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Beckett EM, Abelmann A, Roberts B, Lewis RC, Cheatham D, Miller EW, Hall E, Pierce JS. An updated evaluation of reported no-observed adverse effect levels for chrysotile, amosite, and crocidolite asbestos for lung cancer and mesothelioma. Crit Rev Toxicol 2023; 53:611-657. [PMID: 38126124 DOI: 10.1080/10408444.2023.2283169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
This analysis updates two previous analyses that evaluated the exposure-response relationships for lung cancer and mesothelioma in chrysotile-exposed cohorts. We reviewed recently published studies, as well as updated information from previous studies. Based on the 16 studies considered for chrysotile (<10% amphibole), we identified the "no-observed adverse effect level" (NOAEL) for lung cancer and/or mesothelioma; it should be noted that smoking or previous or concurrent occupational exposure to amphiboles (if it existed) was not controlled for. NOAEL values ranged from 2.3-<11.5 f/cc-years to 1600-3200 f/cc-years for lung cancer and from 100-<400 f/cc-years to 800-1599 f/cc-years for mesothelioma. The range of best-estimate NOAELs was estimated to be 97-175 f/cc-years for lung cancer and 250-379 f/cc-years for mesothelioma. None of the six cohorts of cement or friction product manufacturing workers exhibited an increased risk at any exposure level, while all but one of the six studies of textile workers reported an increased risk at one or more exposure levels. This is likely because friction and cement workers were exposed to much shorter chrysotile fibers. Only eight cases of peritoneal mesothelioma were reported in all studies on predominantly chrysotile-exposed cohorts combined. This analysis also proposed best-estimate amosite and crocidolite NOAELs for mesothelioma derived by the application of relative potency estimates to the best-estimate chrysotile NOAELs for mesothelioma and validated by epidemiology studies with exposure-response information. The best-estimate amosite and crocidolite NOAELs for mesothelioma were 2-5 f/cc-years and 0.6-1 f/cc-years, respectively. The rate of peritoneal mesothelioma in amosite- and crocidolite-exposed cohorts was between approximately 70- to 100-fold and several-hundred-fold higher than in chrysotile-exposed cohorts, respectively. These findings will help characterize potential worker and consumer health risks associated with historical and current chrysotile, amosite, and crocidolite exposures.
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Affiliation(s)
| | | | | | | | | | | | - Ethan Hall
- Benchmark Risk Group, Grand Rapids, MI, USA
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Giles Murphy T, Bornstein S, Oudyk J, Demers PA. A Quantitative Retrospective Exposure Assessment for Former Chrysotile Asbestos Miners and Millers from Baie Verte, NL, Canada. Ann Work Expo Health 2021; 65:113-126. [PMID: 32959879 DOI: 10.1093/annweh/wxaa092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/27/2020] [Accepted: 08/24/2020] [Indexed: 11/14/2022] Open
Abstract
Despite numerous studies of asbestos workers in the epidemiologic literature, there are very few cohort studies of chrysotile asbestos miners/millers that include high-quality retrospective exposure assessments. As part of the creation of the Baie Verte Miners' Registry in 2008, a two-dimensional job exposure matrix (JEM) was developed for estimating asbestos exposures for former chrysotile asbestos miners/millers. Industrial hygiene data collected between 1963 and 1994 were analysed to assess validity for use in a retrospective exposure assessment and epidemiologic study. Registered former employees were divided into 52 exposure groups (EGs) based on job title and department and mean asbestos concentrations were calculated for each EG. The resulting exposure estimates were linked to individual registrants' work histories allowing for the calculation of cumulative asbestos exposure for each registrant. The distribution of exposure for most EGs (82.6%) could be described as fitting a log-normal distribution, although variability within some EGs (55%) exceeded a geometric standard deviation (GSD) of 2.5. Overall, the data used to create EGs in the development of the JEM were deemed to be of adequate quality for estimating cumulative asbestos exposures for the former employees of the Baie Verte asbestos mine/mill. The variability between workers in the same job was often high and is an important factor to be considered when using estimates of cumulative asbestos exposure to adjudicate compensation claims. The exposures experienced in this cohort were comparable to those of other chrysotile asbestos miners/millers cohorts, specifically Italian and Québec cohorts.
