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Original article
Pleural mesothelioma and lung cancer risks in relation to occupational history and asbestos lung burden
  1. Clare Gilham1,
  2. Christine Rake1,
  3. Garry Burdett2,
  4. Andrew G Nicholson3,
  5. Leslie Davison4,
  6. Angelo Franchini1,
  7. James Carpenter1,5,
  8. John Hodgson6,
  9. Andrew Darnton6,
  10. Julian Peto1
  1. 1London School of Hygiene and Tropical Medicine, London, UK
  2. 2Health and Safety Laboratory, Buxton, UK
  3. 3Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
  4. 4Department of Cellular Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5Medical Research Council Clinical Trials Unit, Kingsway, London, UK
  6. 6Health and Safety Executive, Bootle, UK
  1. Correspondence to Clare Gilham, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; clare.gilham{at}


Background We have conducted a population-based study of pleural mesothelioma patients with occupational histories and measured asbestos lung burdens in occupationally exposed workers and in the general population. The relationship between lung burden and risk, particularly at environmental exposure levels, will enable future mesothelioma rates in people born after 1965 who never installed asbestos to be predicted from their asbestos lung burdens.

Methods Following personal interview asbestos fibres longer than 5 µm were counted by transmission electron microscopy in lung samples obtained from 133 patients with mesothelioma and 262 patients with lung cancer. ORs for mesothelioma were converted to lifetime risks.

Results Lifetime mesothelioma risk is approximately 0.02% per 1000 amphibole fibres per gram of dry lung tissue over a more than 100-fold range, from 1 to 4 in the most heavily exposed building workers to less than 1 in 500 in most of the population. The asbestos fibres counted were amosite (75%), crocidolite (18%), other amphiboles (5%) and chrysotile (2%).

Conclusions The approximate linearity of the dose–response together with lung burden measurements in younger people will provide reasonably reliable predictions of future mesothelioma rates in those born since 1965 whose risks cannot yet be seen in national rates. Burdens in those born more recently will indicate the continuing occupational and environmental hazards under current asbestos control regulations. Our results confirm the major contribution of amosite to UK mesothelioma incidence and the substantial contribution of non-occupational exposure, particularly in women.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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