The medical surveillance of asbestos workers

Our plain-English summary of The medical surveillance of asbestos workers, by H.C. Lewinsohn (Royal Society of Health Journal, 1972).

The study

• Author: H.C. Lewinsohn
• Journal: Royal Society of Health Journal
• Published: 1972;92(2):69-77
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001336).

Summary of the article

This paper, presented in 1971 by the Chief Medical Officer of Turner Brothers Asbestos Company (T.B.A.), Rochdale, described the medical surveillance of asbestos workers in Britain and at the company's factory. The author reviewed early case reports of asbestosis, the Merewether and Price report of 1930, the 1931 regulations and compensation schemes, and national statistics on new asbestosis cases from 1950 to 1969. He summarised evidence on asbestos-related lung cancer, pleural changes and mesothelioma. He reported 15 mesothelioma cases among employees or ex-employees of the textile factory, with an average latent period of 38.8 years (range 23 to 53 years). He then described the company's surveillance scheme: chest X-rays since 1951 (annual for asbestos-area workers), medical examinations alternating with the Pneumoconiosis Medical Panel, and a lung function laboratory operating since May 1967. In preliminary results on 970 men and 317 women, pleural thickening was the most prevalent change related to increasing exposure. Pulmonary fibrosis was reported more often as exposure increased, especially in women. In 807 men, the percentage with abnormal X-rays and abnormal FEV1/FVC increased with exposure. Gas transfer factor in 452 men and 190 women showed no marked increase in abnormal values across exposure groups. The author concluded, tentatively, that in this factory radiological diagnosis was more reliable than a lowered gas transfer factor for early diagnosis.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article, by the Chief Medical Officer of Turner Bros. Asbestos Co. Ltd., reviewed the history of medical surveillance and laws for asbestos workers in Britain. It described the company's medical surveillance at its Rochdale factory and gave preliminary results. The author reported 15 known mesothelioma cases among employees or ex-employees of the textile factory. The average time from first exposure to diagnosis was 38.8 years, ranging from 23 to 53 years, excluding one case with a doubtful start date. One case involved the peritoneum; the others almost solely the pleura. In chest X-rays of 970 men and 317 women, pleural thickening appeared to be the most common change related to increasing exposure. Pulmonary fibrosis, especially in women, was reported more often as exposure rose, though breast shadows may have caused over-reporting. Among 807 men, abnormal X-rays and abnormal airways-obstruction test results increased with exposure. Low gas transfer factor showed no marked increase across exposure groups. The author said only tentative opinions were possible and concluded that, in this factory, X-rays were more reliable than gas transfer factor for early diagnosis.

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: Historical review of asbestos surveillance and legislation in Britain, combined with a description of one company's medical surveillance programme and preliminary results from it
• Who was studied: Employees and ex-employees of the Turner Brothers Asbestos (T.B.A.) asbestos textile factory in Rochdale, England. X-ray results were given for 970 males and 317 females exposed to asbestos. X-ray and FEV1 results were given for 807 men. Gas transfer factor was measured in 452 males and 190 females.
• Exposure: Work in asbestos areas of an asbestos textile factory, grouped into 10-year exposure periods. The article does not state which fiber types were used at the factory.
• Main results:
  • 15 mesothelioma cases were known among employees or ex-employees of the textile factory.
  • Among these mesothelioma cases, the average latent period from first exposure to diagnosis was 38.8 years, excluding one case with a doubtful date of first exposure.
  • Among these mesothelioma cases, the time from first exposure to diagnosis ranged from 23 to 53 years, again excluding that one case.
  • One mesothelioma case involved the peritoneum; in all the other cases the pleura was almost solely involved.
  • In the X-rayed men and women, pleural thickening appeared to be the most prevalent change related to increasing exposure.
  • Pulmonary fibrosis, especially in women, was reported more often as exposure increased. The author noted that breast shadows in women may possibly cause over-reporting of pulmonary fibrosis.
  • Among 807 men with X-ray and FEV1 results, the percentage with abnormal X-rays and an abnormal FEV1/FVC percentage (a measure of airways obstruction) increased with exposure.
  • There was no marked increase across exposure groups in the percentage of men or women with an abnormally lowered gas transfer factor.
• The authors' conclusion: The author stated that only tentative opinions could be expressed. The author concluded that, in this factory, more reliance could be placed on X-ray diagnosis than on a lowered gas transfer factor for early diagnosis.
• Limitations the authors state:
  • Only tentative opinions could be expressed from the information available.
  • The study was incomplete because physical signs were not correlated with the other measurements.
  • Past medical records were not designed for rapid retrieval of information.
  • The X-ray and FEV1/FVC findings had not yet been statistically analysed taking symptoms and smoking habits into account.
  • Airways obstruction and gas transfer defects were common in non-exposed new starters, which affects how results in exposed workers can be interpreted.

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Chest X-Ray, Pneumoconiosis, Pleural Thickening, Pulmonary Fibrosis, FEV1/FVC Ratio.

Related studies

• Protecting the workers: the medical board and the asbestos industry, 1930s-1960s — G. Tweedale, P. Hansen (1998)
• A study of the mortality of female asbestos workers — M.L. Newhouse, G. Berry, et al. (1972)
• 'B-readers' and asbestos medical surveillance — A.M. Ducatman, W.N. Yang, et al. (1988)
• Trends in pleural radiographic findings in the Navy Asbestos Medical Surveillance Program (1990-1999) — J.G. Muller, B.K. Bohnker, et al. (2005)
• Navy Asbestos Medical Surveillance Program 1990-1999: demographic features and trends in abnormal radiographic findings — D.M. Dell, B.K. Bohnker, et al. (2006)
• Navy Asbestos Medical Surveillance Program (1984-1990): linear regression analysis for effect of asbestos exposure on pulmonary function testing — B.K. Bohnker, L.S. Betts, et al. (2004)

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