Asbestos exposure, pleural plaques, and the risk of death from lung cancer.
BACKGROUND
Although asbestos is a well-known lung carcinogen, the pleural plaque-lung cancer link remains controversial.


OBJECTIVE
This study was designed to examine this link in asbestos-exposed workers.


METHODS
A 6-year follow-up was conducted to study lung cancer mortality in the 5,402 male subjects participating in an asbestos-related disease screening program conducted from October 2003 to December 2005 in four French regions. Chest computed tomography (CT) scan was performed in all subjects with randomized, independent, double reading of CT scans focusing on benign asbestos-related abnormalities. Cox model survival regression analysis was used to model lung cancer mortality according to the presence of pleural plaques, with age as the main time variable, adjusting for smoking and asbestos cumulative exposure index. All statistical tests were two-sided.


RESULTS
Thirty-six deaths from lung cancer were recorded. Lung cancer mortality was significantly associated with pleural plaques in the follow-up study in terms of both the unadjusted hazard ratio of 2.91 (95% confidence interval = 1.49-5.70) and the adjusted hazard ratio of 2.41 (95% confidence interval = 1.21-4.85) after adjustment for smoking and asbestos cumulative exposure index.


CONCLUSIONS
Pleural plaques may be an independent risk factor for lung cancer death in asbestos-exposed workers and could be used as an additional criterion in the definition of high-risk populations eligible for CT screening.
1 INSERM, U955, Equipe 4, Créteil, France.
Jean-Claude
JC
Pairon
Pascal
P
Andujar
Mickael
M
Rinaldo
Jacques
J
Ameille
Patrick
P
Brochard
Soizick
S
Chamming's
Bénédicte
B
Clin
Gilbert
G
Ferretti
Antoine
A
Gislard
François
F
Laurent
Amandine
A
Luc
Pascal
P
Wild
Christophe
C
Paris
D001194:Asbestos / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000401:mortality*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010994:Pleura / Q000000981:diagnostic imaging; D010995:Pleural Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D016016:Proportional Hazards Models; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D001194:Asbestos
CT scan; asbestos; lung cancer; pleural plaques; screening