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Affiliation(s)
- Tina Giles Murphy
- Memorial University of Newfoundland, SafetyNet Centre for Occupational Health & Safety Research, Bruneau Centre, St. John's, NL, Canada
| | - Stephen Bornstein
- Memorial University of Newfoundland, SafetyNet Centre for Occupational Health & Safety Research, Bruneau Centre, St. John's, NL, Canada
| | - John Oudyk
- Occupational Health Clinics for Ontario Workers, Hamilton, ON, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada
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HUANG Q, LAN YJ. Colorectal cancer and asbestos exposure-an overview. INDUSTRIAL HEALTH 2020; 58:200-211. [PMID: 31511437 PMCID: PMC7286717 DOI: 10.2486/indhealth.2018-0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
The relationship between colorectal cancer and asbestos exposure has not been fully clarified. This study aimed to determine the associations between asbestos exposure and colorectal cancer. We performed a meta-analysis to quantitatively evaluate this association. A fixed effects model was used to summarize the relative risks across studies. Sources of heterogeneity were explored through subgroup analyses and meta-regression. We analyzed the dose-effect relationship using lung cancer standardized mortality ratio (SMR) and the risk of mesothelioma as a percent (%) as exposure surrogates. A total of 47 cohort studies were included. We identified 28 incidence cohort studies from 17 separate papers and extracted colorectal cancer standardized incidence ratio (SIR). Cancer mortality data were extracted from 19 separate cohorts among 13 papers. The overall colorectal cancer SMR for synthesis cohort was 1.07 (95% CI 1.02-1.12). Statistically significant excesses were observed in exposure to mixed asbestos (SMR/SIR=1.07), exposure to production (SMR/SIR=1.11), among asbestos cement workers (SMR/SIR=1.18) and asbestos textile workers (SMR/SIR=1.11). Additionally, we determined that the SMR for lung cancer increased with increased exposure to asbestos, as did the risk for colorectal cancer. This study confirms that colorectal cancer has a positive weak associations with asbestos exposure.
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Affiliation(s)
- Qian HUANG
- West China School of Public Health and West China Fourth
Hospital, Sichuan University, China
| | - Ya-jia LAN
- West China School of Public Health and West China Fourth
Hospital, Sichuan University, China
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Ferrante D, Mirabelli D, Silvestri S, Azzolina D, Giovannini A, Tribaudino P, Magnani C. Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: A cohort study. Am J Ind Med 2020; 63:135-145. [PMID: 31821579 DOI: 10.1002/ajim.23071] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND We studied cancer mortality and mesothelioma incidence in 974 male workers employed at least 6 months at the Balangero mine (Italy), the largest chrysotile mine in Western Europe, active from 1917 to 1985. METHODS Vital status as of 31 May 2013, causes of deaths and mesothelioma incidence from 1990 were ascertained. Past exposure to asbestos by working area and calendar period was estimated, based on historical data of fibers concentrations. Individual cumulative exposure was assessed by applying estimates to the job history of cohort members. Standardized mortality ratios (SMRs) for selected causes and standardized incidence ratios for malignant mesothelioma (MM) were calculated based on regional reference rates. Poisson regression analysis was used to study MM and lung cancer risk by latency, duration, and cumulative exposure. RESULTS Mortality was increased for all causes (SMR = 1.28; 95% confidence interval [CI] = 1.17-1.40), pleural cancer (SMR = 4.30; 95% CI = 1.58-9.37), asbestosis (SMR = 375.06; 95% CI = 262.68-519.23). An increase was also found for lung cancer (SMR = 1.14; 95% CI = 0.81-1.55) and peritoneal cancer (SMR = 3.25; 95% CI = 0.39-11.75). The risk of both pleural and peritoneal cancer mortality and of mesothelioma incidence increased with increasing cumulative exposure, duration, and latency. Poisson regression analyses showed an increase in mesothelioma risk with cumulative asbestos exposure and suggest a similar trend for lung cancer. Asbestosis mortality also increased with cumulative exposure. CONCLUSIONS Among Balangero chrysotile miners and millers, the occurrence of malignant and nonmalignant asbestos-related diseases was increased by exposure, with dose-response relation. The study confirms the carcinogenicity of chrysotile asbestos, in particular for pleural mesothelioma.
