Occupational asbestos exposure and gastrointestinal cancers: systematic review and meta-analyses

• Published in: Occupational and environmental medicine (London, England) Vol. 81; no. 12; pp. 639 - 646
• Main Authors: Koehoorn, Mieke, McLeod, Christopher B, Fan, Jonathan, Arrandale, Victoria H, Davies, Hugh W, Dement, John M, Pahwa, Manisha, Peters, Cheryl E, Stayner, Leslie, Straif, Kurt, Demers, Paul A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 12.02.2025; BMJ Publishing Group LTD
• Subjects: Asbestos; Asbestos - adverse effects; Cohort analysis; Collaboration; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - epidemiology; Dose-response effects; Epidemiology; Esophageal cancer; Esophageal Neoplasms - epidemiology; Esophagus; Estimates; Exposure; Gastric cancer; Gastroenterology; Gastrointestinal cancer; Gastrointestinal Neoplasms - chemically induced; Gastrointestinal Neoplasms - epidemiology; Gastrointestinal Neoplasms - etiology; Health risks; Humans; Hygiene; Insulation; Keywords; Lung cancer; Meta-analysis; Mortality; Occupational Diseases - epidemiology; Occupational Diseases - etiology; Occupational exposure; Occupational Exposure - adverse effects; Occupational Health; Risk assessment; Stomach; Stomach Neoplasms - epidemiology; Subject heading schemes; Systematic review; Working groups; Asbestos; Occupational Health; Epidemiology; Gastroenterology; Meta-analysis
• ISSN: 1351-0711; 1470-7926; 1470-7926
• DOI: 10.1136/oemed-2024-109707

ObjectiveTo conduct meta-analyses of occupational asbestos exposure and oesophageal, stomach and colorectal cancer risk, including a critical exposure assessment approach.MethodsThe search strategy was executed on MEDLINE, Embase, CINAHL, Scopus and Web of Science databases (March 2022, March 2024). Effect estimates (ORs, HRs, standardised incidence ratio and standardised mortality ratio) from eligible cohort and case-control studies were combined in random effects models. Meta-relative risks (mRRs) were calculated by cancer site and exposure characteristics. Investigators with occupational epidemiology and hygiene expertise came to a consensus on the estimates where there was confidence in significant asbestos exposure.ResultsA total of 82 (oesophageal), 153 (stomach) and 144 (colorectal) papers met the inclusion criteria. Elevated mRRs were observed for any occupational asbestos exposure for oesophageal (1.17 (95% CI 1.07 to 1.29)), stomach (1.14 (95% CI 1.05 to 1.23)) and colorectal cancer (1.16 (95% CI 1.08 to 1.24)). There was consistency of mRR estimates and higher mRRs in meta-analyses where there was increased confidence in the categorisation of highly exposed workers, including among the highest exposed workers in exposure-response studies (oesophageal: 1.63 (95% CI 1.29 to 2.06); stomach: 1.28 (95% CI 1.09 to 1.52); colorectal: 1.29 (95% CI 1.09 to 1.53)), among asbestos insulation workers (oesophageal: 1.68 (95% 1.19 to 2.36); stomach: 1.53 (95% 0.93 to 2.51); colorectal: 1.59 (95% 1.14 to 2.23)) and among workers in cohorts with a twofold or greater risk of asbestos-related lung cancer (oesophageal: 1.40 (95% CI 1.14 to 1.71); stomach: 1.33 (95% CI 1.14 to 1.56); colorectal: 1.47 (95% CI 1.34 to 1.61)).ConclusionThe meta-analyses support a causal link between occupational asbestos exposure and the risk of oesophageal, stomach and colorectal cancer.