International Journal of Epidemiology

Our medical research library holds 29 studies published in International Journal of Epidemiology (1974–2026). 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. 23 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 2 studies PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Oxford University Press
• Published: 1972 to the present, England
• Language: English
• ISSN: 0300-5771 (print), 1464-3685 (electronic)
• Its record in the NLM Catalog

2020s

• Spatio-temporal trends in pleural mesothelioma mortality in Italy: a 40-year analysis by calendar period and birth cohort. A. Sartore, G. Stoppa, G. Minelli, et al. 2026;55(1). PubMed · Publisher · Free full text

  Abstract

  Background: Italy, among the leading asbestos producers and users until the national ban in 1992, continues to register a high burden of asbestos-related diseases, mainly due to their long latency and delays in remediation. This study investigates the spatio-temporal evolution of pleural mesothelioma (PM) mortality over the past 40 years.

  Materials And Methods: Malignant pleural tumours and PM deaths (1980-2020) were extracted from the national death registry, adjusted for misclassification of pleural tumours, and analysed by region and birth cohort (1905-1984). The analyses by calendar period and cohort, stratified by sex assigned at birth, were followed by a space-cohort Bayesian Hierarchical Model with structured random effects for time (cohorts up to 1960-1969) and space (administrative regions).

  Results: In Italy, from 1980 to 2020, 35 134 people died from PM (24 380 males and 10 754 females). A mortality decrease was observed in males after 2010-14 and in females after 2000-4. Mortality steadily declined in both males and females across cohorts after 1935-44. The space-time analysis enabled the clear identification of the Italian regions most affected by PM.

  Conclusion: Italy's trend mirrors those of other Western countries that have banned asbestos, with the highest risks for birth cohorts in working age before the ban. The results reveal distinct spatio-temporal patterns, with the northern regions exhibiting the highest rates. The Italian experience with asbestos-related diseases detection could help other countries to assess the impact of asbestos, raise awareness, and promote a global ban on asbestos.

  © The Author(s) 2026. Published by Oxford University Press on behalf of the International Epidemiological Association.

• The Wittenoom legacy. A.W.B. Musk, A. Reid, N. Olsen, et al. 2020;49(2):467-476. PubMed · Publisher

  Abstract

  The Wittenoom crocidolite (blue asbestos) mine and mill ceased operating in 1966. The impact of this industry on asbestos-related disease in Western Australia has been immense. Use of the employment records of the Australian Blue Asbestos Company and records of the Wittenoom township residents has permitted two cohorts of people with virtually exclusive exposure to crocidolite to be assembled and studied. Follow-up of these two cohorts has been conducted through data linkage with available hospital, mortality and cancer records. The evolution of asbestos-related disease has been recorded and, with the establishment of exposure measurements, quantitative exposure-response relationships have been estimated. There has been an ongoing epidemic of mortality from lung cancer and malignant mesothelioma and, less so, from asbestosis. Wittenoom crocidolite was used extensively in asbestos-cement products in Western Australia. As a result, the state has recorded a higher malignant-mesothelioma mortality rate than in any other Australian state and in any defined general population in the world. Thus, the legacy of Wittenoom has extended beyond the mine and the town, and is still evident more than 50 years after the closure of the mine.

  © The Author(s) 2019; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

2010s

• Commentary: Asbestos exposure and mesothelioma risk. A. Krupoves. 2018;47(6):1758-1759. Comment PubMed · Publisher

• Commentary: Past and current asbestos exposure and future mesothelioma risks in Britain. B. Terracini. 2018;47(6):1756-1757. Comment PubMed · Publisher

• Impact of low-dose computed tomography screening on lung cancer mortality among asbestos-exposed workers. F. Barbone, F. Barbiero, O. Belvedere, et al. 2018;47(6):1981-1991. PubMed · Publisher

  Abstract

  Background: We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population.

  Methods: Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities.

  Results: A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population.

  Conclusions: In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.

• Past and current asbestos exposure and future mesothelioma risks in Britain: The Inhaled Particles Study (TIPS). C. Gilham, C. Rake, J. Hodgson, et al. 2018;47(6):1745-1756. PubMed · Publisher · Free full text

  Abstract

  Background: Occupational and environmental airborne asbestos concentrations are too low and variable for lifetime exposures to be estimated reliably, and building workers and occupants may suffer higher exposure when asbestos in older buildings is disturbed or removed. Mesothelioma risks from current asbestos exposures are therefore not known.