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Affiliation(s)
- Daniela Ferrante
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational MedicineUniversity of Eastern Piedmont and CPO Piemonte Novara Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Department of Medical SciencesCPO Piemonte and University of Turin Turin Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic ParticulatesUniversity of Turin Turin Italy
| | | | - Danila Azzolina
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational MedicineUniversity of Eastern Piedmont and CPO Piemonte Novara Italy
| | | | | | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational MedicineUniversity of Eastern Piedmont and CPO Piemonte Novara Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic ParticulatesUniversity of Turin Turin Italy
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Gwenzi W. Occurrence, behaviour, and human exposure pathways and health risks of toxic geogenic contaminants in serpentinitic ultramafic geological environments (SUGEs): A medical geology perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 700:134622. [PMID: 31693951 DOI: 10.1016/j.scitotenv.2019.134622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
Serpentinitic ultramafic geological environments (SUGEs) contain toxic geogenic contaminants (TGCs). Yet comprehensive reviews on the medical geology of SUGEs are still lacking. The current paper posits that TGCs occur widely in SUGEs, and pose human health risks. The objectives of the review are to: (1) highlight the nature, occurrence and behaviour of TGCs associated with SUGEs; (2) discuss the human intake pathways and health risks of TGCs; (4) identify the key risk factors predisposing human health to TGCs particularly in Africa; and (5) highlight key knowledge gaps and future research directions. TGCs of human health concern in SUGEs include chrysotile asbestos, toxic metals (Fe, Cr, Ni, Mn, Zn, Co), and rare earth elements. Human intake of TGCs occur via inhalation, and ingestion of contaminated drinking water, wild foods, medicinal plants, animal foods, and geophagic earths. Occupational exposure may occur in the mining, milling, sculpturing, engraving, and carving industries. African populations are particularly at high risk due to: (1) widespread consumption of wild foods, medicinal plants, untreated drinking water, and geophagic earths; (2) weak and poorly enforced environmental, occupational, and public health regulations; and (3) lack of human health surveillance systems. Human health risks of chrysotile include asbestosis, cancers, and mesothelioma. Toxic metals are redox active, thus generate reactive oxygen species causing oxidative stress. Dietary intake of iron and geophagy may increase the iron overload among native Africans who are genetically predisposed to such health risks. Synergistic interactions among TGCs particularly chrysotile and toxic metals may have adverse human health effects. The occurrence of SUGEs, coupled with the several risk factors in Africa, provides a unique and ideal setting for investigating the relationships between TGCs and human health risks. A conceptual framework for human health risk assessment and mitigation, and future research direction are highlighted.
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Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Soil Science and Agricultural Engineering, Faculty of Agriculture, University of Zimbabwe, P.O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
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Brey C, Gouveia FT, Silva BS, Sarquis LMM, Miranda FMD, Consonni D. Lung cancer related to occupational exposure: an integrative review. Rev Gaucha Enferm 2020; 41:e20190378. [DOI: 10.1590/1983-1447.2020.20190378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To identify in the literature the carcinogenic agents found in the work environment, the occupations and the risk for lung cancer. Method: A descriptive and analytical study of the Integrative Literature Review type was carried out in national and international databases from the last ten years in the period from 2009 to 2018, concerning 32 studies referring to association between carcinogenic substances to which the worker is exposed and lung cancer. Results: Nine (28.1%) publications originated in China and only one in Brazil. The most exposed workers were from the secondary sector, 50% being from industry and 6.2% from construction, mostly male. Asbestos and silica stood out among the carcinogenic substances most associated with lung cancer risk, accounting for 37.5% and 28.1%, respectively. Conclusions: The association between occupational exposure and the risk for lung cancer was characterized in this research by the substantial scientific evidence from the described studies that confirm this association.
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Affiliation(s)
- Christiane Brey
- Universidade Federal do Paraná, Brasil; Instituto Federal do Paraná, Brasil
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Yano E. Adverse health effects of asbestos: solving mysteries regarding asbestos carcinogenicity based on follow-up survey of a Chinese factory. Environ Health Prev Med 2018; 23:35. [PMID: 30089452 PMCID: PMC6083519 DOI: 10.1186/s12199-018-0726-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022] Open
Abstract
The present review summarizes the results of several follow-up studies assessing an asbestos product manufacturing plant in Chongqing, China, and discusses three controversial issues related to the carcinogenicity of asbestos. The first issue is the amphibole hypothesis, which asserts that the carcinogenicity of asbestos is limited to amphiboles, such as crocidolite, but not serpentines, such as chrysotile. However, considering the possible multiple component of asbestos carcinogenicity in the presence of tobacco smoke or other carcinogens, chrysotile cannot be regarded as non-carcinogenic. Additionally, in a practical sense, it is not possible to assume "pure" chrysotile due to its ubiquitous contamination with tremolite, which is a type of amphibole. Thus, as the International Agency for Research on Cancer (IARC) assessed, all forms of asbestos including chrysotile should be regarded carcinogenic to humans (Group 1). The second issue is the chrysotile/tremolite paradox, which is a phenomenon involving predominant levels of tremolite in the lung tissues of individuals who worked in locations with negligible levels of tremolite due to the exclusive use of chrysotile. Four possible mechanisms to explain this paradox have been proposed but this phenomenon does not support the claim that amphibole is inert. The final issue discussed is the textile mystery, i.e., the higher incidence of cancer in asbestos textile plants compared to asbestos mines where the same asbestos was produced and the exposure levels were comparable. This phenomenon was first reported in North America followed by UK and then in the present observations from China. Previously, levels of fiber exposure were calculated using a universal converting coefficient to estimate the mass concentration versus fiber concentration. However, parallel measurements of fiber and mass concentrations in the workplace and exposed air indicated that there are wide variations in the fiber/mass ratio, which unjustifies the universal conversion. It is possible that contamination by airborne non-fibrous particles in mines with mass fiber conversion led to the overestimation of fiber concentrations and resulted in the textile mystery. Although the use and manufacturing of asbestos has been banned in Japan, more than 10 million tons of asbestos had been imported and the majority remains in existing buildings. Thus, efforts to control asbestos exposure should be continued.
