close

Вход

Забыли?

вход по аккаунту

?

473

код для вставкиСкачать
549
Mesothelioma, Asbestos, and Reported History of
Cancer in First-Degree Relatives
Ellen F. Heineman, mo.'
Leslie Bernstein, Ph.D.2
Alice D. Stark, D~.P.H?
Robert Spirtas, SC.D.'
' Occupational Studies Section, Environmental
Epidemiology Branch, Epidemiology and Biostatistics f'rogram, National Cancer Institute,
Bethesda. Maryland.
Department of Preventive Medicine, University
of Southern California School of Medicine, Los
Angeles, California.
Bureau of Environniental and Occupational Epidemiology, Center for Environmental Health,
New Yotk State Department of Health, Albany,
New York.
BACKGROUND. Although malignant mesothelioma is known to be strongly related
to asbestos exposure, its relationship to familial factors is unclear.
METHODS. We compared reported histories of cancer in first-degree relatives, obtained from telephone interviews with the next-of-kin of 196 patients who had a
pathologic diagnosis of mesothelioma, and with those from 51 1 deceased controls.
RESULTS. Among men exposed to asbestos, we found a statistically significant
twofold elevation in the risk of mesothelioma for patients reporting cancer in two
or more first-degree relatives. We found no significant elevation in women or
among the small number of men without asbestos exposure. The next-of-kin of
three patients (but no controls) reported a possible mesothelioma in a first-degree
relative: asbestos exposure could not be ruled out in those relatives. Associations
of asbestos with pleural mesothelioma were stronger among men with a reported
family history of cancer than men without, although no statistical evidence of an
interaction was detected.
CONCLUSIONS. These results provide suggestive, but limited, evidence that a family
history of cancer may be a risk factor for mesothelioma, or may indicate an increased susceptibility to mesothelioma given asbestos exposure. Cancer 1996
77:549-54. 0 1996 Aiiierican Caricer Society.
KEYWORDS: mesothelioma, occupational exposure, family, asbestos, etiology, casecontrol studies, risk factors, Li-Fraumeni cancer syndrome.
M
This work was supported by intramural funds
of the National Cancer Institute.
Current address for Robert Spirtas: Center for
Population Research, National Institute of Child
Health and Human Development, Bethesda,
Maryland.
Address for reprints: Dr. Ellen F. Heineman, Occupational Studies Section, EEB, NCI, EPN
Room 418, 6130 Eixecutive Blvd., MSC 7364,
Bethesda, MD 20892-7364.
Received June 19,1995; revision received October 11, 1995; accepted October 11, 1995.
CJ 1996 American Cancer Society
esothelioma is a rare cancer of the lining of the pleural and peritoneal
cavities. Asbestos exposure is the major risk factor for this disease
and is responsible for the vast majority of cases among men and perhaps
25% of cases among women.',' Although other substances induce these
tumors in experimental animals,"-' few etiologic factors other than asbestos have been suggested in humans, and the evidence is weak for most
of them.5 Little is known about the relationship of mesothelioma with
familial or genetic factors. Although several series""' of familial cases of
mesothelioma have been reported, it has been difficult to rule out carryhome exposure to asbestos.'-g To our knowledge, the role of family history
has been explored in only one case-control study in which Vianna and
Polan reported a statistically significant threefold risk of mesothelioma
among women whose parents were diagnosed with cancer, particularly
with gastrointestinal malignancies." We analyzed data from one of the
largest case-control studies of mesothelioma conducted to date, to determine if mesothelioma risk was increased among individuals with a family
history of cancer and if the association of mesothelioma with asbestos
exposure varied according to the presence or absence of a family history
of cancer.
550
CANCER February 1,1996 / Volume 77 / Number 3
MATERIALS AND METHODS
Patients
Details of the design of the study have previously been
published.’ Briefly, potential patients were identified
from population-based cancer registries in New York
State and Los Angeles County, and from the files of 39
large Veterans Administration hospitals. Eligible patients
were those diagnosed between January 1, 1975, and December 31, 1980. Of 720 eligible patients, the next-of-kin
of 536 (74%)completed a telephone interview, 106 (15%)
were not located, 64 (9%) refused an interview, the physician of 8 (1%)refused to allow contact, and 6 (< 1%)had
partially completed interviews. Of the 536 patients whose
next-of-kin had a completed interview, 208 (39%) were
confirmed as having a “definite” or “probable” mesothelioma by a review by 2 pathologists expert in the diagnosis
of mesothelioma.’ Details of the pathology review have
previously been reported.”
