RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd
SP 611
OP 616
DO 10.1136/oemed-2019-105779
VO 76
IS 9
A1 Francesco Barone-Adesi
A1 Daniela Ferrante
A1 Elisabetta Chellini
A1 Enzo Merler
A1 Venere Pavone
A1 Stefano Silvestri
A1 Lucia Miligi
A1 Giuseppe Gorini
A1 Vittoria Bressan
A1 Paolo Girardi
A1 Laura Ancona
A1 Elisa Romeo
A1 Ferdinando Luberto
A1 Orietta Sala
A1 Corrado Scarnato
A1 Simona Menegozzo
A1 Enrico Oddone
A1 Sara Tunesi
A1 Patrizia Perticaroli
A1 Aldo Pettinari
A1 Francesco Cuccaro
A1 Stefania Curti
A1 Antonio Baldassarre
A1 Tiziana Cena
A1 Alessia Angelini
A1 Alessandro Marinaccio
A1 Dario Mirabelli
A1 Marina Musti
A1 Roberta Pirastu
A1 Alessandra Ranucci
A1 Corrado Magnani
A1 ,
YR 2019
UL http://oem.bmj.com/content/76/9/611.abstract
AB 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.