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(Chest. 1998;113:1517-1521.)
© 1998 American College of Chest Physicians

Progression of Asbestosis Predicts Lung Cancer

Panu Oksa MD1; Matti Klockars MD, FCCP2; Antti Karjalainen MD1; Matti S. Huuskonen MD, MSc, FCCP1; Kimmo Vattulainen PhLic1; Eero Pukkala PhD3; and Henrik Nordman MD1

1 From the Finnish Institute of Occupational Health, University of Helsinki, Helsinki, Finland
2 From the Department of Public Health, University of Helsinki, Helsinki, Finland
3 From the Finnish Cancer Registry, Helsinki, Finland

Study objectives: To explore whether the progression of asbestosis correlates with the risk of lung cancer among patients with asbestosis.

Design: A group of 85 asbestosis patients (78 men and 7 women) were radiographically followed up between 1979 and 1987. Two or three posteroanterior radiographs taken from each patient in 1978 to 1979, 1983 to 1984, and 1986 to 1987 were classified according to the International Labour Office 1980 classification and were used to divide the patients into progressors and nonprogressors. Follow-up for cancer was done automatically through the files of the Finnish Cancer Registry from the time of determination of the progression status to December 31, 1994. Predictors of lung cancer risk were studied with a logistic regression model, and the standardized incidence ratio (SIR) was calculated for lung cancer.

Results: Of the 24 male patients with progressive small opacity profusion, 11 (46%) developed lung cancer, as opposed to 5 (9%) of the 54 male patients without progression. The SIR for lung cancer was 37 (95% confidence interval, 18 to 66) for the progressors and 4.3 (1.4 to 9.9) for the nonprogressors. In both groups, all the lung cancer cases occurred among smokers or ex-smokers. None of the seven female patients showed progressive small opacity profusion. One of them developed lung cancer. In the logistic regression model including all 85 asbestosis patients, radiographic progression of small opacity profusion (p=0.0009) and current smoking (0.0021) were significant predictors of lung cancer morbidity.

Conclusions: Asbestosis patients with radiographic progression of small opacity profusion over a few years are at a higher risk of lung cancer than those with a less aggressive course of the disease. The progression of pulmonary fibrosis may be an independent risk factor that, in addition to smoking history and the intensity of asbestos exposure, could be used to estimate lung cancer risk.

Key Words: asbestosis • cohort study • follow-up • ILO classification • incidence • lung cancer • record linkage • smoking

Submitted on April 8, 1997
Accepted on November 20, 1997




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