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Noelle H, Pérol O, Pérol M, Avrillon V, Belladame E, Fayette J, Fournié F, Swalduz A, Dessemon J, Blay JY, Neidhardt EM, Saintigny P, Tabutin M, Boussageon M, Praud D, Charbotel B, Fervers B. Occupational asbestos exposure and survival among lung cancer patients. Lung Cancer 2023; 179:107182. [PMID: 37001440 DOI: 10.1016/j.lungcan.2023.107182] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This study investigated the association between occupational asbestos exposure (OAE) and survival in patients with histologically confirmed lung cancer (LC). METHODS This monocentric study was conducted in the Comprehensive Cancer Centre Léon Bérard, Lyon, France. A systematic screening has been in place since 2014 for occupational exposure to carcinogens using a self-assessment questionnaire sent to all patients newly diagnosed with histologically confirmed LC identified through the multidisciplinary LC board from 2014 to 2019. When the physician suspected a work-related exposure from the questionnaire including job history, an occupational cancer consultation was carried out to detail carcinogen exposures and assess if the LC was work-related. Demographics, clinical characteristics and survival data were extracted from medical records. The association between asbestos exposure and overall survival (hazard ratio and 95% confidence intervals) was estimated by Cox proportional hazards regression. RESULTS Overall, 702 patients were eligible to the present study, including 180 patients with OAE. In the crude analysis, LCs assessed as moderately or highly attributable to OAE were associated with decreased overall survival (HR = 1.32, 95 %CI 1.04-1.67) compared to LC without OAE or with a low degree of imputability to OAE (median follow-up 28.8 months). After adjustment for confounding (age at diagnosis, smoking status, stage, brain metastasis at diagnosis, and histology), the association of OAE with overall survival was no longer statistically significant (HR = 1.21, 95 %CI 0.94-1.56). CONCLUSION Overall survival in occupationally asbestos exposed LC patients may be decreased in comparison with non-exposed LC patients, warranting further investigations in larger studies.
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Girardi P, Merler E, Ferrante D, Silvestri S, Chellini E, Angelini A, Luberto F, Fedeli U, Oddone E, Vicentini M, Barone-Adesi F, Cena T, Mirabelli D, Mangone L, Roncaglia F, Sala O, Menegozzo S, Pirastu R, Azzolina D, Tunesi S, Miligi L, Perticaroli P, Pettinari A, Cuccaro F, Nannavecchia AM, Bisceglia L, Marinaccio A, Pavone VLM, Magnani C. Factors Affecting Asbestosis Mortality Among Asbestos-Cement Workers in Italy. Ann Work Expo Health 2020; 64:622-635. [PMID: 32328661 DOI: 10.1093/annweh/wxaa037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was performed with the aim of investigating the temporal patterns and determinants associated with mortality from asbestosis among 21 cohorts of Asbestos-Cement (AC) workers who were heavily exposed to asbestos fibres. METHODS Mortality for asbestosis was analysed for a cohort of 13 076 Italian AC workers (18.1% women). Individual cumulative asbestos exposure index was calculated by factory and period of work weighting by the different composition of asbestos used (crocidolite, amosite, and chrysotile). Two different approaches to analysis, based on Standardized Mortality Ratios (SMRs) and Age-Period-Cohort (APC) models were applied. RESULTS Among the considered AC facilities, asbestos exposure was extremely high until the end of the 1970s and, due to the long latency, a peak of asbestosis mortality was observed after the 1990s. Mortality for asbestosis reached extremely high SMR values [SMR: males 508, 95% confidence interval (CI): 446-563; females 1027, 95% CI: 771-1336]. SMR increased steeply with the increasing values of cumulative asbestos exposure and with Time Since the First Exposure. APC analysis reported a clear age effect with a mortality peak at 75-80 years; the mortality for asbestosis increased in the last three quintiles of the cumulative exposure; calendar period did not have a significant temporal component while the cohort effect disappeared if we included in the model the cumulative exposure to asbestos. CONCLUSIONS Among heaviest exposed workers, mortality risk for asbestosis began to increase before 50 years of age. Mortality for asbestosis was mainly determined by cumulative exposure to asbestos.