  Methods: We interviewed and measured asbestos levels in lung samples from 257 patients treated for pneumothorax and 262 with resected lung cancer, recruited in England and Wales. Average lung burdens in British birth cohorts from 1940 to 1992 were estimated for asbestos-exposed workers and the general population.

  Results: Regression analysis of British mesothelioma death rates and average lung burdens in birth cohorts born before 1965 suggests a lifetime mesothelioma risk of approximately 0.01% per fibre/mg of amphiboles in the lung. In those born since 1965, the average lung burden is ∼1 fibre/mg among those with no occupational exposure.

  Conclusions: The average lifetime mesothelioma risk caused by recent environmental asbestos exposure in Britain will be about 1 in 10 000. The risk is an order of magnitude higher in a subgroup of exposed workers and probably in occupants in the most contaminated buildings. Further data are needed to discover whether asbestos still present in buildings, particularly schools, is a persistent or decreasing hazard to workers who disturb it and to the general population, and whether environmental exposure occurs predominantly in childhood or after beginning work. Similar studies are needed in other countries to estimate continuing environmental and occupational mesothelioma hazards worldwide, including the contribution from chrysotile.

• Asbestos and product defence science. B. Terracini, D. Mirabelli. 2016;45(3):614-8. Editorial PubMed · Publisher

  Summary

  In this editorial, the authors discussed 'product defence science' in relation to asbestos. They defined it as research whose goal is not scientific knowledge but influencing policy decisions on an industrial product. They noted that in 2015 the Collegium Ramazzini issued three statements on chrysotile, the only form of asbestos still in use, and that 2 million tons of asbestos are used annually, mostly in low- and middle-income countries. The authors argued that a 2012 review concluding that stopping exposure does not materially modify mesothelioma risk had selected findings and ignored duration and cumulative exposure. They reported that it was accepted five days after submission and used by the defence in an Italian criminal trial. A 2015 corrigendum corrected its conflict-of-interest statement and disclaimed funding from the Italian Association for Cancer Research. They reported that a Medline search (1 March 2016) for 'controlled use' and 'asbestos' gave 18 references that did not clarify the term. They also stated that, to their knowledge, no thorough 'controlled use' programme had been implemented and evaluated in any country. They criticised claims that chrysotile is harmless or that lung fibre burden data disprove its carcinogenicity. They concluded that conflict-of-interest statements and standard peer review had proven insufficient, and they called for resources to monitor and respond to biased publications. They warned that trade agreements such as TTIP could be used to challenge health regulations.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Asbestos and product defence science. Response to: Boffetta and La Vecchia. B. Terracini, D. Mirabelli. 2016;45(5):1692-1693. Letter · Comment PubMed · Publisher

• Re: Asbestos and product defence science. P. Boffetta, C. La Vecchia. 2016;45(5):1690-1691. Letter · Comment PubMed · Publisher

• Impact of occupational carcinogens on lung cancer risk in a general population. S. De Matteis, D. Consonni, J.H. Lubin, et al. 2012;41(3):711-21. PubMed · Publisher · Free full text

  Abstract

  Background: Exposure to occupational carcinogens is an important preventable cause of lung cancer. Most of the previous studies were in highly exposed industrial cohorts. Our aim was to quantify lung cancer burden attributable to occupational carcinogens in a general population.

  Methods: We applied a new job-exposure matrix (JEM) to translate lifetime work histories, collected by personal interview and coded into standard job titles, into never, low and high exposure levels for six known/suspected occupational lung carcinogens in the Environment and Genetics in Lung cancer Etiology (EAGLE) population-based case-control study, conducted in Lombardy region, Italy, in 2002-05. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in men (1537 cases and 1617 controls), by logistic regression adjusted for potential confounders, including smoking and co-exposure to JEM carcinogens. The population attributable fraction (PAF) was estimated as impact measure.

  Results: Men showed an increased lung cancer risk even at low exposure to asbestos (OR: 1.76; 95% CI: 1.42-2.18), crystalline silica (OR: 1.31; 95% CI: 1.00-1.71) and nickel-chromium (OR: 1.18; 95% CI: 0.90-1.53); risk increased with exposure level. For polycyclic aromatic hydrocarbons, an increased risk (OR: 1.64; 95% CI: 0.99-2.70) was found only for high exposures. The PAFs for any exposure to asbestos, silica and nickel-chromium were 18.1, 5.7 and 7.0%, respectively, equivalent to an overall PAF of 22.5% (95% CI: 14.1-30.0). This corresponds to about 1016 (95% CI: 637-1355) male lung cancer cases/year in Lombardy.

