The epidemiology and clinical features of asbestosis and related diseases

Our plain-English summary of The epidemiology and clinical features of asbestosis and related diseases, by P.C. Elmes (Postgraduate Medical Journal, 1966).

The study

• Author: P.C. Elmes
• Journal: Postgraduate Medical Journal
• Published: 1966;42(492):623-35
• Type of article: Review
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001498).

In plain English

This 1966 article was a review of what was then known about asbestosis and related diseases. It drew on published studies and on the author's own work in Belfast, some of it not yet published. It described the main asbestos types (chrysotile, crocidolite, amosite and anthophyllite), how people were exposed, the clinical features of asbestosis, and the features and diagnosis of mesothelioma. Among 107 deaths in Belfast insulation workers from 1940 to 1965, 28 were intrathoracic tumours, against roughly 5.3 expected. Where no autopsy material had been preserved, lung cancer and pleural mesothelioma were hard to distinguish, so those deaths were counted together. In a survey of 21 working insulation workers with definite asbestosis, six had cyanosis, 7 had finger clubbing and 13 had basal rales. A table combining four retrospective studies of 168 mesothelioma cases found no history of exposure in 30%. The author concluded that more mesothelioma cases seemed likely over the next 30 years. The author also concluded that removing crocidolite from commercial use might considerably reduce the tumour's incidence. The author noted that the expected death figures were only a rough estimate.

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 the epidemiology and clinical features of asbestos-related diseases, including some of the author's own Belfast data and one case description
• Who was studied: Asbestos-exposed groups described in the literature (miners, factory workers, insulation workers, people with domestic or environmental exposure), plus Belfast insulation workers, including 107 deaths investigated from 1940 to 1965
• Exposure: Chrysotile, crocidolite (blue asbestos), amosite and anthophyllite, through mining, factory work, insulation work, building trades, and domestic or environmental contact
• Main results:
  • Among 107 deaths in Belfast insulation workers (1940 to 1965), deaths from lung cancer and pleural mesothelioma were classified together because they were hard to differentiate where no autopsy material had been preserved. Together these deaths were about five times the expected number: 28 observed intrathoracic neoplasms against 5.3 expected.
  • In a group of 21 Belfast insulation workers with definite asbestosis who were still at work, six were cyanosed, 7 had clubbing of the fingers and 13 had basal rales
  • All Belfast insulators examined who were over 50 with 30 years of exposure showed definite lung damage, compared with about 30% of men aged 30 to 40 or with 10 to 19 years of exposure
  • Pleural plaques were seen in 13 of 87 dead Belfast asbestos workers who had chest X-rays, and in six of 100 living pipe coverers in the same area
  • In every case of proven primary lung carcinoma in the Belfast series there was histological evidence of asbestosis, though this was not always obvious on X-ray
  • In a table combining four retrospective mesothelioma studies (London, Belfast, Liverpool, South Africa; 168 cases in total), 30% had no history of exposure
  • In the reviewed reports, mesotheliomas were unknown in Finland (anthophyllite areas) and in the amosite areas of South Africa, although plaques were common in both
  • Case description: a 53-year-old woman with lung fibrosis compatible with asbestosis, who denied occupational exposure, had helped her husband build two asbestos bungalows; her husband showed similar fibrosis on X-ray
• The authors' conclusion: The author concluded that asbestos-related lung cancer appeared common in people whose exposure was not long or intense enough to cause crippling fibrosis. The author also concluded that there is an association between asbestos exposure and mesothelioma, that increasing numbers of cases seemed likely over the next 30 years, and that eliminating crocidolite from commercial use might considerably reduce the tumour's incidence.
• Limitations the authors state:
  • The expected numbers of deaths for Belfast insulators were only a rough estimate based on 1951 national death figures for ages 45 to 64
  • In the Belfast insulator deaths, lung cancer could not easily be separated from pleural mesothelioma where no autopsy material had been preserved
  • The rising number of insulator deaths over successive five-year periods may reflect better case finding rather than a real change in the death rate
  • For insulation workers, exposure to individual fibre types usually could not be identified

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Epidemiology.

Related studies

• Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice — M.R. Becklake (1976)
• Clinical features and epidemiology of malignant pleural mesothelioma in west Glasgow 1987-1992 — A.N. McLean, K.R. Patel (1997)
• Epidemiology of asbestos-related diseases — R.A. Lemen, J.M. Dement, et al. (1980)
• The epidemiology of asbestos-related diseases — J. Niklinski, W. Niklinska, et al. (2004)
• Epidemiology of occupational asbestos-related diseases in China — S.X. Cai, C.H. Zhang, et al. (2001)
• The relative importance of clinical, radiological and pulmonary function variables in evaluating asbestosis and chronic obstructive airway disease in asbestos workers — G.M. Regan, B. Tagg, et al. (1971)

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