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?

• 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

• 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