Public health significance of smoking-asbestos interactions

Our plain-English summary of Public health significance of smoking-asbestos interactions, by A.L. Frank (Annals of the New York Academy of Sciences, 1979).

The study

• Author: A.L. Frank
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:791-4
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003993).

In plain English

This was a short written report of a workshop on how cigarette smoking and asbestos exposure act together. The author opened the session; the report mainly summarized talks by others. Dr. Meurman described the Finnish experience with anthophyllite: lung cancer risk appeared to be 1.4:1 for employees exposed to low to moderate asbestos dust levels (an editor's note said no numbers were cited for this), and 3.3:1 for heavily exposed miners and millers with two or more years of exposure. All 44 lung cancer cases were in males, all but one in smokers. Mr. Seidman presented unpublished results from a study by Hammond, Selikoff and Seidman. It compared asbestos insulation workers, 20 or more years after first asbestos employment, with American Cancer Society control men for 1967 to 1976. Age-standardized cancer death rates per 100,000 man-years were 208 with neither exposure, 353 with smoking only, 564 with asbestos work only and 1317 with both. The report called the excess beyond the separate effects presumably synergistic and warned that these figures were approximations. It concluded that cigarette smoking poses special hazards to asbestos workers.

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: Workshop report summarizing presentations (a brief review by the author, a description of Finnish experience by Dr. Meurman, and unpublished results from the Hammond, Selikoff and Seidman study presented by Mr. Seidman); not an original study by the author
• Who was studied: In the Seidman presentation: asbestos insulation workers 20 or more years after first asbestos employment, followed 1967-1976, compared with control men from the American Cancer Society prospective study (white, not farmers, no more than high school education, with occupational exposure to dust, fumes, vapors, gases, chemicals or radiation). The number of men is not given. In the Meurman presentation: Finnish workers and the general population near anthophyllite mines.
• Exposure: Asbestos insulation work and cigarette smoking (current or ex-smokers) in the U.S. data; anthophyllite asbestos in the Finnish data
• Main results:
  • Hammond, Selikoff and Seidman data: age-standardized total cancer death rates per 100,000 man-years were 208 for men with no asbestos work and no smoking, 353 for smokers without asbestos work, 564 for non-smoking asbestos workers, and 1317 for asbestos workers who smoked
  • Compared with men with neither exposure, total cancer death rates were 1.70 times as high for smoking only, 2.71 times for asbestos work only, and 6.33 times for both
  • For total cancer, the expected rate if the two exposures acted independently was 709; the observed rate was 1317; the difference of 608 was described as presumably the synergistic effect
  • As a percent of the baseline total cancer rate, smoking only added 70% more deaths, asbestos work only added 171%, and the synergistic excess was almost 300%
  • Lung cancer mortality ratios (table, OCR-scrambled but consistent with the printed rates 11.3, 122.6, 80.2 and 693.8): 10.85 for smoking only, 7.10 for asbestos work only, and 61.40 for both, relative to men with neither exposure
  • Finnish experience (Meurman): for heavily exposed anthophyllite miners and millers with two years or longer exposure, the lung cancer risk appeared to be 3.3:1, which was described as suggesting a dose-response relationship
  • Finnish experience (Meurman): the risk for employees exposed to low to moderate asbestos dust levels appeared to be 1.4:1; an editor's note says no numbers were cited
  • Finnish experience (Meurman): all lung cancer cases were in males, and of 44 cases all but one occurred in smokers
  • Meurman suggested risks of 1.6 for a non-smoking asbestos worker, 12 for a smoker not exposed to asbestos, and 19 for a smoking asbestos worker
  • Meurman stated that asbestos levels near Finnish anthophyllite mines seemed to cause pleural changes but not to raise lung cancer risk in the general population
• The authors' conclusion: The report concluded that cigarette smoking poses special hazards to asbestos workers, and that avoiding smoking offers them special benefits
• Limitations the authors state:
  • Other factors are involved, and the synergism figures should be taken as approximations, not literally
  • An editor's note states that no numbers were cited to support the Finnish 1.4:1 risk figure for employees with low to moderate exposure
  • Death rates for asbestosis and mesothelioma were not available for the groups without asbestos work

Topics

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

Related studies

• The interactions of tobacco smoking and other agents in cancer etiology — R. Saracci (1987)
• Asbestos exposure, cigarette smoking and death rates — E.C. Hammond, I.J. Selikoff, et al. (1979)
• Asbestos in the air of public buildings: a public health risk? — J. Whysner, V.T. Covello, et al. (1994)
• Asbestos and lung cancer: an analysis of the epidemiological evidence on the asbestos-smoking interaction — R. Saracci (1977)
• Low-dose exposure to asbestos and lung cancer: dose-response relations and interaction with smoking in a population-based case-referent study in Stockholm, Sweden — P. Gustavsson, F. Nyberg, et al. (2002)
• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)

Browse more research in Annals of the New York Academy of Sciences, or return to medical research.