National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
BMJ Open. 2018 Dec 9;8(12):e021063. doi: 10.1136/bmjopen-2017-021063.
Exposure to asbestos is the major cause for malignant pleural mesothelioma (MPM), but the causal link of individual cases is difficult to establish for lack of exposure information and long disease latency.
We established a retrospective cohort of workers employed in asbestos industries during the period of 1950-1989 and the occurrence of MPM during the period of 1980-2009 was examined with the Taiwan Cancer Registry. Estimated rate ratios (eRRs) were computed for each factory where any case of MPM was diagnosed by assuming Poisson distribution with a minimal latency of 20 years.
A total of 18 MPM (17 males, 1 female) in eight factories were found. The incidence rate of MPM for the eight factories was 18.0 per million, ranging from 6.2 per million (military factory) to 268.2 per million (asbestos cement). We observed significantly increased risks for MPM in asbestos cement, thermal insulation and shipbuilding industries, with eRR (genders combined) of 113.6, 87.5 and 15.8, respectively. The sensitivity analyses considering latency showed similar findings in latency 30 years, and the shipbuilding industry presented a significant eRR given a latency 40 years. The gender-specific eRR showed similar results in men, but high eRR of 729.6 was observed in an asbestos cement factory where a female MPM was diagnosed.
This nationwide study in Taiwan comprehensively shows that different asbestos manufacturing processes, including asbestos cement, thermal insulation and shipbuilding industries, were at significantly increased risks for MPM. We recommend to establish a medical screening programme for workers previously exposed to asbestos to identify MPM and other asbestos-related diseases at an earlier stage.
石棉暴露是恶性胸膜间皮瘤（MPM）的主要原因，但由于缺乏暴露信息和较长的疾病潜伏期，个体病例的因果关系难以确定。
我们建立了一个回溯队列，纳入 1950 年至 1989 年期间在石棉行业工作的工人，并利用台湾癌症登记处检查了 1980 年至 2009 年期间 MPM 的发病情况。通过假设泊松分布，对于每个诊断出 MPM 病例的工厂，计算了每个工厂的估计率比（eRR），潜伏期最小为 20 年。
共发现 8 家工厂的 18 例 MPM（17 例男性，1 例女性）。8 家工厂的 MPM 发病率为 180 万分之 18.0，范围从 62 万分之 1.8（军工厂）到 2682 万分之 1.8（石棉水泥）。我们观察到石棉水泥、隔热和造船行业的 MPM 风险显著增加，男性和女性综合 eRR 分别为 113.6、87.5 和 15.8。考虑潜伏期的敏感性分析在潜伏期 30 年时得出了相似的发现，在潜伏期 40 年时，造船业的 eRR 呈显著增加。性别特异性 eRR 在男性中得出了相似的结果，但在一家诊断出女性 MPM 的石棉水泥工厂中观察到了高达 729.6 的高 eRR。
这项在台湾进行的全国性研究全面表明，不同的石棉制造工艺，包括石棉水泥、隔热和造船业，与 MPM 的风险显著增加有关。我们建议为以前接触过石棉的工人建立医疗筛查计划，以更早地发现 MPM 和其他与石棉相关的疾病。
