Rate advancement measurement for lung cancer and pleural mesothelioma in asbestos-exposed workers

Thorax 2022 November 10 [Link]

Danila Azzolina, Dario Consonni, Daniela Ferrante, Dario Mirabelli, Stefano Silvestri, Ferdinando Luberto, Alessia Angelini, Francesco Cuccaro, Anna Maria Nannavecchia, Enrico Oddone, Massimo Vicentini, Francesco Barone-Adesi, Tiziana Cena, Lucia Mangone, Francesca Roncaglia, Orietta Sala, Simona Menegozzo, Roberta Pirastu, Sara Tunesi, Elisabetta Chellini, Lucia Miligi, Patrizia Perticaroli, Aldo Pettinari, Vittoria Bressan, Enzo Merler, Paolo Girardi, Lucia Bisceglia, Alessandro Marinaccio, Stefania Massari, Corrado Magnani


Introduction: Exposure to asbestos increases the risk of lung cancer and mesothelioma. Few studies quantified the premature occurrence of these diseases in asbestos-exposed workers. Focus on premature disease onset (rate advancement or acceleration) can be useful in risk communication and for the evaluation of exposure impact. We estimated rate advancement for total mortality, lung cancer and pleural mesothelioma deaths, by classes of cumulative asbestos exposure in a pooled cohort of asbestos cement (AC) workers in Italy.

Method: The cohort study included 12 578 workers from 21 cohorts, with 6626 deaths in total, 858 deaths from lung cancer and 394 from pleural malignant neoplasm (MN). Rate advancement was estimated by fitting a competitive mortality Weibull model to the hazard of death over time since first exposure (TSFE).

Result: Acceleration time (AT) was estimated at different TSFE values. The highest level of cumulative exposure compared with the lowest, for pleural MN AT was 16.9 (95% CI 14.9 to 19.2) and 33.8 (95% CI 29.8 to 38.4) years at TSFE of 20 and 40 years, respectively. For lung cancer, it was 13.3 (95% CI 12.0 to 14.7) and 26.6 (95% CI 23.9 to 29.4) years, respectively. As for total mortality, AT was 3.35 (95% CI 2.98 to 3.71) years at 20 years TSFE, and 6.70 (95% CI 5.95 to 7.41) at 40 years TSFE.

Conclusion: The current study observed marked rate advancement after asbestos exposure for lung cancer and pleural mesothelioma, as well as for total mortality.