Independent report

Asbestos and Lung Cancer report: Research into Malignant and Non-malignant Respiratory Disease Prescriptions

Published 3 June 2025

Authors: Will Mueller, Hilary Cowie, Damien McElvenny, Anne Sleeuwenhoek, Helena Copsey, Ken Dixon, David Fishwick (HSE).

Our impact on the environment
At IOM we seek to minimise our environmental impact. We produce thousands of reports every year and these consume a large quantity of paper. To minimise our impact on the environment, we prefer to only provide an electronic copy of reports, although we can provide a paper copy on request. If you have any additional requirements, please let us know.

1. Introduction

Asbestos and lung cancer is one of 6 high-priority occupational exposure-disease combinations that were identified with IIAC as being of highest priority for more detailed investigation (see Report of Phase 1 of this project).

This document contains a commentary on the extracted data for relevant occupational epidemiological studies relating to lung cancer and asbestos exposure and is meant to be read in conjunction with the associated spreadsheets containing the data extraction from these studies (Appendix 1).聽 These data relate to both those studies reported in the most recent IARC Monograph (IARC Working Group, 2012) and more recent publications identified from literature searches by the IOM research team.聽 A particular issue to be clarified, if possible, is the strength of evidence for associations in the absence of asbestosis (the latter generally regarded as a sign of heavy asbestos exposure).

2. Methods

In February 2023, an initial broad search (Exposure AND (lung AND cancer) AND asbestos) was run in the NLM PubMed database to determine how many studies would be retrieved: 1,631 references were returned.聽Due to this high volume of results, following a meeting with IIAC, it was agreed that the focus should be on occupations already included in the current list of prescribed diseases:聽

The current prescriptions for D1, D8A and D9 list those occupational circumstances associated with high levels of exposure to asbestos.聽 A search string was compiled for Web of Science (WoS) and NLM PubMed to cover D1, D8A and D9:

(Exposure AND (lung AND cancer) AND asbestos) AND ((manufacture AND textiles) OR (spray* OR insulation) OR (바카라 사이트渟hip building바카라 사이트� AND materials AND (apply* OR remov* OR clean*)) OR (dust AND (machinery OR plant))).聽

The focus of the search was on asbestos and lung cancer and so we did not explicitly search using the term 바카라 사이트榓sbestosis바카라 사이트�.聽 This search was run in January 2024 and retrieved 11 PubMed references and 26 Web of Science references to cover the period 2017 to the present. The searches were run in PubMed in the title/abstract field in 바카라 사이트楢dvanced Search바카라 사이트� and in Web of Science Core Collection in the topic field (title, abstract, keywords). Variations of this search were then tried to see the difference in the number of papers identified:聽

1. (Exposure AND (lung AND cancer) AND asbestos) AND ((manufacture AND textiles) OR (spray* OR insulation) OR (바카라 사이트渟hip building바카라 사이트� AND materials AND (apply* OR remov* OR clean*)) OR (dust AND (machinery OR plant))) 2009 to present바카라 사이트�聽聽

2. (Exposure AND (lung AND cancer) AND asbestos) AND (textiles OR (spray* OR insulation) OR (바카라 사이트渟hip building바카라 사이트� AND materials AND (apply* OR remov* OR clean*)) OR (dust AND (machinery OR plant))) both from 2017 and 2009 to present聽

3. (Exposure AND (lung AND cancer) AND asbestos) AND ((manufacture AND textiles) OR (spray* OR insulation) OR 바카라 사이트渟hip building바카라 사이트� OR (dust AND (machinery OR plant))) both from 2017 and 2009 to present바카라 사이트�聽聽

4. (Exposure AND (lung AND cancer) AND asbestos) AND (textiles OR (spray* OR insulation) OR 바카라 사이트渟hip building바카라 사이트� OR (dust AND (machinery OR plant))) both from 2017 and 2009 to present聽聽

Search no. 4 above, which had generated the most hits (47 Web of Science and 211 PuMed), was then extended to include some additional 바카라 사이트榟igh risk바카라 사이트� industries: (Exposure AND (lung AND cancer) AND asbestos) AND (textiles OR (spray* OR insulation) OR 바카라 사이트渟hip building바카라 사이트� OR shipbuilding OR ship builder* OR shipbuilder* OR (asbestos AND product AND manufacture) OR 바카라 사이트渕etal plate worker바카라 사이트� OR riveter OR coachbuilder* OR 바카라 사이트渃oach builder바카라 사이트� OR (vehicle AND (body-maker* OR builder)) OR lagger OR聽 (work* AND energy) OR 바카라 사이트渂oiler attendant바카라 사이트� OR docker OR navy OR plumber* OR electric* OR painter* OR decorator* OR carpenter* OR joiner* OR (dust AND (machinery OR plant))).聽The references from 2009 were exported to DistillerSR for screening, this being the latest date for publications included in the IARC monograph (2012).聽

