BMC Public Health

Our medical research library holds 28 studies published in BMC Public Health (2010–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 28 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: BioMed Central
• Published: 2001 to the present, England
• Language: English
• ISSN: 1471-2458 (electronic)
• Absorbed: BMC International Health and Human Rights
• Its record in the NLM Catalog

2020s

• Attributable fraction and number of cancer cases attributed to occupational carcinogens in Iran in 2019. A. Naghibzadeh-Tahami, Y. Khosravi, A.R. Zamani, et al. 2026;26(1). PubMed · Publisher · Free full text

  Abstract

  Background: Although occupational exposure to carcinogenic agents accounts for only a relatively small fraction of cancers, the estimated burden in Iran remains considerable due to widespread exposure in major industries and the scarcity of national data. This study aimed to estimate the proportion and number of cases of bladder, leukemia, lung, laryngeal, and liver cancers attributable to four major occupational carcinogens-silica, benzene, asbestos, and lead-in Iran in 2019.

  Methods: An attributable fraction (AF)-based approach was used to estimate the burden of occupational cancers in Iran. AFs were calculated using odds ratios (ORs) associated with specific occupational exposures. Although AFs are traditionally calculated using relative risks (RRs), ORs were used because they are more commonly reported in occupational studies and can approximate RRs when outcomes are rare. For each exposure, ORs were selected from epidemiological sources, including industry- or population-based studies, meta-analyses, and reviews. The number of workers exposed to occupational carcinogens in 2019 was obtained from the national occupational exposure surveillance system. AFs were then applied to national cancer incidence data to estimate the attributable numbers (ANs) of cancers related to occupational exposures. Monte Carlo simulation was used to estimate uncertainty intervals (UIs) for both AFs and ANs.

  Results: In 2019, 60 (95% UI: 46-77) cases of lung, bladder, liver, laryngeal, and leukemia cancers were attributable to historical lead exposure (AF = 34%). The total number of cancer cases attributable to historical silica exposure was estimated at 623 (95% UI: 365-881) (AF = 36%). Furthermore, 602 (95% UI: 334-887) cases of bladder, lung, liver, leukemia, and laryngeal cancers were attributable to occupational benzene exposure (AF = 23%). For asbestos, the AF was 42%, but the estimated attributable number was very small because of the limited number of exposed workers (AN = 0.41, 95% UI: 0.264-0.538).

  Conclusion: These findings suggest that occupational exposure to carcinogenic agents may contribute substantially to the burden of selected cancers in Iran. Although the estimates are exploratory and based on scenario-based modeling assumptions, they highlight the importance of preventive workplace interventions and improved occupational exposure surveillance systems.

  © 2026. The Author(s).

• Persistence burden and poor survival of pleural mesothelioma in central Italy, 2013-2022: a population-based study thirty years after asbestos ban. M. Iommi, M. Bonifazi, D. Sarti, et al. 2026;26(1). PubMed · Publisher · Free full text

  Abstract

  BACKGROUND: Pleural Mesothelioma (PM) is an asbestos-related cancer with poor prognosis. Despite the 1992 national asbestos ban, new cases continue to occur due to the long latency of the disease. The study aim was to evaluate incidence and survival trends of pleural mesothelioma in the Marche Region, central Italy, between 2013 and 2022. METHODS: This population-based incidence study included adult residents of the Marche Region between 2013 and 2022. Incident PM cases were identified from the Cancer Registry of Marche Region. Incidence rates per 100,000 person-years (py) were calculated and stratified by sex, age, and province of residence. Temporal trend and covariates effect were assessed with Poisson regression. Overall survival was estimated using the Kaplan-Meier method and compared across subgroups; adjusted hazard ratios (HR) were obtained from multiple Cox regression model. RESULTS: Between 2013 and 2022, there were 322 incident PM cases (82% male; median age 77 years). The crude incidence rate was 2.1 per 100,000 py (95% CI: 1.9–2.4), with no temporal change over the study period. The highest rates were observed in men, in age-group 75–79 years, and in the province of Ancona. One- and five-year survival rates were 48.8% and 8.3%, respectively. Older age and non-epithelioid histology were independently associated with higher mortality. CONCLUSIONS: The incidence of pleural mesothelioma in the Marche Region remained stable between 2013 and 2022, with a peak in 2018 requiring further observation to confirm it. The persistently high burden among men, older adults, and those living in industrialized coastal areas reflects the legacy of historical asbestos exposure. Continued population-based surveillance, integrated with follow-up of previously exposed workers, remains essential to monitor disease trends and support timely diagnosis and appropriate care pathways.

• Asbestos exposure, pleural plaques and digestive cancers. B. Clin, C. Gramond, F. Delva, et al. 2025;25(1):686. PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this study was to analyse the incidence and mortality from various digestive cancer sites and their potential link with pleural plaques, in a French cohort of workers previously occupationally exposed to asbestos.

  Methods: We conducted a 10-year follow-up study in 13,481 male subjects, included in the cohort between October 2003 and December 2005, for whom asbestos exposure was assessed by calculation of a cumulative exposure index (CEI) in equivalent fibres.years/mL for each subject. We conducted an incidence study and a mortality study. Complementary analysis was restricted to men who had performed at least one chest CT-scan (N = 4,794). We used a Cox model with age as the time axis variable, adjusted for smoking, time since first exposure (TSFE), CEI to asbestos and the existence of pleural plaques on CT-scan.

  Results: In the incidence study, a significant dose-response relationship was observed between CEI to asbestos and oesophageal cancer (HR 1.03, 95% CI [1.01-1.06]) in the entire cohort after adjustment for TSFE and smoking status. In subjects undergoing CT-scan, a significant association between pleural plaques was observed for oesophageal cancer incidence (HR 2.80, 95% CI [1.09-7.20]) and in the mortality study, multivariate analyses showed a significant dose-effect response between CEI to asbestos and death from oesophageal cancer (HR 1.03, 95% CI [1.00-1.05]) in the entire cohort.

