Nieuwsarchief

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.