Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Our plain-English summary of Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia, by A. Suraya, D. Nowak, A.W. Sulistomo, et al (International Journal of Environmental Research and Public Health, 2020).

The study

• Authors: A. Suraya, D. Nowak, A.W. Sulistomo, A. Ghanie Icksan, E. Syahruddin, U. Berger, S. Bose-O'Reilly
• Journal: International Journal of Environmental Research and Public Health
• Published: 2020;17(2)
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21-3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01-9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71-44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.

In plain English

This hospital-based case-control study compared 336 patients with histologically confirmed lung cancer and 360 without it. All were aged 35 or older and had chest CT scans in Jakarta, Indonesia, from May 2018 to August 2019. A Korean job-exposure matrix was used to estimate cumulative occupational asbestos exposure in fiber-years. The authors did not report participants' fiber types. Fifty-five cases and 29 controls had worked in asbestos-exposed jobs, mostly construction and car repair. Adjusted for age, gender, smoking and other factors, ever-exposed patients had a lung cancer odds ratio of 2.04 (95% CI 1.21–3.42). Those with 10 fiber-years or more had an odds ratio of 3.08 (95% CI 1.01–9.46). Environmental exposure, mostly asbestos roofing, showed no significant effect. Patients with 10 or more fiber-years and 10 or more pack-years of smoking (8 cases, 2 controls) had an odds ratio of 8.70 (95% CI 1.71–44.39) versus patients below both thresholds. The authors concluded that asbestos exposure was associated with higher lung cancer risk and interacted positively with smoking. They noted that Korea-Indonesia differences could bias their estimates.

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: hospital-based case-control study
• Who was studied: 696 patients aged 35 or older who had a thoracic CT scan at the National Respiratory Hospital (Persahabatan Hospital), Jakarta, Indonesia, from May 2018 to August 2019. The 336 cases had primary lung cancer confirmed by histology. The 360 controls came from the same group of CT patients and were negative for lung cancer.
• Exposure: Occupational asbestos exposure, estimated in fiber-years by linking job histories to a Korean general population job-exposure matrix. The authors do not identify the fiber types the participants were exposed to. The most common exposed occupations were technical workers in construction and automobile mechanics. The study also assessed non-occupational (environmental) exposure, mainly asbestos roofing, and smoking in pack-years.
• Main results:
  • 84 subjects (55 cases and 29 controls) had worked in asbestos-exposed industries or occupations. Mean cumulative exposure was 0.86 fiber-years in cases and 0.43 fiber-years in controls; this difference was not statistically significant (p = 0.14).
  • Ever occupationally exposed versus unexposed: adjusted OR for lung cancer 2.04 (95% CI 1.21–3.42).
  • Cumulative exposure of 10 fiber-years or more versus unexposed: adjusted OR 3.08 (95% CI 1.01–9.46).
  • Exposure of less than 10 fiber-years versus unexposed: adjusted OR 1.85 (95% CI 1.05–3.24).
  • When exposure was split at 25 fiber-years, the ORs showed a dose-response pattern but did not reach statistical significance.
  • Exposure lasting 10 years or more: adjusted OR 2.31 (95% CI 1.26–4.26). Exposure lasting less than 10 years: adjusted OR 1.34 (95% CI 0.56–3.20), which was not statistically significant.
  • Latency of 10 to 30 years since first exposure: adjusted OR 2.47 (95% CI 1.10–5.55). Latency of more than 30 years: adjusted OR 1.85 (95% CI 0.98–3.50).
  • Environmental asbestos exposure (ever exposed): adjusted OR 0.77 (95% CI 0.56–1.05). The authors reported no significant effect.
  • Smoking: OR 1.88 (95% CI 1.25–2.83).
  • Patients with both 10 or more fiber-years of asbestos and 10 or more pack-years of smoking numbered 8 cases and 2 controls. Their adjusted OR was 8.70 (95% CI 1.71–44.39). The reference group was patients unexposed or exposed to less than 10 fiber-years who also smoked 0 to 10 pack-years.
  • The synergy index was 6.2 and the multiplicativity index was 3.4. The authors interpreted these as positive additive and multiplicative interaction between smoking and asbestos.
  • No significant association was found between asbestos exposure and lung cancer cell type within the case group. Adenocarcinoma was the most frequent type (188 of 336).
• The authors' conclusion: The authors concluded that exposure to asbestos is associated with an increased risk of lung cancer among Indonesian workers. They stated that the risk is consistent with a dose-response relationship, and that asbestos and smoking show a strong positive additive and multiplicative interaction.
• Limitations the authors state:
  • Exposure levels came from a Korean job-exposure matrix. Differences between Indonesia and Korea in workplace conditions, culture, asbestos policy and perception of hazards could bias the risk estimate.
  • The analysis by duration of exposure does not take exposure intensity into account.

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Case-Control Study, Asbestos Exposure, CT Scan, Histology, Fiber Year.

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