Occupation and mesothelioma in Sweden: updated incidence in men and women in the 27 years after the asbestos ban / 한국역학회지

OBJECTIVES: We updated the Swedish component of the Nordic Occupational Cancer (NOCCA) Study through 2009 in order to investigate the incidence of mesothelioma of the peritoneum and pleura in both genders, and explored occupational exposures that may be associated with mesothelioma. METHODS: The Swedish component of the NOCCA Study includes 6.78 million individuals. Data from this cohort were linked to the population-based Swedish Cancer Registry and Swedish Total Population Registry for three periods between 1961 and 2009, and then further linked to the Swedish NOCCA job-exposure matrix, which includes 25 carcinogenic substances and the corresponding exposure levels for 280 occupations. Multivariate analysis was used to calculate standardized incidence ratios (SIRs) for mesothelioma of the peritoneum and pleura by gender, occupational category, carcinogenic substance, and for multiple occupational exposures simultaneously. RESULTS: A total of 3,716 incident mesotheliomas were recorded (21.1% in women). We found a significantly increased risk of mesothelioma in 24 occupations, as well as clear differences between the genders. Among men, increased risks of mesothelioma of the pleura were observed in male-dominated occupations, with the greatest elevation of risk among plumbers (SIR, 4.99; 95% confidence interval, 4.20 to 5.90). Among women, increased risks were observed in sewing workers, canning workers, packers, cleaners, and postal workers. In multivariate analysis controlling for multiple occupational exposures, significant associations were only observed between asbestos exposure and mesothelioma. CONCLUSIONS: Asbestos exposure was associated with mesothelioma incidence in our study. The asbestos ban of 1982 has yet to show any clear effect on the occurrence of mesothelioma in this cohort. Among women, the occupations of canning workers and cleaners showed increased risks of mesothelioma of the pleura without evidence of asbestos exposure.

Review of carcinogenicity of asbestos and proposal of approval standards of an occupational cancer caused by asbestos in Korea

Carcinogenicity of asbestos has been well established for decades and it has similar approval standards in most advanced countries based on a number of studies and international meetings. However, Korea has been lagging behind such international standards. In this study, we proposed the approval standards of an occupational cancer due to asbestos through intensive review on the Helsinki Criteria, post-Helsinki studies, job exposure matrix (JEM) based on the analysis of domestic reports and recognized occupational lung cancer cases in Korea. The main contents of proposed approval standards are as follows; (1) In recognizing an asbestos-induced lung cancer, diagnosis of asbestosis should be based on CT. In addition, initial findings of asbestosis on CT should be considered. (2) High Exposure industries and occupations to asbestos should be also taken into account in Korea (3) An expert's determination is warranted in case of a worker who has been concurrently exposed to other carcinogens, even if the asbestos exposure duration is less than 10 years. (4) Determination of a larynx cancer due to asbestos exposure has the same approval standards with an asbestos-induced lung cancer. However, for an ovarian cancer, an expert's judgment is necessary even if asbestosis, pleural plaque or pleural thickening and high concentration asbestos exposure are confirmed. (5) Cigarette smoking status or the extent should not affect determination of an occupational cancer caused by asbestos as smoking and asbestos have a synergistic effect in causing a lung cancer and they are involved in carcinogenesis in a complicated manner.