Whitesell P L, Drage C W
Division of Thoracic Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1993 Feb;68(2):183-8. doi: 10.1016/s0025-6196(12)60167-0.
Exposure to certain industrial agents has been thought to have carcinogenic potential, both for employees who work closely with such agents and for the general population that comes in contact with them. Although case reports, laboratory studies, and epidemiologic analyses help to determine the carcinogenicity of implicated agents, each of these types of investigation has limitations and deficiencies in distinguishing causal from noncausal associations. Asbestos has been linked with bronchogenic carcinoma, but several controversial factors--the degree of risk relative to exposure dose, the synergistic effect of cocarcinogens, and the question of existence of a threshold dose--complicate the understanding of the magnitude of the risk for exposed persons. Several other physical and chemical agents (such as chromium, nickel, and radon) have also been associated with an increased incidence of lung cancer in epidemiologic and animal studies. As with asbestos, the specific type of the agent and exposure conditions are important in determining the degree of carcinogenicity. In studies of exposure to man-made mineral fibers, formaldehyde, and silica, the findings have been inconsistent. Because the degree of health hazard attributable to asbestos and other known and suspected lung carcinogens is controversial, a wide range of opinions exists about the importance of occupational exposures to the overall incidence of lung cancers. Nevertheless, attempting to prevent lung cancers by minimizing or eliminating exposure to carcinogens is preferable to treating existent cases.
人们认为,接触某些工业制剂可能具有致癌性,这对于那些与这些制剂密切接触的员工以及接触到它们的普通人群来说都是如此。尽管病例报告、实验室研究和流行病学分析有助于确定相关制剂的致癌性,但每一种这类调查在区分因果关联和非因果关联方面都存在局限性和不足之处。石棉已被认为与支气管源性癌有关,但有几个有争议的因素——相对于接触剂量的风险程度、辅助致癌物的协同作用以及是否存在阈剂量的问题——使得理解接触者的风险程度变得复杂。在流行病学和动物研究中,其他几种物理和化学制剂(如铬、镍和氡)也与肺癌发病率的增加有关。与石棉一样,制剂的具体类型和接触条件在确定致癌程度方面很重要。在对人造矿物纤维、甲醛和二氧化硅接触情况的研究中,结果并不一致。由于归因于石棉以及其他已知和疑似肺癌致癌物的健康危害程度存在争议,对于职业接触对肺癌总体发病率的重要性存在广泛的意见分歧。然而,试图通过尽量减少或消除致癌物接触来预防肺癌比治疗现有病例更为可取。