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.
Highlights
Asbestos exposure has been related to lung cancer causation since the 1930s, and much research has been published since on epidemiological, clinical, biological, and medico-legal aspects of this relationship
Four of the most important outstanding research questions in this area are: (i) How do tobacco smoking and asbestos fibers combine at a biological level to produce the well-known supra-additive interaction in causing lung cancer? (ii) How much asbestos exposure is needed to make a legally-significant contribution to lung cancer causation in the presence or absence of tobacco exposure? (iii) Is the presence of asbestosis necessary for any attribution of lung cancer to asbestos?
This review considers the recent literature on causation and compensation of asbestos-related lung cancer and, in answering the above-mentioned medico-legal questions, proposes a rational, scientifically-based and equitable approach to compensation for asbestos-related lung cancer
Summary
Asbestos exposure has been related to lung cancer causation since the 1930s, and much research has been published since on epidemiological, clinical, biological, and medico-legal aspects of this relationship. Asbestos-related lung cancer is quantitatively more important than mesothelioma but is underrecognized because of the dominating effect of tobacco smoking in the causation of most lung cancers. Four of the most important outstanding research questions in this area are: (i) How do tobacco smoking and asbestos fibers combine at a biological level to produce the well-known supra-additive interaction in causing lung cancer? (ii) How much asbestos exposure is needed to make a legally-significant contribution to lung cancer causation in the presence or absence of tobacco exposure? (iii) Is the presence of asbestosis necessary for any attribution of lung cancer to asbestos?. Public Health 2020, 17, 258; doi:10.3390/ijerph17010258 www.mdpi.com/journal/ijerph
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