The hazards of asbestos. Detailed occupational history is vital

Our plain-English summary of The hazards of asbestos. Detailed occupational history is vital, by A. Seaton (BMJ, 1993).

The study

• Author: A. Seaton
• Journal: BMJ
• Published: 1993;307(6898):258
• Type of article: Comment, Letter
• Read it: PubMed · Publisher · Free full text

In plain English

This was a short letter to the editor, not a research study, and it reported no new data. The author responded to a study by De Vos Irvine and colleagues on asbestos and lung cancer in Glasgow and the west of Scotland. The author contrasted two views. The clinical view is that lung cancer can be attributed to asbestos only when asbestosis or diffuse pleural fibrosis is also present. The author wrote that epidemiologists, by contrast, have regularly found a substantial excess of lung cancers in cohorts of asbestos-exposed workers, an excess at least of the same order of magnitude as the number of mesothelioma cases. The author suggested that because smoking is so widespread among industrial workers, doctors rarely look for other causes. The author objected to the study's suggestion of open lung biopsy for patients seeking redress in the courts, calling it unethical. The author also noted how much lung fibre counts vary and what they cost. The author concluded that taking detailed occupational histories from patients with lung cancer would find the cases epidemiologists say are being missed, and that redress was a matter for the courts and parliament.

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 (correspondence) commenting on a published study; no new data
• Who was studied: No study population. The letter comments on De Vos Irvine and colleagues' study of asbestos and lung cancer in Glasgow and the west of Scotland (BMJ 1993;306:1503-6).
• Exposure: Asbestos exposure in general among workers; no fiber types are named in this letter
• Main results:
  • No data. The author wrote that epidemiologists have regularly found a substantial excess of lung cancers in asbestos-exposed worker cohorts, an excess at least of the same order of magnitude as the number of mesothelioma cases. By contrast, clinical practice attributes cancer to asbestos only when asbestosis or diffuse pleural fibrosis is present.
  • The author suggested that because smoking is so widespread among industrial workers, doctors rarely look for additional causes of lung cancer.
  • The author argued that suggesting open lung biopsy for patients seeking redress in the courts would be advising doctors to act unethically. The author also noted that civil causation uses a less stringent test than clinical diagnosis.
  • The author pointed to the statistical variability of lung tissue fibre counts and to the cost of the electron microscopic methods needed to identify fibres reliably.
• The authors' conclusion: The author concluded that taking detailed occupational histories from patients with lung cancer would find the cases epidemiologists say are being missed, and that whether such patients receive redress is a matter for the courts and parliament.

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: Occupational History.

Related studies

• Detailed occupational history: the cornerstone in diagnosis of asbestos-related lung disease — R. Bégin, J.W. Christman (2001)
• The hazards of asbestos. Access to vital data is denied — M. Greenberg (1993)
• The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices — N. Kilpatrick, H. Frumkin, et al. (2002)
• Family history of cancer and risk of paediatric and young adult's testicular cancer: A Norwegian cohort study — R. Del Risco Kollerud, E. Ruud, et al. (2019)
• Pleural mesothelioma and lung cancer risks in relation to occupational history and asbestos lung burden — C. Gilham, C. Rake, et al. (2016)
• Asbestos exposure among Finnish lung cancer patients: occupational history and fiber concentration in lung tissue — A. Karjalainen, S. Anttila, et al. (1993)

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