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Affiliation(s)
- Paolo Girardi
- Mesothelioma Register of the Veneto Region, Regional Epidemiological System, Azienda Zero, Padua, Italy
| | - Enzo Merler
- Mesothelioma Register of the Veneto Region, Regional Epidemiological System, Azienda Zero, Padua, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,CPO-Piedmont, Novara, Italy
| | - Stefano Silvestri
- CPO-Piedmont, Novara, Italy.,Occupational Hygienists, Unit of Medical Statistics and Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit-Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Alessia Angelini
- Occupational & Environmental Epidemiology Unit-Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ferdinando Luberto
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS, Montecchio Emilia, Reggio Emilia, Italy
| | - Ugo Fedeli
- Mesothelioma Register of the Veneto Region, Regional Epidemiological System, Azienda Zero, Padua, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Massimo Vicentini
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS, Montecchio Emilia, Reggio Emilia, Italy
| | - Francesco Barone-Adesi
- CPO-Piedmont, Novara, Italy.,Department of 'Scienze del Farmaco', University of Eastern Piedmont, Novara, Italy
| | - Tiziana Cena
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,CPO-Piedmont, Novara, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, CPO Piedmont and University of Turin, Turin, Italy
| | - Lucia Mangone
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS, Montecchio Emilia, Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Service, Azienda Unità Sanitaria Locale-IRCCS, Montecchio Emilia, Reggio Emilia, Italy
| | - Orietta Sala
- Occupational Hygienist, Formerly: Regional Agency for Prevention, Environment and Energy Emilia-Romagna, Provincial Office of Reggio Emilia, Reggio Emilia, Italy
| | - Simona Menegozzo
- National Cancer Institute IRCCS Fondazione Pascale, Naples, Italy
| | - Roberta Pirastu
- Department of Biology and Biotechnologies 'Charles Darwin', Sapienza University, Rome, Italy
| | - Danila Azzolina
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,CPO-Piedmont, Novara, Italy
| | - Sara Tunesi
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,CPO-Piedmont, Novara, Italy.,Unit of Cancer Epidemiology, CPO Piedmont and University of Turin, Turin, Italy
| | - Lucia Miligi
- Occupational & Environmental Epidemiology Unit-Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - Aldo Pettinari
- Prevention Department, ASUR Marche, Senigallia, Ancona, Italy
| | - Francesco Cuccaro
- Unit of Epidemiology and Statistics-Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Anna Maria Nannavecchia
- Unit of Epidemiology and Statistics-Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | | | - Alessandro Marinaccio
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
| | - Venere Leda Mara Pavone
- Department of Public Health, Prevention and Security Area Work Environments, Local Health Authority, San Lazzaro di Savena, Italy
| | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,CPO-Piedmont, Novara, Italy
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Luberto F, Ferrante D, Silvestri S, Angelini A, Cuccaro F, Nannavecchia AM, Oddone E, Vicentini M, Barone-Adesi F, Cena T, Mirabelli D, Mangone L, Roncaglia F, Sala O, Menegozzo S, Pirastu R, Azzolina D, Tunesi S, Chellini E, Miligi L, Perticaroli P, Pettinari A, Bressan V, Merler E, Girardi P, Bisceglia L, Marinaccio A, Massari S, Magnani C. Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy. Environ Health 2019; 18:71. [PMID: 31391078 PMCID: PMC6686495 DOI: 10.1186/s12940-019-0510-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Despite the available information on cancer risk, asbestos is used in large areas in the world, mostly in the production of asbestos cement. Moreover, questions are raised regarding the shape of the dose response relation, the relation with time since exposure and the association with neoplasms in various organs. We conducted a study on the relationship between cumulative asbestos exposure and mortality from asbestos related diseases in a large Italian pool of 21 cohorts of asbestos-cement workers with protracted exposure to both chrysotile and amphibole asbestos. METHODS The cohort included 13,076 workers, 81.9% men and 18.1% women, working in 21 Italian asbestos-cement factories, with over 40 years of observation. Exposure was estimated by plant and period, and weighted for the type of asbestos used. Data were analysed with consideration of cause of death, cumulative exposure and time since first exposure (TSFE), and by gender. SMRs were computed using reference rates by region, gender and calendar time. Poisson regression models including cubic splines were used to analyse the effect of cumulative exposure to asbestos and TSFE on mortality for asbestos-related diseases. 95% Confidence Intervals (CI) were computed according to the Poisson distribution. RESULTS Mortality was significantly increased for 'All Causes' and 'All Malignant Neoplasm (MN)', in both genders. Considering asbestos related diseases (ARDs), statistically significant excesses were observed for MN of peritoneum (SMR: men 14.19; women 15.14), pleura (SMR: 22.35 and 48.10), lung (SMR: 1.67 and 1.67), ovary (in the highest exposure class SMR 2.45), and asbestosis (SMR: 507 and 1023). Mortality for ARDs, in particular pleural and peritoneal malignancies, lung cancer, ovarian cancer and asbestosis increased monotonically with cumulative exposure. Pleural MN mortality increased progressively in the first 40 years of TSFE, then reached a plateau, while peritoneal MN showed a continuous increase. The trend of lung cancer SMRs also showed a flattening after 40 years of TSFE. Attributable proportions for pleural, peritoneal, and lung MN were respectively 96, 93 and 40%. CONCLUSIONS Mortality for ARDs was associated with cumulative exposure to asbestos. Risk of death from pleural MN did not increase indefinitely with TSFE but eventually reached a plateau, consistently with reports from other recent studies.
