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Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case–control study within a cohort in China
  1. Eiji Yano1,
  2. Xiaorong Wang2,
  3. Mianzhen Wang3,
  4. Hong Qiu2,
  5. Zhiming Wang3
  1. 1Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
  2. 2School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
  3. 3Department of Occupational Health, Huaxi School of Public Health, Sichuan University, Chengdu, China
  1. Correspondence to Xiaorong Wang, School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China; xrwang{at}


Objective To confirm the association between exposure to chrysotile asbestos and lung cancer risk and to demonstrate the combined effect of smoking and asbestos exposure.

Methods A case–control study of 1139 asbestos workers identified 41 male lung cancer cases in 2001; each case was matched by age (±5 years) with five controls. Workers in seven workshops were categorised into high-, medium- and low-exposure subgroups, and conditional logistic regression was applied to estimate the odds ratios for lung cancer risk associated with the different exposure levels. Smoking, age at first exposure, and exposure duration were considered as covariates/confounding factors. A joint effect of asbestos exposure and smoking on lung cancer risk was analysed using a conditional logistical model.

Results 54% of cases had high exposure and 24% low exposure, while 24% of controls had high exposure and 44% low exposure. Smoking was more common in cases (90%) than in controls (73%). The adjusted OR for lung cancer was 3.66 (95% CI 1.61 to 8.29) for high exposure and was elevated slightly for medium exposure (1.25; 95% CI 0.47 to 3.31). Smoking was related to lung cancer risk (OR 3.33; 95% CI 1.10 to 10.08). In comparison with the low-exposure non-smoking group, the OR for the high-exposure smoking group was 10.39 (1.34 to 82.45), in contrast to 5.23 (0.50 to 54.58) for high-exposure non-smoking workers.

Conclusions These results confirm the strong association between exposure to chrysotile asbestos and lung cancer risk, and support an interactive effect of asbestos exposure and smoking which is more than additive.

  • Chrysotile asbestos
  • asbestos textile
  • smoking
  • lung cancer mortality
  • nested case-control study
  • occupational exposure
  • epidemiology
  • cancer
  • mortality studies
  • asbestos

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  • Funding This study was funded by Grants-in-Aid for Scientific Research (Scientific Research (B) 19390167) from the Japan Society for the Promotion of Science.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Human Subject Committees of Teikyo University and Huaxi School of Public Health, Sichuan University.

  • Provenance and peer review Not commissioned; externally peer reviewed.