Asbestos, Asbestosis, Smoking, and Lung Cancer New Findings from the North American Insulator Cohort

被引:124
作者
Markowitz, Steven B. [1 ]
Levin, Stephen M. [2 ]
Miller, Albert [1 ]
Morabia, Alfredo [1 ]
机构
[1] CUNY Queens Coll, Ctr Biol Nat Syst, Flushing, NY 11367 USA
[2] Mt Sinai Sch Med, Dept Prevent Med, New York, NY USA
关键词
interaction; smoking cessation; asbestos; asbestosis; lung cancer; PULMONARY FIBROSIS; CIGARETTE-SMOKING; WORKERS; EXPOSURE; MORTALITY; RISK; PREDICTORS; SOCIETY; DISEASE; TIME;
D O I
10.1164/rccm.201302-0257OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Asbestos, smoking, and asbestosis increase lung cancer risk in incompletely elucidated ways. Smoking cessation among asbestos-exposed cohorts has been little studied. Objectives: To measure the contributions of asbestos exposure, asbestosis, smoking, and their interactions to lung cancer risk in an asbestos-exposed cohort and to describe their reduction in lung cancer risk when they stop smoking. Methods: We examined lung cancer mortality obtained through the National Death Index for 1981 to 2008 for 2,377 male North American insulators for whom chest X-ray, spirometric, occupational, and smoking data were collected in 1981 to 1983 and for 54,243 non-asbestos exposed blue collar male workers from Cancer Prevention Study II for whom occupational and smoking data were collected in 1982. Measurements and Main Results: Lung cancer caused 339 (19%) insulator deaths. Lung cancer mortality was increased by asbestos exposure alone among nonsmokers (rate ratio = 3.6 [95% confidence interval (CI), 1.7-7.6]), by asbestosis among nonsmokers (rate ratio = 7.40 [95% CI, 4.0-13.7]), and by smoking without asbestos exposure (rate ratio = 10.3 [95% CI, 8.8-12.2]). The joint effect of smoking and asbestos alone was additive (rate ratio = 14.4 [95% CI, 10.7-19.4]) and with asbestosis, supra-additive (rate ratio = 36.8 [95% CI, 30.1-45.0]). Insulator lung cancer mortality halved within 10 years of smoking cessation and converged with that of never-smokers 30 years after smoking cessation. Conclusions: Asbestos increases lung cancer mortality among nonsmokers. Asbestosis further increases the lung cancer risk and, considered jointly with smoking, has a supra-additive effect. Insulators benefit greatly by quitting smoking.
引用
收藏
页码:90 / 96
页数:7
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