  Conclusions: These findings support the substantial role of selected occupational carcinogens on lung cancer burden, even at low exposures, in a general population.

2000s

• Educational differences in lung cancer mortality in male smokers. P. Martikainen, E. Lahelma, S. Ripatti, et al. 2001;30(2):264-7. Randomized trial PubMed · Publisher

  Abstract

  Background: To assess the extent of lung cancer mortality differentials by education while adjusting for exposure to tobacco smoke and asbestos based on survey questions.

  Methods: Alpha-Tocopherol, Beta Carotene Cancer Prevention (ATBC) Study of 50-69-year-old Finnish male smokers enrolled 1985-1988. These analyses are based on the placebo group and the alpha-tocopherol supplementation group, altogether 14 011 men, with full information on tobacco smoking. Mortality follow-up was to the end of April 1993 and it was based on the complete death certificate register of the Statistics Finland.

  Results: Lung cancer mortality of basic-educated men was 32% (rate ratio [RR] = 1.32; 95% CI : 0.93-1.87) higher than that of better-educated men in the ATBC Study. The excess is practically unchanged when additional adjustment was made for age at initiation, duration of smoking, current smoking at baseline and at first follow-up, smoke inhalation, occupational exposure to asbestos and interactions between asbestos exposure and all smoking variables. This excess mortality was about 40% of the similar excess observed in the general population of men of similar age.

  Conclusions: Educational differences in lung cancer mortality in the total Finnish population are likely to be mainly caused by differences in exposure, particularly to active smoking. Further understanding of the determinants and consequences of socioeconomic differences in smoking behaviour are of major scientific and public health importance.

• Occupational risk factors for renal cell carcinoma: agent-specific results from a case-control study in Germany. MURC Study Group. Multicenter urothelial and renal cancer study. B. Pesch, J. Haerting, U. Ranft, et al. 2000;29(6):1014-24. PubMed · Publisher

  Abstract

  Background: This case-control study was conducted to estimate the renal cell cancer (RCC) risk for exposure to occupation-related agents, besides other suspected risk factors.

  Methods: In a population-based multicentre study, 935 incident RCC cases and 4298 controls matched for region, sex, and age were interviewed between 1991 and 1995 for their occupational history and lifestyle habits. Agent-specific exposure was expert-rated with two job-exposure matrices and a job task-exposure matrix. Conditional logistic regression was used to calculate smoking adjusted odds ratios (OR).

  Results: Very long exposures in the chemical, rubber, and printing industries were associated with risk for RCC. Males considered as 'substantially exposed to organic solvents' showed a significant excess risk (OR = 1.6, 95% CI : 1.1-2.3). In females substantial exposure to solvents was also a significant risk factor (OR = 2.1, 95% CI : 1.0-4.4). Excess risks were shown for high exposure to cadmium (OR = 1.4, 95% CI : 1.1-1.8, in men, OR = 2.5, 95% CI : 1.2-5.3 in women), for substantial exposure to lead (OR = 1.5, 95% CI : 1.0-2.3, in men, OR = 2.6, 95% CI : 1.2-5.5, in women) and to solder fumes (OR = 1.5, 95% CI : 1.0-2.4, in men). In females, an excess risk for the task 'soldering, welding, milling' was found (OR = 3.0, 95% CI : 1.1-7.8). Exposure to paints, mineral oils, cutting fluids, benzene, polycyclic aromatic hydrocarbons, and asbestos showed an association with RCC development.

  Conclusions: Our results indicate that substantial exposure to metals and solvents may be nephrocarcinogenic. There is evidence for a gender-specific susceptibility of the kidneys.

1990s

• Occupational risk factors for mortality from stomach and lung cancer among rubber workers: an analysis using internal controls and refined exposure assessment. K. Straif, L. Chambless, S.K. Weiland, et al. 1999;28(6):1037-43. PubMed · Publisher

  Abstract

  Objectives: To determine occupational risk factors for stomach and lung cancer among workers in the German rubber industry.

  Methods: A cohort of all male German rubber workers (n = 11,633) who had been employed for at least one year in one of five study plants and who were alive and actively employed or retired on 1 January 1981 was followed for mortality from 1 January 1981 through December 1991. A subcohort of n = 8,933 workers who were hired after 1 January 1950 was defined to focus on working conditions in the more recent rubber industry. Work histories were reconstructed using routinely documented 'cost centre codes' and classified into six work areas as well as subgroups of some work areas. The work areas are: 1. preparation of materials, 2. production of technical rubber goods, 3. production of tyres, 4. storage and dispatch, 5. maintenance, 6. others. Standardized mortality ratios (SMR) and Cox proportional hazards models were calculated for each of the work areas (>1 year of employment in the respective work area). Hazard rate ratios were adjusted for age (time marker) and stratified for year of hire (1950-1959, > or =1960) and years of employment in the respective work area (1-9 years, > or =10 years); years of employment were lagged 10 years to account for latency.

