© 2006 British Occupational Hygiene Society Published by Oxford University Press
Letter to the Editor |
Estimating the Number of Asbestos-Related Cancer Deaths in Great Britain
Darnton et al.'s (2006)
paper is a sad reminder of a lost opportunity to acquire the data that would have served to evaluate the risks of controlled exposure to asbestos more readily and more accurately than was possible from the authors' sources and models.
In their Methods section, the authors explained their need to exploit indirect sources of data as a result of: (i) there being no source of information providing direct measurements or estimates of asbestos exposure among occupational groups in Great Britain; (ii) there being no quantitative measures of smoking habits. Their failure to expand on these matters is understandable, as well before their time, and after a protracted consultation process, in which experts in the fields of epidemiology, clinical and occupational medicine, as well as representatives of industry, labour and social services participated, HM Factory Inspectorate launched the comprehensive national study of asbestos workers in 1969. This was described in a paper by the Employment Medical Advisory Service (1973).
This longitudinal population study was to collect health data in a standardized manner, that included respiratory symptoms elicited by the administration of the MRC questionnaire, and a descriptive reading of opacities in the chest radiograph scored on the extended scale according to the ILO rubric and quality controlled by a national reading panel. Smoking habits were recorded, and the strategy for asbestos monitoring involved collecting personal samples representative of workers in 66 job codes. Subjects were to be flagged by the Registrar General, and death and cancer registrations sent to the Medical Inspectorate.
The purpose of the study was to derive dose–response relationships for the lower level exposures aimed for by the 1969 Asbestos Regulations, and to obtain a comprehensive measure of the health burden of asbestos in manufacturing. It had been appreciated before the BOHS 1968 standard was published, that the 2 fibres per millilitre (100 f/y) standard to which the Regulations were linked was ill founded. From the British Occupational Hygiene Society (BOHS) documents obtained in legal discovery by Chase Manhattan Bank (1990), it is apparent that not long after 1968, certain members of the reformed BOHS Sub-Committee on Asbestos recommended reducing exposures to less than a fortieth of the 1968 standard.
Darnton et al.'s estimate of asbestos-related lung cancer deaths is inevitably subject to a number of sources of uncertainty. However, the measurement of the full burden of asbestos on health and longevity would have been much more reliable if data had been collected as was advised by scientists in 1968. The Factory Inspectorate survey to obtain this was launched by Dr Trevor Lloyd Davies, the Senior Medical Inspector, with the cooperation of industry and the unions. It proceeded successfully for several years, but was unfortunately terminated by a successor.
74 North End Road, NW11 7SY, UK E-mail: mgreenberg{at}toucansurf.com
Received September 27, 2005; in final form November 2, 2005
REFERENCES
Chase Manhattan Bank. (1990) Photomicrographs of documents obtained by legal discovery from the archives of Turner and Newall, in the case of The Chase Manhattan Bank, N.A. against T and N plc. United States District Court, Southern District of New York. 87 Civ.4435 (VLB) (KAR).
Darnton AJ, McElvenny DM, Hodgson JT. (2006) Estimating the number of asbestos-related cancer deaths in Great Britain from 1980 to 2000. Ann Occup Hyg; 50: 29–38.
Employment Medical Advisory Service. (1973) Occasional Paper 3. A study of asbestos workers. London: Department of Employment.
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