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      Occupational, domestic and environmental mesothelioma risks in the British population: a case–control study

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          Abstract

          We obtained lifetime occupational and residential histories by telephone interview with 622 mesothelioma patients (512 men, 110 women) and 1420 population controls. Odds ratios (ORs) were converted to lifetime risk (LR) estimates for Britons born in the 1940s. Male ORs (95% confidence interval (CI)) relative to low-risk occupations for >10 years of exposure before the age of 30 years were 50.0 (25.8–96.8) for carpenters (LR 1 in 17), 17.1 (10.3–28.3) for plumbers, electricians and painters, 7.0 (3.2–15.2) for other construction workers, 15.3 (9.0–26.2) for other recognised high-risk occupations and 5.2 (3.1–8.5) in other industries where asbestos may be encountered. The LR was similar in apparently unexposed men and women (∼1 in 1000), and this was approximately doubled in exposed workers' relatives (OR 2.0, 95% CI 1.3–3.2). No other environmental hazards were identified. In all, 14% of male and 62% of female cases were not attributable to occupational or domestic asbestos exposure. Approximately half of the male cases were construction workers, and only four had worked for more than 5 years in asbestos product manufacture.

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          Most cited references29

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          The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure.

          Mortality reports on asbestos exposed cohorts which gave information on exposure levels from which (as a minimum) a cohort average cumulative exposure could be estimated were reviewed. At exposure levels seen in occupational cohorts it is concluded that the exposure specific risk of mesothelioma from the three principal commercial asbestos types is broadly in the ratio 1:100:500 for chrysotile, amosite and crocidolite respectively. For lung cancer the conclusions are less clear cut. Cohorts exposed only to crocidolite or amosite record similar exposure specific risk levels (around 5% excess lung cancer per f/ml.yr); but chrysotile exposed cohorts show a less consistent picture, with a clear discrepancy between the mortality experience of a cohort of xhrysotile textile workers in Carolina and the Quebec miners cohort. Taking account of the excess risk recorded by cohorts with mixed fibre exposures (generally<1%), the Carolina experience looks uptypically high. It is suggested that a best estimate lung cancer risk for chrysotile alone would be 0.1%, with a highest reasonable estimate of 0.5%. The risk differential between chrysotile and the two amphibole fibres for lunc cancer is thus between 1:10 and 1:50. Examination of the inter-study dose response relationship for the amphibole fibres suggests a non-linear relationship for all three cancer endpoints (pleural and peritoneal mesotheliomas, and lung cancer). The peritoneal mesothelioma risk is proportional to the square of cumulative exposure, lung cancer risk lies between a linear and square relationship and pleural mesothelioma seems to rise less than linearly with cumulative dose. Although these non-linear relationships provide a best fit ot the data, statistical and other uncertainties mean that a linear relationship remains arguable for pleural and lung tumours (but not or peritoneal tumours). Based on these considerations, and a discussion fo the associated uncertainties, a series of quantified risk summary statements for different elvels of cumulative exposure are presented.
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            The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050

            The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. These data were used to predict the future burden of mesothelioma mortality in Great Britain. Poisson regression analysis was used to model male mesothelioma deaths from 1968 to 2001 as a function of the rise and fall of asbestos exposure during the 20th century, and hence to predict numbers of male deaths in the years 2002–2050. The annual number of mesothelioma deaths in Great Britain has risen increasingly rapidly from 153 deaths in 1968 to 1848 in 2001 and, using our preferred model, is predicted to peak at around 1950 to 2450 deaths per year between 2011 and 2015. Following this peak, the number of deaths is expected to decline rapidly. The eventual death rate will depend on the background level and any residual asbestos exposure. Between 1968 and 2050, there will have been approximately 90 000 deaths from mesothelioma in Great Britain, 65 000 of which will occur after 2001.
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              Collecting retrospective data: accuracy of recall after 50 years judged against historical records.

              Recent interest in a lifecourse perspective on health inequalities will rekindle concerns about the accuracy of retrospective data. The present paper demonstrates that recalled information on some types of social circumstances can be obtained with a useful degree of accuracy using an interview technique which helps to minimize recall bias. Lifegrid information about social circumstances during their youth and childhood was collected from 57 subjects in early old age and compared with archive material of the same subjects' social circumstances recorded 50 years previously. A comparison of interview with archive data revealed that a substantial majority of subjects had recalled simple socio-demographic information after a period of 50 years with a useful degree of accuracy. Within lifecourse research, it is concluded, carefully collected retrospective data offer a valuable complement to birth cohort studies, provided that such usage is sensitive to the types of items of information which can, and can not, be recalled accurately.
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                Author and article information

                Journal
                Br J Cancer
                British Journal of Cancer
                Nature Publishing Group
                0007-0920
                1532-1827
                03 March 2009
                31 March 2009
                07 April 2009
                : 100
                : 7
                : 1175-1183
                Affiliations
                [1 ]Institute of Cancer Research, Sutton Surrey SM2 5NG, UK
                [2 ]Epidemiology Unit, Health and Safety Executive, Bootle Merseyside L20 3QZ, UK
                [3 ]Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London University, Keppel Street London WC1E 7HT, UK
                Author notes
                [* ]Author for correspondence: Julian.Peto@ 123456lshtm.ac.uk
                Article
                6604879
                10.1038/sj.bjc.6604879
                2669989
                19259084
                e5cd55b5-9809-4034-8019-2e2e4bd7fc0e
                Copyright 2009, Cancer Research UK
                History
                : 30 September 2008
                : 15 December 2008
                : 15 December 2008
                Categories
                Epidemiology

                Oncology & Radiotherapy
                mesothelioma,amosite,case–control
                Oncology & Radiotherapy
                mesothelioma, amosite, case–control

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