  Conclusions: This large-scale study confirms results concerning a likely relationship between asbestos exposure and oesophageal cancer, and the association between this cancer and pleural plaques after adjustment on CEI to asbestos.

  © 2025. The Author(s).

• Factors associated with lung cancer among firefighters: a systematic literature review. A.W. Kang, N.S. Lui. 2025;25(1):281. Systematic review PubMed · Publisher · Free full text

  Abstract

  This short review addresses the pressing issue of lung cancer among firefighters, a population facing unique occupational hazards such as smoke inhalation and asbestos exposure. With lung cancer being a leading global cause of death, the study emphasizes the disproportionate burden on firefighters. Notably, wildfire smoke, containing carcinogenic elements, poses a rising significant threat to firefighters' respiratory health. Despite evidence linking firefighting to increased lung cancer risk, few studies have explored the underlying mechanisms. This study conducts a comprehensive review employing PRISMA guidelines to synthesize existing literature from 1972 to 2022. We discuss the association between age, race, and time spent fighting fires with lung cancer development. Our review also underscores the scarcity of studies investigating specific carcinogens and their role in firefighters' lung cancer risk, emphasizing the need for more targeted research. The study advocates for improved methodology, suggesting the use of individual-level exposure metrics like "fire-hours" to enhance causal inference. Despite limitations in current literature, the findings stress the urgency of understanding the intricacies of lung cancer development among firefighters and call for further research to inform preventive measures and potential screening protocols.

  © 2025. The Author(s).

• Global, regional and country-specific burden of larynx cancer due to occupational exposure to asbestos: a systematic analysis of the Global Burden of Disease Study 2021. S. Zhang, D. Du, P. Li, et al. 2025;25(1):2223. PubMed · Publisher · Free full text

  Abstract

  Background: Laryngeal cancer (LC) attributable to occupational asbestos exposure remains a significant global health concern. This study aimed to assess the global burden of LC caused by asbestos exposure using data from the Global Burden of Disease (GBD) 2021 study.

  Methods: Data from the Global Burden of Diseases study 2021 were used to analyze the global burden of LC, including incidence, mortality, prevalence, and disability-adjusted life years (DALYs) from 1990 to 2021. The study employed age-standardized rates (ASR) for comparison. Trend analysis was performed using annual percentage change (EAPC) to examine temporal changes in LC burden. Bayesian age-period-cohort modeling was utilized to project future trends from 2022 to 2046.

  Results: In 2021, the global burden of LC attributable to occupational asbestos exposure was 3,392 deaths and 66,909 DALYs. The burden was significantly higher in males compared to females. The age-standardized mortality rate was highest in high-SDI regions, but low- and middle-SDI regions showed increasing trends. From 1990 to 2021, global LC mortality and DALYs decreased, with a notable reduction in high-income countries, while many low- and middle-income countries experienced either stable or rising trends. Projections indicate continued decline in high-income countries but persistent or increasing burden in lower-income regions.

  Conclusion: This study highlights the ongoing global disparities in the burden of LC due to occupational asbestos exposure. While high-income countries have made significant progress in reducing this burden, low- and middle-income countries continue to face challenges due to ongoing asbestos use.

  © 2025. The Author(s).

• Occupational exposure to ultrafine particles and lung cancer in a population exposed to asbestos. C. Rostello, C. Gramond, S. Audignon, et al. 2025;25(1):784. PubMed · Publisher · Free full text

  Abstract

  Background: Ultrafine particles are present in ever greater quantities in the workplace and only one epidemiological study to date has found an association with the occurrence of lung cancer.

  Objective: To investigate the effect of occupational exposure to ultrafine particles on the risk of lung cancer.

  Methods: The ARDCO is a surveillance program involving retiree workers who had been exposed to asbestos during their working life. Exposure to ultrafine particles over the complete lifetime occupational history was assessed using the French job exposure matrix MATPUF. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI).

  Results: There was no association between exposure to ultrafine particles and lung cancer after adjustment for smoking and exposure to asbestos and crystalline silica.

  Conclusion: The findings do not indicate increased risks of lung cancer for UFP after adjustment for level of exposure to asbestos, crystalline silica, and smoking status.

  Clinical Trial Number: Not applicable.

  © 2025. The Author(s).

• The psychological impact of asbestos exposure: risk perception and emotional distress among former workers in Tuscany. M. Bonafede, E. Chellini, M. Bugani, et al. 2025;25(1):3424. PubMed · Publisher · Free full text

  Abstract

  BACKGROUND: Exposure to asbestos continues to be a global health hazard, with significant mortality linked to asbestos-related diseases. Despite asbestos bans in many countries, including Italy (1992), former asbestos workers continue to experience health risks and psychological distress. This study examines the psychological impact of asbestos exposure among former workers enrolled in the Tuscany Region’s health surveillance program, focusing on risk perception, emotional distress, and service evaluation. METHODS: A cross-sectional study was conducted from October 2021 to September 2022, involving 362 former asbestos-exposed workers participating in the Tuscany Region’s health surveillance program. Participants were interviewed via structured telephone surveys administered by trained psychologists. The questionnaire assessed asbestos-risk perception, self-perceived asbestos exposure, psychological distress (sadness, anxiety, anger, fear), and satisfaction with health services. Statistical analyses, including generalized logistic regression models, were performed to evaluate associations between risk perception and psychological symptoms. RESULTS: Among participants, 77.9% believed they were at risk of developing an asbestos-related disease in the future, and 61.1% reported significant past exposure. Emotional distress was prevalent, with high self-perceived levels of sadness (mean: 5.1), anger (5.3), fear (4.9), and anxiety (4.0). Risk perception strongly correlated with psychological distress: those who believed they were at future risk exhibited higher levels of fear (OR: 2.86) and anger (OR: 2.56), while those who were uncertain about their past exposure showed increased anxiety (OR: 13.0) and anger (OR: 3.60). Additionally, knowing someone affected by an asbestos-related disease was associated with greater sadness (OR: 3.92) and fear (OR: 3.94). Despite psychological distress, health surveillance services were well-rated, particularly in staff availability (56.6%) and assistance quality (55.2%). CONCLUSIONS: This study emphasizes the psychological effects of asbestos exposure over the long term, underlining the need for integrated mental health support within health surveillance programs. The strong link between risk perception and emotional distress suggests that psychological interventions, like counselling and education ought to be used in conjunction with medical monitoring. Addressing these needs can enhance the well-being of former asbestos-exposed workers, mitigating the lasting effects of exposure-related uncertainty and fear. Future research should focus on developing targeted interventions to support this vulnerable population.