  Results: Compared to the national reference population mortality from cancer of stomach (observed 44, SMR = 117; 95% CI: 85-157) and lung (observed 154, SMR = 123; 95% CI: 104-144) was slightly increased. Using internal controls we observed excess deaths from stomach cancer in work area 1 (relative risk [RR] = 2.3; 95% CI: 1.2-4.2) and from lung cancer in work areas 1 (RR = 1.7; 95% CI: 1.2-2.3), 2 (RR = 1.5; 95% CI: 1.1-2.1), and 3 (RR = 1.3; 95% CI: 0.9-1.8). On the basis of cumulative years of employment an exposure response relationship was observed for mortality from both cancer sites among a subcategory of work area 1: weighing and mixing. Increased risks were also seen for lung cancer among workers employed in production of technical rubber goods.

  Conclusion: Our results support an association between an excess mortality from stomach and lung cancer and employment in early production stages of rubber manufacturing, especially weighing and mixing. This may point to an aetiologic role of asbestos or carbon black. For stomach cancer additional risk factors, e.g. exposure to dust and talc, deserve further investigation. The results of the present study do not support a causal role of nitrosamines for stomach or lung cancer.

• Occupational risk factors for lung cancer: a case-control study in West Germany. K.H. Jöckel, W. Ahrens, I. Jahn, et al. 1998;27(4):549-60. PubMed · Publisher

  Abstract

  Background: The aim of this study is to evaluate carcinogens and occupations suspected to cause lung cancer and to generate new hypotheses about occupational risks.

  Methods: In a hospital-based study 1004 incident lung cancer cases and the same number of population controls matched for region, sex and age were interviewed between 1988 and 1993 for their smoking and occupational history. Exposure assessment was based on 33 job-specific supplementary questionnaires. Conditional logistic regression was used to calculate odds ratios (OR) and to control for smoking and occupational asbestos exposure.

  Results: Lifelong prevalence of exposure to asbestos was 20.5% for exposure of more than 940 lifetime working hours among controls, corresponding to an OR of 1.62 (95% confidence interval [CI] : 1.28-2.05) that was reduced to 1.45 after adjustment for smoking (P < 5%). Statistically elevated risks after adjustment for smoking and asbestos were seen in metal production and processing workers, transportation workers and freight handlers, in the rubber and plastics industry, in metal production, in engine and vehicle building, and installation. Significantly increased OR after adjustment for smoking and asbestos that deserve further attention were seen in plastics processing workers (OR = 3.49), and sheet and structural metal workers (OR = 2.01 and 2.37, respectively).

  Conclusions: The results of the study confirm previously described occupational risks. Because of the possibility of controlling for occupational asbestos exposure, the study gives clear indications for prevention and further research.

• Urban-rural differences in cancer incidence in The Netherlands 1989-1991. L.J. Schouten, H. Meijer, J.A. Huveneers, et al. 1996;25(4):729-36. PubMed · Publisher

  Abstract

  Background: Differences in cancer incidence have been observed between urban and rural communities for many decades. These differences have been attributed for the most part to lifestyle aspects. In Western populations, however, differences in lifestyle have diminished. This study addressed the question: For which cancer sites can differences in cancer occurrence still be demonstrated between urban and rural communities in the Netherlands?

  Methods: Cancer incidence data from 1989 to 1991 inclusive, were obtained from the Netherlands Cancer Registry. Age-adjusted, site-specific incidence rates were calculated for five classes of municipalities classified by address density.

  Results: With increasing urbanization, slightly higher incidence rates were observed for all cancer sites combined (rate ratio [RR] = 1.08 in males and 1.12 in females). Statistically significant RR of > 1.4 were observed for Kaposi's sarcoma (m), mesothelioma (m), cancer of the liver (m), mouth/pharynx (m + f), oesophagus (f), larynx (f), lung (f), other respiratory organs (f), cervix (f) and Hodgkin's disease (m). Significantly lower incidence rates were found in urban areas for non-melanoma skin (m + f) and lip cancer (m).

  Conclusions: In males, the urban excess of tobacco-related cancer has largely disappeared. However, urban-rural differences in cancer incidence still exist for other cancer sites and for tobacco-related cancer in females. Apparently, differences in the prevalence of lifestyle factors are still large enough to cause variation in cancer incidence.

• Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices. W. Ahrens, K.H. Jöckel, P. Brochard, et al. 1993;22 Suppl 2:S83-95. PubMed · Publisher

  Abstract

  Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S83-S95. In a lung cancer study in Northern Germany the asbestos exposure assessment obtained from detailed supplementary questionnaires (SQ) was compared to the assessment obtained by the application of two job exposure matrices (JEM) to the job history. The study includes 391 incident male cases and the same number of controls from the general population, matched by sex, age, and region. Almost 16% of the subjects are considered as never having been exposed to asbestos and 24% are classified as certainly exposed according to both of the JEM, the corresponding percentages of the SQ-method being 68% and 32%. Sixty percent are considered by the JEM as having an intermediate probability of exposure. In general, the agreement between the different methods is better when the exposure definition is restricted to definite exposures, the corresponding Kappa statistic being 0.67 for the comparison between both JEM and 0.44/0.39 between the JEM and the SQ. The positive agreement between SQ and JEM (reference) increases from 12% and 17% for subjects with low probability of exposure to 61% and 69% for those with definite exposures. A ranking according to cumulative exposure shows some dose-response relationship for each of the three methods with a smoking-adjusted OR in the highest category of 1.85 (95% CI: 1.01-3.38) for the SQ method and 2.47 (95% CI: 1.40-4.37) and 2.94 (95% CI: 1.73-4.99) for the two JEM. The results are discussed with reference to the conceptual differences between the methods and their potential scope in future studies.

• Retrospective assessment of asbestos exposure--II. At the job level: complementarity of job-specific questionnaire and job exposure matrices. E. Orlowski, H. Pohlabeln, F. Berrino, et al. 1993;22 Suppl 2:S96-105. PubMed · Publisher

  Abstract

  Retrospective assessment of asbestos exposure--II. At the job level: Complementarity of job-specific questionnaire and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S96-S105. The assessments of asbestos exposure by two a priori job exposure matrices (JEM) and by a job-specific questionnaire (SQ) are compared at job level. The data used for the comparison were generated by an ongoing case-control study on lung cancer in a region of northern Germany with a relatively high past prevalence of asbestos exposure. Among job periods assessed as unexposed by either JEM, 96% are recognized as such by the SQ. Discrepancies between the SQ and JEM were observed in jobs rated potentially exposed by the JEM. Despite varying estimates, the JEM and SQ were consistent as regards the relative classification of job periods by probability of exposure. The concordance of the methods, estimated by Kappa statistics, was stronger for the two JEM than for either of the JEM and the SQ. The identification of specific occupation/industry combinations in which discrepancies were most frequent and the comparison with expert ratings in some jobs yield insights into the sources of the disagreement between the methods. The misclassification of exposure by the JEM usually results in an overestimation of exposure. This is essentially related to loss of information due to the use of job codes as surrogates for job task descriptions and to the insufficiency of published data on asbestos exposure in different industries. As regards the SQ, two main sources of potential loss of sensitivity were identified: 1) possible omission of indirect sources of exposure by this method, 2) possible incompleteness of the SQ. The present comparison of methods of asbestos exposure assessment does not allow any one approach to be considered superior to another. Indeed, as proposed by Ahrens et al. in Part I of the study, both should be used to ensure optimal epidemiological performance.

• The risk of lung cancer from asbestos among Swedish construction workers: self-reported exposure and a job exposure matrix compared. A.C. Fletcher, G. Engholm, A. Englund. 1993;22 Suppl 2:S29-35. PubMed · Publisher

  Abstract

  A total of 719 lung cancers were identified in a follow-up of 135,000 Swedish construction workers interviewed during 1971-1974 by occupational health nurses as part of a routine health check-up. These were analysed in a matched case-control study nested within this cohort, to compare different methods of characterizing exposure to asbestos. Self-reported exposure was contrasted with a job exposure matrix (JEM) of five levels of exposure intensity, applied to the job at the time of health check-up. Smoking adjusted odds ratios were computed and the JEM performed better than self-reported exposure, in being able to discriminate high risk subgroups. The same pattern was evident in a parallel analysis of 41 mesotheliomas. However both measures appeared subject to misclassification, and the question put seemed to pick up the use of asbestos cement products more effectively than asbestos insulation products. It is concluded that a simple JEM can be more reliable than a simple question, but that both should be much more detailed, to take account of different types of asbestos exposure and their variation over time.