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Affiliation(s)
- Eiji Yano
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
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Valenzuela M, Giraldo M, Gallo-Murcia S, Pineda J, Santos L, Ramos-Bonilla JP. Recent Scientific Evidence Regarding Asbestos Use and Health Consequences of Asbestos Exposure. Curr Environ Health Rep 2018; 3:335-347. [PMID: 27696225 DOI: 10.1007/s40572-016-0109-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To justify the continuous use of two million tons of asbestos every year, it has been argued that a safe/controlled use can be achieved. The aim of this review was to identify recent scientific studies that present empirical evidence of: 1) health consequences resulting from past asbestos exposures and 2) current asbestos exposures resulting from asbestos use. Articles with evidence that could support or reject the safe/controlled use argument were also identified. A total of 155 articles were included in the review, and 87 % showed adverse asbestos health consequences or high asbestos exposures. Regarding the safe/controlled use, 44 articles were identified, and 82 % had evidence suggesting that the safe/controlled use is not being achieved. A large percentage of articles with evidence that support the safe/controlled use argument have a conflict of interest declared. Most of the evidence was developed in high-income countries and in countries that have already banned asbestos.
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Affiliation(s)
- Manuela Valenzuela
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia
| | - Margarita Giraldo
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia
| | - Sonia Gallo-Murcia
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia
| | - Juliana Pineda
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia
| | - Laura Santos
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia
| | - Juan Pablo Ramos-Bonilla
- Department of Civil and Environmental Engineering, Universidad de los Andes, Cra 1ª Este No. 19A-40, Bogotá, Colombia.
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El Zoghbi M, Salameh P, Stücker I, Brochard P, Delva F, Lacourt A. Absence of multiplicative interactions between occupational lung carcinogens and tobacco smoking: a systematic review involving asbestos, crystalline silica and diesel engine exhaust emissions. BMC Public Health 2017; 17:156. [PMID: 28152992 PMCID: PMC5288859 DOI: 10.1186/s12889-017-4025-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco smoking is the main cause of lung cancer, but it is not the sole causal factor. Significant proportions of workers are smokers and exposed to occupational lung carcinogens. This study aims to systematically review the statistical interaction between occupational lung carcinogens and tobacco smoking, in particular asbestos, crystalline silica and diesel engine exhaust emissions. METHODS Articles were identified using Scopus, PubMed, and Web of Science, and were limited to those published in English or French, without limitation of time. The reference list of selected studies was reviewed to identify other relevant papers. One reviewer selected the articles based on the inclusion and exclusion criteria. Two reviewers checked the eligibility of articles to be included in the systematic review. Data were extracted by one reviewer and revised by two other reviewers. Cohorts and case-control studies were analyzed separately. The risk of bias was evaluated for each study based on the outcome. The results of the interaction between the tobacco smoking and each carcinogen was evaluated and reported separately. RESULTS Fifteen original studies were included for asbestos-smoking interaction, seven for silica-smoking interaction and two for diesel-smoking interaction. The results suggested the absence of multiplicative interaction between the three occupational lung carcinogens and smoking. There is no enough evidence from the literature to conclude for the additive interaction. We believe there is a limited risk of publication bias as several studies reporting negative results were published. CONCLUSION There are no multiplicative interactions between tobacco smoking and occupational lung carcinogens, in particular asbestos, crystalline silica and diesel engine exhaust emissions. Even though, specific programs should be developed and promoted to reduce concomitantly the exposure to occupational lung carcinogens and tobacco smoking.