3. Results

3.1 IARC review of asbestos and lung cancer, 2012

IARC (2012) concluded that the association between asbestos exposure and lung cancer has been 바카라 사이트渨ell established in numerous epidemiological investigations바카라 사이트�, while noting that there are some limitations that may explain the heterogeneity of the findings across studies. In summary, these limitations were:

• Exposure to different types, fibre sizes and levels of asbestos between industries and across time
• Differences in how the issue of latency was accounted for in studies
• Differences in approaches taken to estimate asbestos exposure (these ranged from a binary indicator for employment in a specific industry to quantification of cumulative exposure indices).
• Potential misclassification of disease was also noted as a possible study limitation, but this was more likely to occur for diseases other than lung cancer, for example mesothelioma.

Table 3.1 summarises the results of the occupational cohort studies examined by IARC, broadly categorised by occupational group (classification done by IARC). The information in this table has been collated from Tables 2.2 and 2.3 in the IARC monograph (Appendix 2), non-occupational cohorts and studies for which no risk estimate is reported to have been excluded from the table. References are included in the IARC monograph and not the present report.

Table 3.1: Summary of occupational cohort studies assessed by IARC (2012)

Mining

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Australia	91	1.60	1.31-1.97	Crocidolite	1943-1966 (FU 1980)	Armstrong et al (1988)
Canada	646	1.37	聽	Chrysotile	Born 1891-1920 (FU 1975)	Liddell et al (1997)
Finland	76M 1F	2.88 2.22	2.27-3.60 0.06-12.4	Anthophyllite	1936-1967 (FU 1953-91)	Maurman et al (1994)
Italy	22	1.1	聽	Chrysotile & Balangeroite	1930-1965 (FU 1987)	Piolatto et al (1990)
South Africa	63	1.72	1.32-2.21	Crocidolite	1945-1955 (FU 1980)	Sluis-Cremer et al (1992)
USA	89	1.7	1.4-2.1	Tremolite	1982-2001	Sulllivan (2007)

Insulation manufacturers and insulators

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Canada	1168	4.35	P<0.001	聽	In union 1967 (FU 1967-86)	Selikoff & Seidman (1991)
UK	57	2.0	聽	Amosite	1947-1979 (FU 1947-80)	Acheson et al (1984)
UK	38	3.6	聽	Crocidolite, amosite, chrysotile	1933-1964 (FU 1980)	Berry et al (2000)
USA	35	2.77	1.93-3.85	Amosite	1954-1972 (FU 1964-1993)	Levin et al (1998)

Asbestos textile workers

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Italy	76	2.82	2.22-3.54	聽	1946-1984 (FU 1996)	Pira et al (2005)	聽	聽	聽
UK	132	1.31	P<0.01	Chrysotile, crocidolite	1916-1983 (FU 1983)	Peto et al (1985)	聽	聽	聽
USA	198	1.95	1.68-2.24	Chrysotile, (crocidolite)	1940-1975 (FU 2001)	Hein et al (2007)	聽	聽	聽
USA	277	1.96	1.73-2.20	Chrysotile, (amosite)	1950-1973 (FU 2003)	Loomis et al (2009)	聽	聽	聽
聽	聽	聽	聽	聽	聽	聽	聽	聽	聽

Asbestos cement

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Denmark: to 1984	162	1.80	1.54-2.10	Chrysotile. amosite, crocidolite	1928-1984 (FU 1943-84)	Raffin et al (1989)	聽
Denmark: to 1990	聽	1.63	1.26-2.08	Chrysotile. amosite, crocidolite	1928-1984 (FU 1943-90)	Raffin et al (1996)	聽
Italy	33	1.24	0.91-1.66	Chrysotile, crocidolite	1952-1987 (FU 1989)	Giaroli et al (1994)	聽
Italy	110M 7F	2.71 3.96	2.23-3.27 1.59-8.16	Chrysotile, crocidolite	1950-1980 (FU 1965-93)	Botta et al (1991)	聽
Lithuania	29M 1F	0.90 0.70	0.7-1.3 0.1-4.6	Chrysotile	Pre-1978 (FU 2000)	Smailyte et al (2004a)	聽
Sweden	35	1.8	0.90-3.7	Chrysotile. (amosite, crocidolite)	1907-1977 (FU 1986)	Albin et al (1990)	聽
UK	35M 6F	0.9 1.4	0.6-1.3 0.5-3.1	Chrysotile	1941-1983 (FU 1984)	Gardner et al (1986)	聽
USA	154	1.34	聽	Chrysotile	Pre-1970 (FU 1980)	Hughes et al (1987)	聽