  In plain English

  This study followed 135 000 Swedish construction workers given health check-ups in 1971-1974, tracking cancers to the end of 1987. Within this group, researchers compared 719 workers who developed lung cancer, and 41 with pleural mesothelioma, with matched workers who did not. Asbestos exposure was measured two ways. One was workers' own yes/no answer to a question focused largely on asbestos cement sheets. The other was a job exposure matrix rating each worker's current job by likely exposure intensity. Pleural mesothelioma was more common than expected from Swedish national rates (standardized incidence ratio 1.60, 95% CI 1.13-2.20, 41 cases). For lung cancer, the second-highest job rating had a smoking-adjusted odds ratio of 2.18 (95% CI 1.20-3.98). Self-reports showed no association with lung cancer (odds ratio 0.81, 95% CI 0.62-1.04). The authors suggested this seemed to reflect woodworkers who reported exposure, who had lower lung cancer risk. Mesothelioma results followed a similar pattern, but none was statistically significant. The authors concluded that the job matrix performed better than the simple question. They also concluded that both appeared subject to misclassification and should be more detailed.

  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.

• Pleural plaques and exposure to asbestos: a mathematical model. B. Järvholm. 1992;21(6):1180-4. PubMed · Publisher

  Abstract

  The objective of this study was to find a model to describe the relationship between the occurrence of pleural plaques and exposure to asbestos. A simple model based on the cumulative exposure was postulated and empirically tested on shipyard workers occupationally exposed to asbestos. Exposure time was used to approximate the cumulative dose. It was found that the incidence of pleural plaques could be described as K(t-w)a where 't' is time since onset of exposure; 'K' is a constant that would depend on the level of asbestos exposure; 'w' is a latency period and was around 13 years; 'a' is a constant that was 0.4. In subgroups of the workers, i.e. plumbers, fitters and platers, 'a' was 0.4, 0.6 and 0.2 respectively.

• Environmental contaminants and low-level cancer risks: perceptions and scientific strategies. M.D. Lebowitz. 1990;19 Suppl 1:S11-3. PubMed · Publisher

  Abstract

  Scientific and public perceptions concerning low-level lung cancer risks may vary. Recently the public has been more convinced of causal links between low-level risk agents and cancer, and more interested in prevention of environmental exposures, especially those induced by others. Thus, scientific strategy is partly driven by the public need to resolve issues concerning the importance of low-level exposures and risks. Further, investigators have been challenged intellectually to create methodologies in order to study some of these relationships further, and scientific curiosity has been stimulated by the difficulties of pursuing such investigations. The importance of host characteristics, including the genetic bases of susceptibility, has become a major theme. Likewise, host behaviour has become a potential positive factor (e.g. diet) as well as a negative factor in the risk model for low-level agents. This paper discusses some of the information available on low-level agents and some of the methodological issues involved in studying them. The importance of measuring exposure as well as response is stressed, especially multi-pollutant exposures and interactions with host behaviour.

• Occupation and the risk of bladder cancer. C. la Vecchia, E. Negri, B. D'Avanzo, et al. 1990;19(2):264-8. PubMed · Publisher

  Abstract

  The relationship between bladder cancer, occupation and exposure to a number of occupational agents was assessed in a case-control study conducted in the greater Milan area, Northern Italy. The case series consisted of 263 cases (219 males, 44 females) with histologically confirmed invasive bladder cancer, admitted to a network including major teaching and general hospitals in the area under surveillance. The controls were 287 patients (210 males, 77 females), admitted for acute, non-neoplastic or urinary tract diseases to the same network of hospitals. Cases more frequently reported occupation in dyestuff production (relative risk (RR) = 4.6), painting/spraying work (RR = 1.8), chemical industry (RR = 1.7), pharmaceuticals (RR = 1.7) and coal/gas production (RR = 3.1). Only for dyestuff production however, was the excess statistically significant. There was no association with agriculture or related activities, rubber manufacturing, printing, the petroleum industry, food processing and mechanics. In relation to exposure to occupational agents, significant positive trends in risk were observed for dyes/paints (RR = 4.8 for greater than ten years of exposure), herbicides (RR = 4.1), chemicals (RR = 2.4) and gases/fumes (RR = 4.8). No association was found with metals or metal dusts, plastic resins or glues, oil, wood dust, solvents or benzene, asbestos, electricity or radar and coal tar. Besides confirming the well known association between bladder cancer risk and dyestuff production and, to a lesser extent, a wide spectrum of chemical-related activities, this study provides statistically significant evidence of an independent role of herbicides on the risk of bladder cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