• Update on mesothelioma incidence and forecast of future cases in Belgium. S. Ronsmans, K. Nackaerts, B. Nemery. 2025;25(1):3870. PubMed · Publisher · Free full text

  Abstract

  Background: Belgium has been a "historical champion" in asbestos consumption. A total ban was only introduced in 1998. Previous studies showed a steady rise in malignant mesothelioma incidence. We aimed to update Belgian incidence data through 2022 and model future case projections.

  Methods: We used past asbestos consumption data for Belgium as a proxy for exposure. Data on the yearly incidence of malignant mesothelioma in Belgium were obtained from the Belgian Cancer Registry (2004-2022), Scientific Institute of Public Health (1987-2021), WHO Mortality Database (1969-2004), and Asbestos Fund (2007-2022). We used Distributed Lag Non-Linear Models, to estimate the exposure-lag-response association and forecast future incidence.

  Results: Mesothelioma incidence has increased since the 1970s, plateauing in recent years around 300 cases/year (for a total population of 10-11 million). We predict a decline in the coming decades, estimating 246 cases/year in 2030 (95% prediction interval [PI] 217-278) and 116 cases/year in 2040 (95%PI 96-138). Stratifying by age group, we observed a decline in mesothelioma incidence among the few individuals diagnosed at young ages (< 55y and 55-64y), while cases in the 75-84y and > 85y age groups continue to rise. The number of compensated cases was substantially lower than the registered cases, with 84 cases/year (95%CI 67-101) remaining uncompensated.

  Conclusions: The restrictions and ban on asbestos use have reduced the risk of mesothelioma for those who began working after the peak period of asbestos use. Nevertheless, the overall mesothelioma incidence in Belgium does not yet show signs of decline. More efforts should be made to improve compensation of mesothelioma patients.

  © 2025. The Author(s).

• Asbestos ban policies and mesothelioma mortality in Greece. E. Gogou, C. Hatzoglou, D. Siachpazidou, et al. 2024;24(1):1177. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant mesothelioma is a rare form of cancer that mostly affects the pleura and has a strong link to asbestos exposure. Greece banned the use of asbestos in 2005, however, the public was already aware of this substance in the 1980s. This research aims to present an overview of Greece's mesothelioma age-standardized mortality rates (ASMR) from 1983 to 2019 by age, gender, and geographic region and to determine whether the actions to ban asbestos impacted these rates.

  Methods: Data were retrieved by the Hellenic Statistical Authority (HSA) from death certificates that mentioned mesothelioma as the cause of death from 1983 to 2019 with details on the residence, gender, and age. Statistical analysis was performed using PRISM 6.0 software, a two-way ANOVA test, Trend analysis was conducted using Joinpoint Regression Program 5.0 software. The linear and non-linear model was used to calculate the age-standardized rates of annual percentage change (APC) and its 95% confidential interval (95% CI).

  Results: From 1983 to 2019, 850 total mesothelioma deaths were recorded, the majority of whom were males (634). A rate of 74.6% accounts for males and 25.4% for females, and the ratio of Males: Females was 3:1. Males' ASMR and the whole population's ASMR reached their highest levels in 2011 (0.93/100000person-years and 0.53/100000person-years, respectively). To look for potential changes between the first two decades of the 21st century, we compared the mean ASMR of each geographic region in Greece between two different 10-year subperiods (2000-2009 and 2010-2019). Except for Epirus, all regions of Greece had elevated regional ASMRs, particularly in those with the highest asbestos deposits. Notably, the ASMR in Epirus decreased from 0.54/100000person-years (2000-2009) to 0.31/100000person-years (2010-2019). After 2011, the ASMR for men and the general population stabilized. This stability is important since mesothelioma in men is associated with occupational asbestos exposure. The intriguing discovery of a lower ASMR in Epirus emphasizes the need to raise awareness of the condition and implement effective public health measures.

  Conclusions: In Greece, the annual ASMR for males and the whole population reached its highest level in 2011, which is positive and encouraging and may be a sign that the rate will stabilize during the following years. Moreover, this study showed that the actions made in the 1980s regarding public awareness and surveillance directly impacted the decrease in Epirus rates. Future research, continual awareness, information, and recording are needed to monitor the mesothelioma epidemic. The possible benefit of a mesothelioma registry and the epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, need to be addressed.

  Trial Registration: Not applicable.

  © 2024. The Author(s).

• Assessing trends and burden of occupational exposure to asbestos in the United States: a comprehensive analysis from 1990 to 2019. X. Li, X. Su, L. Wei, et al. 2024;24(1):1404. PubMed · Publisher · Free full text

  Abstract

  Background: This study aimed to analyze the trends and burden of occupational exposure to asbestos in the United States (U.S.) from 1990 to 2019, focusing on mortality rates, geographic distribution, age and sex patterns, and causes of death.

  Methods: Data on the number of deaths attributable to occupational exposure to asbestos were collected from 1990 to 2019 in the U.S. Joinpoint analysis was conducted to assess trends over time, and regression models were applied to calculate annual percentage changes (APC) and annual average percentage changes (AAPC). Geographic distribution was examined using mapping techniques. Age and sex patterns were analyzed, and causes of death were identified based on available data.

