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Asbestos and smoking interaction for lung cancer

It was first reported in 1968 [Selikoff IJ, Hammond EC, Churg J. Asbestos exposure, smoking and neoplasia. JAMA 1968; 204: 106-112] that there is a synergistic effect between asbestos and smoking in the causation of lung cancer. This was confirmed in the workers at the Barking factory in 1972 [23]. This means that in addition to the separate effects of asbestos and smoking, there is an additional effect due to the combination of these two risk factors. In a later follow-up of the same cohort [73] we found that "overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers"; we defined this ratio of risks as the relative asbestos effect (RAE*).

More recently Liddell [Liddell FDK. The interaction of asbestos and smoking in lung cancer. Ann Occup Hyg 2001; 45: 341-356.16] concluded that "the relative risk of lung cancer from asbestos exposure is about twice as high in non-smokers as in smokers". This conclusion is not without controversy since in another review Lee [Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001; 58: 145-153.17] concluded that "asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers."

The work of Liddell has recently been extended by Berry and Liddell [174] who worked with the ratio of excess relative risk (above the base of 1) to define a modified measure (RAEm**). They concluded that

The excess relative risk of lung cancer from asbestos exposure is about three times higher in non-smokers than in smokers. The modified measure has been placed within a more versatile model of interaction. If interaction is present the relative risk from asbestos exposure changes only slightly between light and heavy smokers, but is higher in very light smokers and non-smokers. The relative risk estimated from epidemiological studies of a mixed population of non-smokers and smokers applies to smokers.


* RAE = RR(NS)/RR(S)
where RR(NS) is the relative risk of lung cancer due to asbestos exposure in non-smokers, and RR(S) that in smokers.

** RAEm = [RR(NS)-1]/[RR(S)-1]


23. BERRY, G., NEWHOUSE, M.L. & TUROK, M. (1972). Combined effect of asbestos exposure and smoking on mortality from lung cancer in factory workers. Lancet, 300, 476-9.

73. BERRY, G., NEWHOUSE, M.L. & ANTONIS, P. (1985). Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers. Br. J. ind. Med., 42, 12-18. PDF

174. BERRY, G. & LIDDELL, F.D.K. (2004). The interaction of asbestos and smoking in lung cancer - a modified measure of effect. Ann. Occup. Hyg. 48, 459-462. Full text

180. REID, A., de KLERK, N., AMBROSINI, G.L., BERRY, G. & MUSK, A.W. (2006). The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking. Occup. Environ. Med. 63, 509-512. Abstract PDF

C6 LEIGH, J., BERRY, G., de KLERK, N.H. & HENDERSON, D.W. (1996). Asbestos-related lung cancer: apportionment of causation and damages to asbestos and tobacco smoke. In: Sourcebook of Asbestos Diseases, Volume 13, Asbestos Pathogenesis and Litigation, eds. G.A. Peters & B.J. Peters, 141-166. Michie Co., Charlottesville, VA.

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!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> G Berry publications - asbestos and smoking

Publications - G Berry

Home

 Publications



Asbestos and smoking interaction for lung cancer

It was first reported in 1968 [Selikoff IJ, Hammond EC, Churg J. Asbestos exposure, smoking and neoplasia. JAMA 1968; 204: 106-112] that there is a synergistic effect between asbestos and smoking in the causation of lung cancer. This was confirmed in the workers at the Barking factory in 1972 [23]. This means that in addition to the separate effects of asbestos and smoking, there is an additional effect due to the combination of these two risk factors. In a later follow-up of the same cohort [73] we found that "overall non-smokers have a relative risk of lung cancer due to asbestos that is 1.8 times that of smokers"; we defined this ratio of risks as the relative asbestos effect (RAE*).

More recently Liddell [Liddell FDK. The interaction of asbestos and smoking in lung cancer. Ann Occup Hyg 2001; 45: 341-356.16] concluded that "the relative risk of lung cancer from asbestos exposure is about twice as high in non-smokers as in smokers". This conclusion is not without controversy since in another review Lee [Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med 2001; 58: 145-153.17] concluded that "asbestos exposure multiplies risk of lung cancer by a similar factor in non-smokers and smokers."

The work of Liddell has recently been extended by Berry and Liddell [174] who worked with the ratio of excess relative risk (above the base of 1) to define a modified measure (RAEm**). They concluded that

The excess relative risk of lung cancer from asbestos exposure is about three times higher in non-smokers than in smokers. The modified measure has been placed within a more versatile model of interaction. If interaction is present the relative risk from asbestos exposure changes only slightly between light and heavy smokers, but is higher in very light smokers and non-smokers. The relative risk estimated from epidemiological studies of a mixed population of non-smokers and smokers applies to smokers.


* RAE = RR(NS)/RR(S)
where RR(NS) is the relative risk of lung cancer due to asbestos exposure in non-smokers, and RR(S) that in smokers.

** RAEm = [RR(NS)-1]/[RR(S)-1]


23. BERRY, G., NEWHOUSE, M.L. & TUROK, M. (1972). Combined effect of asbestos exposure and smoking on mortality from lung cancer in factory workers. Lancet, 300, 476-9.

73. BERRY, G., NEWHOUSE, M.L. & ANTONIS, P. (1985). Combined effect of asbestos and smoking on mortality from lung cancer and mesothelioma in factory workers. Br. J. ind. Med., 42, 12-18. PDF

174. BERRY, G. & LIDDELL, F.D.K. (2004). The interaction of asbestos and smoking in lung cancer - a modified measure of effect. Ann. Occup. Hyg. 48, 459-462. Full text

180. REID, A., de KLERK, N., AMBROSINI, G.L., BERRY, G. & MUSK, A.W. (2006). The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking. Occup. Environ. Med. 63, 509-512. Abstract PDF

C6 LEIGH, J., BERRY, G., de KLERK, N.H. & HENDERSON, D.W. (1996). Asbestos-related lung cancer: apportionment of causation and damages to asbestos and tobacco smoke. In: Sourcebook of Asbestos Diseases, Volume 13, Asbestos Pathogenesis and Litigation, eds. G.A. Peters & B.J. Peters, 141-166. Michie Co., Charlottesville, VA.

Back to Publication Index