A Lacourt1, C Gramond1, P Rolland2, S Ducamp2, S Audignon1, P Astoul3, S Chamming's4, A Gilg Soit Ilg5, M Rinaldo1, C Raherison1, F Galateau-Salle6, E Imbernon7, J C Pairon8, M Goldberg9, P Brochard1. 1. Univ. Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique Equipe sante environnement, Bordeaux, France INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Equipe sante environnement, Bordeaux, France. 2. Departement Sante Travail, Institut de Veille Sanitaire, Equipe Associee en Sante Travail, Bordeaux, France Registre Multicentrique a Vocation Nationale des Mesotheliomes Pleuraux (MESONAT), Hopital de la Cote de Nacre, Caen, France. 3. Service d'Oncologie Thoracique, Maladie de la Plèvre et Pneumologie Interventionnelle, Hopital Nord, Aix-Marseille Universite, Marseille, France. 4. Institut Interuniversitaire de Medecine du Travail de Paris Ile de France, Créteil, France. 5. Registre Multicentrique a Vocation Nationale des Mesotheliomes Pleuraux (MESONAT), Hopital de la Cote de Nacre, Caen, France Departement Sante Travail, Institut de Veille Sanitaire, Saint Maurice, France. 6. Registre Multicentrique a Vocation Nationale des Mesotheliomes Pleuraux (MESONAT), Hopital de la Cote de Nacre, Caen, France Service d Anatomie Pathologique, Hopital de la Cote de Nacre, Caen, France. 7. Departement Sante Travail, Institut de Veille Sanitaire, Equipe Associee en Sante Travail, Bordeaux, France Departement Sante Travail, Institut de Veille Sanitaire, Saint Maurice, France. 8. Institut Interuniversitaire de Medecine du Travail de Paris Ile de France, Créteil, France Faculte de Medecine, INSERM U955, Universite Paris-Est Creteil, Creteil, France. 9. Departement Sante Travail, Institut de Veille Sanitaire, Saint Maurice, France.
Abstract
OBJECTIVES: To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos exposure in France including non-occupational exposure. METHODS: A population-based case-control study including 437 incident cases and 874 controls was conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a conditional logistic regression. RESULTS: A clear dose-response relationship was observed between occupational asbestos exposure and pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs. 67.0 (99% CI 25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI 74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI -33.5% to 73.5%) in men and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was 87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women. CONCLUSIONS: Our study suggests that the overall ARp in women is largely driven by non-occupational asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence. Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the observed difference in ARp between men and women. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVES: To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos exposure in France including non-occupational exposure. METHODS: A population-based case-control study including 437 incident cases and 874 controls was conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a conditional logistic regression. RESULTS: A clear dose-response relationship was observed between occupational asbestos exposure and pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs. 67.0 (99% CI 25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI 74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI -33.5% to 73.5%) in men and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was 87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women. CONCLUSIONS: Our study suggests that the overall ARp in women is largely driven by non-occupational asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence. Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the observed difference in ARp between men and women. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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