  Results: From 1990 to 2019, the overall number of deaths due to occupational exposure to asbestos in the U.S. increased by 20.2%. However, age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) exhibited a decline over the same period. Geographic analysis revealed differences in the number of deaths across states in 2019, with California reporting the highest number of fatalities. Age-specific mortality and DALYs showed an increase with age, peaking in older age groups. Tracheal, bronchus, and lung cancer were the leading causes of death attributed to asbestos exposure, with increasing trends observed over the past five years.

  Conclusion: The study highlights significant trends and burden in occupational exposure to asbestos in the U.S., including overall increases in mortality rates, declining ASMR and ASDR, geographic disparities, age and sex patterns, and shifts in causes of death. These findings underscore the importance of continued monitoring and preventive measures to mitigate the burden of asbestos-related diseases.

  © 2024. The Author(s).

• Global, regional, and national burden of non-communicable diseases attributable to occupational asbestos exposure 1990-2019 and prediction to 2035: worsening or improving?. X. Miao, T. Yao, C. Dong, et al. 2024;24(1):832. PubMed · Publisher · Free full text

  Abstract

  Understanding the burden associated with occupational asbestos exposure on a global and regional scale is necessary to implement coordinated prevention and control strategies. By the GBD Study 2019, we conducted a comprehensive assessment of the non-communicable diseases burden attributable to occupational asbestos exposure. In 2019, 239,330 deaths and 4,189,000 disability-adjusted life years (DALYs) worldwide due to occupational asbestos exposure occurred. 1990-2019, deaths and DALYs attributed to occupational asbestos exposure increased by 65.65% and 43.66%, respectively. Age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) decreased, with the most rapid declines in high Socio-Demographic Index (SDI) regions, with average annual percent change (AAPC) of - 1.05(95%CI: -1.2, -0.89) and -1.53(95%CI: -1.71, -1.36), respectively. Lung cancer, mesothelioma and ovarian cancer were the top three contributors to the increase in deaths and DALYs, accounting for more than 96%. AAPCs of ASMR and ASDR were positively associated with SDI. Global deaths from occupational asbestos exposure were predicted to increase and ASMR to decrease by 2035, mostly in males. Due consideration should be given to the susceptibility of the elderly, the lag of asbestos onset, and the regional differences, and constantly improve the prevention and control measures of occupational asbestos exposure and related diseases.

  © 2024. The Author(s).

• A comparative study of the disease burden attributable to asbestos in Brazil, China, Kazakhstan, and Russia between 1990 and 2019. J. Chen, C. Wang, J. Zhang, et al. 2022;22(1):2012. PubMed · Publisher · Free full text

  Abstract

  Background: Brazil, China, Kazakhstan, and Russia are the main asbestos-producing countries, and all forms of asbestos are carcinogenic to humans. The objective of this study was to estimate the disease burden attributable to asbestos between 1990 and 2019 in major producing countries, including Brazil, China, Kazakhstan, and Russia.

  Methods: Age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life year (DALY) rates (ASDR) of disease burden attributable to asbestos by country, age, and sex were extracted from the Global Burden of Disease 2019. Percentage change and estimated annual percentage change (EAPC) were used to assess the trends of ASDR and ASMR of disease burden attributable to asbestos between 1990 and 2019.

  Results: Asbestos-related diseases were highly heterogeneous across Global, Brazil, China, Kazakhstan, and Russia. There was a downward trend in ASMR and ASDR of diseases burden related to asbestos globally. The age-specific mortality rate of disease attributable to asbestos increased in men and women, although it decreased in women aged 85-89, the highest age-specific mortality rate were observed in age 95 + group in men [162.14 (95% UI: 103.76-215.45)] and women [30.58 (95% UI: 14.83-44.33)] per 100 000 population, respectively. Tracheal, bronchus, and lung (TBL) cancer was the leading cause of death and DALYS attributable to asbestos between 1990 and 2019 globally and in Brazil, China, Kazakhstan, and Russia. China had the highest percentage change (73.31%) and EAPC [3.41 (95% CI: 2.75-4.08)] in ASMR related to exposure to asbestos in men, with the highest percentage change (73.31%) and EAPC [3.41 (95% CI: 2.75-4.08)] in ASDR in men.

  Conclusions: The ASMR and ASDR of disease burden attributable to asbestos decreased between 1990 and 2019 globally. TBL cancer was the leading cause of death and DALYs attributable to asbestos between 1990 and 2019. There has been an increasing trend in mortality and DALYs globally, especially in older men. The burden of disease attributable to asbestos is increasing in China, especially in men.

  © 2022. The Author(s).

• The burden of pneumoconiosis in China: an analysis from the Global Burden of Disease Study 2019. J. Li, P. Yin, H. Wang, et al. 2022;22(1):1114. PubMed · Publisher · Free full text

  Abstract

  Background: Pneumoconiosis refers to a class of serious diseases threatening the health of workers exposed to coal or silicosis dust. However, the burden of pneumoconiosis is unavailable in China.

  Methods: Incident cases, deaths, and disability-adjusted life years (DALYs) from pneumoconiosis and its subtypes in China were estimated from the Global Burden of Disease Study 2019 using a Bayesian meta-regression method. The trend of the burden from pneumoconiosis was analyzed using percentage change and annualized rate of change (ARC) during the period 1990-2019. The relationship between subnational socio-demographic index (SDI) and the ARC of age-standardised death rate was measured using Spearman's Rank-Order Correlation.

  Results: In 2019, there were 136.8 (95% uncertainty interval [UI] 113.7-162.5) thousand new cases, 10.2 (8.1-13.6) thousand deaths, and 608.7 (473.6-779.4) thousand DALYs from pneumoconiosis in China. Of the global burdens from pneumoconiosis, more than 60% were in China. Both the total number of new cases and DALYs from pneumoconiosis was keeping increasing from 1990 to 2019. In contrast, the age-standardised incidence, death, and DALY rates from pneumoconiosis and its subtypes, except for the age-standardised incidence rate of silicosis, and age-standardised death rate of asbestosis, experienced a significant decline during the same period. The subnational age-standardised death rates were higher in western China than in eastern China. Meanwhile, the subnational ARC of age-standardised death rates due to pneumoconiosis and its subtypes were significantly negatively correlated with SDI in 2019.