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Affiliation(s)
- Ferdinando Luberto
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy.
- CPO-Piedmont, Novara, Italy.
| | - Stefano Silvestri
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Alessia Angelini
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Francesco Cuccaro
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Anna Maria Nannavecchia
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, and ICS Maugeri IRCCS, Pavia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Barone-Adesi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, and CPO Piedmont, Novara, Italy
| | - Tiziana Cena
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, CPO Piedmont and University of Turin, Turin, Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic Particulates, University of Turin, Turin, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Orietta Sala
- Regional Agency for Prevention, Environment and Energy Emilia-Romagna, Provincial Office of Reggio Emilia, Reggio Emilia, Italy
| | - Simona Menegozzo
- National Cancer Institute IRCCS Fondazione Pascale, Naples, Italy
| | - Roberta Pirastu
- Department of Biology and Biotechnologies "Charles Darwin", Sapienza University, Rome, Italy
| | - Danila Azzolina
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Sara Tunesi
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit - Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Lucia Miligi
- Occupational & Environmental Epidemiology Unit - Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | | | | | - Enzo Merler
- Mesothelioma Register of the Veneto Region, Regional Epidemiologic System, Local Health Unit 6, Padua, Italy
| | - Paolo Girardi
- UOSD Servizio di Epidemiologia AULSS6 EUGANEA, Padua, Italy
| | - Lucia Bisceglia
- Apulia Regional Agency for Health and Social Policies - ARESS Puglia, Bari, Italy
| | - Alessandro Marinaccio
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
| | - Stefania Massari
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
| | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic Particulates, University of Turin, Turin, Italy
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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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5
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Facteurs de risque professionnels du cancer bronchopulmonaire. Rev Mal Respir 2016; 33:444-59. [DOI: 10.1016/j.rmr.2015.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/22/2015] [Indexed: 11/21/2022]
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6
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Alcohol consumption and liver cancer risk: a meta-analysis. Cancer Causes Control 2015; 26:1205-31. [PMID: 26134046 DOI: 10.1007/s10552-015-0615-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/09/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Alcohol is a confirmed risk factor of liver cancer. Yet, its dose-response function and synergistic effects with other risk factors remain unclear. METHODS We performed a meta-analysis on publications up to May 2014. A total of 112 publications were identified. The meta-relative risk (mRR) and the dose-response trend were calculated. Tests for heterogeneity, publication bias, and sensitivity analyses were performed. The synergy index (SI) was recorded or calculated, whenever possible. RESULTS Compared to individuals who never drank or drank at very low frequencies, the mRR for ever drinkers was 1.29 (95% confidence interval, CI 1.16-1.42) and 1.46 (95% CI 1.27-1.65) for case-control studies, and 1.07 (95% CI 0.87-1.27) for cohort studies. Being a current drinker was associated with an increased liver cancer risk in case-control studies (mRR = 1.55, 95% CI 0.38-2.73), but not in cohort studies (mRR = 0.86, 95% CI 0.74-0.97). The dose-response relation between alcohol and liver cancer was apparent with RR = 1.08 (95% CI 1.04-1.11) for 12 g/day (~1 drink), 1.54 (95% CI 1.36-1.74) for 50 g/day, 2.14 (95% CI 1.74-2.62) for 75 g/day, 3.21 (95% CI 2.34-4.40) for 100 g/day, and 5.20 (95% CI 3.25-8.29) for 125 g/day of alcohol consumption. There were synergistic effects of alcohol consumption with hepatitis (S = 2.14, 95% CI 1.31-2.98) and with diabetes (S = 3.57, 95% CI 2.29-4.84) on the risk of liver cancer, although this may be subject to publication bias. CONCLUSION Overall, one alcoholic drink per day (~12 g/day) may be associated with a 1.1 times higher liver cancer risk. Further studies on the synergistic effects of alcohol consumption and other major risk factors are warranted.
