Introduction Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy.
Method The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE).
Result Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE.
Conclusion The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality.
- lung cancer
- asbestos induced lung disease
Data availability statement
Data are available on reasonable request.
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Collaborators The working group: Lisa Bauleo, Antonio Baldassarre, Carol Brentisci, Barbara Cortini, Stefania Curti, Manuela Gangemi, Giuseppe Gorini, Patrizia Legittimo, Francesco Marinelli, Pasqualina Marinilli, Stefano Mattioli, Marina Musti, Chiara Panato, Venere LedaMara Pavone, Alessandra Ranucci, Elisa Romeo, Corrado Scarnato, Cinzia Storchi, Antonella Stura, Simona Verdi.
Contributors CM, DC, DF and DM conceived the study and the analysis which was developed with input from all authors from inception. CM acts as the coordinator. Data analysis was performed by DA and CM and DA produced the first draft of the manuscript to which all other authors contributed in reading and editing. CM act as data guarantor. The final version of the manuscript has been fully reviewed and approved by all authors.
Funding The cohort study was conducted thanks to grants from the ‘Asbestos Project’ of the Italian National Institute of Health (ISS) (current research 2012: asbestos project. Operative Unit 2 'Amedeo Avogadro' University of Eastern Piedmont, Novara, Research Line 1.2) and from the INAIL (Piano Ricerca 2016-2018, 'Programma Speciale Amianto', Ricerca BRIC id 55 and Ricerca BRIC id 59), (Piano Attività di Ricerca 2019-2021, Programma Speciale Amianto, BRIC id 55).
Competing interests The authors declare that they have no competing interests. The following authors or working group components reported that they served as expert witness in court trials on asbestos related diseases: AA, AB, CM, DM, EM, EO, FB-A, LBi, LMa, LMi, MM, SMe, SS, VP.
Provenance and peer review Not commissioned; externally peer reviewed.
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