Widening perspectives of occupational lung disease

Our plain-English summary of Widening perspectives of occupational lung disease, by I.J. Selikoff (Preventive Medicine, 1973).

The study

• Author: I.J. Selikoff
• Journal: Preventive Medicine
• Published: 1973;2(3):412-37
• Type of article: Review
• Cited by: 3 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. 001317).

In plain English

This 1973 article was a narrative review, not a new study. The author surveyed how thinking about occupational lung disease had widened, including mixed dusts, smoking, cancers, pleural disease, community exposure and delayed disease. The author reported that in several cohorts of asbestos workers studied by the author's group, more than 5% of all deaths were from mesothelioma. Citing earlier work by the group, the author stated that increased risk of lung cancer and of what the article called pulmonary mesothelioma was usually not evident much before 15 years from first exposure, with the greatest excess at 25-40 years. The author noted that mesothelioma may occur with no X-ray evidence of asbestosis. Electron micrographs showed chrysotile fibrils in the liver of an asbestos factory worker and in peritoneal fluid from an asbestos worker with peritoneal mesothelioma. X-rays traced one patient who worked six months as an asbestos weaver in 1934 and later developed disabling pulmonary insufficiency. The author concluded that investigating lifetime work exposures helps in seeking an occupational cause, and that a detailed occupational history can be more rewarding than some diagnostic tests.

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 and commentary on occupational lung disease, illustrated with X-rays and electron micrographs from the author's laboratory; no new study methods are described
• Who was studied: No study population of its own. The article draws on published literature and on cohorts of asbestos workers studied by the author's group (reported elsewhere), plus individual patients shown in figures
• Exposure: A broad range of occupational dusts, fumes and vapors, including crystalline silica, coal, asbestos (chrysotile in the figures), talc, beryllium and aluminum
• Main results:
  • In several cohorts of asbestos workers studied by the author's group (reported in earlier work), more than 5% of all deaths were from mesothelioma. The printed split between pleural and peritoneal cases is unreadable in the scanned text.
  • Mesothelioma may occur with no radiological evidence of asbestosis. The author suggested that much less dust may be needed to start the tumor, and that dust controls designed to prevent asbestosis might not prevent cancers of the lung and pleura.
  • Citing the author's group's earlier work, the article states when risk becomes evident for lung cancer and for 'pulmonary mesothelioma' (the article's term; peritoneal mesothelioma is not included in this statement). Increased risk is usually not evident much before 15 years from onset of exposure, and the greatest excess is seen 25-40 years from onset.
  • One illustrated patient had worked as an asbestos weaver in a brake lining plant for six months in 1934. A routine chest X-ray in 1951 showed no abnormality. By 1968, lower lobe fibrosis and pleural calcification made asbestosis very likely. By 1971 the patient had pulmonary insufficiency and had retired because of disability, which the author presented as progression without further exposure.
  • Electron micrographs showed chrysotile fibrils outside the lung: in colonic tissue of an asbestos worker, in the liver of an asbestos factory worker, in pancreatic tissue of an asbestos worker with a pancreatic tumor, and in the peritoneal fluid of an asbestos worker with peritoneal mesothelioma confirmed at autopsy.
  • Citing another study, the author reported that among asbestos-exposed workers with similar duration of work exposure, smokers tended to have more X-ray evidence of lung fibrosis.
  • The author stated that pleural calcification, and fibrotic pleural plaques especially on the diaphragm, can serve as a marker of prior asbestos exposure.
• The authors' conclusion: The author concluded that occupational lung disease often involves several interacting factors and long delays after exposure, so that disease seen today reflects work conditions decades earlier. In the author's view, seeking an occupational cause is facilitated by investigating work exposures over a person's entire lifetime. A full, detailed occupational history can be far more rewarding than tests such as tomograms. The author also stressed the importance of preventive measures at present.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease.

Related studies

• Global perspectives of emerging occupational and environmental lung diseases — S. Moitra, R. Puri, et al. (2015)
• Recent progress in the study of occupational lung diseases in Romania — B. Barhad, L. Pilat, et al. (1975)
• Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study — M. Artvinli, Y.I. Baris (1982)
• Imaging of occupational lung disease — K.I. Kim, C.W. Kim, et al. (2001)
• Occupational lung diseases and global occupational health on the Net — K. Takahashi, A. Sekikawa, et al. (1998)
• New perspectives on basic mechanisms in lung disease. 5. Respirable industrial fibres: mechanisms of pathogenicity — K. Donaldson, R.C. Brown, et al. (1993)

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