Review of carcinogenicity of asbestos and proposal of approval standards of an occupational cancer caused by asbestos in Korea

Our plain-English summary of Review of carcinogenicity of asbestos and proposal of approval standards of an occupational cancer caused by asbestos in Korea, by S. Im, K.W. Youn, D. Shin, et al (Annals of Occupational and Environmental Medicine, 2015).

The study

• Authors: S. Im, K.W. Youn, D. Shin, M.J. Lee, S.J. Choi
• Journal: Annals of Occupational and Environmental Medicine
• Published: 2015;27:34
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Carcinogenicity of asbestos has been well established for decades and it has similar approval standards in most advanced countries based on a number of studies and international meetings. However, Korea has been lagging behind such international standards. In this study, we proposed the approval standards of an occupational cancer due to asbestos through intensive review on the Helsinki Criteria, post-Helsinki studies, job exposure matrix (JEM) based on the analysis of domestic reports and recognized occupational lung cancer cases in Korea. The main contents of proposed approval standards are as follows; ① In recognizing an asbestos-induced lung cancer, diagnosis of asbestosis should be based on CT. In addition, initial findings of asbestosis on CT should be considered. ② High Exposure industries and occupations to asbestos should be also taken into account in Korea ③ An expert's determination is warranted in case of a worker who has been concurrently exposed to other carcinogens, even if the asbestos exposure duration is less than 10 years. ④ Determination of a larynx cancer due to asbestos exposure has the same approval standards with an asbestos-induced lung cancer. However, for an ovarian cancer, an expert's judgment is necessary even if asbestosis, pleural plaque or pleural thickening and high concentration asbestos exposure are confirmed. ⑤ Cigarette smoking status or the extent should not affect determination of an occupational cancer caused by asbestos as smoking and asbestos have a synergistic effect in causing a lung cancer and they are involved in carcinogenesis in a complicated manner.

In plain English

This article combined a literature review with Korean data to propose Korean standards for occupational asbestos-related cancer. The authors reviewed the Helsinki Criteria, later studies, and Japanese, French and German standards. They built a job-exposure matrix from workplace monitoring data and analyzed recognized lung cancer cases: 179 from the Korea Occupational Safety and Health Agency and 31 from the Occupational Lung Diseases Institute. The matrix found 88 industries and 75 occupations with exposure. Asbestos was the main carcinogen in 50% of cases; exposure lasted about 20 years and latency 23 to 26 years. All occupations with two or more asbestos-related lung cancers met a 4 fiber-year benchmark within 5 years, except boiler-related ones. The authors proposed CT-based asbestosis diagnosis, attention to high-exposure industries, and not letting smoking affect decisions. They proposed expert judgment for workers also exposed to other carcinogens even when less than 10 years had passed since asbestos exposure (the abstract says less than 10 years of exposure). Larynx cancer would follow lung cancer standards; ovarian cancer would need expert judgment even with asbestosis, pleural plaque, pleural thickening and high-concentration exposure all confirmed.

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: Review of published criteria and studies, combined with construction of a Korean job-exposure matrix and a descriptive analysis of recognized occupational lung cancer cases in Korea, used to propose approval standards
• Who was studied: Lung cancer cases recognized as occupational in Korea: 179 from the Korea Occupational Safety and Health Agency (KOSHA) epidemiological surveys, 1994 to 2011, and 31 from the Occupational Lung Diseases Institute (2004 to 2011). The job-exposure matrix used Korean workplace monitoring data and earlier exposure reports.
• Exposure: Airborne asbestos in Korean workplaces by industry and occupation (fiber type not specified), measured in fibers per milliliter. Case exposures included asbestos and other carcinogens such as crystalline silica, hexavalent chromium and welding fume.
• Main results:
  • In the job-exposure matrix, 88 industries and 75 occupations involved asbestos exposure
  • The highest exposure in the 1980s was among knitting and weaving machine operators in asbestos, mineral wool and similar product manufacturing, with an arithmetic mean of 7.48 fibers per milliliter
  • Recognized occupational lung cancer occurred at 0.11 per 100,000 (insured workers, per Table 9), and lung cancer due to asbestos at 0.06. Asbestos-related cases were about 60% of all occupational lung cancer cases.
  • Among the lung cancer patients, the mean age at diagnosis was 53 to 55 years and 56.7% were smokers
  • Asbestos was the key carcinogen in 50% of cases. Exposure duration was about 20 years and latent duration was 23 to 26 years.
  • Among the KOSHA cases, 87 involved a single carcinogen and 92 involved multiple carcinogens
  • Among cases with asbestos as a key or secondary carcinogen, manufacturing had 70 cases, construction 31 and transportation 23
  • The authors judged these cases against workplace monitoring results and a 4 fiber-year criterion taken from Gustavsson et al. All occupations with 2 or more asbestos-related lung cancer patients met the criterion within 5 years, except boiler-related occupations.
• The authors' conclusion: The authors proposed five standards. (1) Base the diagnosis of asbestosis on CT. (2) Take Korea's high-exposure industries and occupations into account. (3) Seek an expert's determination for workers also exposed to other carcinogens even when less than 10 years have passed since asbestos exposure; the authors note that most countries require at least 10 years since exposure, while the abstract words this point as less than 10 years of asbestos exposure. (4) Apply the lung cancer standards to larynx cancer, but require expert judgment for ovarian cancer even when asbestosis, pleural plaque, pleural thickening and high-concentration asbestos exposure are confirmed. (5) Do not let smoking status or extent affect the decision, because smoking and asbestos act synergistically.
• Limitations the authors state:
  • Few studies exist on lung cancer risk from combined exposure to asbestos and other carcinogens
  • There are no Korean data on asbestos-related ovarian cancer, and no cases have been claimed or recognized
  • The relatively young age at diagnosis may reflect retired workers not applying for compensation rather than early detection
  • The national monitoring database had no data before 2002, so other data sources were used for 1995 to 2006

Topics

Medical terms in this study, explained in our Lexicon: Helsinki Criteria, Lung Cancer, Asbestos Exposure, Laryngeal Cancer, Ovarian Cancer, Pleural Plaques, Pleural Thickening, Synergistic Effect.

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