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Moolgavkar S, Chang ET, Luebeck EG. Multistage carcinogenesis: Impact of age, genetic, and environmental factors on the incidence of malignant mesothelioma. ENVIRONMENTAL RESEARCH 2023; 230:114582. [PMID: 36965799 DOI: 10.1016/j.envres.2022.114582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/10/2022] [Indexed: 05/30/2023]
Abstract
The current paradigm of carcinogenesis as a cellular evolutionary process driven by mutations of a few critical driver genes has immediate logical implications for the epidemiology of cancer. These include the impact of age on cancer risk, the role played by inherited tumor predisposition syndromes, and the interaction of genetics and environmental exposures on cancer risk. In this paper, we explore the following logical epidemiological consequences of carcinogenesis as a clonal process of mutation accumulation, with special emphasis on asbestos-related cancers, specifically malignant mesothelioma:1 All cancers, including mesothelioma, can and do occur spontaneously, i.e., in the absence of exposure to any environmental carcinogens. 2. Age is an important determinant of cancer risk, with or without exposure to environmental carcinogens. 3. Genetic tumor predisposition syndromes, such as the BAP1 syndrome, increase enormously the risk of cancer even in the absence of exposure to environmental carcinogens. We illustrate these concepts by applying a multistage clonal expansion model to U.S. Surveillance, Epidemiology, and End Results cancer registry data for pleural and peritoneal malignant mesotheliomas in 1975-2018.
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Affiliation(s)
- Suresh Moolgavkar
- Center for Health Sciences, Exponent, Inc, USA; Fred Hutchinson Cancer Research Center, USA.
| | - Ellen T Chang
- Center for Health Sciences, Exponent, Inc, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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Spinazzè A, Consonni D, Borghi F, Rovelli S, Cattaneo A, Zellino C, Dallari B, Pesatori AC, Kromhout H, Peters S, Riboldi L, Cavallo DM, Mensi C. Asbestos Exposure in Patients with Malignant Pleural Mesothelioma included in the PRIMATE Study, Lombardy, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063390. [PMID: 35329075 PMCID: PMC8949216 DOI: 10.3390/ijerph19063390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022]
Abstract
The PRIMATE study is an Italian translational research project, which aims to identify personalized biomarkers associated with clinical characteristics of malignant pleural mesothelioma (MPM). For this purpose, characteristics of MPM patients with different degrees of asbestos exposure will be compared to identify somatic mutations, germline polymorphism, and blood inflammatory biomarkers. In this framework, we assessed exposure to asbestos for 562 cases of MPM extracted from the Lombardy region Mesothelioma Registry (RML), for which a complete interview based on a standardized national questionnaire and histopathological specimens were available. Exposure assessment was performed: (1) through experts' evaluation (considered as the gold standard for the purpose of this study), according to the guidelines of the Italian National Mesothelioma Registry (ReNaM) and (2) using a job-exposure matrix (SYN-JEM) to obtain qualitative (ever/never) and quantitative estimates of occupational asbestos exposure (cumulative exposure expressed in fibers per mL (f/mL)). The performance of SYN-JEM was evaluated against the experts' evaluation. According to experts' evaluation, occupational asbestos exposure was recognized in 73.6% of men and 23.6% of women; furthermore, 29 men (7.8%) and 70 women (36.9%) had non-occupational exposure to asbestos. When applying SYN-JEM, 225 men (60.5%) and 25 women (13.2%) were classified as occupationally exposed, with a median cumulative exposure higher for men (1.7 f/mL-years) than for women (1.2 f/mL-years). The concordance between the two methods (Cohen’s kappa) for occupational exposure assessment was 0.46 overall (0.41 in men, and 0.07 in women). Sensitivity was higher in men (0.73) than in women (0.18), while specificity was higher in women (0.88) than in men (0.74). Overall, both methods can be used to reconstruct past occupational exposure to asbestos, each with its own advantages and limitations.
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Affiliation(s)
- Andrea Spinazzè
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy; (F.B.); (S.R.); (A.C.); (D.M.C.)
- Correspondence:
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
| | - Francesca Borghi
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy; (F.B.); (S.R.); (A.C.); (D.M.C.)
| | - Sabrina Rovelli
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy; (F.B.); (S.R.); (A.C.); (D.M.C.)
| | - Andrea Cattaneo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy; (F.B.); (S.R.); (A.C.); (D.M.C.)
| | - Carolina Zellino
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
| | - Barbara Dallari
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
| | - Angela Cecilia Pesatori
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CM Utrecht, The Netherlands; (H.K.); (S.P.)
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CM Utrecht, The Netherlands; (H.K.); (S.P.)
| | - Luciano Riboldi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
| | - Domenico Maria Cavallo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy; (F.B.); (S.R.); (A.C.); (D.M.C.)
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (D.C.); (C.Z.); (B.D.); (A.C.P.); (L.R.); (C.M.)
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