Abstract
BackgroundThe risk of mesothelioma has been shown to be associated with exposure to asbestos fibers. Most of the existing literature focuses on occupational exposure; however, non-occupational asbestos exposure has also been identified as an important risk factor.ObjectiveTo estimate the association between mesothelioma and non-occupational asbestos exposure, and evaluate control recruitment and exposure measurement methods.MethodsA systematic literature review was conducted to identify case-control (CC) and cohort studies that examined the association between mesothelioma and non-occupational exposure to asbestos, including neighborhood, domestic, and household exposure. Meta-analysis was performed to estimate a summary relative risk estimate (SRRE) and 95% confidence interval using random-effects models. Subgroup analyses were also conducted by exposure type, gender, region, and fiber type.ResultsTwenty CC and 7 cohort studies were selected. Controls in CC studies were selected from the general population (55%), hospital records (18%), cancer registry (23%) and a combination of population and hospital records (5%). Multiple methods were used to measure neighborhood exposure (e.g., linear distance and direction of residence from an asbestos factory), domestic (e.g., whether living with an asbestos worker) and household exposure (e.g., whether involved in asbestos-containing home improvement projects). Primary meta-analyses suggested a SRRE of mesothelioma of 5.33 (95%CI: 2.53, 11.23) from neighborhood exposure, 4.31 (95%CI, 2.58, 7.20) from domestic exposure, and 2.41 (95%CI, 1.30, 4.48) from household exposure with large I2 statistics ranging from 83–99%.ConclusionsNon-occupational asbestos exposure is significantly associated with an elevated risk of mesothelioma. Funnel plots indicated a potential of publication bias. Some SRREs should be interpreted with cautions because of high between-studies heterogeneity.
Highlights
The risk of mesothelioma has been shown to be associated with exposure to asbestos fibers
Non-occupational asbestos exposure is significantly associated with an elevated risk of mesothelioma
27 studies were found to be eligible and were included in the qualitative synthesis of the systematic review, and 24 studies were included in the final meta-analysis cohort (Fig. 1)
Summary
The risk of mesothelioma has been shown to be associated with exposure to asbestos fibers. The relationship between mesothelioma and exposure to asbestos has been the focus of a large body of research spanning decades. Five-year survival rates are less than 5%, and the median survival for malignant mesothelioma patients is only 1 year [1, 2]. The rate of death, alternatively, was estimated to have decreased over that period from 13.96 to 10.93 deaths per 1 million persons. These rates are a challenge to project, and they did not consider cases of mesothelioma resulting from non-occupational exposure [2]
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