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Lung Cancer Risk Associated with Regulated and Unregulated Chrysotile Asbestos Fibers

Hamra, Ghassan B.; Richardson, David B.; Dement, John; Loomis, Dana

doi: 10.1097/EDE.0000000000000597
Occupational Epidemiology

Background: Regulation of asbestos fibers in the workplace is partly determined by which fibers can be visually counted. However, a majority of fibers are too short and thin to count this way and are, consequently, not subject to regulation.

Methods: We estimate lung cancer risk associated with asbestos fibers of varying length and width. We apply an order-constrained prior both to leverage external information from toxicological studies of asbestos health effects. This prior assumes that risk from asbestos fibers increases with increasing length and decreases with increasing width.

Results: When we apply a shared mean for the effect of all asbestos fiber exposure groups, the rate ratios for each fiber group per unit exposure appear mostly equal. Rate ratio estimates for fibers of diameter <0.25 μm and length <1.5 and 1.5–5.0 μm are the most precise. When applying an order-constrained prior, we find that estimates of lung cancer rate ratio per unit of exposure to unregulated fibers 20–40 and >40 μm in the thinnest fiber group are similar in magnitude to estimates of risk associated with long fibers in the regulated fraction of airborne asbestos fibers. Rate ratio estimates for longer fibers are larger than those for shorter fibers, but thicker and thinner fibers do not differ as the toxicologically derived prior had expected.

Conclusion: Credible intervals for fiber size-specific risk estimates overlap; thus, we cannot conclude that there are substantial differences in effect by fiber size. Nonetheless, our results suggest that some unregulated asbestos fibers may be associated with increased incidence of lung cancer.

Supplemental Digital Content is available in the text.

From the aDepartment of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA; bDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; cDuke University Medical Center, Durham, NC; and dInternational Agency for Research on Cancer, Lyon, France.

Submitted 22 February 2016; accepted 21 November 2016.

D.B.R. was supported, in part, by Grant R03-OH-10706 from the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

The authors report no conflicts of interest.

The statistical software code is available from Dr. Hamra and as an eAppendix (; however, authors must obtain permission to analyze the data.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Ghassan B. Hamra, Department of Environmental & Occupational Health, Drexel University School of Public Health, 3215 Market St., Philadelphia, PA 19104. E-mail:

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