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Exposure to asbestos and the risk of colorectal cancer mortality: a systematic review and meta-analysis
  1. Kyeongmin Kwak1,2,
  2. Domyung Paek1,3,
  3. Kyung Ehi Zoh1
  1. 1 Department of Environmental Health Sciences, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
  2. 2 Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
  3. 3 Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
  1. Correspondence to Kyung Ehi Zoh, Department of Environmental Health Sciences, Seoul National University Graduate School of Public Health, Seoul 08826, Republic of Korea; kezoh{at}snu.ac.kr

Abstract

Asbestos exposure is associated with mesothelioma and cancer of the lung, larynx and ovary. However, the association between asbestos exposure and colorectal cancer is controversial despite several systematic reviews of the literature, including a number of meta-analyses. We performed a systematic review and meta-analysis to evaluate quantitatively the association between exposure to asbestos and colorectal cancer. We searched for articles on occupational asbestos exposure and colorectal cancer in PubMed, EMBASE and Web of Science published before April 2018. In total, 44 articles were selected and 46 cohort studies were analysed. The overall pooled risk estimates and corresponding 95% CIs of the association between occupational asbestos exposure and colorectal cancer were calculated using a random-effects model. Subgroup analyses and sensitivity tests were also performed. There was a significantly increased risk of colorectal cancer mortality among workers exposed to asbestos occupationally, with an overall pooled SMR of 1.16 (95% CI: 1.05 to 1.29). The pooled SMR for colorectal cancer was elevated in studies in which the asbestos-associated risk of lung cancer was also elevated (1.43; 95% CI: 1.30 to 1.56). This implies that the risk of colorectal cancer mortality increases as the level of asbestos exposure rises. A sensitivity analysis showed robust results and there was no publication bias. Although the effect size was small and the heterogeneity among studies was large, our findings indicate that occupational exposure to asbestos is a risk factor for colorectal cancer.

  • asbestos
  • meta-analysis
  • GI tract
  • cancer
  • epidemiology
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Footnotes

  • Contributors KK and KEZ searched literatures, identified relevant articles and reviewed full text. KK designed the study, analysed the data and drafted the manuscript. KEZ interpreted the data and revised the manuscript. DP suggested the study design, interpreted the data and revised the manuscript. All authors read and approved the final manuscript.

  • Funding This study was supported by the National Research Foundation of Korea (NRF) funded by the Korea government (MSIT) under grant NRF-2019R1A2C2007484

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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