Friction materials

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Canada	11	1.40	聽	聽	1950 (FU 1985)	Finkelstein (1989a)	聽
UK	229M 12F	1.03 0.57	0.9-1.18 0.29-0.99	Chrysotile	1941-1986 (FU 1986)	Berry (1994)	聽
USSR	1M 1F	0.14 0.33	聽	Chrysotile	1966 (FU 1984)	Kogan et al (1993)	聽
USA	15	0.95	聽	Chrysotile	(FU 1937-1980)	Parnes (1990)	聽

Generic 바카라 사이트榓sbestos workers바카라 사이트�

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
China	67	4.2	p<0.01	Chrysotile	(FU 1986)	Zhu & Wang (1993)	聽
China	3M 6F	5.1 6.8	p<0.01 p<0.01	Chrysotile	(FU 1994)	Pang et al (1997)	聽
Germany	26 12	1.70 4.62	p<0.05 p<0.05	聽	Pre-1977 (FU 1977-82)	Woitowitz et al (1986)	聽
UK	157M 37F	2.55 7.46	聽	Crocidolite, amosite, chrysotile	1933-1964 (FU 1980)	Berry et al (2000)	聽
UK	22	2.00	聽	Chrysotile, crocidolite	1939 (FU 1951-80)	Acheson et al (1982)	聽
UK	157	1.30	p<0.01	Various	(FU 1981)	Hodgson & Jones (1986)	聽
USA	77	2.71	p<0.01	Amosite, chrysotile, crocidolite	1941-1967 (FU 1980)	Enterline et al (1987)	聽

Other occupations with substantial asbestos exposure

Study population	Lung cancer Obs	Lung cancer SMR/RR	Lung cancer 95% CI	Type of exposure	Time period	Reference
Canada Plumbers & pipefitters	393	1.27	1.13-1.42	聽	1950-1999 (FU 1999)	Finkelstein & Verma (2004)	聽
Finland Shipyard workers	227	1.18	1.03-1.35	聽	1945-1960 (FU 1953-81)	Tola et al (1988)	聽
Italy Railway carriage repair and construction	26	1.24	0.87-1.72	Chrysotile, crocidolite	1945-1969 (FU 1970-97)	Battista et al (1999)	聽
Italy Ship repair, refit and construction	298	1.77	1.57-1.98	聽	Pre-1952 (FU 1960-69)	Puntoni et al (2001)	聽
Sweden Shipyard workers	11	1.12	0.56-2.0	Chrysotile	(FU 1978-83)	Sanden & Jarvholm (1987)	聽

3.2 Asbestos and lung cancer studies

Our updated search of occupational exposure to asbestos and lung cancer studies since the most recent IARC report identified 26 studies, most of which (24) were cohort studies, with the remaining (2) using a case-control design.

The most common industry in the cohort studies was asbestos textile (11 studies), which included 5 studies from USA, 5 studies from China, and one study from Italy. The Chinese studies all examined the same cohort with variations on the analysis (e.g., use of internal, external, and occupational control populations). Smoking adjustments was included in these analyses, which appeared to be limited to classification as ever or never smokers.

There was significant overlap in the study population of the US textile studies, which included workers from subsets of the same facilities in North and South Carolina. It was not possible to include smoking status in the data analysis.

The main asbestos fibre of exposure in all studies was chrysotile. All of the included studies demonstrated statistically significant higher risks of lung cancer incidence/mortality or reduced survival time in those exposed to asbestos. Only one study included data on lung cancer deaths with respect to asbestosis status, which suggests a more than doubled rate in those with (17%) asbestosis compared to those without (7%).

