Additive Synergism between Asbestos and Smoking in Lung Cancer Risk: A Systematic Review and Meta-Analysis

Ngamwong, Yuwadee; Tangamornsuksan, Wimonchat; Lohitnavy, Ornrat; Chaiyakunapruk, Nathorn; Scholfield, C.N.; Reisfeld, Brad; Lohitnavy, Manupat

doi:10.1371/journal.pone.0135798

Cited by 74 publications

(47 citation statements)

References 69 publications

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“…The combination of high exposure to asbestos and smoking increased the chances of lung cancer by 770%. The same effect was found by Ngamwong et al in a meta-analysis [24]. The combined effect between smoking and asbestos exhibited a positive additive and multiplicative interaction.…”

Section: Discussionsupporting

confidence: 84%

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Suraya¹,

Nowak

Sulistomo

et al. 2020

IJERPH

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Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.

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Section: Discussionsupporting

confidence: 84%

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Suraya¹,

Nowak

Sulistomo

et al. 2020

IJERPH

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“…At high levels in drinking water, arsenic is a well-established human carcinogen associated with bladder, lung and skin cancer [ 146 ], however at lower doses, its cancer risk may depend upon other variables such as smoking, and on differences in individual susceptibility, either genetically based or via nutritional status or other conditions [ 147 ]. This observation parallels the well-established finding that smokers exposed to asbestos have a significant increase in lung cancer risk compared to non-smokers [ 148 ].…”

Section: Chemical Risk and Chemical Risk Assessmentsupporting

confidence: 88%

Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

Bijlsma

Cohen

2016

IJERPH

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A growing body of evidence suggests chemicals present in air, water, soil, food, building materials and household products are toxicants that contribute to the many chronic diseases typically seen in routine medical practice. Yet, despite calls from numerous organisations to provide clinicians with more training and awareness in environmental health, there are multiple barriers to the clinical assessment of toxic environmental exposures. Recent developments in the fields of systems biology, innovative breakthroughs in biomedical research encompassing the “-omics” fields, and advances in mobile sensing, peer-to-peer networks and big data, provide tools that future clinicians can use to assess environmental chemical exposures in their patients. There is also a need for concerted action at all levels, including actions by individual patients, clinicians, medical educators, regulators, government and non-government organisations, corporations and the wider civil society, to understand the “exposome” and minimise the extent of toxic exposures on current and future generations. Clinical environmental chemical risk assessment may provide a bridge between multiple disciplines that uses new technologies to herald in a new era in personalised medicine that unites clinicians, patients and civil society in the quest to understand and master the links between the environment and human health.

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“…Four meta-analyses were conducted to evaluate the asbestos-smoking statistical interaction; one demonstrated a negative multiplicative interaction [ 43 ], and three suggested the presence of a positive additive interaction [ 13 – 15 ]. The most recent systematic review published in 2015 indicated the presence of a positive additive interaction and the absence of multiplicative interaction [ 15 ]. While we agreed about the absence of a multiplicative interaction, from this systematic review, the presence of a positive additive interaction is less clear.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the statistical interaction between the occupational exposure to asbestos and tobacco smoking was well studied through systematic reviews and meta-analyses, indicating the presence of a positive additive statistical interaction [ 13 – 15 ]. In the other hand, no systematic reviews were conducted to evaluate the statistical interactions between occupational exposure to crystalline silica and tobacco smoking or between diesel engine exhaust emissions and tobacco smoking.…”

Section: Introductionmentioning

confidence: 99%

Absence of multiplicative interactions between occupational lung carcinogens and tobacco smoking: a systematic review involving asbestos, crystalline silica and diesel engine exhaust emissions

et al. 2017

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BackgroundTobacco smoking is the main cause of lung cancer, but it is not the sole causal factor. Significant proportions of workers are smokers and exposed to occupational lung carcinogens. This study aims to systematically review the statistical interaction between occupational lung carcinogens and tobacco smoking, in particular asbestos, crystalline silica and diesel engine exhaust emissions.MethodsArticles were identified using Scopus, PubMed, and Web of Science, and were limited to those published in English or French, without limitation of time. The reference list of selected studies was reviewed to identify other relevant papers. One reviewer selected the articles based on the inclusion and exclusion criteria. Two reviewers checked the eligibility of articles to be included in the systematic review. Data were extracted by one reviewer and revised by two other reviewers. Cohorts and case–control studies were analyzed separately. The risk of bias was evaluated for each study based on the outcome. The results of the interaction between the tobacco smoking and each carcinogen was evaluated and reported separately.ResultsFifteen original studies were included for asbestos-smoking interaction, seven for silica-smoking interaction and two for diesel-smoking interaction. The results suggested the absence of multiplicative interaction between the three occupational lung carcinogens and smoking. There is no enough evidence from the literature to conclude for the additive interaction. We believe there is a limited risk of publication bias as several studies reporting negative results were published.ConclusionThere are no multiplicative interactions between tobacco smoking and occupational lung carcinogens, in particular asbestos, crystalline silica and diesel engine exhaust emissions. Even though, specific programs should be developed and promoted to reduce concomitantly the exposure to occupational lung carcinogens and tobacco smoking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4025-1) contains supplementary material, which is available to authorized users.

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Additive Synergism between Asbestos and Smoking in Lung Cancer Risk: A Systematic Review and Meta-Analysis

Cited by 74 publications

References 69 publications

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room

Absence of multiplicative interactions between occupational lung carcinogens and tobacco smoking: a systematic review involving asbestos, crystalline silica and diesel engine exhaust emissions

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