Occupational and environmental causes of bronchogenic carcinoma

Our plain-English summary of Occupational and environmental causes of bronchogenic carcinoma, by B.M. Haus, H. Razavi, W.G. Kuschner (Current Opinion in Pulmonary Medicine, 2001).

The study

• Authors: B.M. Haus, H. Razavi, W.G. Kuschner
• Journal: Current Opinion in Pulmonary Medicine
• Published: 2001;7(4):220-5
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Occupational and environmental carcinogens account for an important minority of cases of bronchogenic carcinoma. From a public health perspective, it is important to characterize occupational and environmental carcinogens and to define disease risk to reduce preventable lung cancer. From a clinician's perspective, it is important to distinguish individual cases of occupational lung cancer from nonoccupational cases, because cancer acquired from work may be compensable through worker's compensation claims and litigation. Important carcinogens include asbestos, radon daughters, diesel exhaust, and metals. Epidemiologic investigations identify excess cases of lung cancer in populations exposed to carcinogens. Experimental animal and ex vivo human research provide complementary information supporting causal relationships between exposure and carcinogenesis. Clinical challenges include proving that a given case of lung cancer is due to an occupational exposure. Research challenges include determining safe exposure thresholds. Only a small percentage of all chemicals used in industry have been extensively analyzed for their carcinogenic potential. Scientific and regulatory information about pulmonary occupational and environmental health and safety is available from several important agencies and organizations, including the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, the International Agency for Research on Cancer, the American Lung Association, and the Environmental Protection Agency.

In plain English

This article was a review of published research on workplace and environmental causes of lung cancer (bronchogenic carcinoma). It covered asbestos, radon, silica, diesel exhaust, beryllium and arsenic, and reported no new data of its own. On asbestos, it cited an earlier review in which the combined relative risk of lung cancer across 20 cohort studies was 2.00 (95% CI, 1.90–2.11), and 5.91 (95% CI, 4.98–7.00) across six studies of people with asbestosis. It stated that latency is typically 20 years or more and that it is unknown whether there is a safe level of asbestos exposure. It described an unresolved debate over whether asbestosis must be present before lung cancer can be attributed to asbestos, citing work on both sides. It also cited a review of 23 studies that found no overall departure from a multiplicative model of asbestos and smoking acting together. The authors wrote that occupational lung cancer is almost always preventable, and that telling work-related cases apart matters because they may be compensable.

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: Narrative review of published studies (no original data)
• Who was studied: No study population of its own; the authors reviewed published research on several workplace and environmental lung carcinogens
• Exposure: Asbestos (fiber types not specified in the review's text), radon daughters, crystalline silica, diesel engine exhaust, and metals (beryllium and arsenic). Asbestos exposure was described among construction, shipbuilding, demolition, carpentry, pipefitting and brake repair workers.
• Main results:
  • Citing an earlier review: the combined relative risk of lung cancer across 20 cohort studies of asbestos-exposed workers was 2.00 (95% CI, 1.90–2.11).
  • Citing the same review: among persons with asbestosis, the combined relative risk across six studies was 5.91 (95% CI, 4.98–7.00).
  • Citing other sources: over half of an estimated 10,000 annual US lung cancer cases attributable to occupational carcinogens are believed to be due to asbestos.
  • Citing other sources: lung cancer accounted for 20% of deaths in asbestos-exposed cohorts, and as much as 4% of all lung cancer is attributable to asbestos exposure.
  • The authors stated that latency is typically 20 years or more from the onset of exposure.
  • The authors stated that it is unknown whether a safe threshold for asbestos exposure exists. They cited reviews and studies that suggested a threshold.
  • On whether asbestosis is required, the review cited a review of 19 studies concluding that asbestosis is not necessary for attributing a lung cancer to asbestos. It also cited a review reporting a summarized relative risk of 1.00 in seven cohorts with no asbestosis deaths.
  • Citing a review of 23 studies on asbestos and smoking together: there was no overall departure from the multiplicative model. In that review, the proportional increase in lung cancer risk with asbestos was estimated as 0.90 times higher in smokers than in nonsmokers (95% CI, 0.67–1.20).
• The authors' conclusion: The authors wrote that occupational lung cancer is almost always preventable. They said work-related cases should be distinguished from other cases where possible, because they may be compensable.

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: Bronchogenic Carcinoma, Lung Cancer, Carcinogenesis, Occupational Exposure, Carcinogenic.

Related studies

• Association of asbestos and bronchogenic carcinoma in a population with low asbestos exposure — M.L. Warnock, A.M. Churg (1975)
• Asbestosis associated with bronchogenic carcinoma — R. Stoll, R. Bass, et al. (1951)
• Asbestos, an extrinsic factor in the pathogenesis of bronchogenic carcinoma and mesothelioma — W.M. O'Donnell, R.H. Mann, et al. (1966)
• Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations — E. Pluygers, P. Baldewyns, et al. (1992)
• Morphology of bronchogenic carcinoma in workers formerly exposed to crocidolite at Wittenoom Gorge in Western Australia — J.E. Baker, D.C. Reutens, et al. (1986)
• Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations — E. Pluygers, P. Baldewyns, et al. (1991)

Browse more research in Current Opinion in Pulmonary Medicine, or return to medical research.