Predictors of lung cancer among asbestos-exposed men in the β-carotene and retinol efficacy trial

被引:45
作者
Cullen, MR
Barnett, MJ
Balmes, JR
Cartmel, B
Redlich, CA
Brodkin, CA
Barnhart, S
Rosenstock, L
Goodman, GE
Hammar, SP
Thornquist, MD
Omenn, GS
机构
[1] Yale Univ, Sch Med, Dept Internal Med, Occupat & Environm Med Program, New Haven, CT 06510 USA
[2] Yale Univ, Sch Med, Ctr Canc, New Haven, CT 06510 USA
[3] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[4] Univ Calif San Francisco, Sch Med, Dept Med, San Francisco, CA 94143 USA
[5] Univ Washington, Harborview Med Ctr, Seattle, WA 98104 USA
[6] Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USA
[7] Swedish Med Ctr, Inst Canc, Seattle, WA USA
[8] Pathol Associates Kitsap Cty Diagnost Specialt La, Bremerton, WA USA
[9] Univ Michigan, Sch Med, Dept Internal Med, Ann Arbor, MI USA
[10] Univ Michigan, Sch Med, Dept Human Genet, Ann Arbor, MI USA
[11] Univ Michigan, Sch Publ Hlth, Dept Publ Hlth, Ann Arbor, MI 48109 USA
关键词
asbestos; asbestosis; beta carotene; clinical trial [publication type; lung neoplasms; occupational exposure; vitamin A;
D O I
10.1093/aje/kwi034
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Despite numerous published studies, debate continues regarding the risk of developing lung cancer among men exposed occupationally to asbestos, particularly those without radiographic or functional evidence of asbestosis. The beta-Carotene and Retinol Efficacy Trial (CARET), a study of vitamin supplementation for chemoprevention of lung cancer, has followed 4,060 heavily exposed US men for 9-17 years. Lung cancer incidence for 1989-2002 was analyzed using a stratified proportional hazards model. The study confirmed excessive rates of lung cancer among men with radiographic asbestosis. Comparison of study arms revealed a strong, unanticipated synergy between radiographic profusion category and the active intervention. In the large subgroup of men with normal lung parenchyma on chest radiograph at baseline, there was evidence of exposure-related lung cancer risk: Men with more than 40 years' exposure in high-risk trades had a risk approximately fivefold higher than men with 5-10 years, after adjustment for covariates. The effect in these men was independent of study intervention arm, but pleural plaques on the baseline radiograph and abnormal baseline flow rate were strong independent predictors of subsequent lung cancer. Residual confounding by subclinical asbestosis, exposure to unmeasured lung carcinogens, or differences in smoking are unlikely to explain these observations better than a carcinogenic effect of asbestos per se.
引用
收藏
页码:260 / 270
页数:11
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