Document b3m106NoGrao7MKMxwoOxmbD

Cigarette Smoking, Asbestos Exposure, and Malignant Mesothelioma Joshua E. Muscat and Ernst L. Wynder Cancer Res 1991;51:2263-2267. Published online May 1, 1991. Updated Version Access the most recent version of this article at: http://cancerres.aacrjournals.org/content/51/9/2263 Citing Articles This article has been cited by 2 HighWire-hosted articles. Access the articles at: http://cancerres.aacrjournals.org/content/51/9/2263#related-urls E-mail alerts Reprints and Subscriptions Permissions Sign up to receive free email-alerts related to this article or journal. To order reprints of this article or to subscribe to the journal, contact the AACR Publications Department at pubs@aacr.org. To request permission to re-use all or part of this article, contact the AACR Publications Department at permissions@aacr.org. Downloaded from cancerres.aacrjournals.org on May 10, 2011 Copyright 1991 American Association for Cancer Research Authors; study design; location Tagnon et al. (8); case-con trol study of shipbuilding industry in Tidewater, VA McDonald and McDonald (7); case-control study in United States and Canada Hammond et al. (4) and Selikoff (6); cohort study in United States and Can ada. Zielhuis et al. (S); case-con trol study in Amsterdam Selikoff etal. (10); standard ized mortality ratio study in New Jersey Berry et al. (9); standardized mortality ratio study in London SMOKING, ASBESTOS, AND MESOTHELIOMA Table 1 Summary ofstudies ofcigarette exposure and mesothelioma # subjects; methods of interview; criteria Results 56 white male cases and 236 matched non-respiratory-diseased controls, selected from hospital discharge di agnoses, pathology files, and tumor registries. 668 cases and single matched controls with nonpulmonary tumors, selected from pathologists from Canadian pathological societies and U.S. Armed Forces Institute of Pathology relatives interviewed. 17,800 male Insulation Union workers and 73,763 controls with a history of occupational exposures. 4% of cases smoked >2 packs/day vs. 19% of controls. Decreased risk among heavy smokers. No association found between cigarette smoking and mesothelioma among males. Elevated risk among female heavy smokers. Among male never smokers, 8 deaths from mesothelioma vs. 8 expected. 67 cases and age- (3 yr) and sexmatched controls with cardiovascu lar conditions; obtained from pa thology reports. Personal interview of relatives, neighbors, employees, or patients (if alive). 933 amosite asbestos workers, fol lowed up for 20 yr. 3700 male and female asbestos factory workers followed up 16-47 yr. No increased risk of mesothelioma found with smoking. Observed and expected death rate from mesothelioma: 9 vs. 14.8 among smokers, for never smokers, 3 vs. 3.0. Among female and male smokers, ob served to expected ratio mortality was similar for smokers and non smokers. Comments Information concerning exposures ob tained from relatives. Some controls include tobacco-related diseases. No women studied. Information concerning exposure ob tain from relatives. Some controls included tobacco-related disease. Histological confirmation not avail able. Sample size was too small to evaluate effects of smoknig. No women studied. Controls included tobacco-related con ditions. Exposure information ob tained from relatives. No women studied. Too few male nonsmokers to evaluate. Table 2 Sociodemographic characteristics ofcases and controls Males Females tumor of the right pleura compared to 8 of 17 women (47%) (OR 2.0, 95% Cl 0.7-5.5). Cases (n = 105) Controls (/i =193) Cases (n = 19) Controls (n = 74) Among male cases, 82 men (78%) were considered exposed to asbestos; 72 men (69%) were employed in asbestos-related Age (yr) <44 45-54 55-64 65-74 >75 Education (yr) 1-8 9-12 13-15 >16 Religion Protestant Catholic Jewish Other None No. % No. % No. % No. % 8 7.6 19 9.8 23 21.9 37 19.2 39 37.1 78 40.4 30 28.6 54 28.0 5 4.8 5 2.5 1 5.3 9 12.2 4 21.1 18 24.3 9 47.4 26 35.1 4 21.1 15 20.3 1 5.3 6 8.1 7 6.7 16 8.3 1 5.3 10 13.5 52 49.5 66 34.2 11 57.9 32 43.2 36 34.3 63 32.6 6 31.6 19 25.7 10 9.5 48 24.9 1 5.3 13 17.6 40 38.1 46 23.8 7 36.8 9 12.2 48 45.7 88 45.6 10 52.6 50 67.6 14 13.3 49 25.4 2 10.5 14 18.9 2 1.9 4 2.1 0 0.0 1 1.4 1 1.0 6 3.1 0 0.0 0 0.0 industries and 59 of these 72 also self-reported asbestos expo sure. Ten men (9.5%) reported asbestos exposure but worked in jobs that are not considered asbestos-related industries, in cluding 2 policemen, 3 Navy seamen, one school teacher, one potter, one environmental consultant, one insurance salesman, and one plant manager. The potter reported working with an asbestos-lined kiln, and the teacher reported friable asbestos leaking from his classroom ceiling, although he stated anecdo tally that he had also worked 2 months previously in an asbestos factory. One Navy ensign reported exposure on a Navy ship. The plant manager reported workplace exposure. One police man reported domestic exposure during childhood. Among the 72 men who worked in asbestos-related occupa tions, 18 worked in shipyards during World War II as pipefit ters, electricians or insulators; 5 were subsequently employed than cases (P < 0.05); they were more likely to have worked in professional or managerial jobs. A larger proportion of female controls were Catholic and Jewish than female cases. Most subjects lived the majority of their adult lives in New York, New Jersey, Pennsylvania, and Illinois. Controls were more likely than cases to have lived in New York. Residency was further classified by urban density: city, >250,000 persons; town, 50,000-250,000 persons; village or suburb, 2,500-49,999 persons; and rural area, <2,000 persons. More cases resided in suburban or rural areas than controls: males, 56 versus 40.4% (test for trend, P < 0.02); females, 73.3 versus 37.9% (P < 0.01). The site of mesothelioma was known for 84 cases; 82 (97%) had pleural mesothelioma and 2 (3%) had peritoneal meso thelioma. Histopathological subtyping was reported for 75 in other asbestos-related occupations. Forty-three men worked in construction and 11 were employed in other asbestos-related jobs. Among women, only one (5%) case worked in an asbestosrelated industry as a textile operative for 27 years. Three females (16%) self-reported exposure to asbestos: the textile worker, a bank teller who was exposed during extensive home renovation, and an executive director who was exposed during childhood. The mean latent period between the first year employed in an asbestos-related occupation and diagnosis of mesothelioma was 38.4 years (1.4 years) for male cases and 36.6 years (1.4 years) from first self-reported exposure. Only one case devel oped mesothelioma within 10 years of initial exposure (5 years). Twenty-three male cases (22%) and 16 female cases (84%) cases. Sixty-one (81.3%) had epithelial mesothelioma, 9 (12%) never worked in an asbestos-related industry or self-reported had sarcomatous tumors, and 5 (6.7%) had biphasic or tumors exposure to asbestos. Five of these males worked in occupations of mixed histology. 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