Asbestos and renal adenocarcinoma: a case-control study

Our plain-English summary of Asbestos and renal adenocarcinoma: a case-control study, by M. Maclure (Environmental Research, 1987).

The study

• Author: M. Maclure
• Journal: Environmental Research
• Published: 1987;42(2):353-61
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000983).

Abstract

A case-control study of renal adenocarcinoma has corroborated the hypothesis that asbestos is a cause of the disease. The odds of having been moderately or heavily exposed to asbestos 30 years before diagnosis were 45:473 among cases, whereas the comparable odds among controls were 26:492. A matched-pair analysis yielded an exposure odds ratio of 1.8 with 95% confidence limits of 1.1 and 3.1. After controlling for potential confounders and selection factors by means of logistic regression, the incidence rate ratio was estimated to be 1.6, with a one-sided 95% confidence limit of 1.0.

In plain English

This case-control study compared past asbestos exposure in people with renal adenocarcinoma, a kidney cancer, and in people without it, in an area around Boston, Massachusetts. Each of 518 interviewed cases, found through 37 hospitals in 1981-84, was matched with a control of the same age and sex from the case's precinct of residence. Two reviewers, who did not know who was a case, rated exposure from interview job histories. Shipyard work was the main source of exposure, and no fiber types were named. Exposure within three decades before diagnosis was no more common among cases than controls. Exposure therefore counted only if both reviewers rated it intermediate or high at least 30 years earlier. In pairs where only one member was exposed, the case was exposed 42 times and the control 23 times. That gave an exposure odds ratio of 1.8 (95% confidence limits 1.1 and 3.1). After adjusting for smoking, obesity, kidney stones and other factors, the estimate was 1.6, with a one-sided 95% confidence limit of 1.0. The author concluded that asbestos exposure, as defined here, causes a 50 to 100% increase in the disease's incidence rate.

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: Case-control study with matched pairs (one control per case, plus a second control for cases under 50), using interviews
• Who was studied: 1190 cases of renal adenocarcinoma were identified in 1981-84 from 37 hospitals in about 100 townships around Boston, eastern Massachusetts. 549 cases were interviewed and 31 were excluded, leaving 518 cases. Each was matched with a control of the same age and sex chosen from residence lists of the case's precinct. The 87 second controls for cases under 50 were left out of all analyses except the overall logistic regression.
• Exposure: Asbestos exposure, with no fiber type specified. Subjects were listed for review if they reported asbestos exposure, shipbuilding work, or work as a pipefitter, steamfitter or boilermaker. Two reviewers, blind to case status, independently rated exposure as high, intermediate, low or negligible. Exposure was defined as both reviewers agreeing on intermediate or high exposure at least 30 years before the case's diagnosis. Shipyard employment contributed most to this definition.
• Main results:
  • Exposure that began within three decades of the case's diagnosis was no more common among cases than among controls (exposure odds ratio 1), so a 30-year induction period was assumed.
  • Matched-pair analysis: the ratio of discordant pairs (case exposed vs control exposed) was 42:23, giving an exposure odds ratio of 1.8 with 95% confidence limits of 1.1 and 3.1.
  • Conditional logistic regression controlled for smoking, obesity, kidney stones, hypertension, phenacetin, dietary protein, years of schooling, income and status of recent job. It estimated the exposure odds ratio at 1.6, with a one-sided 95% confidence limit of 1.0.
  • Using a broader definition (moderate or heavy exposure as rated by at least one reviewer), the matched-pair odds ratio was 2.0 (95% confidence limits 1.2 and 3.4).
  • Using the same broader definition, the logistic regression estimate was 1.8 (95% confidence limits 1.1 and 3.1).
  • Models adjusting in various ways for smoking history, nutrient intake, ethnicity, drug use and disease history gave asbestos exposure odds ratios between 1.5 and 2.
• The authors' conclusion: The author concluded that the analyses suggest that asbestos exposure, as operationally defined in this study, causes a 50 to 100% increase in the incidence rate of renal adenocarcinoma.
• Limitations the authors state:
  • Self-reports of asbestos exposure were found to be unreliable. Some people with clearly exposed jobs did not report exposure, and others who reported it likely had low exposure.
  • Probable random error in classifying exposure could not be quantified. The author states that such error would cause underestimation.
  • Unknown risk factors, or suspected risk factors measured imperfectly, could not be ruled out as explanations for the association. Lead and other metal exposures in the same jobs are given as an example.
  • When the data were split by smoking history, the odds ratios were too imprecise to test whether smoking modifies the asbestos association.

Topics

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Case-Control Study, Odds Ratio, Incidence.

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• A case-control study of renal cancer mortality at a Texas chemical plant — G.G. Bond, R.J. Shellenberger, et al. (1985)
• Case-control study on renal cell cancer and occupational exposure to trichloroethylene. Part I: Exposure assessment — J. Fevotte, B. Charbotel, et al. (2006)
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• Cigarette smoking associated with lung adenocarcinoma in situ in a large case-control study (SFBALCS) — P.M. Bracci, J. Sison, et al. (2012)

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