Low-dose exposure to asbestos and lung cancer: dose-response relations and interaction with smoking in a population-based case-referent study in Stockholm, Sweden.

This population-based case-referent study investigated the lung cancer risk associated with occupational exposure to asbestos, focusing on dose-response relations and the interaction with tobacco smoking. Incident cases of lung cancer among males aged 40-75 years in Stockholm County, Sweden, were identified from 1985 to 1990. Referents were selected randomly within strata (age, inclusion year) of the study base. Questionnaires administered to subjects or their next of kin gave information on occupations, tobacco smoking habits, and residences. Response rates of 87% and 85% resulted in 1,038 cases and 2,359 referents, respectively. Occupational exposures were assessed by an industrial hygienist. Lung cancer risk increased almost linearly with cumulative dose of asbestos. The risk at a cumulative dose of 4 fiber-years was 1.90 (95% confidence interval (CI): 1.32, 2.74), higher than that predicted by downward linear extrapolation from highly exposed occupational cohorts. The relative risk (exp(beta)) for a transformed dose variable ln(fiber-years + 1) was 1.494 (95% CI: 1.193, 1.871) per unit of exposure. The joint effect of asbestos and smoking was estimated to be 1.15 (95% CI: 0.77, 1.72) times that predicted from the sum of their individual effects and 0.31 (95% CI: 0.11, 0.86) times that predicted from their product, indicating a joint effect between additivity and multiplicativity.