Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers.

The mortality of over 1250 male and 420 female asbestos factory workers was observed over the period 1971-80. Smoking habits were obtained from the subjects in 1971 before the start of the follow up period. Mortality due to lung cancer and to mesothelioma was related to smoking habits. After allowing for the effect of smoking on lung cancer the relative risk due to asbestos was highest for those who had never smoked, lowest for current smokers, and intermediate for ex-smokers; the trend was statistically significant (p less than 0.05). There was no significant association between smoking and deaths due to mesothelioma. Data from several studies are reviewed, and although overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers, there is some uncertainty on the accuracy of this figure because of possible biases and sampling variation. Overall the evidence is that mesothelioma risk is independent of smoking.