• Protective dietary factors and lung cancer. E.T. Fontham. 1990;19 Suppl 1:S32-42. Review PubMed · Publisher

  Abstract

  Since the first report of a protective effect of dietary vitamin A on lung cancer risk was issued in 1975, a succession of retrospective (case-control) and prospective (cohort) epidemiological studies have examined the association. Food frequency questionnaires have been used to assess dietary intake of food groups and to generate indices of specific dietary components, in particular retinol and carotene. Serum levels of retinol, carotenoids, and other micronutrients have been determined as well, and related to risk of lung cancer. The dietary studies have been notably consistent, finding an approximate 50% reduction in risk associated with high compared to low consumption of carotene-containing fruits and vegetables. Unresolved issues include gender differences, histological specificity and the interaction with cigarette smoking as well as the role of other possible protective factors found in these foods--indoles, vitamin C, trace minerals. Most studies in which serum beta-carotene was assayed in prospectively collected blood samples have found lower levels of beta-carotene in people who subsequently developed lung cancer. Unlike carotene, blood retinol levels do not reflect dietary intake under normal conditions and, as might be expected, have failed to show a consistent relation with risk of lung cancer. Although epidemiological studies have not strongly supported the role of preformed retinol as a protective agent, animal studies have provided convincing evidence that retinol and synthetic retinoids are protective against epithelial tumours including those of the lung. A number of on-going clinical trials are testing the efficacy of retinol, beta-carotene, synthetic retinoids and alpha-tocopherol for preventing cancer of the lung, especially in high risk groups such as heavy smokers, miners and asbestos workers. It is hoped that these trials will help explain the nature of the observed protective effect of fruit and vegetables.

1980s

• Analytical implications of epidemiological concepts of interaction. N. Pearce. 1989;18(4):976-80. PubMed · Publisher

  Abstract

  In contrast to definitions based on statistical or biological concepts, Rothman has adopted an unambiguous epidemiological definition of interaction in which two factors are not 'independent' if they are component causes in the same sufficient cause. This leads to the adoption of additivity of incidence rates as the state of 'no interaction'. However, there are other considerations which generally favour the use of multiplicative models. This implies an apparent dilemma as to how an analysis can be conducted which combines the advantages of ratio measures of effect with the assessment of independence in terms of a departure from additivity. These apparently contradictory goals can be reconciled through the analysis of separate and joint effects. This approach is discussed with reference to studies of asbestos exposure, cigarette smoking and lung cancer.

• Incidence density matching with a simple SAS computer program. N. Pearce. 1989;18(4):981-4. PubMed · Publisher

  Abstract

  Incidence density matching is the method of choice for selecting controls in nested case-control studies, but its use has been limited by its computational complexity. We describe incidence density matching in nested case-control studies with a simple and flexible SAS computer program. The program contains no restrictions on the number of matching factors, although it is usually only necessary to match on age (in incidence density fashion) and on gender. The program is illustrated with data from an historical cohort study of the mortality experience of workers at an asbestos textile manufacturing plant.

• Mesothelioma in South Africa, 1976-84: incidence and case characteristics. A.B. Zwi, G. Reid, S.P. Landau, et al. 1989;18(2):320-9. PubMed · Publisher

  Abstract

  Malignant mesothelioma is a rare tumour known to be associated with prior exposure to asbestos. Previous studies have described the occupational and clinical features of cases of mesothelioma in the Republic of South Africa (RSA) but none has set out to determine incidence of this disease. To estimate incidence, a case register was compiled for 1976-84 by contacting all medical practitioners and institutions likely to have seen cases of mesothelioma in this period; demographic, diagnostic and exposure details were sought. Cases were accepted if they provided evidence of histological diagnosis of mesothelioma. Fifty-two per cent of 1347 cases identified were in whites, 31% in blacks, 16% in coloureds and 1% in Asians. Seventy-three per cent of cases occurred in males. The majority of whites were aged 51-70 years, while the majority in other race groups were aged 41-60 years. The ratio of only pleural to only peritoneal mesothelioma was 11:1, although there were marked differences by race. Eighty-five per cent of males with exposure information available had prior exposure to asbestos, mostly occupational. A similar proportion of women had contact with asbestos but mostly through other types of exposure. Standardized incidence rates per million population aged 15 years and over were calculated for sex-race subgroups and were highest in white males (32.9 per million per year, 95% Cl 22.7-46.4), coloured males (24.8 per million per year, 95% Cl 16.2-36.9) and coloured females (13.9 per million per year, 95% Cl 7.7-23.5). These incidence rates are amongst the highest ever reported for a national population. Age-specific standardized incidence rates were highest in white males (over 100 per million per year in men over 55 years). Reasons for the differing rates by population group are likely to include differential access to health services. More rigorous control of asbestos exposure in the RSA is recommended.

