Background Occupational asbestos exposure is associated with pleural plaques (PP), a benign disease often seen as a marker of past exposure to asbestos and lung cancer. The association between these two diseases has not been formally proved, the aim of this study was to evaluate this association in the asbestos-related disease cohort (ARDCO) cohort.
Methods ARDCO is a French multicentric cohort including workers formerly occupationally exposed to asbestos from 2003 to 2005. CT scan was performed to diagnose PP with double reading and lung cancer (incidence and mortality) was followed through health insurance data and death certificates. Cox models were used to estimate the association between PP and lung cancer adjusting for occupational asbestos exposure (represented by cumulative exposure index, time since first exposure and time since last exposure) and smoking status.
Results A total of 176 cases (of 5050 subjects) and 88 deaths (of 4938 subjects) of lung cancer were recorded. Smoking status was identified as an effect modifier. Lung cancer incidence and mortality were significantly associated with PP only in non-smokers, respectively, HR=3.13 (95% CI 1.04 to 9.35) and HR=16.83 (95% CI 1.87 to 151.24) after adjustment for age, occupational asbestos exposure and smoking status.
Conclusions ARDCO study was the first to study this association considering equal asbestos exposure, and more specifically, our study is the first to test smoking as an effect modifier, so comparison with scientific literature is difficult. Our results seem to consolidate the hypothesis that PP may be an independent risk factor for lung cancer but they must be interpreted with caution.
- occupational health
- respiratory system
Data availability statement
No data are available.
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Contributors JG performed literature review, all statistical analysis and drafted the first version ofthis manuscript.Conception or design of the work was done by CP, BC, PB, J-CP and AL. Acquisition and interpretation of data was done by CP, BC, AG, FL, IT, SC and GO. AL supervised all aspects of this manuscript. All coauthors participated in the drafting, revision and correction of the final text. J-CP is the guarantor of the paper.
Funding This study was supported by the French Ministry of Labour and Social Relations; the French National Health Insurance (Occupational Risk Prevention Department); the French Agency for Food, Environmental and Occupational Health & Safety, Grant number: ANSES Grant 07-CRD-51 and EST 2006/1/43 and EST 2009/68.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.