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Affiliation(s)
- Mohamad El Zoghbi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, F-33000 France
| | - Pascale Salameh
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
- Epidemiological & Clinical Laboratory Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Isabelle Stücker
- Université Paris Saclay, University of Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Patrick Brochard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, F-33000 France
- CHU de Bordeaux, Pole de sante publique, Service de médecine du travail et de pathologie professionnelle, Bordeaux, F-33000 France
| | - Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, F-33000 France
- CHU de Bordeaux, Pole de sante publique, Service de médecine du travail et de pathologie professionnelle, Bordeaux, F-33000 France
| | - Aude Lacourt
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team EPICENE, UMR 1219, Bordeaux, F-33000 France
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Marsili D, Terracini B, Santana VS, Ramos-Bonilla JP, Pasetto R, Mazzeo A, Loomis D, Comba P, Algranti E. Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E494. [PMID: 27187433 PMCID: PMC4881119 DOI: 10.3390/ijerph13050494] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/11/2016] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
Abstract
More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four countries: Russia, China, Brazil and Kazakhstan; and the wide use of asbestos worldwide represents a global threat. The purpose of this paper is to present a review of the asbestos health impact and to discuss the role of epidemiological investigations in countries where asbestos is still used. In these contexts, new, "local" studies can stimulate awareness of the size of the problem by public opinion and other stakeholders and provide important information on the circumstances of exposure, as well as local asbestos-related health impacts. This paper suggests an agenda for an international cooperation framework dedicated to foster a public health response to asbestos, including: new epidemiological studies for assessing the health impact of asbestos in specific contexts; socio-cultural and economic analyses for contributing to identifying stakeholders and to address both the local and global implications of asbestos diffusion; public awareness on the health and socio-economic impact of asbestos use and banning.
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Affiliation(s)
- Daniela Marsili
- Environment and Primary Prevention, Istituto Superiore di Sanità, Rome 00161, Italy.
| | - Benedetto Terracini
- Professor of Biostatistics, University of Turin (Now Retired), Turin 10124, Italy.
| | - Vilma S Santana
- Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil.
| | - Juan Pablo Ramos-Bonilla
- Departamento de Ingeniería Civil y Ambiental/Department of Civil and Environmental Engineering, Universidad de los Andes, Bogotá 110231, Colombia.
| | - Roberto Pasetto
- Environment and Primary Prevention, Istituto Superiore di Sanità, Rome 00161, Italy.
- WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome 00161, Italy.
| | - Agata Mazzeo
- Department of History and Cultures, University of Bologna, Bologna 40126, Italy.
| | - Dana Loomis
- International Agency for Research on Cancer, Lyon 69372, France.
| | - Pietro Comba
- Environment and Primary Prevention, Istituto Superiore di Sanità, Rome 00161, Italy.
- WHO Collaborating Centre for Environmental Health in Contaminated Sites, Istituto Superiore di Sanità, Rome 00161, Italy.
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Pierce JS, Ruestow PS, Finley BL. An updated evaluation of reported no-observed adverse effect levels for chrysotile asbestos for lung cancer and mesothelioma. Crit Rev Toxicol 2016; 46:561-86. [DOI: 10.3109/10408444.2016.1150960] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
PURPOSE OF REVIEW Recent epidemiologic investigations suggest that occupational and environmental exposures contribute to the overall burden of idiopathic pulmonary fibrosis (IPF). This article explores the epidemiologic and clinical challenges to establishing exposure associations, the current literature regarding exposure disease relationships and the diagnostic work-up of IPF and asbestosis patients. RECENT FINDINGS IPF patients demonstrate a histopathologic pattern of usual interstitial pneumonia. In the absence of a known cause or association, a usual interstitial pneumonia pattern leads to an IPF diagnosis, which is a progressive and often terminal fibrotic lung disease. It has long been recognized that asbestos exposure can cause pathologic and radiographic changes indistinguishable from IPF. Several epidemiologic studies, primarily case control in design, have found that a number of other exposures that can increase risk of developing IPF include cigarette smoke, wood dust, metal dust, sand/silica and agricultural exposures. Lung mineralogic analyses have provided additional support to causal associations. Genetic variation may explain differences in disease susceptibility among the population. SUMMARY An accumulating body of literature suggests that occupational and environmental exposure can contribute to the development of IPF. The impact of exposure on the pathogenesis and clinical course of disease requires further study.
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Baur X, Soskolne CL, Lemen RA, Schneider J, Woitowitz HJ, Budnik LT. How conflicted authors undermine the World Health Organization (WHO) campaign to stop all use of asbestos: spotlight on studies showing that chrysotile is carcinogenic and facilitates other non-cancer asbestos-related diseases. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:176-9. [PMID: 25729927 PMCID: PMC4457129 DOI: 10.1179/2049396714y.0000000105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The silicate mineral asbestos is categorized into two main groups based on fiber structure: serpentine asbestos (chrysotile) and amphibole asbestos (crocidolite, amosite, anthophyllite, tremolite, and actinolite). Chrysotile is used in more than 2 000 applications and is especially prevalent in the construction industry. Although its use is banned or restricted in more than 52 countries, an estimated 107 000 workers die from asbestos exposure each year, and approximately 125 million workers continue to be exposed. Furthermore, ambient exposures persist to which the public is exposed, globally. Today, the primary controversies regarding the use of asbestos are the potencies of different types of asbestos, as opposed whether or not asbestos causes morbidity and mortality. The asbestos industry has promoted and funded research based on selected literature, ignoring both clinical and scientific knowledge. In this piece, we highlight a prominent example of a conflicted publication that sought to undermine the World Health Organization (WHO) campaign to stop the use of all forms of asbestos, including chrysotile asbestos. Independent and rigorous scientific data provide sufficient evidence that chrysotile asbestos, like other forms of asbestos, is a cause of asbestos-related morbidity and premature mortality.
