Correlation between fibre content of the lung and disease in east London asbestos factory workers.

The lungs from 36 past workers at an east London asbestos factory who had died from asbestos related disease were compared with lung tissue from 56 matched control patients being operated on in east London for carcinoma of the lung, correlating the severity of asbestosis and the presence of pulmonary carcinoma or mesothelioma of the pleura or peritoneum with an asbestos exposure index and type and amount of mineral fibre in the lungs. Asbestosis was associated with far heavier fibre burdens than mesothelioma. There was also a striking difference in the degree of asbestosis between the subjects with mesothelioma and those with carcinoma of the lung, the asbestosis being more severe in the latter. A further finding was that crocidolite and amosite were strongly associated with asbestosis, carcinoma of the lung complicating asbestosis, and mesothelioma, whereas no such correlation was evident with chrysotile or mullite. It is suggested that more emphasis should be placed on the biological differences between amphibole and serpentine asbestos fibre.     

Mortality from all cancers of asbestos factory workers in east London 1933-80

OBJECTIVE—To give the observed and expected deaths due to cancer at all separate sites in asbestos workers in east London, and to analyse these for overall effect and exposure-response trend.
METHODS—The mortality experience of a cohort of over 5000 men and women followed up for over 30 years since first exposure to asbestos has been extracted.
RESULTS—There was a large excess of deaths due to cancer (537 observed, 222 expected). Most of these were due to cancer of the lung (232 observed, 77 expected) and pleural (52) and peritoneal (48) mesothelioma. The exposure-response trend for all these three causes was highly significant. There was also an excess of cancer of the colon (27 observed, 15 expected) which was significantly related to exposure. There were significant excesses of cancer of the ovary, of the liver, and of the oesophagus but with no consistent relation to exposure.
CONCLUSIONS—The excess risk of cancer after exposure to asbestos was mainly due to cancer of the lung and mesothelioma. An exposure related excess of cancer of the colon was also detected but the possibility that some of these deaths may have been peritoneal mesotheliomas could not be excluded. There was no consistent evidence of exposure related excesses at any other site.


Keywords: asbestos; cancer; exposure-response     

Correlation between fibre content of the lungs and disease in naval dockyard workers

In the period 1966-82 lungs from 333 workers who had been employed at a Royal Naval dockyard were referred to the MRC Pneumoconiosis Unit where they were investigated for the severity of asbestosis, the presence of tumours, and an assessment of mineral fibre content and the type and amount of mineral present. The occupational exposure to mineral dust has been coded for 189 of these cases. There is good correlation between the severity of asbestosis and the coded exposures, electron microscopic mineral fibre count, and the fibre count as seen under the light microscope. The information collected showed that mesotheliomas occurred in those who had had minimal or slight asbestosis, by contrast with the pulmonary carcinomas found in those with moderate to severe asbestosis. The amphibole (crocidolite and amosite) lung content correlated with severity of asbestosis.     

Correlation between fibre content of the lungs and disease in naval dockyard workers.

In the period 1966-82 lungs from 333 workers who had been employed at a Royal Naval dockyard were referred to the MRC Pneumoconiosis Unit where they were investigated for the severity of asbestosis, the presence of tumours, and an assessment of mineral fibre content and the type and amount of mineral present. The occupational exposure to mineral dust has been coded for 189 of these cases. There is good correlation between the severity of asbestosis and the coded exposures, electron microscopic mineral fibre count, and the fibre count as seen under the light microscope. The information collected showed that mesotheliomas occurred in those who had had minimal or slight asbestosis, by contrast with the pulmonary carcinomas found in those with moderate to severe asbestosis. The amphibole (crocidolite and amosite) lung content correlated with severity of asbestosis.     

Mortality of factory workers in east London 1933-80

The mortality of 3000 male factory workers, 1400 laggers, and 700 women factory workers in east London has been studied. The men were first employed between 1933 and 1964, the women between 1936 and 1942. Textiles were produced until the late 1950s as well as other asbestos products. Laggers were employed on contract in increasing numbers in later years. Crocidolite asbestos was used until the late 1950s as well as asmosite and chrysotile. Exposure of workers was graded according to the job into two categories, low/moderate and severe, and subdivided by duration of employment up to two years or longer. Mesothelial tumours accounted for 7.5% of the total mortality in men, and 9% in women with their longer follow up period. Lung cancer accounted for 20% of deaths in men and 14% in women. Both mesothelial tumours and lung cancer showed a dose response relationship. Histopathological examination of a series of predominantly postmortem specimens showed 22% of adenocarcinomas of lung among men and 21% in women. There was an excess of gastrointestinal tumours but no dose response relationship could be shown. Among severely exposed male factory workers there was an excess of deaths from cancer of the larynx and among severely exposed women of carcinoma of the breast and ovary. Twenty four deaths (2%) were due to asbestosis. There is an indication that the incidence of mesothelial tumours is declining but a further period of observation is required for confirmation.     

