Lung Cancer Mortality Trends in a Brazilian City with a Long History of Asbestos Consumption

Our plain-English summary of Lung Cancer Mortality Trends in a Brazilian City with a Long History of Asbestos Consumption, by G.A. Fernandes, E. Algranti, G.M.S. Conceição, et al (International Journal of Environmental Research and Public Health, 2019).

The study

• Authors: G.A. Fernandes, E. Algranti, G.M.S. Conceição, V. Wünsch Filho, T.N. Toporcov
• Journal: International Journal of Environmental Research and Public Health
• Published: 2019;16(14)
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

There are scarce epidemiological studies on lung cancer mortality in areas exposed to asbestos in developing countries. We compared the rates and trends in mortality from lung cancer between 1980 and 2016 in a municipality that made extensive use of asbestos, Osasco, with rates from a referent municipality with lower asbestos exposure and with the rates for the State of São Paulo. We retrieved death records for cases of lung cancer (ICD-9 C162) (ICD-10 C33 C34) from 1980 to 2016 in adults aged 60 years and older. The join point regression and age-period-cohort models were fitted to the data. Among men, there was an increasing trend in lung cancer mortality in Osasco of 0.7% (CI: 0.1; 1.3) in contrast to a mean annual decrease for Sorocaba of -1.5% (CI: -2.4; -0.6) and a stable average trend for São Paulo of -0.1 (IC: -0.3; 0.1). Similar increasing trends were seen in women. The age-period-cohort model showed an increase in the risk of death from 1996 in Osasco and a reduction for Sorocaba and São Paulo State during the same period. Our results point to a need for a special monitoring regarding lung cancer incidence and mortality in areas with higher asbestos exposure.

In plain English

This ecological study compared deaths from trachea, bronchus and lung cancer among people aged 60 and older in three areas of São Paulo State, Brazil, from 1980 to 2016. The areas were Osasco, which housed a large asbestos-cement plant for more than 50 years; Sorocaba, a similar city with much less asbestos use; and the whole State. Among men, age-standardized death rates rose an average of 0.7% a year in Osasco (confidence interval 0.1 to 1.3). They fell 1.5% a year in Sorocaba (minus 2.4 to minus 0.6) and were stable in the State (minus 0.1%; minus 0.3 to 0.1). A second analysis showed rising risk for Osasco men in most periods from 1996, unlike elsewhere. Among women, trends were upward in all three areas, statistically significant only in Osasco and the State. The authors concluded there was evidence of increased lung cancer death risk among Osasco men, and possibly in cities exposed to asbestos, especially chrysotile. They had no local smoking data and could not link deaths to any individual's exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Ecological study of death records and population estimates, using trend (joinpoint) analysis and age-period-cohort models
• Who was studied: Deaths from trachea, bronchus and lung cancer among adults aged 60 and older, 1980 to 2016. Osasco had 967 deaths in men and 444 in women; Sorocaba had 905 and 399; the State of São Paulo had 73,308 and 33,406.
• Exposure: Exposure was measured only by place of residence. Osasco housed the largest asbestos-cement plant in Latin America for more than 50 years, with an estimated 10,700 employees in asbestos-cement plants between 1941 and 1994. Sorocaba had much less asbestos consumption, from one large and two small brake and clutch lining plants. Most asbestos used in Brazil was chrysotile. No individual exposure was measured.
• Main results:
  • Men, 1980 to 2016, average annual change in age-standardized death rates: Osasco increased 0.7% (CI 0.1 to 1.3); Sorocaba decreased 1.5% (CI minus 2.4 to minus 0.6); State of São Paulo stable at minus 0.1% (CI minus 0.3 to 0.1).
  • Men: the highest age-standardized rate was in Sorocaba in 1980–84 (168.50) and in Osasco in 2012–2016 (150.54). Osasco went from 138.47 to 150.54; Sorocaba from 168.50 to 106.9; the State from 132.09 to 129.01.
  • Men: rates rose in all locations early in the period, peaked at the end of the 1990s and then fell. The fall was smaller in Osasco, whose rates surpassed those of Sorocaba and the State.
  • Age-period-cohort analysis, older men in Osasco: death rates rose between 1996 and 2015, except for a decrease in 2006–2010.
  • Age-period-cohort analysis, older men elsewhere: risk fell in Sorocaba. In the State it was stable in 1996–2000 and 2001–2005, then fell in 2006–2010.
  • Men: the highest rates occurred in similar birth cohorts everywhere: born 1916 to 1935 in Osasco, 1926 to 1940 in Sorocaba, and 1921 to 1940 in the State.
  • Women in Osasco: average annual increase of 4.7% (2.9 to 6.5), 1980 to 2016, statistically significant.
  • Women in Sorocaba: average annual change of 1.5% (minus 0.9 to 3.9), not statistically significant.
  • Women in the State of São Paulo: average annual increase of 2.2% (1.9 to 2.5), statistically significant.
  • Women: the authors described similar rising trends in all three areas, with a slightly higher increase in Osasco.
  • Women: age-period-cohort analysis showed similar increases in all locations for cohorts born after 1940 and for periods after 2000.
• The authors' conclusion: The authors concluded there was evidence of an increased risk of death from tracheal, bronchial and lung cancer in males, specifically in Osasco. They said their study points to the possibility of increased lung cancer mortality in cities exposed to asbestos, especially chrysotile.
• Limitations the authors state:
  • There were no data on tobacco smoking or air pollution for Osasco, Sorocaba or the State.
  • The authors assumed that smoking trends were the same across the locations and similar to those of São Paulo City.
  • Mesothelioma deaths could not be analyzed because there were too few cases in the study areas.
  • As an ecological study, it cannot show whether the people who died of lung cancer were the ones exposed to the risk factors.
  • Small numbers of cases in Osasco and Sorocaba may explain larger swings in their rates compared with the whole State.

Topics

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

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

Related studies

• The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil — E. Algranti, C.A. Saito, et al. (2015)
• Asbestos and mesothelioma: worldwide trends — L. Kazan-Allen (2005)
• Lung cancer in Brazil — E. Algranti, A.M. Menezes, et al. (2001)
• Tests for effect of asbestos on benzo[a]pyrene carcinogenesis in the respiratory tract — L. Miller, W.E. Smith, et al. (1965)
• Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017 — C.A. Saito, M.A. Bussacos, et al. (2022)
• Asbestos Consumption and Malignant Mesothelioma Mortality Trends in the Major User Countries — C. Gariazzo, A. Gasparrini, et al. (2023)

Browse more research in International Journal of Environmental Research and Public Health, or return to medical research.