Tobacco consumption and asbestos exposure in patients with lung cancer: a three year prospective study

Our plain-English summary of Tobacco consumption and asbestos exposure in patients with lung cancer: a three year prospective study, by G. Hillerdal, E. Karlén, T. Aberg (British Journal of Industrial Medicine, 1983).

The study

• Authors: G. Hillerdal, E. Karlén, T. Aberg
• Journal: British Journal of Industrial Medicine
• Published: 1983;40(4):380-3
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000613).

Abstract

During the three years 1979-81, all patients with bronchial carcinoma of World Health Organisation types I to IV were given a questionnaire to determine occupation, smoking habits, and exposure to asbestos. Chest x rays were screened for the presence of pleural plaques. Of the men, 96.2% were current or ex-smokers, as were 71% of the women. In those who had never smoked 70% had an adenocarcinoma. In smokers the risk of getting other types was greater, but the risk of getting an adenocarcinoma was also considerably increased compared with the normal population. Of the men, 35.8% were occupationally exposed to asbestos and 15.6% were carriers of radiological plaques, a frequency five to six times greater than expected. Practically all asbestos exposed patients with lung tumours were smokers or ex-smokers and their total tobacco consumption was as high as that of non-exposed patients. The average latency from first exposure to asbestos to diagnosis of the lung tumour was 37 years. Even if strict regulations are warranted for the use of asbestos, this cannot prevent future asbestos cancers resulting from exposure that has already occurred. Elimination of smoking seems the only way to reduce such tumours.

In plain English

This prospective study in Uppsala, Sweden, gave a questionnaire on smoking, occupation and asbestos exposure to patients with bronchial carcinoma diagnosed 1979 to 1981, and checked chest x rays for pleural plaques. It included 346 men and 89 women. Among the men, 96.2% were smokers or ex-smokers, as were 71% of the women. Adenocarcinoma was the most common type in people who had never smoked: 9 of 13 men and 19 of 26 women. Among the men, Table 3 gives 35.8% as occupationally exposed to asbestos (the text says 38.5%), and 54 (15.6%) had pleural plaques on x ray. Exposure was mostly intermittent and never heavy. Fiber types were not specified for these patients. The asbestos group averaged 229 kg of lifetime tobacco versus 222 kg for the others, a difference that was not statistically significant. Only four exposed or plaque-carrying patients had never smoked. The average time from first exposure to diagnosis was 37.1 years. The authors concluded that eliminating smoking would probably be almost as effective as eliminating asbestos in reducing these cancers. They noted that cancer patients may recall exposures more readily.

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: Prospective questionnaire study of consecutive lung cancer patients, with chest x rays reviewed for pleural plaques
• Who was studied: 346 men and 89 women with bronchial carcinoma (WHO types I to IV or undifferentiated). Patients were seen at the departments of lung medicine (1979 to 1981) and thoracic surgery (September 1980 to 1981), University Hospital, Uppsala, Sweden, and came from the county and a wider referral region.
• Exposure: Self-reported lifetime tobacco consumption and self-reported occupational asbestos exposure, plus pleural plaques on chest x ray. Asbestos exposure was mostly intermittent and never heavy. The commonest jobs were plumbers, builders and electricians. The fiber types these patients were exposed to were not specified.
• Main results:
  • 96.2% of men and 71% of women were current smokers or ex-smokers
  • Among never-smokers, 9 of 13 men (69%) and 19 of 26 women (73%) had adenocarcinoma (WHO type III)
  • In men, the text gives 38.5% claiming occupational asbestos exposure, while Table 3 gives a total of 35.8%
  • 54 patients (15.6% of men) had radiological pleural plaques, and eight of them denied asbestos exposure
  • Lifetime tobacco consumption was 229 kg in the asbestos group and 222 kg in the other groups, not statistically different
  • Only four patients with pleural plaques or asbestos exposure (or both) had never smoked, and all four had adenocarcinomas
  • Latency from first asbestos exposure to tumour diagnosis ranged from 9 to 60 years, averaging 37.1 years
  • In men, the upper-to-lower lobe tumour ratio was about 2 to 1 in the unexposed and almost 1 to 1 in the asbestos-exposed. This was not statistically significant unless women were included, when p was less than 0.05.
  • Comparing with preliminary county data (about 6% of men over 40 admitting exposure), the authors stated that asbestos exposure was at least five times more frequent in this lung cancer series than in the general population
• The authors' conclusion: The authors concluded that, because practically all patients with asbestos-related lung cancers were heavy smokers or ex-smokers, eliminating smoking would probably be almost as effective as eliminating asbestos in reducing such cancers, and would likely give quicker results
• Limitations the authors state:
  • Patients with lung cancer may be more likely to recall exposure to various agents
  • In most cases there were no specific questions about passive smoking
  • Several patients in occupations likely to involve asbestos denied exposure, which the authors found hard to evaluate

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Lung Cancer, Carcinoma, Habit, Pleural Plaques, Adenocarcinoma, Latency.

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