Occupational asbestos exposure and lung cancer--a systematic review of the literature

Arch Environ Occup Health. 2014;69(4):191-206. doi: 10.1080/19338244.2013.863752.


The objective of this study was to evaluate the scientific literature concerning asbestos and lung cancer, emphasizing low-level exposure. A literature search in PubMed and Embase resulted in 5,864 citations. Information from included studies was extracted using SIGN. Twenty-one statements were evidence graded. The results show that histology and location are not helpful in differentiating asbestos-related lung cancer. Pleural plaques, asbestos bodies, or asbestos fibers are useful as markers of asbestos exposure. The interaction between asbestos and smoking regarding lung cancer risk is between additive and multiplicative. The findings indicate that the association between asbestos exposure and lung cancer risk is basically linear, but may level off at very high exposures. The relative risk for lung cancer increases between 1% and 4% per fiber-year (f-y)/mL, corresponding to a doubling of risk at 25-100 f-y/mL. However, one high-quality case-control study showed a doubling at 4 f-y/mL.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Air Pollutants, Occupational / adverse effects*
  • Asbestos / adverse effects*
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / etiology*
  • Occupational Diseases / diagnosis
  • Occupational Diseases / etiology*
  • Occupational Exposure / adverse effects*
  • Risk Factors
  • Smoking / adverse effects


  • Air Pollutants, Occupational
  • Asbestos