Tobacco and asbestos: consistent treatment advocated

Our plain-English summary of Tobacco and asbestos: consistent treatment advocated, by M. Silverstein, R. Pak, N. Maizlish (Journal of Occupational Medicine., 1983).

The study

• Authors: M. Silverstein, R. Pak, N. Maizlish
• Journal: Journal of Occupational Medicine.
• Published: 1983;25(9):694-5
• Type of article: Editorial
• Cited by: 1 article, 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. 001730).

In plain English

This is an editorial, not a research study, and it reported no new data. The authors, from the Health and Safety Department of the United Automobile Workers union, commented on an article by Suta and Thompson in the same journal issue. That article used survey data on smoking habits to adjust earlier lung cancer figures for workers at 10 motor vehicle assembly plants. The authors raised four cautions about the analysis. They argued that smoking estimates based on 800 interviews were unstable, given only 7% to 10% mean differences in smoking between white male automotive workers and the white male general population. They also argued that the adjustment method might over-adjust proportional mortality ratios, and that excesses of other cancers among the auto workers were not explained by smoking. Using asbestos as an example, the authors were skeptical of companies that banned smoking on the job while resisting stricter asbestos exposure standards. The authors concluded that companies should completely eliminate worker exposure 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: Editorial (opinion and commentary). No new data were collected or analyzed.
• Who was studied: No population was studied. The editorial commented on an article by Suta and Thompson, which used smoking-habit data to adjust lung cancer estimates for workers at 10 motor vehicle assembly plants. Those estimates came from an earlier study by Chiazze.
• Exposure: Cigarette smoking combined with toxic workplace exposures. The synergism between asbestos and tobacco smoke was given as the prototype example. The auto study being discussed concerned spray painters working with chromate-based paints.
• Main results:
  • The authors argued that Suta and Thompson's smoking estimates were statistically unstable. These estimates were based on 800 interviews and carried a 13% uncertainty, compared with only 7% to 10% mean differences in smoking between white male automotive workers and the white male general population.
  • The authors argued that the adjustment method, while suitable for standardized mortality ratios, may over-adjust proportional mortality ratios. They said the adjustment should instead cover all smoking-related causes of death, particularly cardiovascular disease.
  • The authors pointed out that the underlying study had found excesses of other cancers among the auto workers, though less large and consistent than for lung cancer. They said these excesses were unaffected by any apparent smoking effect and remained largely unexplained.
  • The authors noted that some companies, particularly in the asbestos industry, had banned on-the-job smoking. They were skeptical of companies that treat one carcinogen (tobacco) as an absolute hazard and another (asbestos) as a problem to be handled by minimal compliance with the law.
  • The authors criticized the Motor Vehicle Manufacturers Association (MVMA), which supported the Suta and Thompson study. In their view, the MVMA limited its industry-wide follow-up to examining smoking habits rather than also examining work-related causes.
• The authors' conclusion: The authors concluded that, for consistency, companies should treat asbestos in the same absolute fashion as tobacco. That would mean environmental measures that completely eliminate worker exposure, which is the approach they favored.

Related studies

• The interactions of tobacco smoking and other agents in cancer etiology — R. Saracci (1987)
• Arsenic, tobacco smoke, and occupation: associations of multiple agents with lung and bladder cancer — C. Ferreccio, Y. Yuan, et al. (2013)
• Asbestos, dental X-rays, tobacco, and alcohol in the epidemiology of laryngeal cancer — M.W. Hinds, D.B. Thomas, et al. (1979)
• p53 protein accumulation in lung carcinomas of patients exposed to asbestos and tobacco smoke — K. Nuorva, R. Mäkitaro, et al. (1994)
• Homozygous deletion of p16INK4a and tobacco carcinogen exposure in nonsmall cell lung cancer — K.S. Kraunz, H.H. Nelson, et al. (2006)
• Survival in operable non-small-cell lung cancer: role of p53 mutations, tobacco smoking and asbestos exposure — T. Sioris, K. Husgafvel-Pursiainen, et al. (2000)

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