The next most common sector was mining (6 studies), of which there were 4 studies from China and one study each from Italy and Finland. One of the Chinese studies produced risk estimates for both the textile industry (included above) and mining. All of the Chinese studies were from the country바카라 사이트檚 largest chrysotile mine and indicated lung cancer risks that were at least 2.5 times higher in the exposed groups. Smoking (ever/never) and occupational histories were available for the cohorta. The Italian study also suggested elevated risks, though the CI included the null value. Similar to the studies of the textile industry, the main exposure was chrysotile. Other than Wang et al. (2013a) stating that there was one case of asbestosis in the lung cancer deaths, the studies did not include information on the relationship between the presence of asbestosis and lung cancer.

The remaining 8 studies examined asbestos exposures in different settings, involving shipbuilding and shipyards (3 studies from Italy & Japan), navy workers (2 studies from Norway), insulation (1 study from USA), vehicle mechanics (1 study from Denmark), and mixed occupations (1 study from Italy), plus 1 Finnish study that also provided risk estimates for a mining cohort, included above. Some of these studies reported chrysotile and other asbestos fibres, such as amosite and crocidolite, but others did not report the fibre type at all. Most of the studies indicated elevated risks for those exposed to asbestos, with the exceptions of boiler repairers in Japan (n=8 cases) and male civilian navy personnel in Norway (n=185 cases), though central risk estimates were above the null in both instances. Only the Finnish study included a lung cancer risk estimate for asbestosis patients, which was highly elevated compared to the general population (i.e., SIR>8).

In addition to the cohort studies, two nested case-control studies were identified in the search: one study of the textile industry in China (chrysotile) and one study of workers at asbestos processing plants in Poland (asbestos fibres not reported). These studies each suggested significantly elevated risks in the highest exposed groups. The Chinese study also noted that the incidence of asbestosis was approximately twice as high in cases (39%) compared to controls (19%).聽

Table 3.2 a) to e) (below) summarises these studies using the occupational categorisation as those presented in the IARC report. 바카라 사이트楾ime period바카라 사이트� includes both the periods of occupation and follow-up. We have also included any available information on asbestosis and lung cancer, though such studies were a small minority.

Table 3.2 a): 聽Textile cohort studies.

Study population	Lung cancer cases/deaths	Effect	Lower CI	Upper CI	Type of exposure	Time period	Adjustment for smoking/Notes	Reference
China	51	Power model 尾=0.53 (SE=0.12) p<0.001	not reported	not reported	Chrysotile	1972-2006	Ever/never smokers	Deng et al (2011)
China	53	HR= 3.31	1.6	6.87	Chrysotile	1972-2008	Ever/never smokers	Wang et al., (2012b)
China	53	Hazard ratio=2.99	1.30	6.91	Chrysotile	1972-2008	Ever/never smokers	Wang et al., (2012c)
China	Males: 53 Females: 2	SMR= Males: 4.08 Females: 1.23	Males: 3.12 Females: 0.34	5.334.50	Chrysotile	1972-2008	No smoking adjustment; Males: Lung cancer deaths: 17% (22 鈦� 127) in those with asbestosis 7% (31 鈦� 450) in those without asbestosis Females: No lung cancer deaths in those with asbestosis	Wang et al (2013a)
China	46	SMR= 6.34	4.75	8.45	Chrysotile	1972-2008	Ever/never smokers	Wang et al., (2014)
USA	116	ERR fiber-year/ml (cumulative exposure)=0.015	0.007	0.0028	Chrysotile	1940-2001	None	Richardson (2009)
USA	277	RR per 100 fiber-year/ml =1.102	1.044	1.164	Chrysotile	1950-2003	None	Loomis et al (2009)
USA	180	Change in lung cancer risk (total fibers)=0.03 (3%)	p=0.002	p=0.002	Chrysotile	1950-2003	None	Loomis et al (2010)
USA	361	Change in log of lung cancer risk (total fibers)=0.039	0.020	0.057	Chrysotile	1940-2003	None	Loomis et al (2012)
USA	142	Survival time ratio=0.57	0.33	0.96	Chrysotile	1940-2001	None	Naimi et al., (2014)
Italy (Northern)	143	SMR=2.96	2.50	3.49	Chrysotile (mainly), some crocidolite	1946-2013	None	Pira et al (2016)

