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Journal List > Occup Environ Med > v.62(12); Dec 2005

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Occup Environ Med. 2005 December; 62(12): 885–889.
doi: 10.1136/oem.2005.020834.
PMCID: PMC1740938
Copyright notice
The effect of asbestosis on lung cancer risk beyond the dose related effect of asbestos alone
A Reid, N de Klerk, G Ambrosini, N Olsen, S Pang, G Berry, and A Musk
Occupational & Environmental Epidemiology Group, School of Population Health, University of Western Australia, Crawley, WA 6009, Australia. Email: alisonr/at/sph.uwa.edu.au
Abstract
Aims: To determine if the presence of asbestosis is a prerequisite for lung cancer in subjects with known exposure to blue asbestos (crocidolite).
Methods: Former workers and residents of Wittenoom with known amounts of asbestos exposure (duration, intensity, and time since first exposure), current chest x ray and smoking information, participating in a cancer prevention programme (n = 1988) were studied. The first plain chest radiograph taken at the time of recruitment into the cancer prevention programme was examined for radiographic evidence of asbestosis according to the UICC (ILO) classification. Cox proportional hazards modelling was used to relate asbestosis, asbestos exposure, and lung cancer.
Results: Between 1990 and 2002 there were 58 cases of lung cancer. Thirty six per cent of cases had radiographic evidence of asbestosis compared to 12% of study participants. Smoking status was the strongest predictor of lung cancer, with current smokers (OR = 26.5, 95% CI 3.5 to 198) having the greatest risk. Radiographic asbestosis (OR = 1.94, 95% CI 1.09 to 3.46) and asbestos exposure (OR = 1.21 per f/ml-year, 95% CI 1.02 to 1.42) were significantly associated with an increased risk of lung cancer. There was an increased risk of lung cancer with increasing exposure in those without asbestosis.
Conclusion: In this cohort of former workers and residents of Wittenoom, asbestosis is not a mandatory precursor for asbestos related lung cancer. These findings support the hypothesis that it is the asbestos fibres per se that cause lung cancer, which can develop with or without the presence of asbestosis.
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Selected References
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  • de Klerk NH, Armstrong BK, Musk AW, Hobbs MS. Cancer mortality in relation to measures of occupational exposure to crocidolite at Wittenoom Gorge in Western Australia. Br J Ind Med. 1989 Aug;46(8):529–536. [PubMed]
  • de Klerk NH, Musk AW, Eccles JL, Hansen J, Hobbs MS. Exposure to crocidolite and the incidence of different histological types of lung cancer. Occup Environ Med. 1996 Mar;53(3):157–159. [PubMed]
  • Weiss W. The attribution of lung cancer to asbestos. Chest. 1993 Feb;103(2):654–655. [PubMed]
  • Sluis-Cremer GK, Bezuidenhout BN. Relation between asbestosis and bronchial cancer in amphibole asbestos miners. Br J Ind Med. 1989 Aug;46(8):537–540. [PubMed]
  • Hughes JM, Weill H. Asbestosis as a precursor of asbestos related lung cancer: results of a prospective mortality study. Br J Ind Med. 1991 Apr;48(4):229–233. [PubMed]
  • Hillerdal G, Henderson DW. Asbestos, asbestosis, pleural plaques and lung cancer. Scand J Work Environ Health. 1997 Apr;23(2):93–103. [PubMed]
  • Liddell FD, McDonald AD, McDonald JC. The 1891-1920 birth cohort of Quebec chrysotile miners and millers: development from 1904 and mortality to 1992. Ann Occup Hyg. 1997 Jan;41(1):13–36. [PubMed]
  • Case BW, Dufresne A. Asbestos, asbestosis, and lung cancer: observations in Quebec chrysotile workers. Environ Health Perspect. 1997 Sep;105 Suppl 5:1113–1119. [PubMed]
  • Musk AW, de Klerk NH, Eccles JL, Hobbs MS, Armstrong BK, Layman L, McNulty JC. Wittenoom, Western Australia: a modern industrial disaster. Am J Ind Med. 1992;21(5):735–747. [PubMed]