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Moon EK, Son M, Jin YW, Park S, Lee WJ. Variations of lung cancer risk from asbestos exposure: impact on estimation of population attributable fraction. INDUSTRIAL HEALTH 2012; 51:128-133. [PMID: 23269225 DOI: 10.2486/indhealth.ms1350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study is to investigate the potential impact of differing lung cancer risks in study populations on estimating population attributable fraction (PAF) from asbestos exposure. Studies were identified via a MEDLINE search up to September 2009 and from the reference lists of publications about asbestos exposure and lung cancer risk. Relative risk estimates were extracted from 160 studies and meta-relative risks were calculated according to random-effect models. Hypothetical PAFs were calculated based on the meta results and on the difference exposure scenarios. The risks for lung cancer from asbestos exposure were variable according to the region as well as other study characteristics. The risk estimates proved higher in Asian countries (RR=3.53), in studies with 500 or fewer subjects (RR=2.26), and papers published in the 1990s or earlier (RR=1.91), than did those for European or North American countries, studies with more than 500 subjects, and papers published in the 2000s, respectively. The differences in PAFs between Asian and North American studies were 15.5%, 30.3%, and 36.2% when the exposure prevalence was 10%, 30%, and 50%, respectively. This study suggested that it is important to apply appropriate lung cancer estimates to each study population when calculating PAF from asbestos exposure.
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Affiliation(s)
- Eun Kyeong Moon
- Department of Preventive Medicine, College of Medicine, Korea University, Republic of Korea
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8
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Lotti M, Bergamo L, Murer B. Occupational toxicology of asbestos-related malignancies. Clin Toxicol (Phila) 2010; 48:485-96. [PMID: 20849338 DOI: 10.3109/15563650.2010.506876] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Asbestos is banned in most Western countries but related malignancies are still of clinical concern because of their long latencies. This review identifies and addresses some controversial occupational and clinical aspects of asbestos-related malignancies. METHODS Papers published in English from 1980 to 2009 were retrieved from PubMed. A total of 307 original articles were identified and 159 were included. ASSESSMENT OF EXPOSURE The retrospective assessment of exposure is usually performed by using questionnaires and job exposure matrices and by careful collection of medical history. In this way crucial information about manufacturing processes and specific jobs can be obtained. In addition, fibers and asbestos bodies are counted in lung tissue, broncho-alveolar lavage, and sputum, but different techniques and interlaboratory variability hamper the interpretation of reported measurements. SCREENING FOR MALIGNANCIES: The effectiveness of low-dose chest CT screening in exposed workers is debatable. Several biomarkers have also been considered to screen individuals at risk for lung cancer and mesothelioma but reliable signatures are still missing. ATTRIBUTION OF LUNG CANCER: Exposures correlating with lung cancer are high and in the same range where asbestosis occurs. However, the unresolved question is whether the presence of fibrosis is a requirement for the attribution of lung cancer to asbestos. The etiology of lung cancer is difficult to define in cases of low-level asbestos exposure and concurrent smoking habits. MESOTHELIOMA: The diagnosis of malignant mesothelioma may also be difficult, because of procedures in sampling, fixation, and processing, and uses of immunohistochemical probes. CONCLUSIONS Assessment of exposure is crucial and requires accurate medical and occupational histories. Quantitative analysis of asbestos body burden is better performed in digested lung tissues by counting asbestos bodies by light microscopy and/or uncoated fibers by transmission electron microscopy. The benefits of screenings for asbestos-related malignancies are equivocal. The attribution of lung cancer to asbestos exposure is difficult in a clinical setting because of the need to assess asbestos body burden and the fact that virtually all these patients are also tobacco smokers or former smokers. Given the premise that asbestosis is necessary to causally link lung cancer to asbestos, it follows that the assessment of both lung fibrosis and asbestos body burden is necessary.
