Risk assessment of gastric cancer associated with asbestosis: a case report

Our plain-English summary of Risk assessment of gastric cancer associated with asbestosis: a case report, by S.H. Park, D.M. Kang, B.H. Koo, et al (Annals of Occupational and Environmental Medicine, 2015).

The study

• Authors: S.H. Park, D.M. Kang, B.H. Koo, Y.K. Kim, J.E. Kim
• Journal: Annals of Occupational and Environmental Medicine
• Published: 2015;27:9
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The International Agency for Research on Cancer classifies asbestos as belonging to Carcinogen Group 2A for gastric cancer. We herein report a case of gastric cancer associated with asbestosis and describe the work-related and risk assessments of asbestos exposure for gastric cancer.

Case Presentation: The 66-year-old male patient in our case worked in asbestos spinning factories. His level of cumulated asbestos fiber exposure was estimated to be 38.0-71.0 f-yr/cc. Thus, the Excess Life Cancer Risk for lung cancer associated with asbestos exposure was 9,648×10(-5), almost 9,600 times the value recommended by the United States of America Environmental Protection Agency (1 × 10(-5)). The relative risk of developing lung cancer for this patient was more than 25 f-yr/cc, a well-known criterion for doubling the risk of lung cancer.

Conclusion: The patient's exposure to high-dose asbestos was sufficient to increase his risk of gastric cancer because as the risk of lung cancer increased, the risk of gastric cancer was due to increase as well. Therefore, occupational asbestos fiber exposure might be associated with gastric cancer in this case.

In plain English

This case report described a 66-year-old Korean man who had his stomach removed for gastric cancer (an adenocarcinoma) in 2012 and was diagnosed with asbestosis by chest CT in 2013. He had spun and woven chrysotile asbestos, mixed with synthetic fiber, for 11 years (1983 to 1993). The authors used asbestos levels reported for factories handling asbestos. From these, they estimated his cumulative exposure at 38.0 to 71.0 fiber-years per cc. That is above the 25 fiber-years per cc level at which, under the Helsinki criteria, lung cancer risk more than doubles. They calculated his excess life cancer risk for lung cancer as 9,648 in 100,000. They did not calculate his gastric cancer risk directly. Instead they inferred it from his lung cancer risk, citing studies of exposed groups in which gastric cancer death rates tended to rise with lung cancer death rates. His 2012 endoscopy also found organisms the authors identified as Helicobacter pylori, a known cause of gastric cancer. The authors concluded that occupational asbestos exposure might be associated with his gastric cancer. Their stated limitations included the indirect method and a US EPA risk value.

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: case report (single patient), with an exposure estimate and risk calculation
• Who was studied: One 66-year-old man treated at Pusan National University Yangsan Hospital, South Korea; gastric cancer surgery in October 2012, asbestosis diagnosed November 2013
• Exposure: 11 years (1983 to 1993) of asbestos spinning and weaving using chrysotile mixed with synthetic fiber, on 12-hour shifts. Before that he spent 18 years in a textile factory without asbestos exposure. His exposure was not measured; it was taken from reported factory levels (mean 4.3 f/cc before 1990, 2.3 f/cc in 1990)
• Main results:
  • The patient underwent total gastrectomy for gastric cancer in October 2012; pathology showed a 4.9 by 4.5 cm adenocarcinoma in the stomach body
  • He was diagnosed with asbestosis after a chest CT scan in November 2013; lung function testing showed a mildly restrictive pattern
  • The authors estimated the patient's cumulative asbestos exposure at 38.0 to 71.0 f-yr/cc
  • The authors compared this estimate with the Helsinki criteria, under which lung cancer risk more than doubles at 25 f-yr/cc or higher
  • The patient's calculated excess life cancer risk for lung cancer was 9,648 in 100,000
  • To link lung and gastric cancer risk, the authors cited studies of groups in which the standardized mortality ratio for gastric cancer tended to rise with that for lung cancer
  • Endoscopy in September 2012 found campylobacter-like organisms, which the authors interpreted as H. pylori infection
• The authors' conclusion: The authors concluded that occupational asbestos fiber exposure might be associated with the patient's gastric cancer. Their reasoning was that, according to cited group studies, gastric cancer death rates tend to rise with lung cancer death rates, and his estimated lung cancer risk was high
• Limitations the authors state:
  • Gastric cancer risk was inferred indirectly from the lung cancer risk estimate, not calculated directly from exposure levels
  • The risk calculation used an inhalation unit risk value from the US EPA, which might differ for Korea
  • Results from population studies were extrapolated to one individual's risk

Topics

Medical terms in this study, explained in our Lexicon: Stomach Cancer, Asbestos Exposure, Lung Cancer, Relative Risk.

Related studies

• Occupational exposures and risk of esophageal and gastric cardia cancers among male Swedish construction workers — C. Jansson, A.L. Johansson, et al. (2005)
• Airborne exposures and risk of gastric cancer: a prospective cohort study — K. Sjödahl, C. Jansson, et al. (2007)
• Occupational asbestos exposure and risk of esophageal, gastric and colorectal cancer in the prospective Netherlands Cohort Study — N.S. Offermans, R. Vermeulen, et al. (2014)
• Increased Risk of Gastric Cancer in Asbestos-Exposed Workers: A Retrospective Cohort Study Based on Taiwan Cancer Registry 1980-2015 — Y.J. Fang, H.Y. Chuang, et al. (2021)
• Occupational Burden of Asbestos-Related Diseases in Korea, 1998-2013: Asbestosis, Mesothelioma, Lung Cancer, Laryngeal Cancer, and Ovarian Cancer — D.M. Kang, J.E. Kim, et al. (2018)
• Asbestosis: assessment by bronchoalveolar lavage and measurement of pulmonary epithelial permeability — A.R. Gellert, J.A. Langford, et al. (1985)

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