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Cancer Causes & Control

, Volume 24, Issue 1, pp 1–12 | Cite as

Lung cancer risk at low cumulative asbestos exposure: meta-regression of the exposure–response relationship

  • Sjoukje van der BijEmail author
  • Hendrik Koffijberg
  • Virissa Lenters
  • Lützen Portengen
  • Karel G. M. Moons
  • Dick Heederik
  • Roel C. H. Vermeulen
Review article

Abstract

Purpose

Existing estimated lung cancer risks per unit of asbestos exposure are mainly based on, and applicable to, high exposure levels. To assess the risk at low cumulative asbestos exposure, we provide new evidence by fitting flexible meta-regression models, a notably new and more robust method.

Methods

Studies were selected if lung cancer risk per cumulative asbestos exposure in at least two exposure categories was reported. From these studies (n = 19), we extracted 104 risk estimates over a cumulative exposure range of 0.11–4,710 f-y/ml. We fitted linear and natural spline meta-regression models to these risk estimates. A natural spline allows risks to vary nonlinearly with exposure, such that estimates at low exposure are less affected by estimates in the upper exposure categories. Associated relative risks (RRs) were calculated for several low cumulative asbestos exposures.

Results

A natural spline model fitted our data best. With this model, the relative lung cancer risk for cumulative exposure levels of 4 and 40 f-y/ml was estimated between 1.013 and 1.027, and 1.13 and 1.30, respectively. After stratification by fiber type, a non-significant three- to fourfold difference in RRs between chrysotile and amphibole fibers was found for exposures below 40 f-y/ml. Fiber-type-specific risk estimates were strongly influenced by a few studies.

Conclusions

The natural spline regression model indicates that at lower asbestos exposure levels, the increase in RR of lung cancer due to asbestos exposure may be larger than expected from previous meta-analyses. Observed potency differences between different fiber types are lower than the generally held consensus. Low-exposed industrial or population-based cohorts with quantitative estimates of asbestos exposure a required to substantiate the risk estimates at low exposure levels from our new, flexible meta-regression.

Keywords

Amphiboles Asbestos Chrysotile Exposure Lung cancer Meta-analysis 

Notes

Acknowledgments

This study was supported by the Institute for Asbestos Victims, The Netherlands.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10552_2012_107_MOESM1_ESM.doc (123 kb)
Supplementary material 1 (DOC 123 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Sjoukje van der Bij
    • 1
    • 3
    Email author
  • Hendrik Koffijberg
    • 1
  • Virissa Lenters
    • 2
  • Lützen Portengen
    • 2
  • Karel G. M. Moons
    • 1
  • Dick Heederik
    • 1
    • 2
  • Roel C. H. Vermeulen
    • 1
    • 2
  1. 1.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Division of Environmental Epidemiology, Institute for Risk Assessment SciencesUtrecht UniversityUtrechtThe Netherlands
  3. 3.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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