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De vraag of longkanker door asbest is veroorzaakt terwijl er geen sprake is van asbestose, blijft controversieel. Dit concluderen Engelse onderzoekers na analyse van 9 epidemiologische artikelen. De momenteel beschikbare technische middelen bieden niet voldoende mogelijkheden om dit te onderzoeken. Waarschijnlijk is het type asbestvezel van belang, concluderen Engelse en Amerikaanse onderzoekers.

Bron: Thorax. vol. 60 (2005), afl. 5, pag. 433-436 (4)

Asbestos, asbestosis, and lung cancer : a critical assessment of the epidemiological evidence

Hessel, P.A.. Gamble, J.F.. Mcdonald, J.C. / In: Thorax. vol. 60 (2005), afl. 5, pag. 433-436 (4)

The question of whether lung cancer can be attributed to asbestos exposure in the absence of asbestosis remains controversial. Nine key epidemiological papers are reviewed in a point/counterpoint format, giving the main strengths and limitations of the evidence presented. Of the nine papers, two concluded that asbestosis was necessary and seven that it was not. However, the study design, nature and circumstances of exposure and method of analysis of the studies differed considerably, and none was considered definitive. It is concluded that, because of the relative insensitivity of chest radiography and the uncertain specificity of findings from histological examinations or computed tomography, it is unlikely that epidemiology alone can put either the strict scientific or practical medicolegal questions beyond doubt. It is probable that the issue may depend critically on asbestos fibre type, an aspect not so far addressed.

In Woodstock werd in 1985 asbestvervuiling ontdekt in het drinkwater. Dit kwam door asbestcementpijpen die half jaren 50 waren geïnstalleerd. De kankerstatistieken van Woodstock werden over de periode 1980-1998 vergeleken met nationale gegevens. Er werd geen relatie met asbest gevonden.

Bron: Browne, M. L. et al. (2005). Environmental research. vol. 98 (2005), afl. 2, pag. 224-232 (9)

Cancer incidence and asbestos in drinking water, Town of Woodstock, New York, 1980#x0201.1998

Browne, Marilyn L.. Varadarajulu, Deepa. Lewis-Michl, Elizabeth L.. Fitzgerald, Edward F. / In: Environmental research. vol. 98 (2005), afl. 2, pag. 224-232 (9) / 2005

Abstract

Late in 1985, asbestos contamination was discovered in the public water supply of the Town of Woodstock, Ulster County, New York. Contamination resulted from asbestos’cement pipes installed in the town water system in the mid to late 1950s and the corrosiveness of the local water. The New York State (NYS) Department of Health established the Woodstock Asbestos Exposure Registry (WAER) in 1986 to monitor rates of cancer among individuals who lived on the water supply between 1960 and 1985. Demographic, health, and residential information were collected on 2936 registrants. The follow-up period for observation of cancer was 1980-1998, consistent with the expected lag of 20-30+ years for development of asbestos-related cancers. The NYS Cancer Registry was used to ascertain cancer diagnoses. Standardized incidence ratios (SIRs) for gastrointestinal, respiratory, and total cancers were all approximately 1.00 or less and all 95% confidence intervals (CIs) included 1.00. For individual types of the gastrointestinal cancers, only the SIR for pancreatic cancer was marginally statistically significant at 2.19 (95% CI=1.00-4.16), based on a total of nine observed cases. The excess in pancreatic cancer occurred primarily among men (SIR=3.08. 95% CI=1.13-6.70) and was only slightly elevated among women (SIR=1.39. 95% CI=0.29-4.06). This association may be related to factors other than asbestos exposure such as occupation and lifestyle or to chance. No cases of mesothelioma were observed among WAER participants. There was no increase in incidence by latency or duration of residence on the water supply, but the ability to detect these trends is limited by small numbers and unknown dates of initial exposure. The general pattern of results did not demonstrate a likely link between exposure to asbestos in drinking water and cancer occurrence among participants in the WAER.

Australische onderzoekers hebben een bloedtest ontwikkeld die kan helpen bij het opsporen van mesothelioom. De niet invasieve test, Mesomark genaamd, werd ontwikkeld door onderzoekers van de Universiteit van West Australië. In Australië krijgen ongeveer 700 mensen per jaar deze ziekte.

Bron: The Advertiser, 20 april / The West Australian, 19 april.

The Advertiser

April 20, 2005 Wednesday

HEADLINE: Breakthrough

AUSTRALIAN researchers have developed a world-first blood test which could help people worldwide in the early detection of mesothelioma, a deadly asbestos-related cancer of the lung lining. The non-invasive blood test developed by University of Western Australia Professor Bruce Robinson and researchers is a breakthrough in the early detection of the disease. About 700 people each year are diagnosed with the disease in Australia, which has the highest reported incidence in the world.

