P N Lee1. 1. P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey SM2 5DA, UK. PeterLee@pnlee.demon.co.uk
Abstract
OBJECTIVES: To review evidence about the joint relation of exposure to asbestos and smoking on the risk of lung cancer to answer three questions: (1) does asbestos increase risk in non-smokers; (2) are the data consistent with an additive model; and (3) are the data consistent with a multiplicative model? METHODS: Analysis of 23 studies reporting epidemiological evidence on the joint relation. Comparison of risk of lung cancer in subjects unexposed to asbestos or smoking, exposed to asbestos only, to smoking only, or to both. Estimation of the relative risk associated with asbestos exposure in non-smokers and of statistics testing for additivity and multiplicativity of risk. RESULTS: Eight of the 23 studies provided insufficient data on the risk of lung cancer in non-smokers to test for possible effects of asbestos. Asbestos exposure was associated with a significantly (p<0.05) increased risk in non-smokers in six of the remaining studies and with a moderately increased, but not significant, increase in a further six. In two of the three studies that found no increase, asbestos exposure was insufficient to increase risks in smokers. In 30 of 31 data sets analysed, risk in the combined exposure group was greater than predicted by the additive model. There was no overall departure from the multiplicative model, the proportional increase in risk of lung cancer with exposure to asbestos being estimated as 0.90 (95% confidence interval (95% CI) 0.67 to 1.20) times higher in smokers than non-smokers. For two studies significant (p<0.05) departures from a multiplicative relation were found in some, but not all, analyses. Reasons are presented why these may not indicate true model discrepancies. CONCLUSIONS: Asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers. The extent to which it multiplies risk varies between studies, no doubt depending on the type of asbestos involved, and the nature, extent, and duration of exposure.
OBJECTIVES: To review evidence about the joint relation of exposure to asbestos and smoking on the risk of lung cancer to answer three questions: (1) does asbestos increase risk in non-smokers; (2) are the data consistent with an additive model; and (3) are the data consistent with a multiplicative model? METHODS: Analysis of 23 studies reporting epidemiological evidence on the joint relation. Comparison of risk of lung cancer in subjects unexposed to asbestos or smoking, exposed to asbestos only, to smoking only, or to both. Estimation of the relative risk associated with asbestos exposure in non-smokers and of statistics testing for additivity and multiplicativity of risk. RESULTS: Eight of the 23 studies provided insufficient data on the risk of lung cancer in non-smokers to test for possible effects of asbestos. Asbestos exposure was associated with a significantly (p<0.05) increased risk in non-smokers in six of the remaining studies and with a moderately increased, but not significant, increase in a further six. In two of the three studies that found no increase, asbestos exposure was insufficient to increase risks in smokers. In 30 of 31 data sets analysed, risk in the combined exposure group was greater than predicted by the additive model. There was no overall departure from the multiplicative model, the proportional increase in risk of lung cancer with exposure to asbestos being estimated as 0.90 (95% confidence interval (95% CI) 0.67 to 1.20) times higher in smokers than non-smokers. For two studies significant (p<0.05) departures from a multiplicative relation were found in some, but not all, analyses. Reasons are presented why these may not indicate true model discrepancies. CONCLUSIONS:Asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers. The extent to which it multiplies risk varies between studies, no doubt depending on the type of asbestos involved, and the nature, extent, and duration of exposure.
Authors: M Minowa; S Hatano; M Ashizawa; H Oguro; H Naruhashi; M Suzuki; K Mitoku; M Miwa; C Wakamatsu; Y Yasuda Journal: Environ Health Perspect Date: 1991-08 Impact factor: 9.031
Authors: B Clin; A Luc; F Morlais; C Paris; J Ameille; P Brochard; J De Girolamo; A Gislard; F Laurent; M Letourneux; E Schorle; G Launoy; J-C Pairon Journal: Int J Tuberc Lung Dis Date: 2011-12 Impact factor: 2.373
Authors: Xiaorong Wang; Sihao Lin; Eiji Yano; Hong Qiu; Igtanius T S Yu; Lapah Tse; Yajia Lan; Mianzhen Wang Journal: Int Arch Occup Environ Health Date: 2011-07-28 Impact factor: 3.015
Authors: Sara De Matteis; Dario Consonni; Jay H Lubin; Margaret Tucker; Susan Peters; Roel Ch Vermeulen; Hans Kromhout; Pier Alberto Bertazzi; Neil E Caporaso; Angela C Pesatori; Sholom Wacholder; Maria Teresa Landi Journal: Int J Epidemiol Date: 2012-03-31 Impact factor: 7.196
Authors: Marie Uguen; Jean-Dominique Dewitte; Pascale Marcorelles; Brice Loddé; Richard Pougnet; Philippe Saliou; Marc De Braekeleer; Arnaud Uguen Journal: Mol Clin Oncol Date: 2017-05-30