  Conclusion: China suffers the largest health loss from pneumoconiosis in the world. Reducing the burden of pneumoconiosis is still an urgent task in China.

  © 2022. The Author(s).

• The global burden and associated factors of ovarian cancer in 1990-2019: findings from the Global Burden of Disease Study 2019. S. Zhang, C. Cheng, Z. Lin, et al. 2022;22(1):1455. PubMed · Publisher · Free full text

  Abstract

  Background: Ovarian cancer (OC) is a major cause of cancer-related deaths among women. The aim of this study was to estimate and report data on the current burden of ovarian cancer worldwide over the past 30 years.

  Method: Based on the data provided by GBD 2019, we collected and interpreted the disease data of ovarian cancer by incidence, mortality, disability-adjusted life-years (DALYs), and used corresponding age-standardized rates as indicators. Also, we categorized the data by attributed risk factors and captured deaths due to high fasting plasma glucose, occupational exposure to asbestos and high body-mass index, respectively. All outcomes in the study were reported using mean values and corresponding 95% uncertainty intervals (95% UI).

  Results: Globally, there were 294422 (260649 to 329727) incident cases in 2019, and the number of deaths and DALYs were 198412 (175357 to 217665) and 5.36 million (4.69 to 5.95). The overall burden was on the rise, with a percentage change of 107.8% (76.1 to 135.7%) for new cases, 103.8% (75.7 to 126.4%) for deaths and 96.1% (65.0 to 120.5%) for DALYs. Whereas the age-standardized rates kept stable during 1990-2019. The burden of ovarian cancer increased with age. and showed a totally different trends among SDI regions. Although high SDI region had the declining rates, the burden of ovarian cancer remained stable in high-middle and low SDI regions, and the middle and low-middle SDI areas showed increasing trends. High fasting plasma glucose was estimated to be the most important attributable risk factor for ovarian cancer deaths globally, with a percentage change of deaths of 7.9% (1.6 to 18.3%), followed by occupational exposure to asbestos and high body mass index.

  Conclusions: Although the age-standardized rates of ovarian cancer didn't significantly change at the global level, the burden still increased, especially in areas on the lower end of the SDI range. Also, the disease burden due to different attributable risk factors showed heterogeneous, and it became more severe with age.

  © 2022. The Author(s).

• An approach to estimating the environmental burden of cancer from known and probable carcinogens: application to Ontario, Canada. S.L. Greco, E. MacIntyre, S. Young, et al. 2020;20(1):1017. PubMed · Publisher · Free full text

  Abstract

  Background: Quantifying the potential cancer cases associated with environmental carcinogen exposure can help inform efforts to improve population health. This study developed an approach to estimate the environmental burden of cancer and applied it to Ontario, Canada. The purpose was to identify environmental carcinogens with the greatest impact on cancer burden to support evidence-based decision making.

  Methods: We conducted a probabilistic assessment of the environmental burden of cancer in Ontario. We selected 23 carcinogens that we defined as "environmental" (e.g., pollutants) and were relevant to the province, based on select classifications provided by the International Agency for Research on Cancer. We evaluated population exposure to the carcinogens through inhalation of indoor/outdoor air; ingestion of food, water, and dust; and exposure to radiation. We obtained or calculated concentration-response functions relating carcinogen exposure and the risk of developing cancer. Using both human health risk assessment and population attributable fraction models in a Monte Carlo simulation, we estimated the annual cancer cases associated with each environmental carcinogen, reporting the simulation summary (e.g., mean and percentiles).

  Results: We estimated between 3540 and 6510 annual cancer cases attributable to exposure to 23 environmental carcinogens in Ontario. Three carcinogens were responsible for over 90% of the environmental burden of cancer: solar ultraviolet (UV) radiation, radon in homes, and fine particulate matter (PM2.5) in outdoor air. Eight other carcinogens had an estimated mean burden of at least 10 annual cancer cases: acrylamide, arsenic, asbestos, chromium, diesel engine exhaust particulate matter, dioxins, formaldehyde, and second-hand smoke. The remaining 12 carcinogens had an estimated mean burden of less than 10 annual cancer cases in Ontario.

  Conclusions: We found the environmental burden of cancer in Ontario to fall between previously estimated burdens of alcohol and tobacco use. These results allow for a comparative assessment across carcinogens and offer insights into strategies to reduce the environmental burden of cancer. Our analysis could be adopted by other jurisdictions and repeated in the future for Ontario to track progress in reducing cancer burden, assess newly classified environmental carcinogens, and identify top burden contributors.

2010s

• Investigating the association between occupational exposure to asbestos and ovarian carcinoma: results from a pilot study in Germany. Z. Rajput, K.G. Hering, T. Kraus, et al. 2019;19(1):1341. PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this pilot study was to assess the feasibility of a large-scale epidemiologic investigation elucidating the quantitative association between occupational exposure to asbestos and ovarian cancer in former German asbestos workers.

  Methods: Between December 2017 and May 2018, a random sample of one thousand insured woman registered at the health service of a German trade association as formerly occupationally exposed to asbestos were invited to participate in a pilot study. Participation included a phone interview using a standardised questionnaire. The feasibility of the project was evaluated using a priori defined criteria. They included response, number of cases, eligibility of the questionnaire data for exact estimation of asbestos fibre-years, and availability of relevant medical documentation (imaging procedures, medical reports, and histologic materials).

  Results: The response (17%) was clearly below the intended number of 60%. With six tumour suspects, of which two could be confirmed by medical documents, the number of cases was within the expected range of two to eleven cases. Exact asbestos fibre-year estimations could be performed for 29% of all interviewees, but only for one suspected case. Medical documentation could be collected for only few participants, while no histology reports could be obtained for all cases. Thus, only the feasibility criterion of the expected number of cases was fulfilled.