Table 3.2 b): 聽Mining cohort studies

Study population	Lung cancer cases/deaths	Effect	Lower CI	Upper CI	Type of exposure	Time period	Adjustment for smoking/Notes	Reference
China	1932	RR=2.57	1.35	4.88	Chrysotile	1981-2010	Smokers/non-smokers	Du et al., (2012)
China	50	SMR=4.71	3.57	6.21	Chrysotile	1981-2006	Ever/never smokers	Wang et al., (2012a)
China	56	SMR=4.69	3.61	6.09	Chrysotile	1981-2006	Smoking/ever smoking or non-smoking; 1 case of asbestosis in lung cancer deaths	Wang et al., (2013b)
China	56	SMR=4.25	3.27	5.52	Chrysotile	1981-2006	Ever/never smokers	Wang et al., (2014)
Italy	40	SMR=1.41	0.81	1.55	Chrysotile	1946-2013	None	Ferrante et al., (2019)
Finland	78	SIR=2.46	1.95	3.07	Anthophyllite	1967바카라 사이트�2012	Smoking-specific risk estimates	Nynas et al (2017)

Table 3.2 c): 聽Other cohort studies.

Study population	Lung cancer cases/deaths	Effect	Lower CI	Upper CI	Type of exposure	Time period	Adjustment for smoking/Notes	Reference
USA (Insulation workers)	89	SMR=2.44	196	300	Amosite	1954-2011	None	Levin et al., (2016)
Finland (Sprayers, construction, shipyard, other)	Asbestosis patients: 41	SIR=8.19	5.88	11.1	Unknown	1978바카라 사이트�2012	Smoking-specific risk estimates	Nynas et al (2017)
Finland (Sprayers, construction, shipyard, other)	Asbestos sprayers: 22	11.3	7.10	17.2	Crocidolite	1967바카라 사이트�2012	Smoking-specific risk estimates	Nynas et al (2017)
Finland (Sprayers, construction, shipyard, other)	Screening cohort (mixed): 994	1.23	1.16	1.30	Chrysotile, crocidolite, unknown	1988바카라 사이트�2012	Smoking-specific risk estimates	Nynas et al (2017)
Italy (shipbuilding & other occupations)	66	SIR=1.61	1.26	2.04	Not reported	1995-2009	Smoking/ever smoking or non-smoking	Barbiero et al., (2018a)
Italy (shipbuilding & other occupations)	70	SMR=1.49	1.17	1.89	Unknown	1989-2011	Smoking/ever smoking or non-smoking	Barbiero et al., (2018b)
Italy (Mixed occupations)	Male: 3535 Female: 99	SMR: 聽Male: 1.28 Female: 1.26	Male: 1.24 Female: 1.02	Male: 1.32 Female: 1.53	Mixed	1970-2018	None	Ferrante et al., (2024)
Japan (Shipyard workers)	Laggers: 7 Boiler repairers: 8	Laggers: 2.64 Boiler repairers: 1.61	Laggers: 1.06 Boiler repairers: 0.70	Laggers: 5.44 Boiler repairers: 3.17	Chrysotile, amosite	1947-2007	None	Tomioka et al., (2011)
Norway (navy workers)	107	SIR (Vessel 鈮�2 years)=1.24	1.03	1.50	Chrysotile (mainly), some crocidolite	1953-2007	None	Strand et al., (2010)
Norway (Navy workers)	Men: 185 Women: 77	SIR= Men: 1.12 Women: 1.35	Men: 0.97 Women: 1.07	Men: 1.30 Women: 1.69	Not reported	1960-2015	None	Strand et al., (2018)
Denmark (vehicle mechanics)	1815	Adjusted HR: 1.09	1.03	1.14	Chrysotile	1970-2012	None	Thomsen et al., (2021)

Table 3.2 e): 聽Case-control studies

Study population	Lung cancer cases/deaths	Effect	LCI	UCI	Type of exposure	Time period	Adjustment for smoking/Notes Notes	Author
China (textile)	1139	OR (medium exposure)=1.25 OR (high exposure)=3.66	OR (medium exposure)=0.47 OR (high exposure)=1.61	OR (medium exposure)=3.31 OR (high exposure)=8.29	Chrysotile	1972-2001	Non-smokers and ever smokers; Asbestosis was diagnosed in 16 cases (39%) and 37 controls (19%)	Yano et al., (2010)
Poland (processing)	165	OR (highest cumulative exposure category)=1.99	1.22	3.25	Not reported	2000-2013	Pack-years of smoking	艢wi膮tkowska et al (2015)

4. Synthesis and Discussion

The current prescription for lung cancer from asbestos exposure (D8 & D8A) is presented in Appendix 3. D8 specifies the prescribed conditions for lung cancer with accompanying asbestosis: working with asbestos, manufacturing asbestos textiles, cleaning machinery involved in such operations, or being exposed to resulting dust. D8A specifies the conditions for the presence of lung cancer (i.e., no evidence of asbestosis), which includes, similar to D8, manufacture of asbestos tiles, spraying asbestos, asbestos insulation, or handling asbestos via shipbuilding. Temporal exposure criteria are also included in D8A.

