Document mpRYE5zQpX9pY9KRndr7gNqNO

91 Morris Greenberg and T. A. Lloyd' Denies 200 cues which had been diagnosed in Britain in the and of necropsy findings. The histological and previous IS years, with histological confirmation or histochemical features of mesothelial tumours have diagnosis, was in their possession with the help of been discussed by UICC panel pathologists (Wagner, information resulting from an enquiry (Smither, Munday, and Harington, 1962; Hourihane, 1964; Gilson, and Wagner, 1962). In that year the register McCaughey, 1963; Whitwell and Rawclifie, 1971) was banded over to the Medical Branch Of HM and the criteria employed by the UICC panel to Factory Inspectorate (now Employment Medical derive a consensus opinion appears hi the Appendix. Advisory Service, Department of Employment). Where material could not be borrowed the reports The objects of the register were stated in the Senior of consultant pathologists were examined. Where Medical Inspector's Advisory Panel Memorandum several pathologists gave varying opinions on a (1968): section and it was not possible to refer material to i to record the annual number of deaths from the UICC panel, the majority decision was taken. mesothelioma of the pleura or peritoneum The occupational history was often sought after the associated with asbestos exposure; histological diagnosis had been made by the non ii to ascertain trends in the prevalence rates; panel pathologists. Diagnoses made by these iii to discover, if possible, rumours occurring pathologists were allocated to the following groups: without any exposure to known or suspected 'Definite', where in the view of the pathologist, occupational causes; based on adequate histological material supported iv to provide part of the evidence on which pre by the gross appearance at thoracotomy, lapar ventive measures should be based. otomyor necropsy,mesotheliomawas the diagnosis This paper presents the results of investigations into of election. cases notified to the register from England and Wales 'Undecided', where the material examined and and from Scotland for the period 1 January 1967 to other features while compatible with a diagnosis of 31 December 1968. Preliminary results have been mesothelioma did not permit the pathologist to published elsewhere (Lloyd Davies, 1970) and the present report relates to information available to May 1972. make a firm diagnosis (this corresponds to the categoty `undecided* finally employed by UICC pathologists). 'Insufficient histological material", where the Plan of Investigation The Registrars General for England and Wales and pathologist was dissatisfied with the material, or where neither histological' nor necropsy material were ever examined. for Scotland forwarded copies of (a) death certifi `Definitely not', where a definite alternative cates which included a diagnosis of mesothelioma diagnosis was made by the pathologist. of pleura or peritoneum and (b)- Cancer Bureaux When tumour was present in both thorax and registrations with a diagnosis of malignant mesothe abdomen the site stated in the analysis is that given lioma. Pneumoconiosis Medical Panels also notified by the pathologist as the primaty site. Where the cases of mesothelioma which were subject to claims death certificate differed from the necropsy report, for benefit under the National Insurance Acts or the latter was accepted. otherwise came to their notice. Information about other cases was received from chest physicians, surgeons, pathologists, and coroners. The majority Asbestos exposure history of cases were notified from two or more sources. Where possible living subjects were interviewed, but The Central Ethical Committee of the British' for deceased subjects the relatives were interviewed Medical Association agreed that tracing of cases by in the first instance. Occupational histories were also medical advisers should take place only after the sought from coroners and from former employers prior approval of the patient's medical attendant. In and workmates. The initial classification was made the event, approval was given in all cases. Where by the investigating medical adviser who may or possible histological slides or blocks of histological may not have been aware of the interim diagnosis material were obtained: these were submitted to the and was rarely aware of the final diagnosis. The final Union International contre le Cancer (UICC) Panel classification was made by a second medical adviser of Pathologists (see Appendix). in consultation with the first, and often this took place before the final diagnosis had been received. Diagnostic criteria i A definitive diagnosis was made only when histo' logical proof was available. Borrowed material was referred to the UTCC Panel of Pathologists together with an abstract ofoccupational and clinical histories Occupational exposure Occupational exposure to asbestos was defined as follows: 'Definite', where the job involved full-time or intermittent handling of asbestos or asbestos- containing c worked in an tos dust. 'Possible', w imprecise to suspicion of. 'None', whe occupational `Unknown', v not forthcoi exposure wa before .death intermittentfigure. Domestic expo Domestic expc a history that come home v obtained. Hobby exposn Hobby expos holders or si sawing asbest outhouses, ga: Nelghbouriioa Ncighboutho* jects lived wit' shipyard usir exposure. Other evidcnc Asbestos exp evidence of ai at necropsy) NonrtCATiot UICC Panel Other patbolot Total Alt cases See teat for 4