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Additive Synergism between Asbestos and Smoking in Lung Cancer Risk: A Systematic Review and Meta-Analysis

Author

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  • Yuwadee Ngamwong
  • Wimonchat Tangamornsuksan
  • Ornrat Lohitnavy
  • Nathorn Chaiyakunapruk
  • C Norman Scholfield
  • Brad Reisfeld
  • Manupat Lohitnavy

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.

Suggested Citation

  • Yuwadee Ngamwong & Wimonchat Tangamornsuksan & Ornrat Lohitnavy & Nathorn Chaiyakunapruk & C Norman Scholfield & Brad Reisfeld & Manupat Lohitnavy, 2015. "Additive Synergism between Asbestos and Smoking in Lung Cancer Risk: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-19, August.
    • Handle: RePEc:plo:pone00:0135798
    DOI: 10.1371/journal.pone.0135798
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    References listed on IDEAS

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    1. Xiaorong Wang & Eiji Yano & Sihao Lin & Ignatius T S Yu & Yajia Lan & Lap Ah Tse & Hong Qiu & David C Christiani, 2013. "Cancer Mortality in Chinese Chrysotile Asbestos Miners: Exposure-Response Relationships," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-8, August.
    2. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    1. Sonja Klebe & James Leigh & Douglas W. Henderson & Markku Nurminen, 2019. "Asbestos, Smoking and Lung Cancer: An Update," IJERPH, MDPI, vol. 17(1), pages 1-23, December.
    2. Nicole Bijlsma & Marc M. Cohen, 2016. "Environmental Chemical Assessment in Clinical Practice: Unveiling the Elephant in the Room," IJERPH, MDPI, vol. 13(2), pages 1-27, February.
    3. Anna Suraya & Dennis Nowak & Astrid Widajati Sulistomo & Aziza Ghanie Icksan & Elisna Syahruddin & Ursula Berger & Stephan Bose-O’Reilly, 2020. "Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia," IJERPH, MDPI, vol. 17(2), pages 1-10, January.
    4. Lucia Fazzo & Alessandra Binazzi & Daniela Ferrante & Giada Minelli & Dario Consonni & Lisa Bauleo & Caterina Bruno & Marcella Bugani & Marco De Santis & Ivano Iavarone & Corrado Magnani & Elisa Romeo, 2021. "Burden of Mortality from Asbestos-Related Diseases in Italy," IJERPH, MDPI, vol. 18(19), pages 1-14, September.
    5. Noluthando P. Mbeje & Themba Ginindza & Nkosana Jafta, 2022. "Epidemiological Study of Risk Factors for Lung Cancer in KwaZulu-Natal, South Africa," IJERPH, MDPI, vol. 19(11), pages 1-13, May.

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