Our search focussing on terms related to the presently prescribed diseases resulted in the identification of 26 relevant studies published since 2009 (i.e., the latest year for which the most recent IARC monograph had included studies). Nearly two thirds of the studies (17/26; 65%) pertained to asbestos mining or textile industries. Most of these studies were from China or USA, with significant overlap of participants within these sectors in each country. The remaining 9 studies mainly took place in Europe, covering shipbuilding, navy workers, and a mix of other occupations.

It is noteworthy that none of the identified studies took place in the UK. Since the search terms were based on the current prescriptions (to achieve a more manageable list of studies to review given resource and timeline constraints), it would be expected that the results would predominantly address these industries. There were also studies relating to mining exposure, but this is not relevant for occupational exposures in the UK.

The main results from each study indicated clear increases in lung cancer risks with asbestos exposure. Only four studies distinguished between lung cancer rates in those with asbestosis (though not in asbestosis-free individuals). A cohort study indicated lung cancer rates were more than doubled in individuals with asbestosis, and a case-control study found asbestosis rates were twice as high in cases compared to controls. Another one of the studies quantified very high risks of lung cancer in those with asbestosis. Based on this limited evidence, it was not possible to estimate lung cancer risk levels in those without asbestosis from different occupational exposure scenarios.

It is worth noting that there is now statistical evidence that the interaction between smoking and asbestos exposure on lung cancer risk, with no requirement for asbestosis (Klebe et al, 2020).聽 In addition, the earlier Helsinki criteria for diagnosis of asbestos and asbestos-related cancer states that 바카라 사이트淎 cumulative exposure of 25 fibre-years is estimated to increase the risk of lung cancer 2-fold, clinical cases of asbestosis may occur at comparable cumulative exposures (Wolff et al 2014).

Overall, the studies identified since the most recent IARC report continue to indicate strong lung cancer risks with occupational exposure to asbestos, with the possible exception of the removal of the requirement for job history information in the presence of asbestosis in PD D8. From this review, there is no evidence base to recommend revisions to the current IIAC prescription. However, there may be additional occupational circumstances with relevance to the UK, which could be examined in a broader review of the literature: for example, studies of lung cancer risks in construction workers, navy personnel, and vehicle mechanics, etc. Risk levels in these occupations from our search did appear to be lower than those currently prescribed, but nevertheless, a broadened search focussing on specific occupational exposures may be warranted, and could be guided by the job categories that are known to be at risk of mesothelioma and or asbestosis. Alternatively, a review of exposure studies could identify specific occupational circumstances whereby exposure to asbestos is likely to be associated with an RR>2.

5. Conclusions

Our updated search of occupational exposure to asbestos and lung cancer studies since 2009, based on the current prescriptions, identified 26 studies. Most of the search results were cohort studies (24), with the remaining using a case-control design (2). The majority of studies examined the textile and mining industries, with the others involving shipbuilding, navy personnel, insulation workers, vehicle mechanics, and other occupations. The studies demonstrated substantially elevated lung cancer risks in those occupationally exposed to asbestos, with limited evidence differentiating risk levels only in those with asbestosis.

While there is no clear rationale to revise the current IIAC prescription definitions for lung cancer and asbestos exposure, a broader search including other occupational circumstances involving asbestos exposure may be warranted in order to ensure that there are not other groups of asbestos exposed workers with lung cancer currently being excluded by the current process. Alternatively, a review of exposure studies could identify specific occupational circumstances whereby exposure to asbestos is likely to be associated with an RR>2.

6. References

Barbiero, F., Zanin, T., Pisa, F.E., Casetta, A., Rosolen, V., Giangreco, M., Negro, C., Bovenzi, M. and Barbone, F., 2018a. Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance.聽International Archives of Occupational and Environmental Health,聽91, pp.831-841.

Barbiero, F., Zanin, T., Pisa, F.E., Casetta, A., Rosolen, V., Giangreco, M., Negro, C., Bovenzi, M. and Barbone, F., 2018b. Mortality in a cohort of asbestos-exposed workers undergoing health surveillance.聽La Medicina del Lavoro,聽109(2), p.83.

Deng, Q., Wang, X., Wang, M. and Lan, Y., 2012. Exposure바카라 사이트搑esponse relationship between chrysotile exposure and mortality from lung cancer and asbestosis.聽Occupational and environmental medicine,聽69(2), pp.81-86.

