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Štěpánek L, Nakládalová M, Janošíková M, Štěpánek L, Boriková A. Cumulative asbestos exposure as a key predictor of long-term pleuropulmonary outcomes: insights from decades of follow-up. Int Arch Occup Environ Health 2025:10.1007/s00420-025-02143-w. [PMID: 40404863 DOI: 10.1007/s00420-025-02143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 04/19/2025] [Indexed: 05/24/2025]
Abstract
PURPOSE Occupational asbestos exposure was widespread before regulatory bans, and it remains a risk during renovations or demolitions of older buildings. While asbestos-related diseases are well-documented, less is known about minor radiological changes in exposed individuals. This longitudinal study aimed to identify predictors of pleural and parenchymal lung disorders in individuals with previous occupational asbestos exposure, focusing on both established asbestos-related diseases and minor radiological abnormalities. METHODS The study tracked 445 former employees (334 men, 111 women) of two Czech asbestos-processing plants, who underwent regular examinations from the 1980s to December 2022. Cox proportional hazards regression models were employed to analyse predictors of asbestos-related diseases, as well as minor radiological findings alone. RESULTS Over a median latency of 37 years, 127 participants (28.5%) developed asbestos-related diseases, mainly pleural mesothelioma (59 cases). An additional 168 participants (37.8%) exhibited minor radiological findings, predominantly pleural plaques (129 cases), while 150 (33.7%) had no abnormalities. Substantial cumulative exposure was a strong predictor for minor radiological findings (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.18-3.35, p = 0.010) and any endpoint, including diseases (OR 1.89, 95% CI 1.18-3.02, p = 0.008). Respiratory symptoms and impaired spirometry results significantly increased the likelihood of endpoint occurrence. No significant differences emerged between settings with predominantly chrysotile exposure and those with a chrysotile-crocidolite mixture. CONCLUSION This study highlights the predictive value of cumulative exposure and the need for ongoing surveillance of occupationally exposed individuals to better understand radiological changes, their significance, and to refine risk assessment models.
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Affiliation(s)
- Ladislav Štěpánek
- Department of Occupational Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Zdravotníků 248/7, Olomouc, 77900, Czech Republic.
| | - Marie Nakládalová
- Department of Occupational Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Zdravotníků 248/7, Olomouc, 77900, Czech Republic
| | - Magdaléna Janošíková
- Department of Occupational Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Zdravotníků 248/7, Olomouc, 77900, Czech Republic
| | - Lubomír Štěpánek
- Institute of Biophysics and Informatics, First Faculty of Medicine, Charles University, Salmovská 1, Prague, 12000, Czech Republic
| | - Alena Boriková
- Department of Occupational Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacký University Olomouc, Zdravotníků 248/7, Olomouc, 77900, Czech Republic
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Collatuzzo G, Hamdani M, Boffetta P. Risk of bladder, kidney and prostate cancer from occupational exposure to welding fumes: a systematic review and meta-analysis. Int Arch Occup Environ Health 2024; 97:221-230. [PMID: 38231405 DOI: 10.1007/s00420-023-02040-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Our aimed to conduct a meta-analysis of cohort studies on risk of genitourinary (GU) cancers in workers exposed to welding fumes (WF). METHODS We performed a systematic review of studies published on Pubmed, Scopus and Embase following PRISMA criteria. Two researchers selected cohort studies on WF exposure. From 2582 articles, 7 non-overlapping studies were included. Quality of studies was scored according to CASP. We run a random effects meta-analysis to calculate the relative risk (RR) and 95% confidence intervals (CI) of GU cancer, overall and stratified by cancer, country, and quality score. RESULTS We included seven studies reporting results on GU cancers, including prostate, bladder and kidney cancer (PC, BC, and KC). The RR was 1.19 (95% CI = 1.07-1.32, 16 risk estimates) for GU cancer; 1.13 (95% CI = 0.90-1.42, 4 risk estimates) for PC; 1.26 (95% CI = 0.98-1.60, 7 risk estimates) for BC and 1.28 (95% CI = 1.12-1.47, 5 risk estimates) for KC. Heterogeneity was present in all meta-analyses (p < 0.001). The increased risk was more pronounced in North American than in European studies (respectively, OR = 1.35, 95% CI = 1.18-1.55; OR = 1.13, 95% CI = 1.01-1.27 p heterogeneity = 0.03). There was no heterogeneity according to quality score (p = 0.4). Data were insufficient to investigate associations by industry or welding type. Publication bias for each cancer was excluded. CONCLUSION This meta-analysis suggests increased risk of KC and BC, but not of PC, in workers exposed to WF. Confounding by other occupational and non-occupational risk factors could not be excluded. Data were not adequate to address the risk of specific exposure circumstances.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, BO, Italy
| | - Maha Hamdani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138, Bologna, BO, Italy.
