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Increased lung cancer mortality among chrysotile asbestos textile workers is more strongly associated with exposure to long thin fibres
  1. Dana Loomis1,
  2. John M Dement2,
  3. Leslie Elliott1,
  4. David Richardson3,
  5. Eileen D Kuempel4,
  6. Leslie Stayner5
  1. 1Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
  2. 2Division of Occupational & Environmental Medicine, Department of Community & Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
  3. 3Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4National Institute for Occupational Safety and Health, MS C-15, Cincinnati, Ohio, USA
  5. 5Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Professor Dr Dana Loomis, Department of Epidemiology, College of Public Health, 984395 University of Nebraska Medical Center, Omaha, NE 68198, USA; dana.loomis{at}


Background Animal data and physical models suggest that the carcinogenicity of asbestos fibres is related to their size and shape.

Objectives To investigate the influence of fibre length and diameter on lung cancer risk in workers at asbestos textile mills in North Carolina and South Carolina, USA.

Methods Men and women (n=6136) who worked ≥30 days in production and were employed between 1940 and 1973 were enumerated and followed for vital status through 2003. A matrix of fibre size-specific exposure estimates was constructed using determinations of fibre numbers and dimensions through analysis of 160 historical dust samples by transmission electron microscopy. Associations of lung cancer mortality with metrics of fibre exposure were estimated by Poisson regression with adjustment for age, sex, race and calendar year.

Results Exposure to fibres throughout the range of length and diameter was significantly associated with increased risk of lung cancer. Models for fibres >5 μm long and <0.25 μm in diameter provided the best fit to the data, while fibres 5–10 μm long and <0.25 μm in diameter were associated most strongly with lung cancer mortality (log rate about 4% per IQR, p<0.001). When indicators of mean fibre length and diameter were modelled simultaneously, lung cancer risk increased as fibre length increased and diameter decreased.

Conclusions The findings support the hypothesis that the occurrence of lung cancer is associated most strongly with exposure to long thin asbestos fibres. The relationship of cancer risk and fibre dimensions should be examined in cohorts exposed to other types of fibres.

  • Asbestos
  • chrysotile
  • fibres
  • lung cancer
  • epidemiology
  • cancer
  • hygiene/occupational hygiene
  • epidemiology
  • public health
  • asthma
  • respiratory

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  • Funding Support for this research was provided by grant R01-OH007803 from the National Institute for Occupational Safety and Health (USA).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by University of North Carolina Public Health Institutional Review Board.

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