Mortality of factory workers in east London 1933-80.

The mortality of 3000 male factory workers, 1400 laggers, and 700 women factory workers in east London has been studied. The men were first employed between 1933 and 1964, the women between 1936 and 1942. Textiles were produced until the late 1950s as well as other asbestos products. Laggers were employed on contract in increasing numbers in later years. Crocidolite asbestos was used until the late 1950s as well as asmosite and chrysotile. Exposure of workers was graded according to the job into two categories, low/moderate and severe, and subdivided by duration of employment up to two years or longer. Mesothelial tumours accounted for 7.5% of the total mortality in men, and 9% in women with their longer follow up period. Lung cancer accounted for 20% of deaths in men and 14% in women. Both mesothelial tumours and lung cancer showed a dose response relationship. Histopathological examination of a series of predominantly postmortem specimens showed 22% of adenocarcinomas of lung among men and 21% in women. There was an excess of gastrointestinal tumours but no dose response relationship could be shown. Among severely exposed male factory workers there was an excess of deaths from cancer of the larynx and among severely exposed women of carcinoma of the breast and ovary. Twenty four deaths (2%) were due to asbestosis. There is an indication that the incidence of mesothelial tumours is declining but a further period of observation is required for confirmation.     

A study of magnetic field in the lung of workers in an asbestos factory

Magnetic field at the chest in 93 male workers exposed to asbestos dust in an asbestos products factory in China was studied by local magnetization and flux-gate gradiometry. The average field intensity at 12 measurement points over the anterior chest wall was compared among workers with and without asbestosis and among workers of different working age. The field intensity in workers with asbestosis and those suspected to have asbestosis on the basis of X-ray findings was significantly higher than that in workers without asbestosis. It was also found that the field intensity increased with working age. It is suggested that dynamic measurement of magnetic field in the lung of workers exposed to dust containing ferrimagnetic particles would at least serve as a quantitative method for estimating lung dust loads and be valuable for pneumoconiosis prevention.     

Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers

The mortality of over 1250 male and 420 female asbestos factory workers was observed over the period 1971-80. Smoking habits were obtained from the subjects in 1971 before the start of the follow up period. Mortality due to lung cancer and to mesothelioma was related to smoking habits. After allowing for the effect of smoking on lung cancer the relative risk due to asbestos was highest for those who had never smoked, lowest for current smokers, and intermediate for ex-smokers; the trend was statistically significant (p less than 0.05). There was no significant association between smoking and deaths due to mesothelioma. Data from several studies are reviewed, and although overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers, there is some uncertainty on the accuracy of this figure because of possible biases and sampling variation. Overall the evidence is that mesothelioma risk is independent of smoking.     

A study of the mortality of workers in an asbestos factory

Newhouse, M. L. (1969).Brit. J. industr. Med.,26, 294-301. A study of the mortality of workers in an asbestos factory. A cohort study of over 4,500 male workers employed at an asbestos factory making both textiles and insulation materials is described. The main analysis of the mortality of workers employed between April 1, 1933, the date of the implementation of the Asbestos Regulations, and May 1, 1964. The analysis was made in relation to job, length of exposure, and length of follow-up after first exposure. There was no significant difference between the number of deaths occurring in the factory population and the national figures, until an interval of 16 years or longer had elapsed from first exposure in the factory. There were 1,160 men who fulfilled this criterion. In this group there was no excess mortality among those who worked in jobs where exposure was low or moderate, but among those with jobs which entailed heavy exposure there was a significant excess of deaths from cancer of the lung and pleura, and cancer of other sites, in men with a total period of employment in the factory of less than two years, as well as with those who worked for longer. Excess mortality from respiratory disease was observed only among severely exposed workers with long service.     

Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers.

The mortality of over 1250 male and 420 female asbestos factory workers was observed over the period 1971-80. Smoking habits were obtained from the subjects in 1971 before the start of the follow up period. Mortality due to lung cancer and to mesothelioma was related to smoking habits. After allowing for the effect of smoking on lung cancer the relative risk due to asbestos was highest for those who had never smoked, lowest for current smokers, and intermediate for ex-smokers; the trend was statistically significant (p less than 0.05). There was no significant association between smoking and deaths due to mesothelioma. Data from several studies are reviewed, and although overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers, there is some uncertainty on the accuracy of this figure because of possible biases and sampling variation. Overall the evidence is that mesothelioma risk is independent of smoking.     