  Conclusion: The results of the pilot study indicate that the planned project is feasible only to a very limited extent. For further planning of the study, measures to improve recruitment of participants are necessary.

• Absence of multiplicative interactions between occupational lung carcinogens and tobacco smoking: a systematic review involving asbestos, crystalline silica and diesel engine exhaust emissions. M. El Zoghbi, P. Salameh, I. Stücker, et al. 2017;17(1):156. Systematic review PubMed · Publisher · Free full text

  Abstract

  Background: Tobacco smoking is the main cause of lung cancer, but it is not the sole causal factor. Significant proportions of workers are smokers and exposed to occupational lung carcinogens. This study aims to systematically review the statistical interaction between occupational lung carcinogens and tobacco smoking, in particular asbestos, crystalline silica and diesel engine exhaust emissions.

  Methods: Articles were identified using Scopus, PubMed, and Web of Science, and were limited to those published in English or French, without limitation of time. The reference list of selected studies was reviewed to identify other relevant papers. One reviewer selected the articles based on the inclusion and exclusion criteria. Two reviewers checked the eligibility of articles to be included in the systematic review. Data were extracted by one reviewer and revised by two other reviewers. Cohorts and case-control studies were analyzed separately. The risk of bias was evaluated for each study based on the outcome. The results of the interaction between the tobacco smoking and each carcinogen was evaluated and reported separately.

  Results: Fifteen original studies were included for asbestos-smoking interaction, seven for silica-smoking interaction and two for diesel-smoking interaction. The results suggested the absence of multiplicative interaction between the three occupational lung carcinogens and smoking. There is no enough evidence from the literature to conclude for the additive interaction. We believe there is a limited risk of publication bias as several studies reporting negative results were published.

  Conclusion: There are no multiplicative interactions between tobacco smoking and occupational lung carcinogens, in particular asbestos, crystalline silica and diesel engine exhaust emissions. Even though, specific programs should be developed and promoted to reduce concomitantly the exposure to occupational lung carcinogens and tobacco smoking.

• The future excess fraction model for calculating burden of disease. L. Fritschi, J. Chan, S.J. Hutchings, et al. 2016;16:386. PubMed · Publisher · Free full text

  Abstract

  Background: Estimates of the burden of disease caused by a particular agent are used to assist in making policy and prioritizing actions. Most estimations have employed the attributable fraction approach, which estimates the proportion of disease cases or deaths in a specific year which are attributable to past exposure to a particular agent. While this approach has proven extremely useful in quantifying health effects, it requires historical data on exposures which are not always available.

  Methods: We present an alternative method, the future excess fraction method, which is based on the lifetime risk approach, and which requires current rather than historical exposure data. This method estimates the future number of exposure-related disease cases or deaths occurring in the subgroup of the population who were exposed to the particular agent in a specific year. We explain this method and use publically-available data on current asbestos exposure and mesothelioma incidence to demonstrate the use of the method.

  Conclusions: Our approach to modelling burden of disease is useful when there are no historical measures of exposure and where future disease rates can be projected on person years at risk.

• Lung cancer risk among workers in the construction industry: results from two case-control studies in Montreal. A. Lacourt, J. Pintos, J. Lavoué, et al. 2015;15:941. PubMed · Publisher · Free full text

  Abstract

  Background: Given the large number of workers in the construction industry, it is important to derive accurate and valid estimates of cancer risk, and in particular lung cancer risk. In most previous studies, risks among construction workers were compared with general populations including blue and white collar workers. The main objectives of this study were to assess whether construction workers experience excess lung cancer risk, and whether exposure to selected construction industry exposures carries excess risks. We wished to address these objectives within the sub-population of blue collar workers.

  Methods: Two case-control studies were conducted in Montreal. Combined, they included 1593 lung cancer cases and 1427 controls, of whom 1304 cases and 1081 controls had been blue collar workers. Detailed lifetime job histories were obtained and translated by experts into histories of exposure to chemical agents. The two key analyses were to estimate odds ratio (OR) estimates of lung cancer risk: a) for all blue-collar construction workers compared with other blue-collar workers, and b) for construction workers exposed to each of 20 exposure agents found in the construction industry compared with construction workers unexposed to those agents. All analyses were conducted using unconditional logistic regression adjusted for socio-demographic factors and smoking history.

  Results: The OR for all construction workers combined was 1.11 (95 % CI: 0.90-1.38), based on 381 blue collar construction workers. Analyses of specific exposures were hampered by small numbers and imprecise estimates. While none of 20 occupational agents examined was significantly associated with lung cancer, the following agents manifested non-significantly elevated ORs: asbestos, silica, Portland cement, soil dust, calcium oxide and calcium sulfate.

  Conclusions: Compared with other blue collar workers, there was only a slight increased risk of lung cancer for subjects who ever held an occupation in the construction industry. The analyses of agents within the construction industry produced imprecise estimates of risk, but nevertheless pointed to some plausible associations. Excess risks for asbestos and silica were in line with previous knowledge. The possible excess risks with the other inorganic dusts require further corroboration.

• INTEROCC case-control study: lack of association between glioma tumors and occupational exposure to selected combustion products, dusts and other chemical agents. A. Lacourt, E. Cardis, J. Pintos, et al. 2013;13:340. PubMed · Publisher · Free full text

  Abstract

  Background: The aim was to investigate possible associations between glioma (an aggressive type of brain cancer) and occupational exposure to selected agents: combustion products (diesel and gasoline exhaust emissions, benzo(a)pyrene), dusts (animal dust, asbestos, crystalline silica, wood dust) and some other chemical agents (formaldehyde, oil mist, sulphur dioxide).

