Neurological signs in relation to cancer in patients with asbestosis.

OBJECTIVE

To chart the subtle neurological abnormalities in patients with asbestosis relative to possible development of cancer.

METHODS

In 1979-81 a standardised neurological examination was made of 115 patients with asbestosis who carried a high risk of occupational cancer and their cancer morbidity was analysed 15 years later.

RESULTS

Slight disturbances of unknown aetiology were found in the central nervous system (CNS) of 33 and in the peripheral nervous system (PNS) of 41 patients. Of these 17 had disturbances of both the CNS and PNS. This cohort was followed up to the end of 1994. During this time 47 of the patients developed cancer. Statistical analyses showed that disturbances of the CNS such as psycho-organic syndrome, cerebellar dysfunction, and motor disturbances of unknown origin were significantly associated with cancer, whereas no such association was found for peripheral neuropathy. Interaction between the radiological progression of asbestosis and disturbances of the CNS was an even stronger predictor of cancer.

CONCLUSIONS

It seems that slight disturbances of the CNS are predictors of development of cancer. Whether or not these disturbances are manifestations of involvement of a paraneoplastic nervous system or some factor associated with progression of asbestosis remains open.