Asbestos and lung cancer: what we know

Our plain-English summary of Asbestos and lung cancer: what we know, by J.R. Balmes (American Journal of Respiratory and Critical Care Medicine, 2013).

The study

• Author: J.R. Balmes
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2013;188(1):8-9
• Type of article: Editorial, Comment
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commented on a study of the North American insulator cohort by Markowitz and colleagues, published in the same journal issue. The author noted continuing controversy over three questions: whether asbestos exposure increases lung cancer risk in nonsmokers, whether asbestosis is a necessary precondition for asbestos-related lung cancer, and how asbestos exposure and smoking interact. He reviewed earlier work by Irving Selikoff's group. A 1968 report on 370 New York insulators estimated more than a 90-fold increased risk of lung cancer death in those with both exposures. Later reports on 17,800 union insulators showed a greater than fourfold increased risk. These studies had been criticized for comparing insulators with the U.S. general population and for not adjusting for smoking. The new study followed 2,377 insulators with chest X-ray, spirometric, occupational and smoking data from 1981 to 1983, and compared them with 54,237 non-asbestos-exposed blue-collar workers from an American Cancer Society cohort. From 1981 to 2008, there were 18 lung cancer deaths among 468 nonsmoking insulators, a 3.6-fold increased risk. Combined asbestos exposure and smoking was associated with a 14-fold increase. Asbestosis doubled the risk in nonsmokers and was associated with a 37-fold increase in smokers. The author defended Selikoff's work. He concluded that asbestos alone can cause lung cancer, that asbestos and smoking together carry an at least additive risk, that asbestosis further increases risk, and that quitting smoking substantially lowers the risk.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was an editorial by the author, not a new study. It commented on a study by Markowitz and colleagues of North American asbestos insulation workers, published in the same journal issue. The author said that study was designed to address criticisms of the earlier insulator studies by Irving Selikoff's group, including their comparison with the U.S. general population and their lack of adjustment for smoking. As the author described it, the study followed 2,377 insulators who had chest X-ray, breathing-test, job and smoking data from 1981 to 1983. It compared them with 54,237 blue-collar workers not exposed to asbestos from an American Cancer Society cohort. The editorial reported that from 1981 to 2008 there were 18 lung cancer deaths among 468 nonsmoking insulators, a 3.6-fold increased risk compared with nonsmokers in the comparison group. Asbestos exposure plus smoking was associated with a 14-fold increased risk. Asbestosis doubled the risk among nonsmoking insulators and was linked to a 37-fold increase among smoking insulators. The author concluded that these results, with other studies, show that asbestos exposure alone can cause lung cancer.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial commenting on a cohort study by Markowitz and colleagues published in the same issue; not original research by the author
• Who was studied: As described by the editorial: Markowitz and colleagues studied a subgroup of 2,377 North American asbestos insulators with chest X-ray, spirometry, occupational and smoking data from 1981 to 1983. The comparison group was 54,237 non-asbestos-exposed blue-collar workers from an American Cancer Society cohort.
• Exposure: Occupational asbestos exposure as insulation workers, alone and combined with cigarette smoking. The editorial does not name fiber types for this cohort.
• Main results:
  • Reported from the Markowitz study: from 1981 to 2008 there were 18 lung cancer deaths among 468 nonsmoking asbestos-exposed workers, a 3.6-fold increased risk compared with nonsmokers in the American Cancer Society cohort.
  • Reported from the Markowitz study: combined asbestos exposure and cigarette smoking was associated with an additive effect on lung cancer mortality, a 14-fold increased risk.
  • Reported from the Markowitz study: asbestosis doubled lung cancer risk among nonsmoking insulators and was linked to a supraadditive 37-fold increase among smoking insulators.
• The authors' conclusion: The author concluded that the Markowitz results, together with other studies, show that asbestos exposure alone can cause lung cancer. The author also concluded that asbestos and smoking together carry an at least additive increased risk, that asbestosis further increases risk, and that quitting smoking substantially lowers the risk.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Insulator, Asbestos Exposure, Chest X-Ray.

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