title: Occupational exposure to asbestos and ovarian cancer: a meta-analysis.
abstract: OBJECTIVE
  A recent Monographs Working Group of the International Agency for Research on Cancer (IARC) concluded that there is sufficient evidence for a causal association between exposure to asbestos and ovarian cancer. We performed a meta-analysis to quantitatively evaluate this association.
  
  
  METHODS
  Searches of PubMed and unpublished data yielded a total of 18 cohort studies of women occupationally exposed to asbestos.
  
  
  METHODS
  Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer.
  
  
  RESULTS
  All but one study reported standardized mortality ratios (SMRs) comparing observed numbers of deaths with expected numbers for the general population; the exception was a study that reported standardized incidence ratios. For simplicity, we refer to all effect estimates as SMRs. The overall pooled SMR estimate for ovarian cancer was 1.77 (95% confidence interval, 1.37-2.28), with a moderate degree of heterogeneity among the studies (I2 = 35.3%, p = 0.061). Effect estimates were stronger for cohorts compensated for asbestosis, cohorts with estimated lung cancer SMRs > 2.0, and studies conducted in Europe compared with other geographic regions. Effect estimates were similar for studies with and without pathologic confirmation, and we found no evidence of publication bias (Egger's test p-value = 0.162).
  
  
  CONCLUSIONS
  Our study supports the IARC conclusion that exposure to asbestos is associated with increased risk of ovarian cancer.
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois, Chicago, Illinois 60612-4392, USA.
authors.forename: M Constanza
authors.initials: MC
authors.lastname: Camargo
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Stayner
authors.forename: Kurt
authors.initials: K
authors.lastname: Straif
authors.forename: Margarita
authors.initials: M
authors.lastname: Reina
authors.forename: Umaima
authors.initials: U
authors.lastname: Al-Alem
authors.forename: Paul A
authors.initials: PA
authors.lastname: Demers
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Landrigan
mesh_terms: D000328:Adult; D001194:Asbestos / Q000633:toxicity*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality; D009784:Occupational Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D016273:Occupational Exposure; D010051:Ovarian Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D012044:Regression Analysis; D018570:Risk Assessment
chemical_list: D001194:Asbestos