Asbestos, smoking and lung cancer: An update

Sonja Klebe, James Leigh, Douglas W. Henderson, Markku Nurminen

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    This review updates the scientific literature concerning asbestos and lung cancer, emphasizing cumulative exposure and synergism between asbestos exposure and tobacco smoke, and proposes an evidence-based and equitable approach to compensation for asbestos-related lung cancer cases. This update is based on several earlier reviews written by the second and third authors on asbestos and lung cancer since 1995. We reevaluated the peer-reviewed epidemiologic studies. In addition, selected in vivo and in vitro animal studies and molecular and cellular studies in humans were included. We conclude that the mechanism of lung cancer causation induced by the interdependent coaction of asbestos fibers and tobacco smoke at a biological level is a multistage stochastic process with both agents acting conjointly at all times. The new knowledge gained through this review provides the evidence for synergism between asbestos exposure and tobacco smoke in lung cancer causation at a biological level. The evaluated statistical data conform best to a multiplicative model for the interaction effects of asbestos and smoking on the lung cancer risk, with no requirement for asbestosis. Any asbestos exposure, even in a heavy smoker, contributes to causation. Based on this information, we propose criteria for the attribution of lung cancer to asbestos in smokers and non-smokers.

    Original languageEnglish
    Article number258
    Number of pages23
    JournalInternational Journal of Environmental Research and Public Health
    Issue number1
    Publication statusPublished - 1 Jan 2020

    Bibliographical note

    This article is an open access
    article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (


    • Asbestosis
    • Carcinoma
    • Cumulative exposure
    • Mesothelioma
    • Multiplicative model
    • Pathogenesis
    • Smoking
    • Synergism


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