Epidemiology of asbestos-related diseases

Abstract

This paper is intenden to give the reader an overview of the epidemiology of asbestos-related diseases and is restricted to primarily occupational exposure studies. However, some mention of nonoccupational exposures are made because of their direct relationship to a worker or to a secondary occupational source. Over 100 epidemiological studies are reviewed, dating back to the first case of asbestos-associated disease reported by Montague Murray in 1906. The studies are divided by specific fiber type and by specific disease outcomes and the interaction of asbestos and cigarette smoking is discussed in great detail. In addition to the nonmalignant effects of asbestos, all commercial forms of asbestos have been shown to be carcinogenic in man, and occupational exposure during mining where asbestiform fibers occur also accounted for an excess of cancer in miners. In addition, household contact with asbestos workers has demonstrated a risk for nonmalignant and carcinogenic effects. It has been estimated that of the 4 million workers heavily exposed to asbestos, at least 1.6 million (35-44%) are thus expected to die of asbestos-related cancers, while in the absence of asbestos exposure only about 0.35 million (8-9%) would have been expected to die of cancer. Broken down more specifically, these cancer deaths include 20-25% from lung cancer, 7-10% of pleural or peritoneal mesothelioma, and 8-9% of gastrointestinal cancer. It is estimated that between 58,000 and 75,000 asbestos-associated deaths will occur each year, which will account for between 13 and 18% of the total cancer deaths in the United States. (108 references)