  Methods: The INTEROCC study included cases diagnosed with glioma during 2000-2004 in sub-regions of seven countries. Population controls, selected from various sampling frames in different centers, were frequency or individually matched to cases by sex, age and center. Face-to-face interviews with the subject or a proxy respondent were conducted by trained interviewers. Detailed information was collected on socio-economic and lifestyle characteristics, medical history and work history. Occupational exposure to the 10 selected agents was assessed by a job exposure matrix (JEM) which provides estimates of the probability and level of exposure for different occupations. Using a 25% probability of exposure in a given occupation in the JEM as the threshold for considering a worker exposed, the lifetime prevalence of exposure varied from about 1% to about 15% for the different agents. Associations between glioma and each of the 10 agents were estimated by conditional logistic regression, and using three separate exposure indices: i) ever vs. never; ii) lifetime cumulative exposure; iii) total duration of exposure.

  Results: The study sample consisted of 1,800 glioma cases and 5,160 controls. Most odds ratio estimates were close to the null value. None of the ten agents displayed a significantly increased odds ratio nor any indication of dose-response relationships with cumulative exposure or with duration of exposure.

  Conclusion: Thus, there was no evidence that these exposures influence risk of glioma.

• Medicines and the media: news reports of medicines recommended for government reimbursement in Australia. J. Robertson, E.J. Walkom, M.D. Bevan, et al. 2013;13:489. PubMed · Publisher · Free full text

  Abstract

  Background: Previous analyses of the listings of trastuzumab on the Australian Pharmaceutical Benefits Scheme (PBS) and HPV vaccine on the National Immunisation Program (NIP) suggest a media influence on policy makers. We examined the timing and content of Australian newspaper reports of medicines in relation to Pharmaceutical Benefits Advisory Committee (PBAC) decisions.

  Methods: We identified newspaper reports (2005-2008) of medicines recommended for PBS listing in 2006-2007, analysing the content for mentions of the medicine, PBS and medicine costs to the patient and the government and counting the numbers of articles published in the six months before, the month of, and the six months after the relevant PBAC meeting. Case studies examined reporting for infliximab for Crohn's Disease, pemetrexed for mesothelioma, and ADHD (Attention Deficit Hyperactivity Disorder) medicines atomoxetine and methylphenidate.

  Results: Of 79 eligible medicines, 62 had news reports. Most often reported were HPV vaccine (1230 stories), trastuzumab (410), pemetrexed (83), botulinum toxin (71), lapatinib (65), methylphenidate (57), atomoxetine (54), infliximab (49), rotavirus vaccine (45). Eighteen medicines had ≥20 news reports (total 2350 stories); nine of these cost more than AU$10,000 per course or year of treatment. For these 18 medicines, 31% of stories appeared in the six months prior to the PBAC meeting, 14% in the meeting month and 33% in the six months post-meeting. 38% of the stories had ≥3 medicine mentions, 37% referred to the PBS, 24% to cost to the patient, and 9% cost to Government.There was active patient lobby group campaigning in support of listing of infliximab and pemetrexed; the stories for ADHD were often more negative, referring to the dangers of the medicines and sometimes questioning the appropriateness of treatment and public subsidy. There was little discussion of the PBAC's evidence-based decision-making processes.

  Conclusions: While there was no general trend to increased news reporting associated with PBAC meetings, some drugs did attract media attention. With more new and expensive drugs, decisions on public funding will become increasingly difficult. The media have an important role in enhancing public understanding of the issues around resource allocation. Specialist journalists, guidelines and checklists may help reporting.

• Risk factors associated with asbestos-related diseases: a community-based case-control study. M.I. Rosell-Murphy, R. Abós-Herràndiz, J.T. Olivella, et al. 2013;13:723. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos is a first level carcinogen. However, few epidemiological studies analyse the risk and protective factors associated with asbestos-related diseases and follow up these conditions in the general population. Pleural mesothelioma, caused by inhalation of asbestos fibres at work, at home or in the environment, is the most representative asbestos-related disease.The objectives of this study are to analyse the risk and protective factors associated with asbestos-related diseases and to investigate the incidence of new clinical manifestations in patients already diagnosed with some form of ARD.

  Methods/Design: We have designed a matched case-control study with follow up of both cohorts from a population of a health district of the Barcelona province that has been exposed to asbestos for a period of 90 years.

  Discussion: A better understanding of asbestos-related diseases should improve i) the clinical and epidemiological follow up of patients with this condition; ii) the design of new treatment strategies; iii) and the development of preventive activities. At the end of the study, the two cohorts created in this study (affected cases and healthy controls) will constitute the basis for future research.

• Infectious disease risk in asbestos abatement workers. J.H. Lange, G. Mastrangelo, L. Cegolon. 2012;12:665. PubMed · Publisher · Free full text

  Abstract

  Background: The current literature reports increased infectious disease occurrence in various construction occupations, as an important contributor to morbidity and mortality arising from employment.These observations should be expanded to asbestos abatement workers, as the abatement can create an environment favorable for bacterial, viral and fungal infections.

  Discussion: Asbestos abatement work employs activities resulting in cuts, blisters and abrasions to the skin, work in a dirty environment and exposure to dust, mists and fumes.Furthermore, this population exhibits a high smoking rate which increases the risk of chronic obstructive pulmonary disease and respiratory infections.In addition, these workers also commonly employ respirators, which can accumulate dirt and debris magnifying exposure to microbes. Use of respirators and related types of personal protective equipment, especially if shared and in the close environment experienced by workers, may enhance communicability of these agents, including viruses.

  Summary: Abatement workers need to be provided with information on hazards and targeted by appropriate health education to reduce the infection risk. Epidemiological studies to investigate this risk in asbestos removers are recommended.

• Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework. A. Marinaccio, A. Scarselli, E. Merler, et al. 2012;12:314. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases.

  Methods: We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables.

  Results: We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos.

  Conclusions: Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.

• Investigation of occupational and environmental causes of respiratory cancers (ICARE): a multicenter, population-based case-control study in France. D. Luce, I. Stücker, ICARE Study Group. 2011;11:928. PubMed · Publisher · Free full text

  Abstract

  Background: Occupational causes of respiratory cancers need to be further investigated: the role of occupational exposures in the aetiology of head and neck cancers remains largely unknown, and there are still substantial uncertainties for a number of suspected lung carcinogens. The main objective of the study is to examine occupational risk factors for lung and head and neck cancers.

