Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea

Our plain-English summary of Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea, by D.A. Huh, W.R. Chae, Y.H. Choi, et al (International Journal of Environmental Research and Public Health, 2022).

The study

• Authors: D.A. Huh, W.R. Chae, Y.H. Choi, M.S. Kang, Y.J. Lee, K.W. Moon
• Journal: International Journal of Environmental Research and Public Health
• Published: 2022;19(23)
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Korea was one of the major consumers of asbestos in the late 1900s, and asbestos-related disease patients have been reported continuously to date, owing to long disease latency. Several studies have been conducted to predict the future incidence of malignant mesothelioma and lung cancer in Korea, but little is understood about the latency time. Therefore, the aim of this study is to estimate the latency period of malignant mesothelioma and asbestos-related lung cancer in Korea and its determinants. We obtained information from the Environmental Health Centers for Asbestos in Korea on the history of asbestos exposure and demographic characteristics of 1933 patients with malignant mesothelioma and asbestos-related lung cancer. In our study, the latency periods for malignant mesothelioma and lung cancer were 33.7 and 40.1 years, respectively. Regardless of the disease type, those with a history of exposure related to the production of asbestos-containing products or asbestos factories had the shortest latency period. In addition, we observed that those who worked in or lived near asbestos mines tended to have a relatively long disease latency. Smoking was associated with shorter latency, but no linear relationship between the lifetime smoking amount (expressed in pack years) and latent time was observed. In addition, the age of initial exposure showed a negative linear association with the latency period for mesothelioma and lung cancer.

In plain English

The authors studied the time between first asbestos exposure and diagnosis (latency) in 1,933 South Koreans approved as asbestos victims by 2021: 923 with malignant mesothelioma and 1,010 with lung cancer. They used questionnaire-based exposure histories checked against records. Mean latency was 33.7 years for mesothelioma and 40.1 years for lung cancer. After adjustment, people exposed at work had shorter latency than people exposed environmentally (mesothelioma 33.4 versus 35.8 years; lung cancer 39.5 versus 40.7). For both diseases, workers making asbestos-containing products had the shortest latency of the job groups. Among mesothelioma cases, those living near asbestos factories had shorter latency and those near asbestos mines had longer latency. For lung cancer, differences by exposure source were not statistically significant. Each one-year-older age at first exposure was associated with about one year shorter latency. Exposure duration, distance from the source and pack-years showed no linear association. The authors concluded that occupational exposure had shorter latency than environmental exposure. They noted that fiber levels were not considered and that smoking data covered only 169 mesothelioma and 298 lung cancer cases.

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: Analysis of existing government compensation and health-center records of patients approved as asbestos victims (patients only, with no comparison group of people without disease), using descriptive statistics, analysis of covariance and multiple linear regression
• Who was studied: 1,933 patients in South Korea approved as asbestos victims by 2021, drawn from 3,902 approved victims: 923 with malignant mesothelioma (616 men, 307 women) and 1,010 with lung cancer (721 men, 289 women). Data came from the Ministry of Environment and Soonchunhyang University Cheonan Hospital (an Environmental Health Center for Asbestos). The article does not say whether the mesotheliomas were pleural or peritoneal.
• Exposure: Occupational exposure (at least one year of work contact with asbestos fibers), grouped by job type: building construction or demolition, production of asbestos-containing products (cements, slates, fabrics), maintenance, mining, and others. Environmental exposure (non-occupational exposure from asbestos mines, industries, shipyards, asbestos-containing buildings and other sources). Occupational cases numbered 610 for mesothelioma and 505 for lung cancer; environmental cases numbered 313 and 505. Fiber types and fiber levels were not measured.
• Main results:
  • Mean latency (standard deviation) was 33.7 (13.8) years for malignant mesothelioma and 40.1 (16.3) years for lung cancer. Medians were 34.0 and 39.0 years.
  • Latency did not differ significantly by gender but tended to increase with age group, in both diseases.
  • Adjusted mean latency was shorter for occupational than for environmental exposure. For mesothelioma it was 33.4 years (95% CI 32.4, 34.4) versus 35.8 years (34.7, 36.9). For lung cancer it was 39.5 years (39.0, 40.0) versus 40.7 years (40.2, 41.2). Both differences had p less than 0.001.
  • By job type, production of asbestos-containing products had the shortest adjusted latency. This was 31.3 years (29.7, 33.0) for mesothelioma and 36.7 years (35.4, 38.0) for lung cancer. Asbestos mining work had longer latency than other occupational groups.
  • Among mesothelioma cases with environmental exposure, adjusted latency was 33.0 years (31.7, 34.3) for those living near asbestos industries and 40.4 years (38.2, 42.5) for those living near asbestos mines (p less than 0.001).
  • Among lung cancer cases, differences in adjusted latency by type of environmental exposure source were not statistically significant (p = 0.238). For example, latency was 43.5 years near asbestos mines and 41.3 years near asbestos industries.
  • In mesothelioma, current smokers had a shorter adjusted latency: 33.3 years (31.7, 34.8), compared with 35.4 years (33.9, 36.8) for never smokers and 36.4 years (33.6, 39.1) for past smokers (p = 0.011).
  • In lung cancer, latency was not significantly related to smoking (p = 0.875).
  • Each one-year increase in age at first exposure was associated with about one year shorter latency. The regression coefficients were -1.023 (mesothelioma) and -0.990 (lung cancer) in the occupational models, and -0.985 and -0.960 in the environmental models, all with p less than 0.001.
  • Distance from the exposure source to the residence, exposure duration and smoking pack-years had no linear association with latency.
  • Four mesothelioma cases and two lung cancer cases had a latency of fewer than 10 years.
• The authors' conclusion: The authors concluded that occupational asbestos exposure had a shorter disease latency than environmental exposure. They also concluded that latency can be shortened depending on exposure patterns, type of job, type of exposure source and age at first exposure, and they called for further and prospective studies.
• Limitations the authors state:
  • The asbestos fiber levels the patients were exposed to were not considered, because few asbestos concentration measurements exist in Korea. The authors suggested this may explain why no link between exposure duration and latency was seen.
  • Smoking data were available for only a limited number of cases: 169 for mesothelioma and 298 for lung cancer.
  • Cases with a latency of fewer than 10 years may reflect inaccurate exposure histories, such as early exposure the patients were unaware of.

Topics

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

Medical terms in this study, explained in our Lexicon: Latency, Asbestos Exposure, Malignant Mesothelioma, Lung Cancer, Mesothelioma.

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