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Asbestos, smoking, and lung cancer: interaction and attribution
  1. B W Case
  1. Correspondence to:
 Dr B W Case
 Department of Pathology, McGill University Hospital Centre, 1650 Cedar Avenue West, Room C3-157, Montreal, Quebec, Canada H3G 1A4; bruce.case{at}mcgill.ca

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Commentary on the paper by Reid et al (see page 509)

Lung cancer is almost as dramatic a disease as is mesothelioma in its clinical course and prognosis. It has been a “rule of thumb” that there may be two asbestos related lung cancers for every mesothelioma, with a ratio of up to 10:1 in some heavily exposed occupational cohorts. Even in the United Kingdom, where mesothelioma deaths have risen so high they may have surpassed asbestos related lung cancer deaths,1 the latter remains estimated at 2–3% of all lung cancer. Due to disease time course, the potential effects of smoking cessation, and possibly improved screening of at-risk populations, lung cancer seems more amenable to early detection or prevention. Yet lung cancer receives far less attention, both scientifically and in the popular press.

The problem is partly one of ease of attribution. For compensation boards and others charged with this task, this has proved more difficult for lung cancer. For mesothelioma, most—80% generally, and perhaps over 90% in the UK—are currently due to one factor. The potent associated influences of asbestos fibre type and of time from first exposure make deconstruction of the cause of individual cases of mesothelioma a straightforward matter given adequate information.2

Lung cancer has always presented less simple dilemmas. Approximately the same proportion of …

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