The West Australian (Perth)

April 19, 2005 Tuesday

HEADLINE: Test offers hope on mesothelioma

Rockingham man David Saw believes a new blood test for mesothelioma, which is being launched today, could have saved him a three-day hospital visit and a lot of trauma.

Mr Saw went to his doctor last year believing he had pulled a muscle.

He was suffering chest pain and shortness of breath.

After a CAT scan and biopsy, it was revealed the 49-year-old had contracted the deadly lung cancer from working with asbestos as a young man.

“A test would have been a lot easier, I ended up in hospital and they had to cut me open,” he said.

The test, called MESOMARK, will be available from general practitioners or specialists who can order it from a pathology provider.

The head of the mesothelioma research team at Sir Charles Gairdner Hospital which developed the test, Professor Bruce Robinson, said it would not only help in diagnoses of the disease, but also in treatment.

“Until now you could only gauge whether treatment was working effectively by doing a CAT scan, and they’re difficult to do. With this test, we can gauge treatment and also diagnose it at an earlier stage,” Professor Robinson said. Biopsy would be needed to confirm diagnosis.

The blood test measures levels of a substance called soluble mesothelin-related peptide, a distinctive biomarker released by mesothelioma cells.

About 700 Australians are diagnosed with the disease every year and WA has the highest rate of mesothelioma in the world.

Asbestos Diseases Society of Australia president Robert Vojakovic said the test could help the possible 6000 people who were children in Wittenoom when the town still had an active blue asbestos mine.

Bij mannen die geen asbestose (“stoflongen” door asbest) hebben komt asbestgerelateerde longkanker vaker voor dan was verwacht. “Pleurale plaques” (een goedaardige verdikking van het borstvlies) is een belangrijke voorspeller van asbestgerelateerde longkanker. Deze nieuwe inzichten komen uit een onderzoek van meer dan 10 jaar onder 4000 Amerikaanse mannen die aan asbest blootgesteld zijn geweest.
Increased lung cancer among asbestos workers with no evidence of asbestosis

Below, details of a new paper on asbestos and lung cancer, forwarded by Frank Mirer, director of health and safety at the US autoworkers’ union UAW.

The paper looks important for two reasons – firstly because of the lung cancer without asbestosis finding – in some jurisdictions official workers’ compensation schemes only pay benefits to lung cancer sufferers who also have asbestosis.

Secondly, the paper is valuable because it establishes the importance of pleural plaques as a predicator of lung cancer. Insurers and employers in the UK, USA and elsewhere are at this moment trying to play down the significance of the association between pleural plaques and asbestos.

Their motive is to reduce their compensation liabilities. One consequence of this might be a lower likelihood of diagnosis of pleural plaques (many of the health checks are the result of compensation inquiries), so we could lose our early warning system or “sentinel health event” for an enormous lung cancer risk. In the UK at the moment there are several thousand asbestos related lung cancers ever year – the combined annual death toll for asbestos related lung cancers and mesothelioma is expect to reach 10,000 within 20 years.

Yours, Rory

Rory O’Neill

International Federation of Journalists

Increased lung cancer among asbestos workers with no evidence of asbestosis

A very important study giving quantitative measures of risks of asbestos exposure was just published. The study is an important data source for evaluating medical criteria for compensation of asbestos exposed workers, now being discussed in Congress.

The project was a chemoprevention test whether Vitamin A – an antioxidant – protected against future effects of past asbestos exposure. The investigators had enrolled over 4,000 asbestos workers and followed them for over a decade. Recruitment must have been a huge task The chemoprevention study was terminated because Vitamin A increased the risk of lung cancer.

The study confirmed excessive rates of lung cancer among men with radiographic asbestosis, but also among workers with no evidence of asbestosis. Among workers with no evidence of asbestosis at baseline, men with more than 40 years’ exposure in high-risk trades had a risk approximately fivefold higher than men with 5-10 years. Pleural plaques on the baseline x-ray and abnormal baseline flow rate were strong independent predictors of subsequent lung cancer.

Hopefully, people with access to the full text of this study will comment further.

American Journal of Epidemiology 2005 161(3):260-270.

