Asbestosis: a marker for the increased risk of lung cancer among workers exposed to asbestos

Our plain-English summary of Asbestosis: a marker for the increased risk of lung cancer among workers exposed to asbestos, by W. Weiss (Chest, 1999).

The study

• Author: W. Weiss
• Journal: Chest
• Published: 1999;115(2):536-49
• Type of article: Review
• Cited by: 62 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This review examines the hypothesis that excess lung cancer risk in worker cohorts exposed to asbestos occurs only among those with asbestosis. The adequately designed studies in the literature support this hypothesis. The summary relative risk for lung cancer was 1.00 in seven cohorts with no deaths from asbestosis. In addition, there is a high correlation between asbestosis rates and lung cancer rates in 38 cohorts in contrast to a poor correlation between cumulative exposure data and lung cancer relative risks in eight cohorts with adequate data. The evidence indicates that asbestosis is a much better predictor of excess lung cancer risk than measures of exposure and serves as a marker for attributable cases.

In plain English

This single-author review, published as an opinion/hypothesis article, examined cohort studies of asbestos-exposed workers published through January 1997. It examined the hypothesis that excess lung cancer risk occurs only among workers with asbestosis, treating asbestosis as a marker of risk. In seven cohorts with no asbestosis deaths, the author's combined standardized mortality ratio (SMR) for lung cancer was 1.00 (95% CI 0.88 to 1.14; 228 observed versus 227.5 expected deaths). Across 38 cohorts, asbestosis rates and excess lung cancer rates were correlated (coefficient 0.74), more strongly in 20 inception cohorts (0.93). In eight cohorts with exposure data, lung cancer SMRs showed no correlation with cumulative asbestos exposure (coefficient 0.036). In the author's earlier review, four studies of people with pleural plaques but no asbestosis gave a summary lung cancer SMR of 1.01 (95% CI 0.75 to 1.33). The author concluded that asbestosis is a much better predictor of excess lung cancer risk than exposure measures and serves as a marker for attributable cases. The author noted that smoking was evaluated in only a few studies, unsatisfactorily.

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: Narrative review (Opinions/Hypotheses article) of cohort studies, with the author's own pooled SMR and correlation analyses of published data; case-control studies were excluded
• Who was studied: Published cohorts of asbestos-exposed workers (literature through January 1997): seven cohorts with no asbestosis deaths, 38 cohorts from 30 reports for the correlation analysis, and eight cohorts with exposure data
• Exposure: Occupational asbestos exposure in varied industries, including miners, factory workers (asbestos cement, friction products, textiles) and maintenance workers; cumulative exposure was expressed in fiber/mL-years
• Main results:
  • In seven cohorts with no deaths from asbestosis, the summary lung cancer SMR was 1.00 (95% CI 0.88 to 1.14), based on 228 observed versus 227.5 expected lung cancer deaths
  • Across all 38 cohorts, cumulative asbestosis rate and cumulative excess lung cancer rate had a correlation coefficient of 0.74, which the author reported as statistically highly significant
  • The correlation was 0.93 in the 20 inception cohorts. In the 18 cross-sectional cohorts it was lower, at 0.69
  • In eight cohorts (42 pairs of data), lung cancer SMR showed no correlation with cumulative asbestos exposure in fiber/mL-years (correlation coefficient 0.036)
  • In the author's 1993 review of studies of people with pleural plaques but no asbestosis, four studies gave a summary lung cancer SMR of 1.01 (95% CI, 0.75 to 1.33)
  • In the author's recalculation of data on 2,636 Dresden asbestos workers (Jacob and Anspach), lung cancer risk was elevated only in workers with radiologic asbestosis, in both men and women
• The authors' conclusion: The author concluded that asbestosis is a much better predictor of excess lung cancer risk than measures of exposure and serves as a marker for attributable cases
• Limitations the authors state:
  • Smoking, the most common cause of lung cancer, was evaluated in only a few of the studies, and not satisfactorily
  • None of the seven cohorts without asbestosis deaths had adequate adjustment for smoking
  • Only a few cohort studies directly addressed whether asbestosis is a marker for increased lung cancer risk
  • Larger studies are needed, ideally with serial chest radiographs and tissue confirmation

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, Relative Risk, Cumulative Exposure.

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• Increased risk of lung cancer in pesticide-exposed male agricultural workers — E. Barthel (1981)
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• Absence of radiographic asbestosis and the risk of lung cancer among asbestos-cement workers: Extended follow-up of a cohort — M.M. Finkelstein (2010)
• Chronic obstructive lung diseases and risk of non-small cell lung cancer in women — A.G. Schwartz, M.L. Cote, et al. (2009)

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