Relative burden of lung and pleural cancers from exposure to asbestos: a cross-sectional analysis of occupational mortality in England and Wales.
OBJECTIVES
To explore the extent to which asbestos-exposed jobs vary in the ratio of excess mortality from lung cancer to deaths from pleural cancer.


DESIGN
Using data on underlying cause of death and last full-time occupation for 3 688 916 deaths among men aged 20-74 years in England and Wales during 1979-2010, we calculated proportional mortality ratios (PMRs), standardised for age and social class, with all occupations combined as reference. For each of 22 asbestos-exposed job groups with significantly elevated PMRs for pleural cancer, we calculated excess mortality from lung cancer (observed minus expected deaths) and its ratio to number of deaths from pleural cancer. To reduce confounding effects of smoking, we adjusted expected deaths from lung cancer in each job group, according to a formula based on its PMR for chronic obstructive pulmonary disease.


SETTING
England and Wales.


PARTICIPANTS
3 688 916 men who died aged 20-74 years during 1979-2010.


OUTCOME MEASURES
Ratios of excess mortality from lung cancer to deaths from pleural cancer by job group.


RESULTS
Adjusted PMRs for lung cancer were elevated in all but 4 of the 22 asbestos-exposed job groups, but the ratio of excess lung cancer to deaths from pleural cancer varied widely between job groups, being significantly greater than the overall ratio in six, and significantly less in seven. Analysis for 2001-2010, when (because of changes in coding) ascertainment of pleural tumours was more reliable, showed similar variation between job groups, and indicated an overall ratio of 0.28.


CONCLUSIONS
Excess lung cancer in asbestos-exposed jobs is not in a simple proportion to deaths from pleural cancer, and the ratio may vary importantly according to intensity of exposure to different types of asbestos and concomitant smoking habits. The current burden of lung cancer from occupational exposure to asbestos in Britain may not be so high as previously thought.
['Harris|Elizabeth Clare|EC|0000-0001-8037-566X', "D'Angelo|Stefania|S|", 'Darnton|Andrew|A|', 'Coggon|David|D|0000-0003-1930-3987']
D000328:Adult D000368:Aged D001194:Asbestos D003430:Cross-Sectional Studies D004739:England D006801:Humans D008168:Lung D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009784:Occupational Diseases D016273:Occupational Exposure D010997:Pleural Neoplasms D012907:Smoking D014852:Wales D055815:Young Adult
epidemiology occupational & industrial medicine respiratory tract tumours