Peto J
Lancet. 1978 Mar 4;1(8062):484-9. doi: 10.1016/s0140-6736(78)90145-9.
Previous studies, including the analysis on which the current 2 fibres/cm3 hygiene standard is based, may have underestimated the risk of morbidity or mortality following exposure to low levels of asbestos dust. Accurate dose-response data at levels below 2 fibres/cm3 are unlikely to be available for the foreseeable future, and the biologically plausible assumption that excess cancer mortality is approximately proportional to dust level should be provisionally accepted. It may be reasonable, however, to postulate a safe threshold for mortality from asbestosis. If excess mortality from asbestos-related disease is proportional to dust level for each cause, approximately 10% of male asbestos workers might, under certain assumptions, eventually die of asbestos-induced disease after 50 years' exposure at 2 fibres/cm3. Peritoneal mesothelioma is usually due to crocidolite (blue asbestos) or other amphiboles, but exposure to chrysotile (white asbestos) alone may lead to a substantial risk of pleural mesothelioma. These predictions are based on rather small numbers in a single factory, and further studies in other working environments are required. Fibre counts based on optical microscopy are likely to be less relevant than total counts by electron microscopy, and excess mortality is virtually confined to men first exposed more than 20 years ago, when little or no accurate data on dust levels were collected.
以往的研究,包括当前每立方厘米2根纤维的卫生标准所依据的分析,可能低估了接触低水平石棉粉尘后发病或死亡的风险。在可预见的未来,不太可能获得每立方厘米低于2根纤维水平的准确剂量反应数据,因此应暂时接受癌症超额死亡率大致与粉尘水平成正比这一生物学上合理的假设。然而,推测石棉沉滞症死亡率的安全阈值可能是合理的。如果与石棉相关疾病的超额死亡率与每种病因的粉尘水平成正比,在某些假设下,每立方厘米2根纤维的环境中暴露50年后,约10%的男性石棉工人最终可能死于石棉所致疾病。腹膜间皮瘤通常由青石棉(蓝石棉)或其他闪石引起,但仅接触温石棉(白石棉)也可能导致患胸膜间皮瘤的重大风险。这些预测基于一家工厂中数量相当少的数据,需要在其他工作环境中进行进一步研究。基于光学显微镜的纤维计数可能不如电子显微镜的总计数相关,超额死亡率实际上仅限于20多年前首次接触石棉的男性,当时几乎没有收集到关于粉尘水平的准确数据。