Predictors of Lung Cancer among Asbestos-exposed Men in the µ-Carotene and

Retinol Efficacy Trial

Mark R. Cullen1 , Matt J. Barnett2, John R. Balmes3, Brenda Cartmel1, Carrie

A. Redlich1, Carl A. Brodkin4, Scott Barnhart4, Linda Rosenstock5, Gary E.

Goodman2,6, Sam P. Hammar7, Mark D. Thornquist2 and Gilbert S. Omenn8,9

Despite numerous published studies, debate continues regarding the risk of developing lung cancer among men exposed occupationally to asbestos, particularly those without radiographic or functional evidence of asbestosis. The µ-Carotene and Retinol Efficacy Trial (CARET), a study of vitamin supplementation for chemoprevention of lung cancer, has followed 4,060 heavily exposed US men for 9-17 years. Lung cancer incidence for 1989-2002 was analyzed using a stratified proportional hazards model. The study confirmed excessive rates of lung cancer among men with radiographic asbestosis. Comparison of study arms revealed a strong, unanticipated synergy between radiographic profusion category and the active intervention. In the large subgroup of men with normal lung parenchyma on chest radiograph at baseline, there was evidence of exposure-related lung cancer risk: Men with more than 40 years’ exposure in high-risk trades had a risk approximately fivefold higher than men with 5-10 years, after adjustment for covariates. The effect in these men was independent of study intervention arm, but pleural plaques on the baseline radiograph and abnormal baseline flow rate were strong independent predictors of subsequent lung cancer. Residual confounding by subclinical asbestosis, exposure to unmeasured lung carcinogens, or differences in smoking are unlikely to explain these observations better than a carcinogenic effect of asbestos per se.

Dit artikel in de Lancet beschrijft de hypothese dat asbestblootstelling een oorzaak is van bindweefseltoename rond organen achter het buikvlies. De onderzoekers concluderen dat dat beroepsmatige asbestblootstelling een belangrijke oorzaak van deze aandoening is. RPF zou daarom als een beroepsziekte moeten worden gezien.

Bron: the Lancet, mei 2004.
Asbestos exposure as a risk factor for retroperitoneal fibrosis

Summary

Background Retroperitoneal fibrosis (RPF) is an uncommon disease with unknown causation in most cases. The pathognomonic finding is a fibrous mass covering the abdominal aorta and the ureters. Our aim was to clarify the possible role of asbestos exposure in the development of RPF. The hypothesis was based on the ability of asbestos to cause fibrosis in pulmonary and pleural tissue. Methods We undertook a case-control study of 43 patients with the disease (86% of eligible cases) treated in three university hospital districts of Finland in 1990-2001. For every patient, five population-based controls were selected, matched by age, sex, and central hospital district. We assessed asbestos exposure and medical history using a postal questionnaire and a personal interview. Of the 215 eligible controls, 179 (83%) participated in the study. Findings The age-standardised incidence of RPF was 0-10 (95% CI 0-07-0-14) per 100 000 person-years. The disease was strongly associated with asbestos exposure. The odds ratio (OR) was 5-54 (1-64-18-65) for less than 10 fibre-years of asbestos exposure and 8-84 (2-03-38-50) for 10 or more fibre-years, the attributable fraction being 82% and 89%, respectively. Other risk factors were previous use of ergot derivates (OR 9-92 [1-63-60-26]), abdominal aortic aneurysm (OR 6-73 [0-81-56-08]), and smoking for more than 20 pack-years (OR 4-73 [1-28-17-41]). Interpretation Our results show that occupational asbestos exposure is an important causal factor for RPF. For patients with work-related asbestos exposure, RPF should be considered an occupational disease.

Toomas Uibu, Panu Oksa, Anssi Auvinen, Eero Honkanen, Kaj Metsärinne, Heikki Saha, Jukka Uitti, Pekka Roto. Lancet 2004. 363: 1422-26.

Dit onderzoek beschrijft het geval van een 76 jarige vrouw met buikvlieskanker door het eten van met asbest besmet voedsel. Zij vertelde dat ze gewend was groenten te koken in regenwater dat verzameld werd uit een dakgoot van asbestgolfplaat.

Bron: Van Kesteren et al. (2004). International Journal of Gynecological Cancer.
Malignant peritoneal mesothelioma in a 76-year-old woman with a history of asbestos fiber ingestion

Author(s): P. Van Kesteren . J. Bulten . C. Schijf . H. Boonstra . L. Massuger

Source: International Journal of Gynecological Cancer Volume: 14 Number: 1 Page: 162 — 165

DOI: 10.1111/j.1048-891x.2004.14149.x

Publisher: Blackwell Publishing

Abstract: Abstract. van Kesteren P, Bulten J, Schijf C, Boonstra H, Massuger L. Malignant peritoneal mesothelioma in a 76-year-old woman with a history of asbestos fiber ingestion.

We report on a woman with malignant mesothelioma of the peritoneum. This is the first report of a subject with this disease who revealed a history of asbestos ingestion by asbestos-contaminated food. She presented with episodes of sweating and fever, ascites, and weight loss. At laparotomy, small tumor deposits were noted on the peritoneum. The omental cake was removed, together with the uterus, ovaries, and tubes which were all macroscopically normal. The diagnosis was established by immunohistochemistry and electron microscopy. Postoperatively, her complaints of fever and sweating disappeared. She refused further chemotherapy. After questioning her for asbestos exposure, she told us that, years ago, she used to prepare vegetables for cooking in rain water collected from a roof made of asbestos.