title: The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking.
abstract: OBJECTIVE
  To examine if the risk of lung cancer declines with increasing time since ceasing exposure to asbestos and quitting smoking, and to determine the relative asbestos effect between non-smokers and current smokers.
  
  
  METHODS
  A cohort study of 2935 former workers of the crocidolite mine and mill at Wittenoom, who responded to a questionnaire on smoking first issued in 1979 and on whom quantitative estimates of asbestos exposure are known. Conditional logistic regression was used to relate asbestos exposure, smoking category, and risk of lung cancer.
  
  
  RESULTS
  Eighteen per cent of the cohort reported never smoking; 66% of cases and 50% of non-cases were current smokers. Past smokers who ceased smoking within six years of the survey (OR = 22.1, 95% CI 5.6 to 87.0), those who ceased smoking 20 or more years before the survey (OR = 1.9, 95% CI 0.50 to 7.2), and current smokers (<20 cigarettes per day (OR = 6.8, 95% CI 2.0 to 22.7) or >20 cigarettes per day (OR = 13.2, 95% CI 4.1 to 42.5)) had higher risks of lung cancer compared to never smokers after adjusting for asbestos exposure and age. The asbestos effect between non-smokers and current smokers was 1.23 (95% CI 0.35 to 4.32).
  
  
  CONCLUSIONS
  Persons exposed to asbestos and tobacco but who subsequently quit, remain at an increased risk for lung cancer up to 20 years after smoking cessation, compared to never smokers. Although the relative risk of lung cancer appears higher in never and ex-smokers than in current smokers, those who both smoke and have been exposed to asbestos have the highest risk; this study emphasises the importance of smoking prevention and smoking cessation programmes within this high risk cohort.
authors.affiliation: Occupational & Environmental Epidemiology Group, School of Population Health, University of Western Australia, Crawley, WA 6009, Australia. alisonr@dph.uwa.edu.au
authors.forename: A
authors.initials: A
authors.lastname: Reid
authors.forename: N H
authors.initials: NH
authors.lastname: de Klerk
authors.forename: G L
authors.initials: GL
authors.lastname: Ambrosini
authors.forename: G
authors.initials: G
authors.lastname: Berry
authors.forename: A W
authors.initials: AW
authors.lastname: Musk
mesh_terms: D017638:Asbestos, Crocidolite / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology*; D008297:Male; D008906:Mining; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D013997:Time Factors; D014904:Western Australia
chemical_list: D017638:Asbestos, Crocidolite