Skip to main content

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



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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  • 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 2004:61e14

    Google Scholar 

  • Boffetta P (2014) Malignant mesothelioma: epidemiology. In: Anttila S, Boffetta P (eds) Occupational cancers. Springer, London, pp 253–264

    Google Scholar 

  • 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 75:160

    Article  Google Scholar 

  • 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 29:484–489

    CAS  Article  Google Scholar 

  • 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 164:1233–1241

    Article  Google Scholar 

  • Carbone M, Kanodia S, Chao A et al (2016) Consensus report of the 2015 Weinman international conference on mesothelioma. J Thorac Oncol 11:1246–1262

    Article  Google Scholar 

  • DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    CAS  Article  Google Scholar 

  • Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol 13:1301–1309

    Article  Google Scholar 

  • Harding AH, Darnton AJ (2010) Asbestosis and mesothelioma among British asbestos workers (1971–2005). Am J Ind Med 53:1070–1080

    Article  Google Scholar 

  • International Agency for Research on Cancer (2007) Reversal of risk after quitting smoking. IARC handbooks of cancer prevention, Tobacco Control, vol 11. IARC, Lyon

  • 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)

    Article  Google Scholar 

  • Lacourt A, Leffondré K, Gramond C et al (2012) Temporal patterns of occupational asbestos exposure and risk of pleural mesothelioma. Eur Respir J 39:1304–1312

    Article  Google Scholar 

  • 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 55:155–160

    CAS  Article  Google Scholar 

  • Lippmann M (1994) Deposition and retention of inhaled fibres: effects on incidence of lung cancer and mesothelioma. Occup Environ Med 51:793–798

    CAS  Article  Google Scholar 

  • 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 65:164–170

    CAS  Article  Google Scholar 

  • Mossman BT, Churg A (1998) Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med 157:1666–1680

    CAS  Article  Google Scholar 

  • Orsini N, Bellocco R, Greenland S (2006) Generalized least squares for trend estimation of summarized dose–response data. Stat J 6:40–57

    Article  Google Scholar 

  • 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 213:44–51

    Article  Google Scholar 

  • 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 47:810–814

    CAS  Google Scholar 

  • Pira E, Pelucchi C, Buffoni L et al (2005) Cancer mortality in a cohort of asbestos textile workers. Br J Cancer 92:580–586

    CAS  Article  Google Scholar 

  • 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 97:1300–1304

    CAS  Article  Google Scholar 

  • 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 66:805–809

    CAS  Article  Google Scholar 

  • Pira E, Romano C, Violante FS et al (2016) Updated mortality study of a cohort of asbestos textile workers. Cancer Med 5:2623–2628

    CAS  Article  Google Scholar 

  • Pira E, Romano C, Donato F et al (2017) Mortality from cancer and other causes among Italian chrysotile asbestos miners. Occup Environ Med 74:558–563

    Article  Google Scholar 

  • Rubino GF, Piolatto G, Newhouse ML et al (1979) Mortality of chrysotile asbestos workers at the Balangero mine, northern Italy. Br J Ind Med 36:187–194

    CAS  Google Scholar 

  • 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 5:281–285

    Google Scholar 

  • 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 283:2008–2012

    CAS  Article  Google Scholar 

  • Świątkowska B, Szeszenia-Dąbrowska N (2017) Mesothelioma continues to increase even 40 years after exposure—evidence from long-term epidemiological observation. Lung Cancer 108:121–125

    Article  Google Scholar 

  • 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 57:161–171

    CAS  Article  Google Scholar 

Download references


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).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Paolo Boffetta.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Boffetta, P., Donato, F., Pira, E. et al. Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression. Int Arch Occup Environ Health 92, 949–957 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Asbestos
  • Mesothelioma
  • Time since last exposure