The hazards of asbestos. Inaccurate diagnoses distort results

Our plain-English summary of The hazards of asbestos. Inaccurate diagnoses distort results, by F.G. Mayall (BMJ, 1993).

The study

• Author: F.G. Mayall
• Journal: BMJ
• Published: 1993;307(6898):258-9
• Type of article: Comment, Letter
• Read it: PubMed · Publisher · Free full text

In plain English

This is a letter to the editor of the BMJ, not a research study. The author commented on a published study by De Vos Irvine and colleagues of asbestos and lung cancer in Glasgow and the west of Scotland. The author pointed out that 54% of the "lung cancers" in that study were not confirmed by tissue examination, and argued that many may have been cancers spread from elsewhere, or not cancers at all. The author added that although 80% of the mesotheliomas were confirmed by tissue examination, they were diagnosed in 1975-84, before immunohistochemical testing was routine. The author found it difficult to have complete faith in the results, but agreed that the study's main conclusion, that many cancers linked to asbestos go unrecognised, was probably beyond dispute. The author argued against using occupational histories to pick patients for open lung biopsy and fibre counts (about £400 each). The author suggested lung tissue taken at coroners' postmortem examinations instead, because counts are more accurate on large samples. The author also wrote that counting asbestiform bodies is inaccurate.

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 another group's published study; no new data
• Who was studied: No study population of its own; the letter discusses the De Vos Irvine et al. study of asbestos and lung cancer in Glasgow and the west of Scotland
• Exposure: Asbestos exposure in general; the letter discusses amphibole asbestos fibre counts in lung tissue measured by electron microscopy
• Main results:
  • The author noted that 54% of the "lung cancers" in the De Vos Irvine study were not verified histologically, and argued that many would have been metastatic cancers or not cancers at all
  • The author noted that 80% of the mesotheliomas in that study were verified histologically, but said the diagnosis is suspect because it was made in 1975-84, before routine immunohistochemical examination
  • The author argued that occupational history is a poor way to select patients for biopsy, because most manual workers can recall a possible exposure when asked directly, while some patients with mesothelioma have no known exposure but a raised amphibole fibre count
  • The author argued that this approach would lead to many unnecessary open lung biopsies and expensive electron microscopic fibre counts on terminally ill patients
  • The author suggested taking lung tissue at a coroner's postmortem examination for a fibre count, stating that counts on large samples are more accurate than on biopsy specimens because fibres are unevenly distributed in the lung
  • The author wrote that counting asbestiform bodies is inaccurate, because they can be formed by non-asbestos mineral fibres and are not always seen in lungs with a raised asbestos fibre burden
• The authors' conclusion: The author found it difficult to have complete faith in the study's results because of the number of dubious diagnoses, but agreed that its main conclusion, that many malignancies associated with asbestos are not recognised as such, is probably beyond dispute

Topics

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

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