Occupational exposure to asbestos and man-made vitreous fibres and risk of lung cancer: a multicentre case-control study in Europe

Our plain-English summary of Occupational exposure to asbestos and man-made vitreous fibres and risk of lung cancer: a multicentre case-control study in Europe, by R. Carel, A.C. Olsson, D. Zaridze, et al (Occupational and Environmental Medicine, 2007).

The study

• Authors: R. Carel, A.C. Olsson, D. Zaridze, N. Szeszenia-Dabrowska, P. Rudnai, J. Lissowska, E. Fabianova, A. Cassidy, D. Mates, V. Bencko, L. Foretova, V. Janout, J. Fevotte, T. Fletcher, A. 't Mannetje, P. Brennan, P. Boffetta
• Journal: Occupational and Environmental Medicine
• Published: 2007;64(8):502-8
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To investigate the contribution of occupational exposure to asbestos and man-made vitreous fibres (MMVF) to lung cancer in high-risk populations in Europe.

Methods: A multicentre case-control study was conducted in six Central and Eastern European countries and the UK, during the period 1998-2002. Comprehensive occupational and sociodemographic information was collected from 2205 newly diagnosed male lung cancer cases and 2305 frequency matched controls. Odds ratios (OR) of lung cancer were calculated after adjusting for other relevant occupational exposures and tobacco smoking.

Results: The OR for asbestos exposure was 0.92 (95% CI 0.73 to 1.15) in Central and Eastern Europe and 1.85 (95% CI 1.07 to 3.21) in the UK. Similar ORs were found for exposure to amphibole asbestos. The OR for MMVF exposure was 1.23 (95% CI 0.88 to 1.71) with no evidence of heterogeneity by country. No synergistic effect either between asbestos and MMVF or between any of them and smoking was found.

Conclusion: In this large community-based study occupational exposure to asbestos and MMVF does not appear to contribute to the lung cancer burden in men in Central and Eastern Europe. In contrast, in the UK the authors found an increased risk of lung cancer following exposure to asbestos. Differences in fibre type and circumstances of exposure may explain these results.

In plain English

This multicentre case-control study, run from 1998 to 2002 in six Central and Eastern European countries and the UK, compared 2205 men with newly diagnosed lung cancer with 2305 control men. Local experts, unaware of who had cancer, judged each man's past job exposure to asbestos and to man-made vitreous fibres (glass and mineral wool). Results were adjusted for smoking and other workplace exposures. In Central and Eastern Europe, men ever exposed to asbestos had an odds ratio for lung cancer of 0.92 (95% CI 0.73 to 1.15). In the UK the odds ratio was 1.85 (95% CI 1.07 to 3.21), and 1.91 (95% CI 1.06 to 3.45) for amphibole exposure, but risk did not rise with cumulative exposure. For man-made vitreous fibres, all countries combined, the odds ratio was 1.23 (95% CI 0.88 to 1.71). The authors concluded that asbestos did not appear to contribute to lung cancer in Central and Eastern Europe, suggesting low exposure levels and exposure misclassification may explain this. They noted low power to detect a small risk from man-made fibres.

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: Multicentre case-control study, analysed with unconditional logistic regression
• Who was studied: 2205 men with newly diagnosed lung cancer (under age 75) and 2305 male controls frequency matched on age and sex, from 16 centres in the Czech Republic, Hungary, Poland, Romania, Russia, Slovakia and the UK (Liverpool), 1998 to 2002. Controls were population controls in Warsaw and Liverpool and hospital patients elsewhere. Women were not analysed.
• Exposure: Occupational exposure to asbestos (all types, and separately amphiboles and chrysotile), man-made vitreous fibres (glass fibres and mineral wool) and ceramic fibres. Exposure was assessed by local experts from interview job histories and graded by confidence, frequency and intensity (low below 0.1, medium 0.1 to 1, high above 1 fibres/ml).
• Main results:
  • Lung cancer risk after ever exposure to asbestos differed between countries (p = 0.01), so Central and Eastern Europe and the UK were analysed separately.
  • Central and Eastern Europe, ever exposed to asbestos versus never: 233 cases and 246 controls exposed, OR 0.92 (95% CI 0.73 to 1.15). There was no trend with intensity (p = 0.46), cumulative exposure (p = 0.60) or year of first exposure (p = 0.35).
  • UK: OR 1.85 (95% CI 1.07 to 3.21) for ever exposure to asbestos (84 cases and 56 controls exposed), and OR 1.91 (95% CI 1.06 to 3.45) for amphibole exposure.
  • UK: no trend of increasing risk with rising cumulative asbestos exposure (p = 0.95) and no trend with latency (p = 0.20).
  • Chrysotile-only exposure: OR 0.77 (95% CI 0.56 to 1.05) in Central and Eastern Europe (99 cases and 120 controls) and OR 1.53 (95% CI 0.61 to 3.86) in the UK (18 cases and 12 controls).
  • Prevalence of asbestos exposure among all subjects was 11.4% in Central and Eastern Europe and 46.8% in the UK.
  • The effect of asbestos did not differ detectably between smokers and non-smokers, in Central and Eastern Europe (p = 0.37) or in the UK (p = 0.62).
  • Man-made vitreous fibres, all countries combined: OR 1.23 (95% CI 0.88 to 1.71) for ever exposure (115 cases and 89 controls exposed). There was no consistent pattern with intensity, latency, duration or cumulative exposure.
  • Ceramic fibres without man-made vitreous fibres: OR 1.25 (95% CI 0.33 to 4.74), based on 7 exposed cases and 5 exposed controls. The authors described the number exposed as very small.
• The authors' conclusion: The authors concluded that, according to their data, asbestos does not contribute to the high lung cancer burden in Central and Eastern Europe, though the full burden may not yet be realised because asbestos use there rose later. They found that UK men exposed to asbestos, in particular amphiboles, had increased lung cancer risk, most plausibly explained by a true difference in exposure prevalence. They did not observe a significant overall increased risk for man-made vitreous fibres or ceramic fibres.
• Limitations the authors state:
  • A validation study found poor agreement between expert teams on asbestos and man-made fibres.
  • Non-differential exposure misclassification likely weakened risk estimates toward no effect, especially where exposure prevalence was low (as in Central and Eastern Europe).
  • Recall bias was considered possible, since cases may recall past exposures more readily than controls.
  • The UK part of the study represents only the industrialised Liverpool area, so it may show higher exposure prevalence than the UK overall.
  • Because asbestos use in Central and Eastern Europe peaked later (1970s and 1980s), the asbestos-related lung cancer burden there may not yet be visible.
  • Few subjects were exposed to man-made vitreous fibres or ceramic fibres, mostly at low levels, so power to detect a small increased risk was low.

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: Occupational Exposure, Vitreous, Lung Cancer, Case-Control Study, Odds Ratio, Asbestos Exposure, Amphibole Asbestos, Synergistic Effect.

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