  • Armstrong BK, de Klerk NH, Musk AW, Hobbs MS. Mortality in miners and millers of crocidolite in Western Australia. Br J Ind Med. 1988 Jan;45(1):5–13. [PubMed]
  • de Klerk NH, Musk AW, Williams V, Filion PR, Whitaker D, Shilkin KB. Comparison of measures of exposure to asbestos in former crocidolite workers from Wittenoom Gorge, W. Australia. Am J Ind Med. 1996 Nov;30(5):579–587. [PubMed]
  • Hansen J, de Klerk NH, Musk AW, Hobbs MS. Environmental exposure to crocidolite and mesothelioma: exposure-response relationships. Am J Respir Crit Care Med. 1998 Jan;157(1):69–75. [PubMed]
  • Kiilunen M, Aitio A, Tossavainen A. Occupational exposure to nickel salts in electrolytic plating. Ann Occup Hyg. 1997 Apr;41(2):189–200. [PubMed]
  • de Klerk NH, Armstrong BK, Musk AW, Hobbs MS. Cancer mortality in relation to measures of occupational exposure to crocidolite at Wittenoom Gorge in Western Australia. Br J Ind Med. 1989 Aug;46(8):529–536. [PubMed]
  • de Klerk NH, Armstrong BK, Musk AW, Hobbs MS. Predictions of future cases of asbestos-related disease among former miners and millers of crocidolite in Western Australia. Med J Aust. 151(11-12):616–620. [PubMed]
  • Berry G. Prediction of mesothelioma, lung cancer, and asbestosis in former Wittenoom asbestos workers. Br J Ind Med. 1991 Dec;48(12):793–802. [PubMed]
  • Musk AW, de Klerk NH, Ambrosini GL, Eccles JL, Hansen J, Olsen NJ, Watts VL, Lund HG, Pang SC, Beilby J, Hobbs MS. Vitamin A and cancer prevention I: observations in workers previously exposed to asbestos at Wittenoom, Western Australia. Int J Cancer. 1998 Jan 30;75(3):355–361. [PubMed]
  • de Klerk NH, Musk AW, Ambrosini GL, Eccles JL, Hansen J, Olsen N, Watts VL, Lund HG, Pang SC, Beilby J, Hobbs MS. Vitamin A and cancer prevention II: comparison of the effects of retinol and beta-carotene. Int J Cancer. 1998 Jan 30;75(3):362–367. [PubMed]
  • Albanes D, Heinonen OP, Huttunen JK, Taylor PR, Virtamo J, Edwards BK, Haapakoski J, Rautalahti M, Hartman AM, Palmgren J, et al. Effects of alpha-tocopherol and beta-carotene supplements on cancer incidence in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study. Am J Clin Nutr. 1995 Dec;62(6 Suppl):1427S–1430S. [PubMed]
  • Hansen J, de Klerk NH, Musk AW, Hobbs MS. Environmental exposure to crocidolite and mesothelioma: exposure-response relationships. Am J Respir Crit Care Med. 1998 Jan;157(1):69–75. [PubMed]
  • Hansen KS. Validity of occupational exposure and smoking data obtained from surviving spouses and colleagues. Am J Ind Med. 1996 Oct;30(4):392–397. [PubMed]
  • Wilkinson P, Hansell DM, Janssens J, Rubens M, Rudd RM, Taylor AN, McDonald C. Is lung cancer associated with asbestos exposure when there are no small opacities on the chest radiograph? Lancet. 1995 Apr 29;345(8957):1074–1078. [PubMed]
  • Rogers Alan, Major Gershom. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure: the Wittenoom data. Ann Occup Hyg. 2002 Jan;46(1):127–129. [PubMed]
  • de Klerk NH, Musk AW, Williams V, Filion PR, Whitaker D, Shilkin KB. Comparison of measures of exposure to asbestos in former crocidolite workers from Wittenoom Gorge, W. Australia. Am J Ind Med. 1996 Nov;30(5):579–587. [PubMed]
  • de Klerk NH, Musk AW, Eccles JL, Hansen J, Hobbs MS. Exposure to crocidolite and the incidence of different histological types of lung cancer. Occup Environ Med. 1996 Mar;53(3):157–159. [PubMed]
  • Reid Alison, Ambrosini Gina, de Klerk Nicholas, Fritschi Lin, Musk Bill. Aerodigestive and gastrointestinal tract cancers and exposure to crocidolite (blue asbestos): incidence and mortality among former crocidolite workers. Int J Cancer. 2004 Sep 20;111(5):757–761. [PubMed]
  • Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg. 2000 Dec;44(8):565–601. [PubMed]
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