Malignant mesothelioma and duration of asbestos exposure: Correlation with tissue mineral fibre content

Among 441 cases of malignant mesothelioma in the author's files, there were 324 for whom reliable information was available regarding the duration of exposure to asbestos. Included were 298 pleural and 26 peritoneal mesotheliomas. The mean duration of exposure to asbestos was 23 ± 14 years for all cases, and was not different for the pleural and peritoneal groups. Lung tissue was available for analysis of mineral fibre content in 94 cases. Linear regression analysis showed a significant correlation between duration of exposure and asbestos bodies per gramme of wet lung as determined by light microscopy, and between duration of exposure and total uncoated fibres (5 μm or greater in length) as well as commercial amphibole fibres per gramme as determined by scanning electron microscopy (P < 0.05). Individuals with direct exposures had on average higher asbestos contents than patients with indirect exposures. Furthermore, for each duration of exposure, shipyard workers had on average higher asbestos contents than non-shipyard workers (P < 0.05). Mesotheliomas are associated with a wide range of durations of exposure to asbestos and pulmonary asbestos burdens, and there is a rough correlation between duration of exposure and pulmonary commercial amphibole content.     

Correlation between radiological and functional findings in workers exposed to chrysotile asbestos

The relationship between the extent of respiratory disease from chest radiographs and the severity of functional impairment was assessed in 185 workers with long-term exposure to asbestos in an asbestos-cement factory. The workers were divided into seven subgroups according to functional abnormality findings (restrictive, obstructive, mixed restrictive-obstructive, reduced diffusion capacity, increased diffusion capacity, small airway disease and normal). Restrictive functional abnormality was present in 29% of the workers, obstructive and mixed in 3% small airway disease in 4%, reduced diffusion capacity in 4% increased diffusion capacity in 7%, while the remaining 49% were normal. The subjects with radiological diffuse pleural disease were characterized by FVC reduction, whereas in those with mixed pleural-parenchymal radiological abnormalities both FVC and DLCO were reduced. FVC and DLCO decrements correlated well with the increasing grades of profusion according to the ILO classification. In the group of workers with normal chest radiographs and normal spirometry, a decrease or increase in lung diffusion capacity for CO (DLCO) was an isolated finding. In addition, a correlation existed between the length of exposure and functional parameters (reduced FVC and DLCO, while FEV1/FVC increased with longer exposure). The study shows that reduced lung function indices can be found in subjects without radiological evidence for parenchymal asbestosis (ILO grade 1/1 profusion or greater). The results suggest that asbestos exposure, in addition to lung diffusion capacity decrease, can be accompanied by an increase in lung diffusion capacity.     

Hazards of lung biopsy in asbestos workers

An investigation into the problem of the frequency and hazards of lung biopsy in asbestos workers was performed in two ways. The first study was into the frequency of lung biopsy among 2907 long term asbestos insulation workers in 1981-3 and the second was into the frequency of fatal complications of lung biopsy in 168 deaths from asbestosis among 2271 consecutive deaths of asbestos insulation workers 1967-76. Only 25 (0.9%) of the 2907 asbestos insulation workers reported having had either an open lung biopsy, a needle biopsy, or a transbronchial biopsy. Seven (24%) of these men suffered difficulties as a result of the biopsy. Lung biopsies had been performed on 14 of the 168 workers who died of asbestosis. Three (21%) of these 14 patients had died within 30 days of biopsy as a direct result of the procedure. In most cases there is no need for lung biopsy to establish a diagnosis of asbestosis; generally, it may be defined by history of exposure, clinical and radiological findings, and other well established non-invasive diagnostic procedures. Certainly, legal and compensation recommendation for biopsy should be considered with the possibility of death in mind. If biopsy is performed precautions should be taken, including adequate observation in hospital.     

Predictions of mortality from mesothelial tumours in asbestos factory workers.

Using the accumulated data on deaths from mesothelial tumours among cohorts of male and female factory workers at a London asbestos textile factory, the mortality from this cause up to the year 2000 AD has been predicted. The limitations of the methods used are pointed out, but it is estimated that for men the mortality due to mesothelial tumours will be between 7% and 11% of the total mortality and somewhat higher for women. The highest number of deaths from mesothelial tumours will occur during the 1980s, thereafter the numbers will decline because of the decreasing size of the cohort resulting from general mortality.     

Fibre type and concentration in the lungs of workers in an asbestos cement factory

The predominant asbestos fibre type used in the production of asbestos cement is chrysotile. The use of asbestos in relation to fibre type in a Norwegian asbestos cement plant during 1942-80 was 91.7% chrysotile, 3.1% amosite, 4.1% crocidolite, and 1.1% anthophyllite respectively. Electron microscopy and x ray microanalysis of lung tissue samples of asbestos cement workers who had died of malignant pleural mesothelioma or bronchogenic carcinoma showed a completely inverse ratio with regard to fibre type. The percentage of chrysotile asbestos in lung tissue varied between 0% and 9% whereas the corresponding numbers for the amphiboles were 76% and 99%. These differences are discussed with respect to the behaviour of different fibre types in the human body and to the occurrence of malignant mesothelioma in this asbestos cement factory.