Asbestos, asbestosis, and lung cancer: a critical assessment of the epidemiological evidence
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- 3Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London SW3 6LY, UK
- Correspondence to:
Professor J C McDonald
Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK;c.mcdonaldimperial.ac.uk
- Received 5 November 2004
- Accepted 3 December 2004
Abstract
The question of whether lung cancer can be attributed to asbestos exposure in the absence of asbestosis remains controversial. Nine key epidemiological papers are reviewed in a point/counterpoint format, giving the main strengths and limitations of the evidence presented. Of the nine papers, two concluded that asbestosis was necessary and seven that it was not. However, the study design, nature and circumstances of exposure and method of analysis of the studies differed considerably, and none was considered definitive. It is concluded that, because of the relative insensitivity of chest radiography and the uncertain specificity of findings from histological examinations or computed tomography, it is unlikely that epidemiology alone can put either the strict scientific or practical medicolegal questions beyond doubt. It is probable that the issue may depend critically on asbestos fibre type, an aspect not so far addressed.