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Affiliation(s)
- Marcello Lotti
- Dipartimento di Medicina Ambientale e Sanità Pubblica, Università degli Studi di Padova, Padova, Italy.
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9
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Chuang SC, Lee YCA, Hashibe M, Dai M, Zheng T, Boffetta P. Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2010; 19:1261-8. [PMID: 20447919 DOI: 10.1158/1055-9965.epi-09-1297] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Chronic infection with hepatitis B (HBV) and C viruses (HCV) as well as cigarette smoking are established risk factors of hepatocellular carcinoma (HCC), but it is unclear whether an interaction exists between these factors in causing hepatocellular carcinogenesis. We conducted a meta-analysis to evaluate the interaction of HBV and HCV infection and cigarette smoking on the risk of HCC. METHODS We systematically searched the PUBMED and the China National Knowledge Infrastructure databases. A total of 16 eligible publications were identified. Cigarette smoking and chronic HBV and HCV infections were dichotomized into present or absent. Additive (S) and multiplicative interaction indexes (V) between smoking and each of the two infections and their 95% confidence intervals (95% CI) were calculated for each study and then combined in a meta-analysis. RESULTS We found a more than additive interaction between HBV infection and cigarette smoking (S=1.44; 95% CI, 1.00-2.06; nine studies) and a more than multiplicative interaction (V=1.60; 95% CI, 1.16-2.20; six studies) between HCV infection and cigarette smoking. No publication bias was detected. CONCLUSION Smoking seems to interact with both HBV and HCV in determining HCC risk. A pooled analysis of individual subject data, with appropriate adjustment with other risk factors, is warranted to confirm these results. IMPACT The results of this study imply the evidence of a synergistic effect between smoking and HBV or HCV infection on the risk of HCC. Thus, chronic carriers of HBV or HCV are recommended to avoid smoking.
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Affiliation(s)
- Shu-Chun Chuang
- IARC, International Prevention Research Institute, 95 cours Lafayette, 69006 Lyon, France
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10
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Brown T. Silica exposure, smoking, silicosis and lung cancer--complex interactions. Occup Med (Lond) 2010; 59:89-95. [PMID: 19233828 DOI: 10.1093/occmed/kqn171] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Establishing a clear relationship between workplace exposures and cancer is often difficult. The latent period for cancer development can make it difficult to establish a definite cause-effect relationship. The picture is further complicated by variable job histories, concomitant exposure to other carcinogens and other factors such as genetic susceptibility and poor nutrition. The lack of accurate and detailed record keeping may potentially mask informative differences among group of workers. Removing or reducing exposures to probable and known carcinogens, however, can prevent workplace cancer. AIM This paper gives an overview of the literature reporting investigations of the relationship between exposure to silica and development of lung cancer with a focus on the controversy concerning the roles of silicosis and smoking in the development of cancer. METHOD A literature search was conducted to identify epidemiologic papers on silica, silicosis and lung cancer using electronic databases (MEDLINE, PubMed, Web of Science) from 1996 onwards and paper bibliographies. RESULTS If silicosis were the necessary step leading to lung cancer, enforcing the current silica standards would protect workers against lung cancer risk as well. Alternatively, a direct silica-lung cancer association that has been suggested implies that regulatory standards should be revised accordingly. CONCLUSION Further research is needed in order to understand the complex pattern of interactions leading to lung cancer among silica-exposed workers (and cancers and workplace exposures in general) and to understand whether and to what extent other workplace lung carcinogens, total respirable dust and total surface size and age of silica particles affect the carcinogenic potential of silica. In addition, the apparent paradox of a lower lung cancer risk in some workplaces with high-level silica exposure needs further investigation.
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Affiliation(s)
- Terry Brown
- Health & Safety Laboratory, Harpur Hill, Buxton, Derbyshire, UK.
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