Colorectal Cancer and Asbestos Exposure: A Women's Health Perspective

Our plain-English summary of Colorectal Cancer and Asbestos Exposure: A Women's Health Perspective, by A. Porzio, A. Feola, C. Salzillo, et al (Healthcare, 2024).

The study

• Authors: A. Porzio, A. Feola, C. Salzillo, G. Corbi, C.P. Campobasso
• Journal: Healthcare
• Published: 2024;12(18)
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Colorectal cancer (CRC) is considered a "man's disease". However, emerging data show that females may have a higher prevalence of certain risk factors. A potential causal role of asbestos in CRC carcinogenesis has been suggested. This relationship is controversial, and only a few studies have focused on exposed female populations. The aim of this study was to review the scientific literature related to asbestos-related CRC incidence and mortality rates in female populations to address gender bias in the existing research.

Methods: A systematic review was performed following PRISMA statement.

Results: Fourteen studies reporting 92 cases in total were included. Most women were aged 50 years or older and were employed in occupational activities with high asbestos exposure (steel, textile, and asbestos-cement industry) for at least 10 years. In one single case, household asbestos exposure was reported. The colon was the primary location of the tumor in 47 out of 92 cases. Three women were also affected by synchronous or metachronous peritoneal mesotheliomas.

Conclusions: This study revealed a general methodological "gender bias" in scientific research. A significantly higher representation of women in clinical studies is needed to clarify the link between asbestos exposure and the development of colorectal cancer.

In plain English

This systematic review searched three databases, up to 10 December 2023, for research on colorectal cancer in asbestos-exposed women. It included 14 studies (10 cohorts, two case reports, two case series), mostly European, published 1985 to 2023. These reported 92 cases of colorectal or intestinal cancer in women, though one case-report patient reported no clear history of asbestos exposure. Exposures were mainly at work (asbestos textile, asbestos-cement, mining, steel, asbestos reprocessing); one cohort studied wives of asbestos-cement workers. The colon was the main site in 47 of the 92 cases. The authors noted that only two cohorts reported an increased standardized mortality ratio for colorectal cancer among exposed female workers. Other results were mixed. The wives' cohort had 14 colorectal cancer deaths against 9.9 expected, a standardized mortality ratio of 141.2 (95% confidence interval 77.2 to 236.9, which includes 100, the no-excess level). A German cohort had 3 against 3.1. Three women in the case reports and series also had mesothelioma. The authors concluded that the evidence was not enough to determine a relationship between colorectal cancer and asbestos exposure in women, who are under-represented in this research.

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: systematic review following the PRISMA statement
• Who was studied: 14 published studies (10 cohort studies, 2 case reports, 2 case series), mostly from Europe (Italy, Austria, France, Germany, Great Britain, Poland, Finland) plus one from Saudi Arabia, published 1985 to 2023. Together they reported 92 cases of intestinal cancer in women. In one included case report the patient reported no clear history of asbestos exposure.
• Exposure: Mainly occupational exposure in asbestos textile and asbestos-cement plants, anthophyllite mines, steel, fireproof textile and friction-material manufacture, and asbestos reprocessing. One cohort covered domestic exposure in wives of asbestos-cement workers. The included studies named crocidolite (mostly, in an Italian textile cohort) and chrysotile (Italian textile women compensated for asbestosis).
• Main results:
  • Across the 92 cases, the colon was the main tumor site in 47.
  • The authors stated that only two of the cohort studies reported an increased standardized mortality ratio (SMR) for colorectal cancer among exposed female workers.
  • British asbestos textile cohort (Peto et al. 1985): women first employed before 1950 had 3 colorectal cancer deaths against 1.58 expected (SMR 1.90).
  • Italian women compensated for asbestosis (Germani et al. 1999): colon and sigma tumors SMR 238 (95% CI 103–470); intestine and rectum cancers SMR 218 (95% CI 109–390).
  • Wives of asbestos-cement workers in Casale Monferrato (Magnani et al. 1993): 14 colorectal cancer deaths against 9.9 expected (SMR 141.2; 95% CI 77.2–236.9). On this scale 100 means no excess, and the confidence interval includes 100.
  • German cohort of 616 asbestos-exposed women (Rösler et al.): 3 colorectal cancer deaths against 3.1 expected (SMR 0.96; 95% CI 0.20–2.81).
  • French asbestos reprocessing cohort (Boulanger et al. 2015): standardized incidence ratio for colorectal cancer in women 1.33 (95% CI 0.49–2.91).
  • Italian asbestos textile cohort (Pira et al. 2016): 9 colorectal cancer cases in women (SMR 0.93; 95% CI 0.43–1.77), compared with 24 in men (SMR 1.73; 95% CI 1.11–2.58).
  • In the case reports and series, three women with colorectal cancer also had mesothelioma: two at the same time (synchronous) and one later (metachronous).
  • In one included case report (Alratrout et al. 2023), the 75-year-old woman reported no clear history of asbestos exposure.
• The authors' conclusion: The authors concluded that the review does not provide enough evidence to determine a relationship between colorectal cancer and asbestos exposure in women. They found that research is mostly focused on men and that further sex-specific research is needed.
• Limitations the authors state:
  • The small sample size of the included studies limits how far their findings can be generalized and relied on.
  • Very few included studies reported colorectal cancer risk estimates separately for women.

Topics

Medical terms in this study, explained in our Lexicon: Colorectal Cancer, Asbestos Exposure, Carcinogenesis, Systematic Review, Asbestos-Cement, Peritoneal Mesothelioma.

Related studies

• Colorectal Cancer: 35 Cases in Asbestos-Exposed Workers — A. Porzio, A. Feola, et al. (2023)
• Chronic bronchitis among nonsmoking farm women in the agricultural health study — M. Valcin, P.K. Henneberger, et al. (2007)
• Response to RE: Gordon R, Fitzgerald S, and Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women. Int J Occup Environ Health. 2014;20(4):318-332 — R.E. Gordon (2015)
• Indoor air pollution: a public health perspective — J.D. Spengler, K. Sexton (1983)
• The health effects of chrysotile: current perspective based upon recent data — D.M. Bernstein, J.A. Hoskins (2006)
• Prevention of Asbestos Exposure in Latin America within a Global Public Health Perspective — E. Algranti, J.P. Ramos-Bonilla, et al. (2019)

Browse more research in Healthcare, or return to medical research.