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
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Xiong X, Zhang S, Liao X, Du J, Zheng W, Hu S, Wei Q, Yang L. An umbrella review of the evidence associating occupational carcinogens and cancer risk at 19 anatomical sites. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 345:123531. [PMID: 38341059 DOI: 10.1016/j.envpol.2024.123531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/23/2023] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Occupational exposure to carcinogens of increasing cancer risk have been extensively suggested. A robust assessment of these evidence is needed to guide public policy and health care. We aimed to classify the strength of evidence for associations of 13 occupational carcinogens (OCs) and risk of cancers. We searched PubMed and Web of Science up to November 2022 to identify potentially relevant studies. We graded the evidence into convincing, highly suggestive, suggestive, weak, or not significant according to a standardized classification based on: random-effects p value, number of cancer cases, 95% confidence interval of largest study, heterogeneity between studies, 95% prediction interval, small study effect, excess significance bias and sensitivity analyses with credibility ceilings. The quality of meta-analysis was evaluated by AMSTAR 2. Forty-eight articles yielded 79 meta-analyses were included in current umbrella review. Evidence of associations were convincing (class I) or highly suggeastive (class II) for asbestos exposure and increasing risk of lung cancer among smokers (RR = 8.79, 95%CI: 5.81-13.25 for cohort studies and OR = 8.68, 95%CI: 5.68-13.24 for case-control studies), asbestos exposure and increasing risk of mesothelioma (RR = 4.61, 95%CI: 2.57-8.26), and formaldehyde exposure and increasing risk of sinonasal cancer (RR = 1.68, 95%CI: 1.38-2.05). Fifteen associations were supported by suggestive evidence (class III). In summary, the current umbrella review found strong associations between: asbestos exposure and increasing risk of lung cancer among smokers; asbestos exposure and increasing risk of mesothelioma; and formaldehyde exposure and higher risk of sinonasal cancer. Other associations might be genuine, but substantial uncertainty remains.
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Affiliation(s)
- Xingyu Xiong
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiyu Zhang
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyang Liao
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiajia Du
- State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weitao Zheng
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siping Hu
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wei
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Yang
- Department of Urology, Center of Biomedical Big Data and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Caraballo-Arias Y, Roccuzzo F, Graziosi F, Danilevskaia N, Rota S, Zunarellli C, Caffaro P, Boffetta P, Bonetti M, Violante FS. Quantitative Assessment of Asbestos Fibers in Abdominal Organs: A Scoping Review. LA MEDICINA DEL LAVORO 2023; 114:e2023048. [PMID: 38060208 PMCID: PMC10731569 DOI: 10.23749/mdl.v114i6.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Quantification of asbestos fibers has been mainly performed in the lung but rarely in other organs. However, this may be relevant to understanding better translocation pathways and the oncogenic effects of asbestos on the human body. Electron microscopy is the best technology available to assess the type of fiber, dimensions, and distribution of asbestos fibers in different tissues and as a biomarker of cumulative dose. OBJECTIVES This scoping review aims to summarize the findings of the studies in which asbestos fibers have been quantified by electron microscopy, occasionally associated with X-ray microanalysis, in normal and pathological tissue of ten abdominal organs. METHODS A scoping review has been performed by searching articles that quantified asbestos fibers in abdominal organs by electron microscopy (Scanning- SEM or Transmission- TEM). RESULTS The 12 selected studies included 204 cases, and 325 samples were analyzed. The colon and rectum, kidney, bladder, and abdominal lymph nodes were the organs with at least ten samples available with quantification of asbestos fibers. Asbestos fibers were detected in all the abdominal organs considered: the highest value (152,32 million fibers per gram of dry tissue) was found in the colon and was identified using STEM with EDS. CONCLUSION The studies included were heterogeneous in terms of exposure and cases, type of samples, as well as analytical techniques, therefore we cannot confirm a specific pattern of distribution in any organ, based on the low homogeneity of the exposure status. The colon is the organ in which the number of fibers is the highest, probably because of exposure arising from both internal distribution of inhaled fibers and ingestion. Additional studies of the number of asbestos fibers in abdominal organs should be made to achieve better representativity.