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Affiliation(s)
- Xaver Baur
- Division of Occupational Lung Diseases and Allergy, Institute for Occupational Medicine, Charite-University Medicine, Berlin, Germany
| | - Colin L Soskolne
- University of Alberta, Edmonton, Canada
- Faculty of Health, University of Canberra, Australia
| | - Richard A Lemen
- United States Public Health Service (ret.), Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joachim Schneider
- Institute and Outpatient Clinic for Occupational and Social Medicine, University of Giessen, Germany
| | - Hans-Joachim Woitowitz
- Institute and Outpatient Clinic for Occupational and Social Medicine, University of Giessen, Germany
| | - Lygia Therese Budnik
- Institute for Occupational and Social Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, University of Hamburg, Germany
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Stomach cancer mortality among workers exposed to asbestos: a meta-analysis. J Cancer Res Clin Oncol 2014; 141:1141-9. [PMID: 25115694 DOI: 10.1007/s00432-014-1791-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The relationship between asbestos and stomach cancer is not well understood because of small number of cases. This study aimed to determine the incidence and mortality of stomach cancer among workers exposed to asbestos based on a systematic review and meta-analysis approach. METHODS Relevant English electronic databases were systematically searched for published studies characterizing the risk of developing stomach cancer as a result of asbestos exposure. Standardized mortality rate (SMR) for stomach cancer with its 95% confidence interval (CI) was pooled using a fixed-/random-effect model in STATA. RESULTS A total of 32 independent studies were included for the analysis. The overall SMR for stomach cancer was 1.19 (95% CI 1.06-1.34), with a moderate degree of heterogeneity across the studies (I(2) = 37.6%, P = 0.011). Being male, exposure to crocidolite, miners, studies conducted in Europe and Oceania, and long study follow-up (≥ 25 years) all contribute to significantly higher SMR. Significant publication bias was observed. CONCLUSION Elevated risk of stomach cancer mortality was evidenced among workers exposed to crocidolite, especially male miners.
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Wang X, Lin S, Yano E, Yu ITS, Courtice M, Lan Y, Christiani DC. Exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers. Lung Cancer 2014; 85:119-24. [PMID: 24854404 DOI: 10.1016/j.lungcan.2014.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/06/2014] [Accepted: 04/15/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Whether there is a difference in the exposure-response slope for lung cancer between mining workers and textile workers exposed to chrysotile has not been well documented. This study was carried out to evaluate exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers. SUBJECTS AND METHODS A chrysotile mining worker cohort and a chrysotile textile worker cohort were observed concurrently for 26 years. Information on workers' vital status, occupational history and smoking habits were collected, and causes and dates of deaths were verified from death registries. Individual cumulative fiber exposures were estimated based on periodic dust/fiber measurements from different workshops, job title and duration, and categorized into four levels (Q1-Q4). Standardized mortality ratios (SMRs) for lung cancer were calculated and stratified by industry and job title with reference of the national rates. Cox proportional hazard models were fit to estimate the exposure-specific lung cancer risks upon adjustment for age and smoking, in which an external control cohort consisting of industrial workers without asbestos exposure was used as reference group for both textile and mining workers. RESULTS SMRs were almost consistent with exposure levels in terms of job titles and workshops. A clear exposure-response relationship between lung cancer mortality and exposure levels was observed in both cohorts. At low exposure levels (Q1 and Q2), textile workers displayed higher death risks of lung cancer than mining workers. However, similarly considerably high risks were observed at higher exposure levels, with hazard ratios of over 8 and 11 at Q3 and Q4, respectively, for both textile and mining workers, after both age and smoking were adjusted. CONCLUSION The chrysotile textile workers appeared to have a higher risk of lung cancer than the mining workers at a relatively low exposure level, but no difference was observed at a high exposure level, where both cohorts displayed a considerably high risk.
