The epidemiology of asbestos-related diseases

Our plain-English summary of The epidemiology of asbestos-related diseases, by J. Niklinski, W. Niklinska, E. Chyczewska, et al (Lung Cancer, 2004).

The study

• Authors: J. Niklinski, W. Niklinska, E. Chyczewska, J. Laudanski, W. Naumnik, L. Chyczewski, E. Pluygers
• Journal: Lung Cancer
• Published: 2004;45 Suppl 1:S7-S15
• Type of article: Review
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos has been recognised as a potential health hazard since the 1940s. Of the two major species of asbestos; white asbestos (chrysotile) and blue asbestos (crocidolite), both of which are hazardous. The workers at extraction facilities are at the greatest risk of exposure to asbestos and, therefore, the development of asbestos-related diseases, commonly mesothelioma. However, other individuals at a high risk of exposure include asbestos-cement workers, insulation workers and ship-yard workers. Environmental exposure to asbestos can occur as a result of living in areas either characterised by natural outcrops of asbestos or asbestos-related materials, or those close to asbestos-producing or -using plants. Unfortunately, man-made fibre alternatives to asbestos, such as rock and slag-wool and glass wool, have also been shown to have a detrimental effect on human health. A characteristic of mesothelioma is that there is a long latency period (20-30 years) before the signs and symptoms of the disease become apparent. In addition, diagnosis of the disease can be difficult. The use of biological markers, such as tissue polypeptide antigen, may play a useful role in the early detection of the disease in individuals at risk.

In plain English

This article was a narrative review, not a new study. The authors reviewed published research on diseases linked to chrysotile, crocidolite, amosite and tremolite asbestos, the related fibre erionite, and man-made mineral fibres. They covered miners and millers, asbestos-cement, insulation and shipyard workers, people exposed through natural rock outcrops or by living near asbestos plants, Polish asbestos-cement workers, and workers making rock/slag wool and glass wool. Among the studies described, a South African study reported mesothelioma incidence per 100,000 subject years of 7.8 after amosite exposure and 44.6 after crocidolite exposure. A Swedish asbestos-cement cohort had a relative risk of 7.2 for mesothelioma compared with referents. In discussing serum biomarkers, including the authors' own earlier work, they reported mean tissue polypeptide antigen levels of 36.5 U/l in male controls and 358 in mesothelioma patients. The authors expected mesothelioma incidence to keep increasing until at least 2020. They concluded that following up everyone with at least some asbestos exposure should be standard procedure. They noted that space limits left some topics with little or no discussion.

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 studies, including some earlier biomarker work by the authors
• Who was studied: No new population. The review covered published studies of asbestos miners and millers (Canada, Italy, South Africa, Australia), asbestos-cement, insulation, shipyard and railway workers, residents exposed environmentally (Corsica, Cyprus, Greece, Turkey, New Caledonia, Casale Monferrato in Italy), Polish asbestos-cement workers, and European man-made mineral fibre production workers. It had a separate section on Poland.
• Exposure: Chrysotile (white asbestos) and the amphiboles crocidolite (blue), amosite (brown/grey) and tremolite; erionite (a natural fibrous zeolite); man-made mineral fibres (rock and slag wool, glass wool, continuous filament). Exposure was occupational, environmental and domestic.
• Main results:
  • Reviewed study of 7317 male South African amphibole mine employees (Sluis-Cremer et al.): mesothelioma incidence per 100,000 subject years was 7.8 after amosite exposure and 44.6 after crocidolite exposure.
  • Reviewed Swedish study (Albin et al.) of 1465 asbestos-cement workers compared with 762 referents, 1927 to 1986: the relative risk for mesothelioma was 7.2. Other relative risks were 1.2 for all causes and 2.5 for respiratory cancer.
  • Reviewed prospective study of 17,800 insulation workers in the USA and Canada, followed from 1967 to 1984: 356 died of histopathologically confirmed malignant mesothelioma (134 pleural, 222 peritoneal).
  • Reviewed data from the erionite village of Karain, Turkey, 1970 to 1987: of 217 deaths, 125 were from malignant disease, and pleural mesothelioma accounted for 108 cases.
  • Reviewed Polish cohort of 1526 workers at one asbestos-cement plant: overall mortality was similar to the general population of Poland. There was a two-fold excess in cancer mortality in women (SMR 216, 95% CI 112 to 377), but no excess in lung cancer deaths in men (SMR 99, 95% CI 66 to 142).
  • Reviewed extension of the IARC European cohort of 22,002 man-made mineral fibre production workers: the SMR for all cancers was 113 in the whole cohort, 114 for rock/slag wool and 111 for glass wool. All figures were reported as statistically significant at P less than 0.05.
  • Mean serum tissue polypeptide antigen (TPA) levels, in U/l, were 36.5 in male controls, 118 in asbestosis cases, 240 in lung cancer and 358 in mesothelioma.
  • In a small group of 19 active workers at a French asbestos-cement plant, one had radiological signs of asbestosis, but abnormal biomarker values were found in five. The authors described these results as predictive of mesothelioma in two workers and of lung cancer in two others.
  • Because restrictions or bans on asbestos came around 1985 and the latency period is long, the authors projected that mesothelioma incidence would keep increasing until at least 2020.
• The authors' conclusion: The authors concluded that following up all subjects who have had at least some exposure to asbestos should be standard procedure, using the best available techniques in the prevention, diagnosis and treatment of mesothelioma.
• Limitations the authors state:
  • Because of space limits, some aspects of the asbestos problem received little or no discussion.
  • For the Polish cohort studies, the authors said the subject numbers behind some conclusions were small, with poor statistical strength, and that further studies are needed. They also said the cohorts were still young relative to the long latency of mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Chrysotile, Crocidolite, Mesothelioma, Asbestos-Cement, Insulator, Environmental Exposure, Latency.

Related studies

• Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data — S. Luo, X. Liu, et al. (2003)
• Epidemiology of asbestos-related diseases — R.A. Lemen, J.M. Dement, et al. (1980)
• Environmental exposure to crocidolite and mesothelioma: exposure-response relationships — J. Hansen, N.H. de Klerk, et al. (1998)
• The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease — P. Dumortier, A. Göcmen, et al. (2001)
• Is living close to ophiolites related to asbestos related diseases? Cross-sectional study — I. Döngel, M. Bayram, et al. (2013)
• Asbestos exposure and gestational trophoblastic disease: a hypothesis — A. Reid, J. Heyworth, et al. (2009)

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