The relationship between asbestosis and bronchial cancer

Our plain-English summary of The relationship between asbestosis and bronchial cancer, by G.K. Sluis-Cremer (Chest, 1980).

The study

• Author: G.K. Sluis-Cremer
• Journal: Chest
• Published: 1980;78(2 Suppl):380-1
• Cited by: 33 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. 000866).

In plain English

This short article was a review weighing published evidence on whether bronchial (lung) cancer in asbestos-exposed people is a complication of asbestosis, an independent effect of inhaled asbestos dust, or both. Autopsy series cited by the author found that 12-50 percent of people with asbestosis also had bronchial cancer. In Buchanan's mortality study, 54.5 percent of 77 certified asbestosis cases also had lung cancer, though the author noted some mesotheliomas may have been included. Bohlig and colleagues, studying living cases, reported bronchial cancer rates of 82/10,000 in severe asbestosis, 11/10,000 in minimal asbestosis and 3.7/10,000 in asbestos workers without disease. In Wagner and colleagues' rat experiment, asbestosis grade was strongly related to lung tumors, with no tumor excess when asbestosis was absent. The author concluded that cancer is often a complication of asbestosis, without excluding cancer from doses too low to cause fibrosis. The author wrote that the evidence suggests such cancers invariably occur in lungs with fibrosis detectable at histologic (microscopic) examination. The author judged it unreasonable to demand proof of asbestosis during life before attributing a lung cancer to asbestos.

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: review of published evidence (narrative commentary); no new data
• Who was studied: No new subjects. The author reviewed published human autopsy, mortality and clinical studies of people with asbestosis or asbestos exposure, and rat experiments.
• Exposure: Inhalation of asbestos dust in general. No specific fiber types are named.
• Main results:
  • In autopsy series summarized by Hueper and colleagues, 12-50 percent of persons with asbestosis also had bronchial cancer. This compared with a reported 1.2 percent of bronchial cancer at autopsy in silicotic subjects.
  • In Buchanan's mortality study of subjects certified as having asbestosis, 54.5 percent of 77 cases in 1961-1963 also had lung cancer. Some mesotheliomas may have been included.
  • In Mirabella's review of 2,044 autopsied asbestosis cases from the literature up to 1974, 34.3 percent of those who died between 1955 and 1974 also had an intrathoracic malignancy (including mesothelioma).
  • In Bohlig and colleagues' study of living asbestosis cases, the bronchial cancer incidence was 82/10,000 in severe cases and 11/10,000 in minimal cases. In asbestos workers without disease it was 3.7/10,000, which was not in excess of the rate for the general German population aged over 50.
  • In Wagner and colleagues' 1974 rat experiment, after adjustment for survival time, the grade of asbestosis was strongly related to lung tumors. There was no excess of tumors when asbestosis was absent.
  • Several cited authors noted that the usual ratio of upper-lobe to lower-lobe cancers, about 2.5:1, is inverted in asbestosis workers.
  • In Whitwell and colleagues' mortality study of workers with asbestosis and bronchial cancer, 34 percent had adenocarcinoma.
• The authors' conclusion: The author concluded that bronchial cancer is often a complication of asbestosis, without excluding cancer from asbestos doses insufficient to cause fibrosis. The author stated that the evidence suggests asbestos bronchial cancers invariably occur in lungs with histologically detectable fibrosis. Because clinical diagnosis of mild asbestosis is insensitive, the author judged it unreasonable to demand proof of asbestosis during life before attributing a bronchial cancer to asbestos.
• Limitations the authors state:
  • The author noted that Buchanan's lung cancer figure may have included some mesotheliomas.
  • The author reported Whitwell and colleagues' caution that the proportion of adenocarcinoma varies with the source of the tissue examined (biopsy, surgery or post-mortem).
  • The author stated that clinical methods for diagnosing mild asbestosis are insensitive.

Topics

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

Related studies

• Smoking status, occupational asbestos exposure and bronchial location of lung cancer — C. Paris, J. Benichou, et al. (2003)
• Smoking, occupational risk factors, and bronchial tumor location: a possible impact for lung cancer computed tomography scan screening — M. Gonzalez, J.M. Vignaud, et al. (2012)
• Cohort analysis of changes in incidence of bronchial carcinoma in a textile asbestos factory — J.F. Knox, R.S. Doll, et al. (1965)
• Practical steps towards the prevention of bronchial carcinoma — R. Doll (1970)
• Unsuspected exposure to asbestos and bronchogenic carcinoma — K.M. Martischnig, D.J. Newell, et al. (1977)
• An attempt to use the WHO typing in the histological classification of lung carcinomas — A. Reinilä, K. Dammert (1974)

Browse more research in Chest, or return to medical research.