Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression

  • Paolo BoffettaEmail author
  • Francesca Donato
  • Enrico Pira
  • Hung N. Luu
  • Carlo La Vecchia
Original Article



A ‘risk reversal’ has been observed for several human carcinogens following cessation of exposure, but it is unclear whether it also exists for asbestos-related mesothelioma.


We conducted a systematic review of the literature and identified nine studies that reported information on risk of mesothelioma after cessation of asbestos exposure, and performed a meta-regression based on random effects models. As comparison we analyzed results on lung cancer risk from four of these studies.


A total of six risk estimates from five studies were included in the meta-analysis. The summary relative risk (RR) of mesothelioma for 10-year interval since cessation of exposure was 1.02 [95% confidence interval (CI) 0.87–1.19; p-heterogeneity 0.01]. The corresponding RR of lung cancer was 0.91 (95% CI 0.84–0.98).


This analysis provides evidence that the risk of mesothelioma does not decrease after cessation of asbestos exposure, while lung cancer risk does.


Asbestos Mesothelioma Time since last exposure 



The authors thank C. Pelucchi from the University of Milan, who produced original results for the study of Italian asbestos miners (Pira et al. 2017).

Compliance with ethical standards

Conflict of interest

PB, EP and CLV acted as experts for the defense (PB, EP, CLCV) and the court (EP, CLV) in asbestos-related litigation.


  1. Berry G, de Klerk NH, Reid A et al (2004) Malignant pleural and peritoneal mesotheliomas in former miners and millers of crocidolite at Wittenoom, Western Australia. Occup Environ Med 2004:61e14Google Scholar
  2. Boffetta P (2014) Malignant mesothelioma: epidemiology. In: Anttila S, Boffetta P (eds) Occupational cancers. Springer, London, pp 253–264Google Scholar
  3. Boffetta P, Pira E, Romano C et al (2018a) Response to: ‘Dose-time-response association between occupational asbestos exposure and pleural mesothelioma’ by Lacourt et al. Occup Environ Med 75:160CrossRefGoogle Scholar
  4. Boffetta P, Righi L, Ciocan C et al (2018b) Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 29:484–489CrossRefGoogle Scholar
  5. Brennan P, Crispo A, Zaridze D et al (2006) High cumulative risk of lung cancer death among smokers and nonsmokers in Central and Eastern Europe. Am J Epidemiol 164:1233–1241CrossRefGoogle Scholar
  6. Carbone M, Kanodia S, Chao A et al (2016) Consensus report of the 2015 Weinman international conference on mesothelioma. J Thorac Oncol 11:1246–1262CrossRefGoogle Scholar
  7. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188CrossRefGoogle Scholar
  8. Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol 13:1301–1309CrossRefGoogle Scholar
  9. Harding AH, Darnton AJ (2010) Asbestosis and mesothelioma among British asbestos workers (1971–2005). Am J Ind Med 53:1070–1080CrossRefGoogle Scholar
  10. International Agency for Research on Cancer (2007) Reversal of risk after quitting smoking. IARC handbooks of cancer prevention, Tobacco Control, vol 11. IARC, LyonGoogle Scholar
  11. La Vecchia C, Boffetta P (2012) Role of stopping exposure and recent exposure to asbestos in the risk of mesothelioma. Eur J Cancer Prev 21:227–230 (Erratum in: Eur J Cancer Prev 2015; 24:68) CrossRefGoogle Scholar
  12. Lacourt A, Leffondré K, Gramond C et al (2012) Temporal patterns of occupational asbestos exposure and risk of pleural mesothelioma. Eur Respir J 39:1304–1312CrossRefGoogle Scholar
  13. Levin JL, McLarty JW, Hurst GA, Smith AN, Frank AL (1998) Tyler asbestos workers: Mortality experience in a cohort exposed to amosite. Occup Environ Med 55:155–160CrossRefGoogle Scholar
  14. Lippmann M (1994) Deposition and retention of inhaled fibres: effects on incidence of lung cancer and mesothelioma. Occup Environ Med 51:793–798CrossRefGoogle Scholar
  15. Magnani C, Ferrante D, Barone-Adesi F et al (2008) Cancer risk after cessation of asbestos exposure: a cohort study of Italian asbestos cement workers. Occup Environ Med 65:164–170CrossRefGoogle Scholar
  16. Mossman BT, Churg A (1998) Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med 157:1666–1680CrossRefGoogle Scholar
  17. Orsini N, Bellocco R, Greenland S (2006) Generalized least squares for trend estimation of summarized dose–response data. Stat J 6:40–57CrossRefGoogle Scholar
  18. Pesch B, Taeger D, Johnen G et al (2010) Cancer mortality in a surveillance cohort of German males formerly exposed to asbestos. Int J Hyg Environ Health 213:44–51CrossRefGoogle Scholar
  19. Piolatto G, Negri E, La Vecchia C et al (1990) An update of Cancer mortality among chrysotile asbestos miners in Balangero, northern Italy. Br J Ind Med 47:810–814Google Scholar
  20. Pira E, Pelucchi C, Buffoni L et al (2005) Cancer mortality in a cohort of asbestos textile workers. Br J Cancer 92:580–586CrossRefGoogle Scholar
  21. Pira E, Pelucchi C, Piolatto PG, Negri E, Discalzi G, La Vecchia C (2007) First and subsequent asbestos exposures in relation to mesothelioma and lung cancer mortality. Br J Cancer 97:1300–1304CrossRefGoogle Scholar
  22. Pira E, Pelucchi C, Piolatto PG et al (2009) Mortality from cancer and other causes in the Balangero cohort of chrysotile asbestos miners. Occup Environ Med 66:805–809CrossRefGoogle Scholar
  23. Pira E, Romano C, Violante FS et al (2016) Updated mortality study of a cohort of asbestos textile workers. Cancer Med 5:2623–2628CrossRefGoogle Scholar
  24. Pira E, Romano C, Donato F et al (2017) Mortality from cancer and other causes among Italian chrysotile asbestos miners. Occup Environ Med 74:558–563CrossRefGoogle Scholar
  25. Rubino GF, Piolatto G, Newhouse ML et al (1979) Mortality of chrysotile asbestos workers at the Balangero mine, northern Italy. Br J Ind Med 36:187–194Google Scholar
  26. Sandén A, Järvholm B, Larsson S, Thiringer G (1992) The risk of lung cancer and mesothelioma after cessation of asbestos exposure: a prospective cohort study of shipyard workers. Eur Respir J 5:281–285Google Scholar
  27. Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefGoogle Scholar
  28. Świątkowska B, Szeszenia-Dąbrowska N (2017) Mesothelioma continues to increase even 40 years after exposure—evidence from long-term epidemiological observation. Lung Cancer 108:121–125CrossRefGoogle Scholar
  29. Woitowitz HJ, Lange HJ, Beierl L et al (1986) Mortality rates in the Federal Republic of Germany following previous occupational exposure to asbestos dust. Int Arch Occup Environ Health 57:161–171CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
  3. 3.Department of Public Health and Pediatric SciencesUniversity of TurinTurinItaly
  4. 4.Division of Cancer Control and Population Sciences, UPMC Hillman Cancer CenterUniversity of PittsburghPittsburghUSA
  5. 5.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  6. 6.Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly

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