Occupational asbestos exposure and the incidence of non-hodgkin lymphoma of the gastrointestinal tract: an ecologic study
Introduction
The strong association between occupational asbestos exposure and both mesothelioma and cancers of the respiratory tract has led to investigations of the possible influence of this exposure on the occurrence of other forms of malignancy. One of these, non-Hodgkin lymphoma, has generally been observed to be unrelated to a history of having worked with or around asbestos (1). However, a case-control study of lymphoma arising in the gastrointestinal tract, conducted in Los Angeles in the late 1970s (2), found that 17 of 28 cases had a history of “substantial asbestos exposure” on the job at some point in their lives. This was a considerably higher proportion than that seen in controls who had been matched for age, race, and sex (odds ratio = 12; 95% CI, 1.64, 249.2; one-sided p = 0.002). A Swedish case-control study of gastrointestinal lymphoma (3) also found an association with occupational asbestos exposure, but a considerably weaker one [2 exposed cases of 16 total (12.5%) vs. 21 of 335 controls (6.3%); OR: 2.14 (95% CI, 0.22, 10.29)].
To our knowledge, these two studies—both published 20 years ago—are the only ones in the medical literature to have directly evaluated this hypothesis. We felt we could address the question by means of an ecologic study, taking advantage of the geographic differences in the prevalence of asbestos exposure across the United States.
Section snippets
Methods
We hypothesized that if there were a strong association present between asbestos exposure and the incidence of non-Hodgkin lymphoma of the gastrointestinal tract (GINHL), the geographic pattern of the incidence of GINHL should parallel that of mesothelioma, the majority of which is believed to result from asbestos exposure 4., 5., 6.. Data to test this hypothesis were obtained from the nine US registries participating in the National Cancer Institute's Surveillance, Epidemiology and End Results
Results
The mesothelioma incidence rates were highest in Seattle (Puget Sound) and San Francisco–Oakland—nearly twice that of most of the other SEER areas (Table 1, Figure 1). This was to be expected, given the relatively large proportion of the population of these areas employed in the shipbuilding industry during the years in which asbestos exposure was widespread in that industry. There was no correlation between the rates of mesothelioma and the rates of non-Hodgkin lymphoma of the gastrointestinal
Discussion
There was at most a two-fold difference in mesothelioma incidence between high- and low-risk SEER populations, reflecting a difference in the prevalence of asbestos exposure that was not as great as would be ideal for an ecological analysis. As a result, our failure to find any correlation between the incidence of mesothelioma and GINHL in the US, while it does not support the hypothesis that occupational asbestos exposure predisposes to GINHL, should not be interpreted as particularly strong
Acknowledgements
The authors thank Dr. Lisa Herrinton for her helpful comments during the preparation of this manuscript.
References (14)
- et al.
Asbestos exposure and lymphomas of the gastrointestinal tract and oral cavity
Lancet
(1982) - et al.
Asbestos exposure and malignant lymphoma
Lancet
(1982) - et al.
Generalizability of the surveillance, epidemiology, and end results registry population: factors relevant to epidemiologic and health care research
J Clin Epidemiol
(1997) - et al.
Asbestos exposure and malignant lymphomas–a review of the epidemiological literature
Int Arch Occup Environ Health
(2001) - et al.
Malignant mesothelioma: attributable risk of asbestos exposure
Occup Environ Med
(1994) - et al.
Malignant mesothelioma in North America
Cancer
(1980) - et al.
Absence of evidence for a significant background incidence of diffuse malignant mesothelioma apart from asbestos exposure
Ann N Y Acad Sci
(1991)
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