Reply: comment on 'estimating the asbestos-related lung cancer burden from mesothelioma mortality'

Our plain-English summary of Reply: comment on 'estimating the asbestos-related lung cancer burden from mesothelioma mortality', by V. McCormack, J. Peto, G. Byrnes, et al (British Journal of Cancer, 2013).

The study

• Authors: V. McCormack, J. Peto, G. Byrnes, K. Straif, P. Boffetta
• Journal: British Journal of Cancer
• Published: 2013;109(3):825-6
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This is a letter to the editor, not a new study. The authors replied to a comment by Lemen and colleagues (2013) on the authors' own 2012 article, which estimated the ratio of asbestos-related lung cancer deaths to mesothelioma deaths. They explained that the 2012 article used 68 risk estimates drawn from 55 studies, and that each study had to report both cancers over the same follow-up period. For that reason they left out a recent update of the Balangero cohort, which assessed only one of the two outcomes. They kept the Quebec cohort because excess deaths were calculated as observed minus expected deaths and did not depend on exposure data. The authors restated that their article showed excesses of both mesothelioma (four mesothelioma deaths per 1000 deaths) and lung cancer (SMR 1.7) associated with chrysotile, which they called consistent with IARC's Group 1 classification. They said they had not concluded that mesothelioma in chrysotile-exposed cohorts is due to other asbestos types. They acknowledged that the ratios may vary between cohorts. The authors concluded that the concerns raised were not substantiated.

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: Letter to the editor: a reply to a published comment (Lemen et al, 2013) on the authors' 2012 article. It reports no new data.
• Who was studied: No new population. The letter describes the authors' 2012 analysis, which used 68 risk estimates from 55 studies of asbestos-exposed cohorts.
• Exposure: Asbestos in general, with discussion of chrysotile and amphiboles. The outcome of interest was the ratio of asbestos-related lung cancer (ARLC) deaths to mesothelioma deaths.
• Main results:
  • In the 2012 analysis, each study had to have examined both lung cancer and mesothelioma over the same follow-up. The recent update of the Balangero cohort (Mirabelli et al, 2008) was therefore intentionally left out.
  • Excess deaths were calculated as observed minus expected deaths, using national or regional rates. The authors therefore said exposure data quality did not affect the ratios, and they saw no reason to exclude the Quebec cohort.
  • The authors restated that their 2012 article showed excesses associated with chrysotile of both mesothelioma (four mesothelioma deaths per 1000 deaths) and lung cancer (SMR 1.7, table 3). They called this consistent with IARC's Group 1 classification of chrysotile.
  • The authors said they did not conclude that mesothelioma in chrysotile-exposed cohorts is due to other asbestos types. Their point was that when several carcinogenic fibres are present, the contribution of each is harder to separate.
  • For formerly exposed workers, for whom removing exposure is not an option, the 2012 article highlighted the benefits of smoking cessation. For currently exposed workers, it called removing exposure the priority.
• The authors' conclusion: The authors concluded that none of the concerns raised by Lemen et al were substantiated. They said their message concerns the extent of both the mesothelioma and lung cancer burdens due to all types of asbestos fibres.
• Limitations the authors state:
  • The authors acknowledged that ARLC:mesothelioma ratios may vary between cohorts, or between groups of workers within cohorts. They gave as causes outcome misclassification, latency, exposure levels and potential confounding.
  • The authors said the ratios describe the overall relationship across exposure circumstances over a long period. They said the ratios do not precisely quantify lung cancer excess in a short time period.

Topics

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

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

Related studies

• Estimating the asbestos-related lung cancer burden from mesothelioma mortality — V. McCormack, J. Peto, et al. (2012)
• Comment on 'estimating the asbestos-related lung cancer burden from mesothelioma mortality' - IARC and chrysotile risks — R.A. Lemen, A.L. Frank, et al. (2013)
• Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053" — S.D. Visonà, S. Capella, et al. (2021)
• An approach to estimating the environmental burden of cancer from known and probable carcinogens: application to Ontario, Canada — S.L. Greco, E. MacIntyre, et al. (2020)
• Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico — R. Pasetto, B. Terracini, et al. (2014)
• A critique of a review on the relationship between asbestos exposure and the risk of mesothelioma: reply — C. La Vecchia, P. Boffetta (2014)

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