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Affiliation(s)
- Yohama Caraballo-Arias
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Francesco Roccuzzo
- School of Occupational Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Francesca Graziosi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Nataliia Danilevskaia
- School of Occupational Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Samantha Rota
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Carlotta Zunarellli
- School of Occupational Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Paola Caffaro
- School of Occupational Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna.
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, New York, NY 11794, USA. Stony Brook Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA .
| | - Mattia Bonetti
- School of Occupational Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna.
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Cani M, Turco F, Butticè S, Vogl UM, Buttigliero C, Novello S, Capelletto E. How Does Environmental and Occupational Exposure Contribute to Carcinogenesis in Genitourinary and Lung Cancers? Cancers (Basel) 2023; 15:2836. [PMID: 37345174 PMCID: PMC10216822 DOI: 10.3390/cancers15102836] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Environmental and occupational exposures have been associated with an increased risk of different types of cancers, although the exact mechanisms of higher carcinogenesis risk are not always well understood. Lung cancer is the leading cause of global cancer mortality, and, also, genitourinary neoplasms are among the main causes of cancer-related deaths in Western countries. The purpose of this review is to describe the main environmental and occupational factors that increase the risk of developing lung and genitourinary cancers and to investigate carcinogenesis mechanisms that link these agents to cancer onset. Further objectives are to identify methods for the prevention or the early detection of carcinogenic agents and, therefore, to reduce the risk of developing these cancers or to detect them at earlier stages.
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Affiliation(s)
- Massimiliano Cani
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Fabio Turco
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
| | - Simona Butticè
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
| | - Consuelo Buttigliero
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Silvia Novello
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
| | - Enrica Capelletto
- Oncology Unit, Department of Oncology, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano, Italy; (M.C.); (F.T.); (C.B.); (E.C.)
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Keskitalo E, Salonen J, Nurmi H, Vähänikkilä H, Kaarteenaho R. Comorbidities and Causes of Death of Patients With Asbestosis. J Occup Environ Med 2023; 65:349-353. [PMID: 36728947 DOI: 10.1097/jom.0000000000002777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Comorbidities are common and affect the prognosis of patients with interstitial lung diseases, but few previous studies have investigated patients with asbestosis. METHODS We collected comorbidities and death causes of 116 patients with asbestosis treated in Oulu University Hospital. Causes of death were confirmed by autopsy in 68% of the cases. RESULTS The most common comorbidities of asbestosis patients were pleural plaques (96%) and coronary artery disease (CAD; 67%). The prevalence of rheumatoid arthritis was 8.6%. The most common underlying causes of death were asbestosis (36%), CAD (24%), and lung cancer (LC) (10%). CAD and LC were associated with shorter survival in adjusted analyses. CONCLUSIONS Patients with asbestosis have multiple comorbidities. Prevention and treatment of CAD and LC may influence the prognosis of asbestosis patients.
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Affiliation(s)
- Eerika Keskitalo
- From the ResearchUnit of InternalMedicine, University of Oulu, Oulu, Finland (E.K., J.S., R.K.); Center of Internal and Respiratory Medicine, Medical Research Center (MRC) Oulu, Oulu, Finland (E.K., J.S., R.K.); Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland (H.N.); Center of Medicine and Clinical Research, Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland (H.N.); Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population studies, Faculty of Medicine, University of Oulu, Oulu, Finland (H.V.)
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