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Amosite mesothelioma in a cohort of asbestos workers
J Ribak1, H Seidman, I J Selikoff
1Environmental Research Laboratory, Mount Sinai School of Medicine, City University of New York, New York.
Abstract:
A cohort of 820 asbestos workers with a short duration of exposure to amosite between 1941 and 1945 was followed. These men were alive five years after starting work and were observed until 1988. Seventeen cases of malignant mesothelioma (eight pleural, nine peritoneal) were found. The mean age at the onset of exposure was 33 years for men with pleural mesothelioma and 30 years for those with peritoneal mesothelioma. Chest pain was the main symptom in pleural mesothelioma and abdominal pain in peritoneal mesothelioma. Open lung biopsy was the most useful diagnostic approach for pleural mesothelioma, whereas for peritoneal mesothelioma it was exploratory laparotomy. Pleural patients died of pulmonary insufficiency, and peritoneal patients of wasting and inanition. In both groups the death certificate diagnosis was less accurate than the clinical diagnosis at death. The mean survival was 12.5 months from first symptom to death for the pleural group and 5.4 months for the peritoneal group.
Insights
This study followed 820 asbestos workers, finding 17 cases of malignant mesothelioma. Pleural mesothelioma had longer survival but poorer diagnostic accuracy on death certificates compared to peritoneal mesothelioma.
Area of Science:
- Occupational Health
- Oncology
- Epidemiology
Background:
- Asbestos exposure is a known cause of malignant mesothelioma.
- Understanding the long-term outcomes of specific asbestos types, like amosite, is crucial for occupational health.
- Limited data exists on the distinct clinical courses of pleural versus peritoneal mesothelioma following short-term amosite exposure.
Purpose of the Study:
- To investigate the incidence and clinical characteristics of malignant mesothelioma in a cohort of asbestos workers exposed to amosite.
- To compare the diagnostic approaches, symptoms, and survival rates between pleural and peritoneal mesothelioma.
- To evaluate the accuracy of death certificate diagnoses versus clinical diagnoses.
Main Methods:
- A cohort of 820 asbestos workers with documented amosite exposure between 1941-1945 was followed prospectively.
- Seventeen cases of malignant mesothelioma (8 pleural, 9 peritoneal) were identified and analyzed.
- Data collected included age at exposure, symptoms, diagnostic methods, cause of death, and survival time.
Main Results:
- Seventeen cases of malignant mesothelioma (8 pleural, 9 peritoneal) were diagnosed.
- Mean age at exposure onset differed between pleural (33 years) and peritoneal (30 years) mesothelioma.
- Pleural mesothelioma presented with chest pain, diagnosed via lung biopsy, and had a mean survival of 12.5 months; peritoneal mesothelioma presented with abdominal pain, diagnosed via laparotomy, and had a mean survival of 5.4 months.
Conclusions:
- Malignant mesothelioma can develop after short-term amosite exposure, with distinct clinical presentations and prognoses for pleural and peritoneal forms.
- Clinical diagnosis at death was more accurate than death certificate diagnosis for both mesothelioma types.
- Prompt diagnosis and understanding the specific disease characteristics are vital for patient management and prognosis.

