Transcript Lung Cancer - Dinsmore & Shohl

Lung Cancer
Background and Developments
regarding the Role of Asbestos as a
Cause of Lung Cancer
Lung Cancer: Medical Aspects of
Causation
• Aneuploidy
• Unlimited cell reproduction and failure of cell
death
• Animal Studies
• Basic Toxicology
New Data on Causation
• New Studies
• New Statistics
– Number of cases
– Years since cessation
New Research on DNA and toxicology
Lung Cancer Causation
• Smoking as a Cause
• Other agents
– Radon
– Silica
– Industrial Plant Exposure
• Refinery
• Other types of plants
Lung Cancer Causation: Asbestos as a
Cause
• Lung cancer has historically (early 20th
Century) been associated with certain
exposures to asbestos;
• Selikoff studies of Insulators;
• Usefulness of Historical data for lung cancer in
2014
Plaintiff Arguments on Lung
Cancer Causation
Do not need Asbestosis to
Attribute Lung Cancer to Asbestos
The Role of Animal Studies
Dr. Brody and Photomicrographs
The Role of Epidemiology
• Case Reports and Animal Studies can be
included
• Are some studies better than others?
– If so, which ones and Why?
At What Level of Asbestos
Exposure can one attribute Lung
Cancer to Asbestos?
• Reasoning and Authority
• Increased Risk – Does Doubling of Risk Bear on
Causation?
The Role of Synergy
• Old v. New Studies
• Levels of Exposure
The Role of Governmental
Regulatory Agency Papers
• What is the science?
• When can they Inform on Causation?
Defendants’ Arguments on Lung
Cancer Causation
Asbestosis is needed to attribute
Lung Cancer to Asbestos
Weight of Science
What is Asbestosis?
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Pathology – Roggli Standard
Radiology – CT and HRCT scans
PFT/Other clinical data
Confounding data
– UIP
– Smoking related Interstitial fibrosis
– CHF
If Asbestosis is not Found, one needs
to find Significant Exposure to
Asbestos
• 25 f/cc-years of exposure or more
– Hammar
– Helsinki
– Others
Is Synergy Important?
• Selikoff
• Markowitz
• Others: Additive v. multiplicative
Use of Industrial Hygiene Data to
Prove Exposure
• Usefulness of Retrospective Studies
• What is a fiber/cc-year and how does this fit
with causation?
Treatment of Low Dose Asbestos
Exposure
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Medical v. Legal Cause
Differences between states
Increased risk v. doubling of risk
Effect of smoking on asbestos causation
Does fiber type matter?
Ambient Air levels
Lung Cancer is not Mesothelioma
• Chrysotile issue
• Amphibole: as little as .1 f/cc-year may cause
mesothelioma
• For Lung Cancer, mixed exposure, 25 f/cc-year
exposure or more?
• Helsinki
The Role of Cigarette Warnings
• Post 1962
• Post 1985
• Complete Defense in warnings cases?
Venue for Lung Cancer
• Madison County
• Others – California, New York, Pennsylvania,
Delaware
• Forum Non conveniens
Other Cancers
• 2006 National Academy of Science Data
• Laryngeal and Ovarian Cancer - epidemiology
• Other cancers