to crocidolite than in a Quebec chrysotile mining and milling cohort. The author stated that evidence suggests a gradient in potency to cause mesothelioma, from crocidolite to chrysotile, with amosite in between.
  • The review reported that the interval between first exposure and onset of mesothelioma is usually 35 years or more.
  • The review reported that animal studies produced mesothelioma and lung cancer with all the major commercial asbestos types (chrysotile, amosite, crocidolite, anthophyllite).
  • The review reported that implantation and injection studies related the carcinogenicity of mineral fibers to their dimensions rather than their chemical composition.
  • The author judged the association between occupational asbestos exposure and gastrointestinal cancer to be weak and called for further epidemiological studies.
• The authors' conclusion: The author concluded that, because of experimental and analytical limitations, questions about risk at low-level exposure, dose-response relationships and individual susceptibility remained problematic.
• Limitations the authors state:
  • The author stated that the poor quality of past exposure measurements severely limits quantifying the dose-response relationship for lung cancer.
  • The author stated that no experimental animal reacts to asbestos dust in the same way as humans, which limits extrapolation from animal studies.
  • The author stated that occupational cohorts exposed to a single fiber type over long periods are scarce, and that exposure data are often inaccurate or unavailable.
  • The author stated that estimates of low-level exposure risk rely on downward extrapolation from high-level exposure, which carries considerable uncertainty.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Neoplasm, Mineral Fiber, Dose-response relationship.

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