Controls were identified from death certificate files
for the catchment area of the registries and from deaths
listed in the Beneficiary Identification and Records Locator Subsystem system of the Veterans Administration. Eligible causes of death excluded other cancers, respiratory
disease, suicide, or violence. Pair-matched controls were
selected for 678 of the 720 potentially eligible patients.
For these 678 controls, the next-of-kin of 533 (79%) were
interviewed. We were unable to locate respondents for
138 controls (20%),4 (< 1%)had partially completed interviews, and 3 (< 1%) refused to be interviewed. We
used this larger set of 533 individuals as controls, rather
than the controls individually matched to the 208 cases,
in order to increase statistical power by taking advantage
of the information available from the controls matched
to unconfirmed cases. In the analyses, we controlled for
age, sex, and geographic location.
and reported residence within two miles of an asbestos
mine or mill. For the job-exposure matrix, each job held
by an individual was classified as having a probability of
none, less than lo%, 10% to 19%, 20% to 49%, or 50% or
greater “likelihood” of asbestos exposure, based on the
results of the National Institute for Occupational Safety
and Health’s National Occupational Hazard Survey.13
Each individual was classified into the highest achieved
probability category based on the survey’s estimates of
proportions of workers exposed to asbestos as determined by walk-through surveys of 5000 U S . workplaces
by industrial hygienists in 1972- 1974.13
Asbestos exposure was defined as a nonzero value
for at least one of the five measures listed above. The
unexposed group for all measures of asbestos was comprised of those individuals who had none of the five asbestos exposures (no reported exposure to asbestos, none
of the nine specified activities, no job with a National
Occupational Hazard Survey likelihood of exposure
greater than zero, no cohabitants with asbestos exposures, and no reported residence within two miles of an
asbestos mine or mill). Relative risks (as odds ratios) and
attributable risks for asbestos exposure were previously
reported.2
The original questionnaire data were examined for
all individuals whose next-of-kin reported that the individual had a family history of cancer. We had no means
of verifying these family history data reported by nextof-kin. Cancers reported to have occurred in relatives
other than the mother, father, sister, brother, daughter,
or son were excluded, and the remaining cancers in FDRs
were grouped by relative and reported site. Because of
an interest in the familial Li-Fraumeni cancer spndrome,I4we grouped reports of leukemia, soft tissue sarcoma, or cancer of the breast, brain, bone, or adrenal
cortex in one or more FDRs as “Li-Fraumeni” cancers.
Data Collection
Telephone interviews were conducted with (in order of
preference) the spouse, child, sibling, or other relative or
friend of patients and controls. Verbal informed consent
was obtained from all respondents. Using a standardized
questionnaire, trained interviewers collected information
on demographic factors, occupational history, tobacco
smoking, medical history, exposure of cohabitants to asbestos or asbestos-related work, and cancer in parents,
brothers, sisters, or children (first-degree relatives
[FDRs]).Exposure to asbestos was determined by several
measures: self-reported exposure to asbestos on or off
the job (“ever exposed”); involvement in nine specific
activities thought likely to entail asbestos exposure, such
as insulation or shipyard work (“9 activities”); a job-exposure matrix based on lifetime work history;z reported exposure of a cohabitant of the individual to asbestos or
the cohabitant’s participation in one of the nine activities;
Analyses
Twenty-five men and 5 women lacking information on
a FDR’s history of cancer (including 2 who also lacked
information on smoking), and 4 additional individuals
without smoking data were excluded from the analyses,
leaving 196 patients (172 men; 24 women) and 511 controls (406 men; 105 women). Maximum likelihood estimates of the odds ratio and 95% confidence intervals
were calculated using unconditional logistic regression
methods,Is separately for men and women, adjusting for
age in 4 categories (1-49, 50-59, 60-69, and 70+ years),
cigarette smoking (everlnever, because smoking was associated with being a control and confounded the association with asbestos), and geographic area (New York,
Louisiana, Virginia). All family history analyses were performed controlling for asbestos exposure or within asbestos-defined subgroups. Individuals with no cancers re-
Mesothelioma and Family History of Cancer/Heineman et al.
551
TABLE 1
Relative Risk of Mesothelioma by Reported Number of First-DemeeRelatives with Cancer and Li-Fraumeni Syndrome (Males and Females
Separately and Combined, Cont;olling for Age, Smoking History, and Geographic AreaY
Males
No asbestos exposure
Asbestos-exposedh
Ca
Co
Any FDRs with cancer
95 170
No
Yes
68
99
Number of FDRs with ca
1
415
81
2 or more 22
18
li
2
Pvalue'
.08
20
1
Asbestos-exposed
No asbestos exposure
All individuals
OR 95%CI
Ca
Co
OR
95%CI
Ca
Co
OR 95%CI
Ca
Co
OR 95%CI
Ca
Co
OR 95%CI
1.0
I.?
