Document 83EpLKB0o1beNBXOM5KegmwK

44 Asbestosis and Lung Cancer W. JONES WILLIAMS, MD, MC Pnlh, CARDIFF. WALES Numerous reports in the world literature associate lung tumors and asbestosis. Some from the United States are: Lynch and Smith, 1935 and 1939; Egbert and Geiger, 1936; Holleb and Angrist, 1942; Hornburger, 1943; Clinico-Pathological Confer ence, Massachusetts General Hospital, 1947; Isselbacker ct al, 1953; Lynch and PrattThomas, 1955; Anderson and Campagna, 1960; and Cordova et al, 1962. Hueper (1955) states that there are 21 reported cases in the United States. O'Donnell and Mann (1957) found 13 of 27 cases with car cinoma (50%). Mancuso and Coulter (1963), in a cohort analysis of 1,495 peo ple employed during 1938 and 1939 at one asbestos factory, found eight of 52 with as bestosis died from carcinoma of the lung be tween 1940 and 1960. They further state that this number is on the low side due to inadequacy of available details. It is there fore surprising that a recent report, Hannon et al (1964), suggests that "the incidence of carcinoma of the lung and pleura is not en hanced in North American cases of asbesto sis.'' This paper is based on a study of 52 American cases of asbestosis with lung tumors in ten, (19.2%), an incidence, though not statistically significant, which ap proximates that for Great Britain; Gloyne (1951)--14%; Annual Report Chief In spector, of Factories (1959)--17.8%; and Doll (1955)--14.2%. Isselbacker et al ( 1953), in reviewing the world literature, give an incidence of 13.8%. Material The tumors in this series were discovered during another investigation concerned with peripheral epithelial changes in industrial lung disease (Jones Williams, 1957), The major part of the material consisted of histological slides and paraffin blocks from autopsies, and a few pneumonectomies. In a Submitted for publication July 27, 1964. The British Empire Cancer Campaign provided an American British Exchange Fellowship, 1954 1955. few cases whole lungs were available. Sections were stained with hematoxylin and eosin and with special stains as required, The diagnosis had been made originally from known exposure, gross ap pearance, histological findings of diffuse interstitial fibrosis and presence of asbestos fibers and/or bodies. Results Table 1 summarizes details of the ten cases with carcinoma. With one exception all were over 40 years of age, with a maximum num ber in the sixth decade. Details of exposure were available in the ten carcinoma cases: six fabricators, three process workers, and one asbestos miner. Tabic 2 shows the exposure details, when known, in the total series: 33 fabricators, nine process workers, and six asbestos miners, as well as the distribution of the cases with carcinoma. Fabricators in clude weavers, corders, spinners, and in sulating workers. Process workers are those concerned with extracting asbestos fibers from the ore. The duration of exposure of the tumor cases, with one exception, was 12 or more years. In the total series the range was from one-50 years, 26 with less and 17 with more than 20 years' exposure. The ten tumor cases showed various histologic types: squamous, three; anaplastic, three; adenocarcinoma, two; alveolar cell carcinoma, one; and mesothelioma of pleura, one. They showed all possible sites of origin, Table 1.--Carcinoma--Age, Sex, Exposure, Duration, and Histology Case A go, No. Sox 1 --*,M 2 4ltM 3 43.M 4 37,M 5 45,M e 60, M 7-- 8 --,F 9 03, M 10 50, M Exposure Duration Histology Minor Process Fabricator Fabricator Fabricator Process Fabricator Fabricator Fabricator Process 6 A naplastlc 12 Adenocarcinoma 20 Squamous -- Endothelioma ploura 30 Adenocarcinoma 40 Squamous -- Anaplastic -- Alveolar cell 18 Squamous 21 Anaplastic -- Indicates not known. SCF-FA-5650 SC-ALL-11861 WmBEsrosis and lung cancer ' jF'C'. Table 2.--Mode of Exposure and Carcinoma ... Mode of Exposure No. of Cases (32) No. With Tumor (10) available. Sections and eosin and with diagnosis had been txposure, gross apd diffuse interstitial -.stos fibers and/or iw^:..'fabricators ^;/';Vp,roc6S3 workers -.Miners 33 from main bronchi, distal air passages, to l,'{'The pleura. The following cases have been ^'-pfeviously published: case 3, Clinico-Patho- logical Conference, Massachusetts General Is of the ten cases Hospital, 1947; case 2, Isselbacher et al, 1953; and case 8, Jones Williams, 1957. In ixception all were a maximum num- . (he present series, particular attention was '^Ipcused on the bronchial epithelium. Five Hails of exposure cinoma cases: six cases showed well-marked squamous meta plasia of main bronchi; three of these were workers, and one ^associated with carcinoma but only one was iows the. exposure te total scries: 33 workers, and six squamous, and the other two were adenoyvAcarcinoniata. Four of the five showed wellji'T,'marked bronchiectasis. I have previously the distribution of . Fabricators in- i discussed and illustrated (1957) changes in hjhe peripheral alveolar epithelium in this ipinners, and in workers are those g asbestos fibers tn of exposure of exception, was 12 tl series the range 3 with less and 17 tx posu re. showed various ;, three; anaplastic, :wo; alveolar cell thelioma of pleura, ible sites of origin, ^'series. In ten of the 52 cases there was con- ^h'.cp'rnitant tuberculosis (19.2%), all without '/'carcinoma. With two exceptions, both having ^subapical cavitation, all showed extensive |ifie" ` crculous bronchopneumonia which was cause of death. In the majority, ^Tuberculosis developed a considerable time Rafter the diagnosis of asbestosis. Histo rically, there appeared to be no modification jj/yjSf the tuberculous reaction by the underlying |Tlust fibrosis. w/TTwo of the ten had silicosis to a minor One was an asbestos miner and the e, Sex, Exposure, listology Mother was exposed to silica (lour in the manu.ire of asbestos pipes. In the total series (where were four others with silicosis, a total tlon I-IJatoIoffy : 5-1:six of 52 (11%). . Anaplastic Adenocarcinoma Conclusion Squamous . WvThis report records 52 American cases of Endotheliomapleurai Adonocnrclnoitm Mpestosis among whom there were ten pa- Squamous jj&nts with malignant tumors, an incidence Anaplastic Alveolar cell (Pilar to that reported in Britain. \ Squamous fany American pathologists permitted access to ( Anaplastic jjijt;', material and records. J- Jones Williams, MD, Institute of Pathology, ^fjsh National School of Medicine, Cardiff, Wales. fa-Williams 45 REFERENCES 1. Anderson, ]., and Campagna, F. A.: Asbes tosis and Carcinoma of Lung: Case Report and Review of Literature, Arch Environ Health 1:27 32, 1960. 2. Annual Report of Chief Inspector of Fac tories for 1958, London : Her Majesty's Stationery Office, 1959, p 45. 3. Clinico-Pathological Conference of Massachu, setts General Hospital, New Eng J Med 236:407 412, 1947. 4. Cordova, J. F.; Tesluk, H.; and Knudtson, K. P.: Asbestosis and Carcinoma of Lung, Cancer 15:1181-1187, 1962. 5. Doll, R.: Mortality From Lung Cancer in As bestos Workers, Brit J Industr Med 12:81-86, 1955. 6. Egbert, D. S., and Geiger, A. J.: Pulmonary Asbestosis and Carcinoma: Report of Case With Necropsy Findings, Amer Rev Tuberc 34:143-150, 1936. 7. Gloyne, S. R.: Pneumoconiosis: Histological Survey of Necropsy Material in 1205 Cases, Lancet 1:810-814, 1951. 8. Hannon, J. W. 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