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Environmental exposure to asbestos and the risk of lung cancer: a systematic review and meta-analysis
  1. Kyeongmin Kwak1,
  2. Dongmug Kang2,3,
  3. Domyung Paek4,5
  1. 1 Department of Occupational and Environmental Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
  2. 2 Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
  3. 3 Department of Preventive, Occupational and Environmental Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
  4. 4 Department of Environmental Health Sciences, Seoul National University Graduate School of Public Health, Seoul, Republic of Korea
  5. 5 Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
  1. Correspondence to Dr Domyung Paek, Department of Environmental Health Sciences, Seoul National University Graduate School of Public Health, Seoul 08826, Republic of Korea; paekdm{at}


Asbestos is a carcinogen associated with lung cancer, but few studies have examined the increased risk of lung cancer due to environmental asbestos exposure. We performed a systematic review and meta-analysis to evaluate the association between environmental asbestos exposure and lung cancer. We searched for articles on non-occupational or environmental asbestos exposure and lung cancer in PubMed, EMBASE, CINAHL and Web of Science databases. Our review included 15 studies, and except studies on ingestion exposure we performed a meta-analysis for 13 studies with respect to the type of exposure (neighbourhood and domestic/household exposure). Subgroup analyses and meta-regression were also performed. A significant increase in the risk of lung cancer was found for neighbourhood exposure (1.48, 95% CI 1.18 to 1.86), while the risk was not significantly increased for domestic/household exposure (1.04, 95% CI 0.85 to 1.27). With regard to neighbourhood exposure, naturally occurring asbestos and women were both associated with a higher risk of lung cancer; however, such an increase was not significantly greater compared with that associated with other sources of asbestos exposure and men. Although cautious interpretation is needed due to the large degree of heterogeneity and the small number of included studies, our findings imply that living near the source of asbestos increases the risk of lung cancer.

  • asbestos
  • meta-analysis
  • environmental exposure
  • lung diseases
  • interstitial

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

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Author note This paper is based on the reanalysis of a part of the first author (KK)’s doctoral dissertation at Seoul National University, Republic of Korea.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.