Du, L., Wang, X., Wang, M. and Lan, Y., 2012. Analysis of mortality in chrysotile asbestos miners in China.聽Journal of Huazhong University of Science and Technology [Medical Sciences],聽32, pp.135-140.

Ferrante, D., Mirabelli, D., Silvestri, S., Azzolina, D., Giovannini, A., Tribaudino, P. and Magnani, C., 2020. Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: a cohort study.聽American Journal of Industrial Medicine,聽63(2), pp.135-145.

Ferrante, D., Angelini, A., Barbiero, F., Barbone, F., Bauleo, L., Binazzi, A., Bovenzi, M., Bruno, C., Casotto, V., Cernigliaro, A. and Ceppi, M., 2024. Cause specific mortality in an Italian pool of asbestos workers cohorts.聽American Journal of Industrial Medicine,聽67(1), pp.31-43.

Klebe S, Leigh J, Henderson DW, Nurminen M (2020).聽 Asbestos, Smoking and Lung Cancer: An Update.聽 International Journal of Environmental Research and Public Health 17, 258.

Levin, J.L., Rouk, A., Shepherd, S., Hurst, G.A. and McLarty, J.W., 2016. Tyler asbestos workers: a mortality update in a cohort exposed to amosite.聽Journal of Toxicology and Environmental Health, Part B,聽19(5-6), pp.190-200.

Loomis, D., Dement, J.M., Wolf, S.H. and Richardson, D.B., 2009. Lung cancer mortality and fibre exposures among North Carolina asbestos textile workers.聽Occupational and environmental medicine,聽66(8), pp.535-542.

Loomis, D., Dement, J., Richardson, D. and Wolf, S., 2010. Asbestos fibre dimensions and lung cancer mortality among workers exposed to chrysotile.聽Occupational and environmental medicine,聽67(9), pp.580-584.

Loomis, D., Dement, J.M., Elliott, L., Richardson, D., Kuempel, E.D. and Stayner, L., 2012. Increased lung cancer mortality among chrysotile asbestos textile workers is more strongly associated with exposure to long thin fibres.聽Occupational and environmental medicine,聽69(8), pp.564-568.

Naimi, A.I., Cole, S.R., Hudgens, M.G. and Richardson, D.B., 2014. Estimating the effect of cumulative occupational asbestos exposure on time to lung cancer mortality: using structural nested failure-time models to account for healthy-worker survivor bias.聽Epidemiology,聽25(2), pp.246-254.

Nyn盲s, P., Pukkala, E., Vainio, H. and Oksa, P., 2017. Cancer incidence in Asbestos-exposed workers: an update on four Finnish cohorts.聽Safety and health at work,聽8(2), pp.169-174.

Pira, E., Romano, C., Violante, F.S., Farioli, A., Spatari, G., La Vecchia, C. and Boffetta, P., 2016. Updated mortality study of a cohort of asbestos textile workers.聽Cancer medicine,聽5(9), pp.2623-2628.

Richardson, D.B., 2009. Lung cancer in chrysotile asbestos workers: analyses based on the two-stage clonal expansion model.聽Cancer Causes & Control,聽20, pp.917-923.

Strand, L.A., Martinsen, J.I., Koefoed, V.F., Sommerfelt바카라 사이트怭ettersen, J. and Grimsrud, T.K., 2010. Asbestos바카라 사이트恟elated cancers among 28,300 military servicemen in the Royal Norwegian Navy.聽American journal of industrial medicine,聽53(1), pp.64-71.

Strand, L.A., Martinsen, J.I., Rudvin, I., Fadum, E.A. and Borud, E.K., 2018. Cancer incidence and all-cause mortality among civilian men and women employed by the Royal Norwegian Navy between 1950 and 2005.聽Cancer Epidemiology,聽57, pp.1-6.

艢wi膮tkowska, B., Szubert, Z., Sobala, W. and Szeszenia-D膮browska, N., 2015. Predictors of lung cancer among former asbestos-exposed workers.聽Lung Cancer,聽89(3), pp.243-248.

Thomsen, R.W., Riis, A.H., Flachs, E.M., Garabrant, D.H., Bonde, J.P.E. and S酶rensen, H.T., 2022. Risk of asbestosis, mesothelioma, other lung disease or death among motor vehicle mechanics: a 45-year Danish cohort study.聽Thorax,聽77(5), pp.477-485.#160

Tomioka, K., Natori, Y., Kumagai, S. and Kurumatani, N., 2011. An updated historical cohort mortality study of workers exposed to asbestos in a refitting shipyard, 1947바카라 사이트�2007.聽International archives of occupational and environmental health,聽84, pp.959-967.