G
3
101
36
1.0
1.4
-
27
27
1.0
0.9
33
18
1.0
1.2
(0.2-8.41
117
79
331
(0.2-3.6)
9
2
-
(0.3-6.3)
7
6
-
(0.8-1.8)
180
1.0
1.3
1.0
2.2
(0.6-1.6)
(1.1-4.4)
3
0
28
8
1.8
(0.4-8.1)
-
-
4
2
18
9
1.1 (0.2-5.0)
0.7 (0.1-4.7)
1
1
12
6
1.0
1.5
(0.1-12.61
[O.l-19.1)
54
25
139
41
1.1 (0.8-i.;i
1.7 (0.9-3)
-
Trend test
Pvalue'
.OR
Any Li-Fraumeni cancers in FDRs
Yes
19 21
1.7 (0.9-3.5)
Number of FDRs with Li-Fraumeni cancers
I
2 or more
Trend rest
Females
1.6
5.1
(0.8-3.3)
(0.4-59.7)
.99
0
-
I
3
4.4
(0.1-226.4)
0
0
-
1
0
3
4.4
(0.1-226.4)
0
-
-
-
-
22
.7i
.G3
I
7
1.4
(0.1-16.:)
21
44
1.5
(0.8-2.81
(0.1-16.71
19
2
43
1.4
5.9
(0.8-2.7)
(0.4-81.7)
1
7
1.4
n
o
-
-
-
(0.9-1.8)
1
.I2
Ca: numher of rases; Cn: number of controls: OR: odds ratio: CI: confidence interval: FDR: first-degreerelative
'Also adjusted lor gender and asbestos exposure.
"Individualswh3 had at least one positive answer among all the asbestos exposure measures:the direct question "Was the subject ever exposed to asbestos?;nine specified activities,such as shipyardor insulation
work: at least one job with a National OccupationalHazard Survey likelihoodof exposure grealer than 0: a cohabitant with asbestos exposure or asbestosdated activities;or individuals reported residence within
nvo mile$of an asbestos mine or mill.
' The P value reflects the signifi1:ance of a linear trend for the 3 categories 0. I , and 2 t (more than 1):hvo few individuals reported more than 2 family members with cancer to further subdivide the highest
category
ported arnong FDRs were the referent group for all family
history variables. We tested for effect modification of family history and asbestos exposure by inclusion of interaction terms in the logistic regression model. Linear trends
(two-sided test) were evaluated by testing the statistical
significance of a continuous variable in the model.
RESULTS
Men and women whose next-of-kin reported cancer in
FDRs had a 30% excess of mesothelioma, which was not
statistically significant, after adjusting for asbestos exposure (defined as any exposure to asbestos whether workplace, cohabitant, residential or other reported exposure)
(Table 1). Among men exposed to asbestos, we found a
statistically significant twofold elevation in mesothelioma
risk for report of cancer in two or more FDRs, but there
was little evidence of a linear trend in risk with the number of FDRs with cancer (Table 1). Risk estimates were
larger in both men and women for the subset of "LiFraumeni" cancers in FDRs, and rose to fivefold among
asbestos-exposed men with two or more such relatives,
but were not statistically significant. We found no significant associations with the summary family history mea-
sures among women, nor among the small number of
men without asbestos exposure.
Among men with asbestos exposure, only liver cancer
in a FDR was significantly associated with a risk of mesothelioma (Table 2). A nearly threefold increase with familial history of brain cancer, although nonsignificant, was
notable because of the apparent consistency across most
relatives. Twofold or higher risks of mesothelioma were
observed among individuals whose FDR had colon or
uterine cancer. Numbers were too small to permit meaningful site- or relative-specific analyses among men without asbestos exposure or among women.
Associations of asbestos with pleural mesothelioma
were stronger among men with a family history of cancer
than men without such a history (Table 3). A similar pattern was seen for women (pleural and peritoneal mesothelioma combined due to small numbers). However, risk
estimates had wide, overlapping confidence intervals,
and no statistical evidence of interaction was detected.
For pleural and peritoneal mesothelioma combined in
men, risks were only slightly higher for men with a family
history of cancer than men without one (not shown).
The next-of-kin of three patients and no controls re-
552
CANCER February 1,1996 / Volume 77 / Number 3
TABLE 2
Men with Anv Asbestos Exposure (Relative Risk of Mesothelioma by. Reported
History of Cancer in First-Degree Relatives. Controlling for Age,
.
