Spirtas R, Heineman E F, Bernstein L, Beebe G W, Keehn R J, Stark A, Harlow B L, Benichou J
Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD.
Occup Environ Med. 1994 Dec;51(12):804-11. doi: 10.1136/oem.51.12.804.
To evaluate a case-control study of malignant mesothelioma through patterns of exposure to asbestos based upon information from telephone interviews with next of kin.
Potential cases, identified from medical files and death certificates, included all people diagnosed with malignant mesothelioma and registered during 1975-1980 by the Los Angeles County Cancer Surveillance Program, the New York State Cancer Registry (excluding New York City), and 39 large Veterans Administration hospitals. Cases whose diagnosis was confirmed in a special pathology review as definite or probable mesothelioma (n = 208) were included in the analysis. Controls (n = 533) had died of other causes, excluding cancer, respiratory disease, suicide, or violence. Direct exposure to asbestos was determined from responses to three types of questions: specific queries as to any exposure to asbestos; occupational or non-vocational participation in any of nine specific activities thought to entail exposure to asbestos; and analysis of life-time work histories. Indirect exposures were assessed through residential histories and reported contact with family members exposed to asbestos.
Among men with pleural mesothelioma the attributable risk (AR) for exposure to asbestos was 88% (95% confidence interval (95% CI) 76-95%). For men, the AR of peritoneal cancer was 58% (95% CI 20-89%). For women (both sites combined), the AR was 23% (95% CI 3-72%). The large differences in AR by sex are compatible with the explanations: a lower background incidence rate in women, lower exposure to asbestos, and greater misclassification among women.
Most of the pleural and peritoneal mesotheliomas in the men studied were attributable to exposure to asbestos. The situation in women was less definitive.
根据与近亲的电话访谈信息，通过石棉暴露模式评估恶性间皮瘤的病例对照研究。
从医疗档案和死亡证明中识别出的潜在病例，包括1975年至1980年期间由洛杉矶县癌症监测项目、纽约州癌症登记处（不包括纽约市）以及39家大型退伍军人管理局医院诊断并登记的所有恶性间皮瘤患者。经特殊病理检查确诊为明确或可能的间皮瘤的病例（n = 208）纳入分析。对照组（n = 533）死于其他原因，不包括癌症、呼吸系统疾病、自杀或暴力。通过对三类问题的回答来确定直接石棉暴露：关于是否接触过石棉的具体询问；参与九种被认为会接触石棉的特定活动中的任何职业或非职业活动；以及对终生工作经历的分析。通过居住史和报告的与接触石棉的家庭成员的接触情况来评估间接暴露。
在患有胸膜间皮瘤的男性中，石棉暴露的归因风险（AR）为88%（95%置信区间（95%CI）76 - 95%）。对于男性，腹膜癌的AR为58%（95%CI 20 - 89%）。对于女性（两个部位合并），AR为23%（95%CI 3 - 72%）。按性别划分的AR差异巨大，这与以下解释相符：女性的背景发病率较低、石棉暴露较少以及女性中的错误分类较多。
在所研究的男性中，大多数胸膜和腹膜间皮瘤归因于石棉暴露。女性的情况则不太明确。