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Affiliation(s)
- Xiaorong Wang
- JC School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Sihao Lin
- JC School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eiji Yano
- School of Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Ignatius T S Yu
- JC School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Midori Courtice
- JC School of Public Health & Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yajia Lan
- Huaxi School of Public Health, Sichuan University, Chengdu, China
| | - David C Christiani
- Department of Environmental Health, Harvard School of Public Health, Boston, USA
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Lin S, Wang X, Yano E, Yu I, Lan Y, Courtice MN, Christiani DC. Exposure to chrysotile mining dust and digestive cancer mortality in a Chinese miner/miller cohort. Occup Environ Med 2014; 71:323-8. [DOI: 10.1136/oemed-2013-101360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wang X, Yano E, Lin S, Yu ITS, Lan Y, Tse LA, Qiu H, Christiani DC. Cancer mortality in Chinese chrysotile asbestos miners: exposure-response relationships. PLoS One 2013; 8:e71899. [PMID: 23991003 PMCID: PMC3749214 DOI: 10.1371/journal.pone.0071899] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
Objective This study was conducted to assess the relationship of mortality from lung cancer and other selected causes to asbestos exposure levels. Methods A cohort of 1539 male workers from a chrysotile mine in China was followed for 26 years. Data on vital status, occupation and smoking were collected from the mine records and individual contacts. Causes and dates of death were further verified from the local death registry. Individual cumulative fibre exposures (f-yr/ml) were estimated based on converted dust measurements and working years at specific workshops. Standardized mortality ratios (SMRs) for lung cancer, gastrointestinal (GI) cancer, all cancers and nonmalignant respiratory diseases (NMRD) stratified by employment years, estimated cumulative fibre exposures, and smoking, were calculated. Poisson models were fitted to determine exposure-response relationships between estimated fibre exposures and cause-specific mortality, adjusting for age and smoking. Results SMRs for lung cancer increased with employment years at entry to the study, by 3.5-fold in ≥10 years and 5.3-fold in ≥20 years compared with <10 years. A similar trend was seen for NMRD. Smokers had greater mortality from all causes than nonsmokers, but the latter also had slightly increased SMR for lung cancer. No excess lung cancer mortality was observed in cumulative exposures of <20 f-yrs/ml. However, significantly increased mortality was observed in smokers at the levels of ≥20 f-yrs/ml and above, and in nonsmokers at ≥100 f-yrs/ml and above. A similarly clear gradient was also displayed for NMRD. The exposure-response relationships with lung cancer and NMRD persisted in multivariate analysis. Moreover, a clear gradient was shown in GI cancer mortality when age and smoking were adjusted for. Conclusion There were clear exposure-response relationships in this cohort, which imply a causal link between chrysotile asbestos exposure and lung cancer and nonmalignant respiratory diseases, and possibly to gastrointestinal cancer, at least for smokers.
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Affiliation(s)
- Xiaorong Wang
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
- * E-mail: (XW); (EY)
| | - Eiji Yano
- School of Public Health, Teikyo University School of Medicine, Tokyo, Japan
- * E-mail: (XW); (EY)
| | - Sihao Lin
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Ignatius T. S. Yu
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Yajia Lan
- Huaxi School of Public Health, Sichuan University, Chengdu, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Hong Qiu
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - David C. Christiani
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
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A retrospective cohort study of cancer mortality in employees of a Russian chrysotile asbestos mine and mills: Study rationale and key features. Cancer Epidemiol 2013; 37:440-5. [DOI: 10.1016/j.canep.2013.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/27/2013] [Accepted: 03/02/2013] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW China has been the world's top chrysotile asbestos consumer and producer. However, the national mortality rate for asbestos-related diseases, particularly from malignancies, is unknown. This review elaborates recent studies on cancer mortality and nonmalignant respiratory diseases in Chinese chrysotile asbestos workers. RECENT FINDINGS Studies conducted in asbestos products factory workers and miners have demonstrated strong associations between exposure to chrysotile and mortality rates for lung cancer and nonmalignant respiratory diseases. Mortality rates for lung cancer and nonmalignant respiratory diseases in both asbestos workers and miners are four and three times higher, respectively, than expected, which are greater than those seen in studies from western countries, likely a reflection of heavier exposures and less effective protection for workers. An increased risk of gastrointestinal cancer was also detected in chrysotile miners. There have been surprisingly few reported cases of mesothelioma, however, which could, at least partially, indicate a problem in diagnosis. SUMMARY Given the substantially increased death risks for lung cancer and nonmalignant respiratory diseases, urgent efforts must be made to implement occupational health and safety regulations and decrease workers' exposures to prevent a future heavier disease burden. Meanwhile, improvements in diagnostics and systematic recording of the incidence and mortality of asbestos-related diseases are needed.
