TY - JOUR T1 - Role of asbestos clearance in explaining long-term risk of pleural and peritoneal cancer: a pooled analysis of cohort studies JF - Occupational and Environmental Medicine JO - Occup Environ Med SP - 611 LP - 616 DO - 10.1136/oemed-2019-105779 VL - 76 IS - 9 AU - Francesco Barone-Adesi AU - Daniela Ferrante AU - Elisabetta Chellini AU - Enzo Merler AU - Venere Pavone AU - Stefano Silvestri AU - Lucia Miligi AU - Giuseppe Gorini AU - Vittoria Bressan AU - Paolo Girardi AU - Laura Ancona AU - Elisa Romeo AU - Ferdinando Luberto AU - Orietta Sala AU - Corrado Scarnato AU - Simona Menegozzo AU - Enrico Oddone AU - Sara Tunesi AU - Patrizia Perticaroli AU - Aldo Pettinari AU - Francesco Cuccaro AU - Stefania Curti AU - Antonio Baldassarre AU - Tiziana Cena AU - Alessia Angelini AU - Alessandro Marinaccio AU - Dario Mirabelli AU - Marina Musti AU - Roberta Pirastu AU - Alessandra Ranucci AU - Corrado Magnani A2 - , Y1 - 2019/09/01 UR - http://oem.bmj.com/content/76/9/611.abstract N2 - Objectives Models based on the multistage theory of cancer predict that rates of malignant mesothelioma continuously increase with time since first exposure (TSFE) to asbestos, even after the end of external exposure. However, recent epidemiological studies suggest that mesothelioma rates level off many years after first exposure to asbestos. A gradual clearance of asbestos from the lungs has been suggested as a possible explanation for this phenomenon. We analysed long-term trends of pleural and peritoneal cancer mortality in subjects exposed to asbestos to evaluate whether such trends were consistent with the clearance hypothesis.Methods We used data from a pool of 43 Italian asbestos cohorts (51 801 subjects). The role of asbestos clearance was explored using the traditional mesothelioma multistage model, generalised to include a term representing elimination of fibres over time.Results Rates of pleural cancer increased until 40 years of TSFE, but remained stable thereafter. On the other hand, we observed a monotonic increase of peritoneal cancer with TSFE. The model taking into account asbestos clearance fitted the data better than the traditional one for pleural (p=0.004) but not for peritoneal (p=0.09) cancer.Conclusions Rates of pleural cancer do not increase indefinitely after the exposure to asbestos, but eventually reach a plateau. This trend is well described by a model accounting for a gradual elimination of the asbestos fibres. These results are relevant for the prediction of future rates of mesothelioma and in asbestos litigations. ER -