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Meta-Analysis
. 2025 Feb 12;81(12):639-646.
doi: 10.1136/oemed-2024-109707.

Occupational asbestos exposure and gastrointestinal cancers: systematic review and meta-analyses

Mieke Koehoorn  1 , Christopher B McLeod  2 , Jonathan Fan  2 , Victoria H Arrandale  3 , Hugh W Davies  2 , John M Dement  4 , Manisha Pahwa  5   6 , Cheryl E Peters  2   7 , Leslie Stayner  8 , Kurt Straif  9   10 , Paul A Demers  2   3   6
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Free article
Meta-Analysis

Occupational asbestos exposure and gastrointestinal cancers: systematic review and meta-analyses

Mieke Koehoorn et al. Occup Environ Med. .
Free article

Abstract

Objective: To conduct meta-analyses of occupational asbestos exposure and oesophageal, stomach and colorectal cancer risk, including a critical exposure assessment approach.

Methods: The search strategy was executed on MEDLINE, Embase, CINAHL, Scopus and Web of Science databases (March 2022, March 2024). Effect estimates (ORs, HRs, standardised incidence ratio and standardised mortality ratio) from eligible cohort and case-control studies were combined in random effects models. Meta-relative risks (mRRs) were calculated by cancer site and exposure characteristics. Investigators with occupational epidemiology and hygiene expertise came to a consensus on the estimates where there was confidence in significant asbestos exposure.

Results: A total of 82 (oesophageal), 153 (stomach) and 144 (colorectal) papers met the inclusion criteria. Elevated mRRs were observed for any occupational asbestos exposure for oesophageal (1.17 (95% CI 1.07 to 1.29)), stomach (1.14 (95% CI 1.05 to 1.23)) and colorectal cancer (1.16 (95% CI 1.08 to 1.24)). There was consistency of mRR estimates and higher mRRs in meta-analyses where there was increased confidence in the categorisation of highly exposed workers, including among the highest exposed workers in exposure-response studies (oesophageal: 1.63 (95% CI 1.29 to 2.06); stomach: 1.28 (95% CI 1.09 to 1.52); colorectal: 1.29 (95% CI 1.09 to 1.53)), among asbestos insulation workers (oesophageal: 1.68 (95% 1.19 to 2.36); stomach: 1.53 (95% 0.93 to 2.51); colorectal: 1.59 (95% 1.14 to 2.23)) and among workers in cohorts with a twofold or greater risk of asbestos-related lung cancer (oesophageal: 1.40 (95% CI 1.14 to 1.71); stomach: 1.33 (95% CI 1.14 to 1.56); colorectal: 1.47 (95% CI 1.34 to 1.61)).

Conclusion: The meta-analyses support a causal link between occupational asbestos exposure and the risk of oesophageal, stomach and colorectal cancer.

Keywords: Asbestos; Epidemiology; Gastroenterology; Meta-analysis; Occupational Health.

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Conflict of interest statement

Competing interests: This research was funded by the Workplace Safety and Insurance Board (WSIB) for Ontario, CA. CBM received salary support from the Michael Smith Foundation for Health Research and the Workers’ Compensation Board of British Columbia, CA (WorkSafeBC); CBM, MK and PD held peer-reviewed research funding from WorkSafeBC and WSIB; VA held peer-reviewed research funding from WSIB; PD and VA are appointed members of an independent WSIB Scientific Advisory Panel on Occupational Disease; JD is funded by the US Department of Energy through the Center for Construction Research and Training and has provided expert testimony in asbestos cases in the past (5+ years ago); CEP held peer-reviewed research funding from WorkSafeBC and the Workers’ Compensation Board of Manitoba.The rest of the authors have no competing interests.

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