Estimating the asbestos-related lung cancer burden from mesothelioma mortality

Br J Cancer. 2012 Jan 31;106(3):575-84. doi: 10.1038/bjc.2011.563. Epub 2012 Jan 10.


Background: Quantifying the asbestos-related lung cancer burden is difficult in the presence of this disease's multiple causes. We explore two methods to estimate this burden using mesothelioma deaths as a proxy for asbestos exposure.

Methods: From the follow-up of 55 asbestos cohorts, we estimated ratios of (i) absolute number of asbestos-related lung cancers to mesothelioma deaths; (ii) excess lung cancer relative risk (%) to mesothelioma mortality per 1000 non-asbestos-related deaths.

Results: Ratios varied by asbestos type; there were a mean 0.7 (95% confidence interval 0.5, 1.0) asbestos-related lung cancers per mesothelioma death in crocidolite cohorts (n=6 estimates), 6.1 (3.6, 10.5) in chrysotile (n=16), 4.0 (2.8, 5.9) in amosite (n=4) and 1.9 (1.4, 2.6) in mixed asbestos fibre cohorts (n=31). In a population with 2 mesothelioma deaths per 1000 deaths at ages 40-84 years (e.g., US men), the estimated lung cancer population attributable fraction due to mixed asbestos was estimated to be 4.0%.

Conclusion: All types of asbestos fibres kill at least twice as many people through lung cancer than through mesothelioma, except for crocidolite. For chrysotile, widely consumed today, asbestos-related lung cancers cannot be robustly estimated from few mesothelioma deaths and the latter cannot be used to infer no excess risk of lung or other cancers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asbestos / toxicity*
  • Carcinogens / toxicity*
  • Cohort Studies
  • Global Health
  • Humans
  • Lung Neoplasms / chemically induced
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / pathology
  • Mesothelioma / chemically induced
  • Mesothelioma / mortality*
  • Mesothelioma / pathology
  • Models, Biological
  • Mortality
  • Tumor Burden
  • United Kingdom / epidemiology
  • United States / epidemiology


  • Carcinogens
  • Asbestos