  Methods/Design: ICARE is a multi-center, population-based case-control study, which included a group of 2926 lung cancer cases, a group of 2415 head and neck cancer cases, and a common control group of 3555 subjects. Incident cases were identified in collaboration with cancer registries, in 10 geographical areas. The control group was a random sample of the population of these areas, with a distribution by sex and age comparable to that of the cases, and a distribution by socioeconomic status comparable to that of the population. Subjects were interviewed face to face, using a standardized questionnaire collecting particularly information on tobacco and alcohol consumption, residential history and a detailed description of occupational history. Biological samples were also collected from study subjects. The main occupational exposures of interest are asbestos, man-made mineral fibers, formaldehyde, polycyclic aromatic hydrocarbons, chromium and nickel compounds, arsenic, wood dust, textile dust, solvents, strong acids, cutting fluids, silica, diesel fumes, welding fumes. The complete list of exposures of interest includes more than 60 substances. Occupational exposure assessment will use several complementary methods: case-by-case evaluation of exposure by experts; development and use of algorithms to assess exposure from the questionnaires; application of job-exposure matrices.

  Discussion: The large number of subjects should allow to uncover exposures associated with moderate increase in risks, and to evaluate risks associated with infrequent or widely dispersed exposures. It will be possible to study joint effects of exposure to different occupational risk factors, to examine the interactions between occupational exposures, tobacco smoking, alcohol drinking, and genetic risk factors, and to estimate the proportion of respiratory cancers attributable to occupational exposures in France. In addition, information on many non-occupational risk factors is available, and the study will provide an excellent framework for numerous studies in various fields.

• Osteopontin, asbestos exposure and pleural plaques: a cross-sectional study. G. Mastrangelo, G. Marangi, M.N. Ballarin, et al. 2011;11:220. PubMed · Publisher · Free full text

  Abstract

  Background: Osteopontin (OPN) is a plasma protein/cytokine produced in excess in several malignancies. In a recent study OPN was reported as being related to the duration of asbestos exposure and presence of benign asbestos-related diseases; however, it was unclear whether this protein was an indicator of exposure or effect.

  Methods: In 193 workers, 50 with pleural plaques (PP), in whom different indicators of past asbestos exposure were estimated, OPN plasma levels were assessed using commercial quantitative sandwich enzyme immunoassays according to the manufacturer's instructions.

  Results: Osteopontin increased with increasing age and several aspects of asbestos exposure, without differences related to the presence of pleural plaques. At multivariable regression analysis, the explanatory variables with a significant independent influence on OPN were length of exposure (positive correlation) and time elapsed since last exposure (positive correlation).

  Conclusions: Since asbestos in lung tissue tends to wane over time, OPN should decrease (rather than increase) with time since last exposure. Therefore, OPN cannot be a reliable biomarker of exposure nor effect (presence of pleural plaques).

• CT scan screening is associated with increased distress among subjects of the APExS. C. Paris, M. Maurel, A. Luc, et al. 2010;10:647. PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers.

  Methods: A HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires. In two of the regions, subjects also received a validated psychological scale, namely the psychological consequences questionnaire (PCQ). The physician was required to provide the subject with the results of the HRCT scan at a final visit. A second assessment of psychological consequences was performed 6 months after the HRCT-scan examination (T2). PCQ scores were compared quantitatively (t-test, general linear model) and qualitatively (chi²-test, logistic regression) to screening results. Multivariate analyses were adjusted for gender, age, smoking, asbestos exposure and counseling.

  Results: Among the 832 subjects included in this psychological impact study, HRCT-scan screening was associated with a significant increase of the psychological score 6 months after the examination relative to baseline values (8.31 to 10.08, p < 0.0001, t-test). This increase concerned patients with an abnormal HRCT-scan result, regardless of the abnormalities, but also patients with normal HRCT-scans after adjustment for age, gender, smoking status, asbestos exposure and counseling visit. The greatest increase was observed for pleural plaques (+3.60; 95%CI [+2.15;+5.06]), which are benign lesions. Detection of isolated pulmonary nodules was also associated with a less marked but nevertheless significant increase of distress (+1.88; 95%CI [+0.34;+3.42]). However, analyses based on logistic regressions only showed a close to significant increase of the proportion of subjects with abnormal PCQ scores at T2 for patients with asbestosis (OR = 1.92; 95%CI [0.97-3.81]) or with two or more diseases (OR = 2.04; 95%CI [0.95-4.37]).

  Conclusion: This study suggests that HRCT-scan screening may be associated with increased distress in asbestos-exposed subjects. If confirmed, these results may have consequences for HRCT-scan screening recommendations.

• Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province. M. Rosell-Murphy, R. Abós-Herràndiz, J. Tarrés, et al. 2010;10:203. PubMed · Publisher · Free full text

  Abstract

  Background: Asbestos related diseases include a number of conditions due to inhalation of asbestos fibres at work, at home or in the environment, such as pleural mesothelioma, asbestosis and calcified pleural plaques. Few epidemiological studies have established the incidence of asbestos related diseases in our area. The present proposal is based on a retrospective study externally funded in 2005 that is currently taking place in the same area and largely carried out by the same research team.The aim of the study is to achieve a comprehensive and coordinated detection of all new cases of Asbestos Related Diseases presenting to primary care practitioners.

  Methods/Design: This is a multicentre, multidisciplinary and pluri-institutional prospective study.Setting12 municipalities in the Barcelona province within the catchment area of the health facilities that participate in the study.SampleThis is a population based study, of all patients presenting with diseases caused by asbestos in the study area.MeasurementsA clinical and epidemiological questionnaire will be filled in by the trained researchers after interviewing the patients and examining their clinical reports.

  Discussion: Data on the incidence of the different Asbestos Related Diseases in this area will be obtained and the most plausible exposure source and space-time-patient profile will be described. The study will also improve the standardization of patient management, the coordination between health care institutions and the development of preventive activities related with asbestos exposure and disease.

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