Mándi A, Posgay M, Vadász P, Major K, Rödelsperger K, Tossavainen A, Ungváry G, Woitowitz H J, Galambos E, Németh L, Soltész I, Egerváry M, Böszörményi Nagy G
Fodor József National Center for Public Health, Budapest, Hungary.
Int Arch Occup Environ Health. 2000 Nov;73(8):555-60. doi: 10.1007/s004200000172.
What is the frequency of occupational asbestos exposure among patients suffering from malignant respiratory tumours and how many of these tumours are associated with asbestos in Hungary?
An internationally established questionnaire with 29 questions, covering the most characteristic activities of asbestos exposure at the workplace was completed for 300 patients with respiratory malignancies, i.e. 297 patients with lung cancer and three with mesothelioma of the pleura. From the questionnaire, the smoking habits were estimated and cumulative asbestos exposure was assessed in fibre-years. Additionally, lung X-rays were classified and the national data on the incidence of malignant pleura mesothelioma were analysed.
A cumulative asbestos exposure of 25 fibre-years or more was detected in 11 patients with lung cancer (4%) and in each of the three patients with pleural mesothelioma (100%). In a further 72 patients (24%), cumulative occupational asbestos exposure was assessed as below 25 fibre-years (between 0.01 and 23.9 fibre-years). In this group, car and truck mechanics, and installation and construction workers using asbestos-cement were registered. Among patients with an asbestos exposure of 25 fibre-years or more, six asbestos-cement production workers were observed, among them the three mesothelioma cases. A weak but significant association between positive X-ray findings and exposure estimates could be demonstrated. Additionally, results of the lung tissue fibre counts by scanning transmission electron microscopy were available for 25 of the lung cancer patients. A good correlation was observed between the asbestos fibre counts and the assessment of cumulative asbestos exposure. In Hungary, 84 cases of pleural mesothelioma were registered in 1997 and 73 in 1998. These numbers correspond to an annual incidence of about one new case per 100,000 inhabitants older than 15 years.
The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.
匈牙利恶性呼吸肿瘤患者中职业性石棉暴露的频率是多少，以及这些肿瘤中有多少与石棉有关？
为300例呼吸恶性肿瘤患者（即297例肺癌患者和3例胸膜间皮瘤患者）完成了一份国际通用的包含29个问题的问卷，该问卷涵盖了工作场所石棉暴露的最典型活动。从问卷中估算吸烟习惯，并以纤维 - 年为单位评估累积石棉暴露量。此外，对肺部X光片进行分类，并分析全国恶性胸膜间皮瘤的发病率数据。
在11例肺癌患者（4%）和3例胸膜间皮瘤患者中的每一例（100%）中检测到累积石棉暴露量达到或超过25纤维 - 年。在另外72例患者（24%）中，累积职业性石棉暴露量评估为低于25纤维 - 年（介于0.01和23.9纤维 - 年之间）。在这组患者中，登记有汽车和卡车机械师以及使用石棉水泥的安装和建筑工人。在石棉暴露量达到或超过25纤维 - 年的患者中，观察到6名石棉水泥生产工人，其中包括3例间皮瘤病例。X光检查阳性结果与暴露量估算之间存在微弱但显著的关联。此外，对25例肺癌患者进行了扫描透射电子显微镜下肺组织纤维计数。石棉纤维计数与累积石棉暴露量评估之间观察到良好的相关性。1997年匈牙利登记了84例胸膜间皮瘤病例，1998年登记了73例。这些数字对应的年发病率约为每10万15岁以上居民中有1例新发病例。
匈牙利肺癌的年发病率约为6000例。由于在我们的肺癌患者系列中观察到约4%的患者，因其累积暴露量达到或超过25纤维 - 年，可被视为职业性疾病，因此每年与石棉相关的肺癌发病率估计约为150例或更多。每例胸膜间皮瘤对应近两例估计的肺癌病例的比例与国际经验相符。到目前为止，肺癌病例仅在极少数情况下被登记为职业性疾病，即在匈牙利它们被严重漏诊。为改善这种情况，对所有新诊断的肺癌患者通过涵盖工作史的问卷进行自我访谈以提供诊断帮助会很有帮助。
