The pneumoconioses

Our plain-English summary of The pneumoconioses, by W. Tsai, W.K. Morgan (Current Opinion in Pulmonary Medicine, 1996).

The study

• Authors: W. Tsai, W.K. Morgan
• Journal: Current Opinion in Pulmonary Medicine
• Published: 1996;2(2):116-20
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The stringent industrial hygiene regulations that have been introduced in North America, Europe, and Australasia have led to a decline in the incidence and prevalence of silicosis, coal workers' pneumoconiosis, and asbestosis. Although new cases of asbestosis are not occurring, an appreciable number of mesotheliomata are still being diagnosed, and there has yet been little, if any, decline in the latter tumor. These new cases are nearly entirely due to exposure to amphiboles in the 1940s and 1950s. It is expected that by about the year 2000 the incidence of mesothelioma will begin to decrease in the United States and Canada. Meanwhile there is an undue preoccupation with more and more sensitive methods of detecting asbestosis, silicosis, and coal workers' pneumoconiosis, eg, magnetic resonance imaging, bronchoalveolar lavage, and so forth. Much effort is being made in trying to detect disease in groups of workers with extremely low exposures and no symptoms. Smaller and smaller effects are being detected, with the ultimate aim appearing to be detecting nothing at all. Efforts should be made at surveying other populations exposed to agents that have recently been introduced and that could conceivably have long-term effects.

In plain English

This article was a review, not an original study. The authors critically assessed a selection of recent papers on coal workers' pneumoconiosis, silica, cobalt chromium dust and asbestos. They stated that new cases of asbestosis were not occurring but mesothelioma was still being diagnosed, nearly entirely because of amphibole exposure in the 1940s and 1950s. They expected its incidence to begin falling in the United States and Canada by about 2000. They described a study by Wilkinson and colleagues that reported an adjusted odds ratio for lung cancer of 1.48 in an asbestos-exposed group. The authors judged that study seriously flawed, partly because readers agreed on category 0 chest films only 59.3% of the time. They cautioned that a prediction by Peto and colleagues of rising mesothelioma deaths in Britain was a projection based on estimated asbestos imports. They described a study of 117 asbestos-exposed workers whose total lung capacity and diffusion capacity fell by only 1.5% and 2.5% over an average two-year period, and called its clinical significance dubious. The authors concluded that much effort was going into detecting disease in workers with extremely low exposures.

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 (critical commentary on selected recently published papers); no original data
• Who was studied: Recently published studies on pneumoconioses: coal workers' pneumoconiosis, silica, cobalt chromium and asbestos. The article studied no participants of its own.
• Exposure: Coal mine dust, silica, cobalt chromium molybdenum dust and asbestos. For mesothelioma, the authors attributed new cases to amphibole exposure in the 1940s and 1950s.
• Main results:
  • The authors stated that new cases of asbestosis were not occurring, but an appreciable number of mesotheliomas were still being diagnosed.
  • The authors expected mesothelioma incidence to begin decreasing in the United States and Canada by about the year 2000.
  • The authors stated that most experts consider the increased lung cancer risk to be present only in people who have asbestosis and who smoke cigarettes.
  • Reviewed study (Wilkinson et al.): the adjusted odds ratio for lung cancer in the asbestos-exposed group was 1.48.
  • Reviewed study (Wilkinson et al.): the odds ratio rose to 2.03 in individuals with an ILO score of 1:0 or more. It was 1.56 for the 738 subjects the authors called 'allegedly exposed' who had an ILO score of 0:1 or less.
  • The authors criticized the Wilkinson study because reader agreement on category 0 chest films was only 59.3%, which they called unacceptable.
  • Reviewed study (Peto et al.): predicted that mesothelioma deaths would keep rising in Britain for the next 15 to 25 years.
  • The authors cautioned that the Peto predictions rested mainly on prior imported asbestos tonnage in the United Kingdom, which they called an estimate at best.
  • Reviewed study (Schwartz et al., 117 patients with occupational asbestos exposure): over an average 2-year period, total lung capacity declined by 1.5% and diffusion capacity of carbon monoxide by 2.5%.
  • The authors judged the clinical significance of the Schwartz findings dubious.
• The authors' conclusion: The authors concluded that there was undue preoccupation with ever more sensitive methods of detecting asbestosis, silicosis and coal workers' pneumoconiosis, with much effort spent trying to detect disease in workers with extremely low exposures.

Topics

Medical terms in this study, explained in our Lexicon: Industrial Hygiene, Silicosis, Pneumoconiosis, Amphibole Group, Mesothelioma, Bronchoalveolar Lavage (BAL).

Related studies

• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)
• 24 years of pneumoconiosis mortality surveillance in Australia — D.R. Smith, P.A. Leggat (2006)
• The classic pneumoconioses: new epidemiological and laboratory observations — A.S. Laney, D.N. Weissman (2012)
• Respiratory impairments due to dust exposure: a comparative study among workers exposed to silica, asbestos, and coalmine dust — X. Wang, E. Yano, et al. (1997)
• Between- and within-reader variability in the assessment of pleural abnormality using the ILO 1980 international classification of pneumoconioses — J. Bourbeau, P. Ernst (1988)
• The past and present of pneumoconioses — P. De Vuyst, P. Camus (2000)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.