背景:最初的石棉暴露与石棉相关疾病之间的时间可能跨越数十年。石棉监测计划旨在检测以前接触过石棉的8,565名电力行业工人的早期石棉相关疾病。
目的:石棉暴露模式如何影响癌症死亡率和直至死亡的潜伏期?
方法:进行了死亡随访,其中8,476名参与者(99%)的生命状态可用,89.9%的死亡参与者可用死亡证明。计算石棉相关癌症的标准化死亡率(SMR)。间皮瘤和肺癌的SMR按暴露时间分层,累积石棉暴露和吸烟。第一次接触时年龄的影响,使用多元线性回归分析检查了石棉暴露和吸烟对潜伏期至死亡的影响.
结果:间皮瘤(n=104)的死亡风险随石棉累积暴露而增加,但不随暴露时间增加;在进行短期极高暴露(蒸汽涡轮修订)的参与者中观察到最高死亡率(SMR:23.20;95%CI:17.62-29.99)。肺癌死亡率(n=215)没有增加(SMR:1.03;95%CI:0.89-1.17)。间皮瘤的中位潜伏期为46(15-63)年,肺癌的中位潜伏期为44(15-70)年,死亡发生在64岁至82岁之间。直到死亡的潜伏期不受第一次接触时年龄的影响,累积暴露量,或吸烟。
结论:累积剂量似乎比暴露时间更适合评估间皮瘤死亡风险。此外,应考虑在短时间内暴露高累积剂量。因为只有肺癌死亡率,不是发病率,被记录在这项研究中,与石棉暴露相关的肺癌风险无法评估,肺癌死亡率低于预期,可能是由于筛查效果和治疗方法的改进.石棉相关癌症死亡的关键时间窗口是在生命的第七个和第九个十年之间。未来的研究应进一步探讨潜伏期的概念,特别是因为在整个文献中都报道了大范围。
BACKGROUND: The time between initial asbestos exposure and asbestos-related disease can span several decades. The Asbestos Surveillance Program aims to detect early asbestos-related diseases in a cohort of 8,565 power industry workers formerly exposed to asbestos.
OBJECTIVE: How does asbestos exposure patterns affect cancer mortality and the duration of
latency until death?
METHODS: A mortality follow-up was conducted with available vital status for 8,476 participants (99 %) and available death certificates for 89.9 % of deceased participants. Standardised mortality ratios (SMR) were calculated for asbestos-related cancers. The SMR of mesothelioma and lung cancer were stratified by exposure duration, cumulative asbestos exposure and smoking. The effect of age at first exposure, cumulative asbestos exposure and smoking on the duration of
latency until death was examined using multiple linear regression analysis.
RESULTS: The mortality risk of mesothelioma (n = 104) increased with cumulative asbestos exposure but not with exposure duration; the highest mortality (SMR: 23.20; 95 % CI: 17.62-29.99) was observed in participants who performed activities with short extremely high exposures (steam turbine revisions). Lung cancer mortality (n = 215) was not increased (SMR: 1.03; 95 % CI: 0.89-1.17). Median
latency until death was 46 (15-63) years for mesothelioma and 44 (15-70) years for lung cancer and deaths occurred between age 64 and 82 years.
Latency until death was not influenced by age at first exposure, cumulative exposure, or smoking.
CONCLUSIONS: Cumulative dose seems to be more appropriate than exposure duration for estimating the risk of mesothelioma death. Additionally, exposure with high cumulative doses in short time should be considered. Since only lung cancer mortality, not incidence, was recorded in this study, lung cancer risk associated with asbestos exposure could not be assessed and the lung cancer mortality was lower than expected probably due to screening effects and improved treatments. The critical time window of death from asbestos-related cancer is between the seventh and ninth decade of life. Future studies should further explore the concept of
latency, especially since large ranges are reported throughout the literature.