• Estimating the potential disease rate reduction under varying conditions of combined effects. H. Checkoway, J.L. Hickey. 1988;17(3):666-72. PubMed · Publisher

  Abstract

  The disease rate difference between people exposed and not exposed to some factor is the familiar estimate of attributable risk. When there are two or more causal exposures which demonstrate joint effects and are independently distributed, partitioning a population's overall rate between factors requires estimates of the marginal distributions of exposures and the independent (unconditional) and combined rate ratios for each exposure factor. The net potential reduction in the overall disease rate resulting from elimination of one of the exposures depends on these parameters and on the model of combined effect assumed, additive, multiplicative or some departure therefrom. In this paper the authors illustrate the extent to which the assumed model of combined effect of exposures determines which parameters need to be specified to estimate disease rate reductions. The concepts presented are demonstrated algebraically and with simulated hypothetical data. An application of the method is given with data from a case-control study of smoking, asbestos exposure and lung cancer.

• Multistage modelling of lung cancer mortality in asbestos textile workers. N. Pearce. 1988;17(4):747-52. PubMed · Publisher

  Abstract

  The Armitage-Doll multistage model of cancer is applied to data from a cohort study of lung cancer in 1261 white male workers from one asbestos textile manufacturing plant. Three approaches are used: induction time analysis; analysis of the relationship of the excess incidence rate to age at first exposure and time since first exposure; and direct fitting of the Armitage-Doll model. Poisson regression was used for all analyses. The induction time analysis was conducted using Rothman's 'window of exposure' method. This suggested that the increase in rate ratio was primarily due to exposures occurring 15-24 years previously, whereas there was little effect from exposures occurring 0-14 or 25+ years previously. The excess incidence rate increased both with age at first exposure and time since first exposure, suggesting that asbestos acted at a stage intermediate between the first and penultimate stages. Direct fitting of the Armitage-Doll model suggested that the best fit was obtained by assuming that asbestos acts at stage 3, 4 or 5 of a six-stage process. Most analyses of the type presented here are unable to determine at which stage a carcinogen acts, due to the small numbers of cancer deaths occurring in typical occupational cohorts. Furthermore, there is reason to doubt the validity of the Armitage-Doll model. However, such analyses can at least suggest whether a carcinogen appears to act at an early, intermediate or late stage, and the general statistical methods applied here will retain their usefulness as further models are developed and larger data sets become available.

• Cancer in a factory using amosite asbestos. E.D. Acheson, M.J. Gardner, P.D. Winter, et al. 1984;13(1):3-10. PubMed · Publisher

  Abstract

  The paper describes the mortality experience of 5969 men employed in a factory where insulation board was manufactured using amosite asbestos from 1947 to 1979. 422 (7%) of the men were known to have died by the end of 1980. Among the 4820 men engaged in the manufacture of insulation board a doubling of the risk of lung cancer has occurred (57 deaths observed; 29 deaths expected). An excess is present both in men who entered the factory before and after 1960. Among the 2461 for whom smoking information is available a detectable excess risk is limited to current smokers exposed to higher levels of asbestos. Apart from five deaths from mesothelioma no statistically large or significant excesses of mortality from cancers of other sites have occurred, but further follow-up of the cohort is in progress. Nine deaths from asbestosis have been recorded. The results are discussed in the light of other studies of the effects of exposure to amosite asbestos.

1970s

• Ethnic differences in lung function: evidence for proportional differences. C.E. Rossiter, H. Weill. 1974;3(1):55-61. PubMed · Publisher

  Abstract

  In a group of 244 male low-exposure asbestos cement workers without major clinical symptoms or radiographic changes, marked ethnic differences were found in the relations of lung function to age and height There is anthropometric evidence that for given height whites, of European descent, have a 13.2 per cent larger chest volume at full inspiration than blacks, of African descent and this accounts almost completely for the differences in total lung capacity, vital capacity, forced vital capacity, forced expiratory volume, forced expiratory flow rate and alveolar volume between blacks and whites. Smaller differences occur for functional residual capacity, residual volume, diffusing capacity (transfer factor) and the diffusion constant. It is proposed that until further evidence is forthcoming, for normal values a scaling factor of 1.132 should be used for the major lung volumes to account for the ethnic differences between Africans and Europeans. Smaller scaling factors are proposed for other lung function indices.

  PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

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