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Occupational Asbestos Exposure and Risk of Pleural Mesothelioma, Lung Cancer, and Laryngeal Cancer in the Prospective Netherlands Cohort Study

Offermans, Nadine S.M. MSc; Vermeulen, Roel; Burdorf, Alex; Goldbohm, R. Alexandra; Kauppinen, Timo; Kromhout, Hans; van den Brandt, Piet A.

Journal of Occupational and Environmental Medicine: January 2014 - Volume 56 - Issue 1 - p 6–19
doi: 10.1097/JOM.0000000000000060
Original Articles

Objective: To study the association between occupational asbestos exposure and pleural mesothelioma, lung cancer, and laryngeal cancer, specifically addressing risk associated with the lower end of the exposure distribution, risk of cancer subtypes, and the interaction between asbestos and smoking.

Methods: Using the Netherlands Cohort Study (n = 58,279 men, aged 55 to 69 years), asbestos exposure was estimated by linkage to job-exposure matrices. After 17.3 years of follow-up, 132 pleural mesothelioma, 2324 lung cancer, and 166 laryngeal cancer cases were available.

Results: The multivariable-adjusted model showed overall positive associations between all levels of asbestos exposure and mesothelioma, lung cancer, and laryngeal cancer. Lung adenocarcinoma and glottis cancer showed only a positive association after prolonged higher asbestos exposure (hazard ratio per 10 years increment, 1.43 [95% confidence interval, 1.06 to 1.93] and 1.95 [95% confidence interval, 1.36 to 2.80], respectively). There was no statistically significant interaction between asbestos and smoking.

Conclusions: Asbestos levels encountered at the lower end of the exposure distribution may be associated with an increased risk of pleural mesothelioma, lung cancer, and laryngeal cancer.

From the Department of Epidemiology (Ms Offermans and Mr van den Brandt), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands; Institute for Risk Assessment Sciences (Dr Vermeulen and Mr Kromhout), Environmental Epidemiology Division, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care (Dr Vermeulen), University Medical Center, Utrecht, the Netherlands; Department of Public Health (Mr Burdorf), Erasmus MC, Rotterdam, the Netherlands; TNO (Dr Goldbohm), Leiden, the Netherlands; and Finnish Institute of Occupational Health (Dr Kauppinen), Helsinki, Finland.

Address correspondence to: Piet A. van den Brandt, Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, the Netherlands (

This study was supported by a grant (50-50-500-98-6153) from ZonMw.

The sponsor had no role in the study design; collection, analysis, and interpretation of data; writing process; or decision where to submit the paper for publication.

Authors Offermans, Vermeulen, Burdorf, Goldbohm, Kauppinen, Kromhout, and van den Brandt have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2014 by the American College of Occupational and Environmental Medicine