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Review
. 2019 Dec 30;17(1):258.
doi: 10.3390/ijerph17010258.

Asbestos, Smoking and Lung Cancer: An Update

Sonja Klebe  1 , James Leigh  2 , Douglas W Henderson  1 , Markku Nurminen  3   4
Affiliations
Review

Asbestos, Smoking and Lung Cancer: An Update

Sonja Klebe et al. Int J Environ Res Public Health. .

Abstract

This review updates the scientific literature concerning asbestos and lung cancer, emphasizing cumulative exposure and synergism between asbestos exposure and tobacco smoke, and proposes an evidence-based and equitable approach to compensation for asbestos-related lung cancer cases. This update is based on several earlier reviews written by the second and third authors on asbestos and lung cancer since 1995. We reevaluated the peer-reviewed epidemiologic studies. In addition, selected in vivo and in vitro animal studies and molecular and cellular studies in humans were included. We conclude that the mechanism of lung cancer causation induced by the interdependent coaction of asbestos fibers and tobacco smoke at a biological level is a multistage stochastic process with both agents acting conjointly at all times. The new knowledge gained through this review provides the evidence for synergism between asbestos exposure and tobacco smoke in lung cancer causation at a biological level. The evaluated statistical data conform best to a multiplicative model for the interaction effects of asbestos and smoking on the lung cancer risk, with no requirement for asbestosis. Any asbestos exposure, even in a heavy smoker, contributes to causation. Based on this information, we propose criteria for the attribution of lung cancer to asbestos in smokers and non-smokers.

Keywords: asbestosis; carcinoma; cumulative exposure; mesothelioma; multiplicative model; pathogenesis; smoking; synergism.

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Conflict of interest statement

The first three authors have prepared reports on asbestos exposure and lung cancer for courts and tribunals in Australia and the United Kingdom and have given testimony on the issue for plaintiffs and defendants. None of the authors have any affiliation with the asbestos industry or any nonprofessional group that lobbies for or against industry.

Figures

Figure 1
Figure 1
Mechanism of lung cancer causation by asbestos and tobacco smoke. ROS = reactive oxygen species; RNS = reactive nitrogen species.
Figure 2
Figure 2
Simplified flow chart for attribution of lung cancer to exposure to asbestos, taking into account tobacco smoke.
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