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Affiliation(s)
- Leslie Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago, Illinois 60612-4392;
| | - Laura S. Welch
- CPWR, The Center for Construction Research and Training, Silver Spring, Maryland 20910
| | - Richard Lemen
- Retired, US Public Health Service, Canton, Georgia 30115
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Wang X, Lin S, Yu I, Qiu H, Lan Y, Yano E. Cause-specific mortality in a Chinese chrysotile textile worker cohort. Cancer Sci 2012; 104:245-9. [PMID: 23121131 DOI: 10.1111/cas.12060] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/27/2012] [Accepted: 10/30/2012] [Indexed: 01/23/2023] Open
Abstract
Chrysotile asbestos has continued to be mined and used in China, but its health effects on exposed workers have not been well documented. This study was conducted to give a complete picture about cause-specific mortality in Chinese asbestos workers. A cohort of 586 males and 279 females from a chrysotile textile factory were prospectively followed for 37 years. Their vital status was identified, and the date and underlying cause of death were verified from death registry. Cause-specific standardized mortality ratios by gender were computed with nationwide gender- and cause-specific mortality rates as reference. Male workers were 11 years older, and had 6 years longer exposure duration than females; 79% in males and 1% in females smoked. In males, the mortality rate of all cancers doubled; both larynx and lung cancer were four-fold, and mesothelioma was 33-fold. In females, there was slightly excess mortality from lung cancer and all cancers, and significant increase in mesothelioma and ovarian cancer. Other significantly increased mortality was seen from cancers of thymus, small intestine and penis in males, and cancers of bone and bladder in females. In addition to asbestosis, mortality from pulmonary heart disease was significantly elevated in both genders. The data confirmed significantly excess mortality from mesothelioma in either gender, lung and larynx cancers in males, and ovarian cancer in females. A gender difference in mortality from lung cancer and all cancers could be mainly due to the discrepancies in age, exposure duration and smoking between the male and female workers.
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Affiliation(s)
- Xiaorong Wang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Courtice MN, Lin S, Wang X. An updated review on asbestos and related diseases in China. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2012; 18:247-53. [PMID: 23026008 DOI: 10.1179/1077352512z.00000000021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Asbestos is an industrial mineral that can cause diseases such as asbestosis, lung cancer, and mesothelioma. Asbestos consumption in China has increased steadily since the 1960s and is currently at half a million tonnes per year. Work conditions in the asbestos-related industries are poor and exposure levels frequently exceed the occupational exposure limit. OBJECTIVE To provide an updated overview on asbestos production and consumption in China and discuss what is known about the resulting burden of asbestos-related diseases. FINDINGS China is the world's top chrysotile consumer and second largest producer. Over a million people may be occupationally exposed, yet reliable disease statistics are unavailable and the national burden of asbestos-related disease (ARD) is not well known. Nevertheless, ARD prevalence, incidence, and mortality are expected to be high and will increase for many decades due to the volume of asbestos consumed historically, and a long latency period. CONCLUSIONS Government policies to prevent ARD have been implemented but more actions are necessary to ensure compliance and ultimately, the complete elimination of asbestos to prevent a heavy future disease burden.
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McCormack V, Peto J, Byrnes G, Straif K, Boffetta P. Estimating the asbestos-related lung cancer burden from mesothelioma mortality. Br J Cancer 2012; 106:575-84. [PMID: 22233924 PMCID: PMC3273352 DOI: 10.1038/bjc.2011.563] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Quantifying the asbestos-related lung cancer burden is difficult in the presence of this disease's multiple causes. We explore two methods to estimate this burden using mesothelioma deaths as a proxy for asbestos exposure. METHODS From the follow-up of 55 asbestos cohorts, we estimated ratios of (i) absolute number of asbestos-related lung cancers to mesothelioma deaths; (ii) excess lung cancer relative risk (%) to mesothelioma mortality per 1000 non-asbestos-related deaths. RESULTS Ratios varied by asbestos type; there were a mean 0.7 (95% confidence interval 0.5, 1.0) asbestos-related lung cancers per mesothelioma death in crocidolite cohorts (n=6 estimates), 6.1 (3.6, 10.5) in chrysotile (n=16), 4.0 (2.8, 5.9) in amosite (n=4) and 1.9 (1.4, 2.6) in mixed asbestos fibre cohorts (n=31). In a population with 2 mesothelioma deaths per 1000 deaths at ages 40-84 years (e.g., US men), the estimated lung cancer population attributable fraction due to mixed asbestos was estimated to be 4.0%. CONCLUSION All types of asbestos fibres kill at least twice as many people through lung cancer than through mesothelioma, except for crocidolite. For chrysotile, widely consumed today, asbestos-related lung cancers cannot be robustly estimated from few mesothelioma deaths and the latter cannot be used to infer no excess risk of lung or other cancers.
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Affiliation(s)
- V McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
| | - J Peto
- Faculty of Epidemiology and Population Health, Department of Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - G Byrnes
- Biostatistics Group, Section of Genetics, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
| | - K Straif
- Section of IARC Monographs, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon 69008, France
| | - P Boffetta
- Institute for Translational Epidemiology and Tisch Cancer Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA
- International Prevention Research Institute, Lyon, France
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