A pooled cohort analysis on cancer risk among former asbestos-exposed workers: role of asbestos clearance in explaining long-term mortality trend for pleural cancer.

Objective. Asbestos causes mesothelioma (MM) and cancer of lung, ovary, larynx and possibly other organs. Risk reduction after cessation of exposure is debated. For MM, the predicted increase of rates with Time Since First Exposure (TSFE) might be attenuated by fibre clearance. The ban of asbestos use in Italy gives an opportunity to measure long term risk in formerly exposed workers. Methods. In a pool of 43 Italian asbestos cohorts (asbestos-cement, rolling stock, shipbuilding and other industries), standardized mortality ratios (SMRs) were computed for the major causes, with consideration of time factors (period, duration, latency). The functional relation between pleural cancer mortality rates and TSFE was evaluated using Poisson regression, including a term for fibre clearance. Results The study includes 54,409 subjects (6,054 women): 55.3% alive, 43.0% died (cause known for 94%; 789 pleural cancers), and 1.7% lost to follow-up. Mortality was increased for all causes (SMR=1.06; p<0.001), all malignan...