Wang, X., Lin, S., Yano, E., Qiu, H., Yu, I.T., Tse, L., Lan, Y. and Wang, M., 2012a. Mortality in a Chinese chrysotile miner cohort.聽International archives of occupational and environmental health,聽85, pp.405-412.

Wang, X., Yano, E., Qiu, H., Yu, I., Courtice, M.N., Tse, L.A., Lin, S. and Wang, M., 2012b. A 37-year observation of mortality in Chinese chrysotile asbestos workers.聽Thorax,聽67(2), pp.106-110.

Wang, X.R., Yu, I.T.S., Qiu, H., Wang, M.Z., Lan, Y.J., Tse, L.Y., Yano, E. and Christiani, D.C., 2012c. Cancer mortality among Chinese chrysotile asbestos textile workers.聽Lung Cancer,聽75(2), pp.151-155.

Wang, X., Lin, S., Yu, I., Qiu, H., Lan, Y. and Yano, E., 2013a. Cause바카라 사이트恠pecific mortality in a Chinese chrysotile textile worker cohort.聽Cancer science,聽104(2), pp.245-249.

Wang, X., Yano, E., Lin, S., Yu, I.T., Lan, Y., Tse, L.A., Qiu, H. and Christiani, D.C., 2013b. Cancer mortality in Chinese chrysotile asbestos miners: exposure-response relationships.聽PLoS One,聽8(8), p.e71899

Wang, X., Lin, S., Yano, E., Ignatius, T.S., Courtice, M., Lan, Y. and Christiani, D.C., 2014. Exposure-specific lung cancer risks in Chinese chrysotile textile workers and mining workers.聽Lung Cancer,聽85(2), pp.119-124.

Wolff H, Vehmas T, Oksa P, Rantanen J, Vainio H (2015).聽 Asbestos, asbestosis, and cancer, the Helsinki criteria for diagnosis and attribution 2014: recommendation.聽 Scand J Work Environ Health.聽 Online first.

Yano, E., Wang, X., Wang, M., Qiu, H. and Wang, Z., 2010. Lung cancer mortality from exposure to chrysotile asbestos and smoking: a case바카라 사이트揷ontrol study within a cohort in China.聽Occupational and environmental medicine,聽67(12), pp.867-871.

7. Appendix 1- Data Extraction Spreadsheet and List of All the References Considered

Data extraction spreadsheet

List of all the references considered

8. Appendix 2- Data Tables for cohort, case-control and meta-analyses of asbestos and lung cancer

Table 2.1. Case-control studies of asbestos exposure and lung cancer

Table 2.2. Cohort studies of asbestos exposed populations and lung cancer and mesothelioma

Table 2.3. Summary of asbestos cohort study design characteristics

9. Appendix 3- Current prescription for Asbestos and Lung Cancer

D8.聽Primary carcinoma of the lung where there is accompanying evidence of asbestosis.

(a)聽The working or handling of asbestos or any admixture of asbestos; or (b) the manufacture or repair of asbestos textiles or other articles containing or composed of asbestos; or (c) the cleaning of any machinery or plant used in any of the foregoing operations and of any chambers, fixtures and appliances for the collection of asbestos dust; or (d) substantial exposure to the dust arising from any of the foregoing operations.

D8A. Primary carcinoma of the lung.

Exposure to asbestos in the course of바카라 사이트� (a)聽the manufacture of asbestos textiles; or (b)聽spraying asbestos; or (c)聽asbestos insulation work; or (d)聽applying or removing materials containing asbestos in the course of shipbuilding, where all or any of the exposure occurs before 1st January 1975, for a period of, or periods which amount in aggregate to, five years or more, or otherwise, for a period of, or periods which amount in aggregate to, ten years or more.

email: iom@iom-world.org

IOM Edinburgh
Research Avenue North
Riccarton
Edinburgh
EH14 4AP
Telephone: 0131 449 8000

IOM Chesterfield
Tapton Park Innovation Centre
Brimington Road
Tapton
Chesterfield
S41 0TZ
Telephone: 01246 383110

IOM Stafford
Brookside Business Park
Cold Meece
Stone
Staffordshire
ST15 0RZ
Telephone: 01785 333 200