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. Norman, Reisfeld, Brad and Lohitnavy, Manupat (2015) Additive synergism between asbestos and smoking in lung cancer risk: a systematic review and meta-analysis. PLoS One, 10 8: 1-19. doi:10.1371/journal.pone.0135798


Author Ngamwong, Yuwadee
Tangamornsuksan, Wimonchat
Lohitnavy, Ornrat
Chaiyakunapruk, Nathorn
Scholfield, C. Norman
Reisfeld, Brad
Lohitnavy, Manupat
Title Additive synergism between asbestos and smoking in lung cancer risk: a systematic review and meta-analysis
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2015-08
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1371/journal.pone.0135798
Open Access Status DOI
Volume 10
Issue 8
Start page 1
End page 19
Total pages 19
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2016
Language eng
Formatted abstract
Smoking and asbestos exposure are important risks for lung cancer. Several epidemiological studies have linked asbestos exposure and smoking to lung cancer. To reconcile and unify these results, we conducted a systematic review and meta-analysis to provide a quantitative estimate of the increased risk of lung cancer associated with asbestos exposure and cigarette smoking and to classify their interaction. Five electronic databases were searched from inception to May, 2015 for observational studies on lung cancer. All case-control (N = 10) and cohort (N = 7) studies were included in the analysis. We calculated pooled odds ratios (ORs), relative risks (RRs) and 95% confidence intervals (CIs) using a random-effects model for the association of asbestos exposure and smoking with lung cancer. Lung cancer patients who were not exposed to asbestos and non-smoking (A-S-) were compared with; (i) asbestos-exposed and non-smoking (A+S-), (ii) non-exposure to asbestos and smoking (A-S+), and (iii) asbestos-exposed and smoking (A+S+). Our meta-analysis showed a significant difference in risk of developing lung cancer among asbestos exposed and/or smoking workers compared to controls (A-S-), odds ratios for the disease (95% CI) were (i) 1.70 (A+S-, 1.31–2.21), (ii) 5.65; (A-S+, 3.38–9.42), (iii) 8.70 (A+S+, 5.8–13.10). The additive interaction index of synergy was 1.44 (95% CI = 1.26–1.77) and the multiplicative index = 0.91 (95% CI = 0.63–1.30). Corresponding values for cohort studies were 1.11 (95% CI = 1.00–1.28) and 0.51 (95% CI = 0.31–0.85). Our results point to an additive synergism for lung cancer with co-exposure of asbestos and cigarette smoking. Assessments of industrial health risks should take smoking and other airborne health risks when setting occupational asbestos exposure limits.
Keyword Case referent
Occupational exposures
Malignant mesothelioma
Pleural mesothelioma
Chrysotile asbestos
Cigarette smoking
Epithelial cells
Factory workers
Dust exposure
Mortality
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2016 Collection
School of Public Health Publications
 
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