Smokine, and Geoesaohic heal
Relation
Type of cancer
Any relative
Ca
68
Upper aerodigestiven
Digestive and peritoneum
7
18
Stomach
3
Colon
6
Liver
8
Respiratory and intrathoracic,
excluding larynxb
Lung
10
Bone, connective tissue, etc.
9
Bone
1
Breast
8
Genitourinary
7
Uterus
3
Prostate
2
Lymphatic and hematopoietic
5
Leukemia
3
Hodgkin's disease
2
Other site
9
10
Eye
1
Brain
8
Thyroid
1
Unkriown site
19
OR
(95% GI)
1.2
(0.8-1.8)
1.3
(053.51
1.2
(0.6-2.3)
0.3
(0.1-1.3)
2.0
(0.6-6.4)
5.1
(1.3-20.2)
1.6
(0.7-4)
1.5
(0.6-3.8)
0.9
(0.4-2.11
0.8
(0.1-7.7)
1.6
(0.6-4.3)
1.0
(0.4-2.9)
2.4
(0.4-15)
1.2
(0.2-9.5)
1.4
(0.4-4.9)
1.5
(0.3-7.6)
1.9
(0.3-14.4)
2.4
(0.9-7)
1.4
(0.1-25.6)
2.8
(0.8-9.3)
1.9
(0.1-31.4)
1.5
10.8-3)
Mother
Ca
25
OR
(95%CI)
1.2
(0.7-2.1)
Father
Ca
18
1
L
3
7
1.0
(0.4-2.8)
0.5
(0.1 -2.4)
2.4
(0.5-11.5)
1.5
(0.1-26.2)
4.3
(0.4-50.4)
4.3
(0.4-50.41
0.9
(0.2-3.8)
6
2
4
I
2
2
3
0
3
1
1.3
(0.3-5.6)
0.3
(0.0-2.9)
0
1
OR
(95% GI)
1.2
(0.6-2.4)
1.6
(0.3-7.3)
1.7
(0.5-5.4)
0
1
5
3
3
2.6
(0.2-44.4)
4.8
(0.9-25.6)
2.3
(0.4-12.4)
2.3
(0.4- 12.4)
1
1
5
0
4
0.7
10.2-2.7)
1.4
(0.3-6.2)
5.6
(0.6-57.5)
L
0
1
1.2
(0.1 - 14.1)
ZI
6.9
(0.7-72.4)
1.o
(0.5-1.8)
1.1
(0.2-7)
0.4
(0-3.3)
1.0
(0.1- 11.2)
1.9
(0.5-7)
1.6
(0.4-6.4)
OR
(95% GI)
1.7
(0.3-8.i)
Ca
OR
(95% GI)
2
r
(-1
0
0
0
0
0
0
0
0
0
0
0
3
6.5
(0.6-65.4)
0
0
1
ZI
0
0
2
4.3
(0.4-50.41
0
0
1
x
I
0
1
0
0
0
1
2.4
(0.4-14.9)
1.5
(0.2- 115)
0
0
0
0
3
1
2.2
(0.1-38)
1
Y,
0
0
2
X
1
0.6
(0.1-5.9)
0
l
0
0
0
l
0
0
0
0
0
0.4
(0.0-3.3)
Ca
Son
0
2
0
OR
(95%GI)
0
5
2
3.1
(0.5-19.5)
1
0
3
2.6
(0.2 -3 1.9)
1.4
(0.1-25.6)
2
0
3
1.3
(0.1-21.2)
1.3
(0.1-21 2)
18
2
0
0.4
(0-3.5)
1.6
(0.9-3.0)
1.4
(0.2-9)
2.2
(0.6-8.1)
0.7
(0.1-7.4)
Ca
1
0
1
OR
(95% GI)
Daughter
Brother
0
0
0.7
(0.1-7.9)
1.6
(0.6-4.2)
2
3
0
8
22
0
0
2
Ca
1
n
0
1
Sister
0
1
x
1
1
X
0
7
4.0
(1.0-17)
6
0.6
(0.1-5.91
1.3
(0.4-4.2)
x
7-
r
a
La: number of cases; OR adds ratio; CI: confidence interval.
'Includes cancer of oral cavity. pharynx, "throat" and larynx
Excluder "throat" and lalynx, which were grouped with upper aerodigestive tract cancers
ported a possible mesothelioma among the patient's immediate family. The father of a woman with pleural mesothelioma was reported to have had "asbestos cancer."
(We assume this is likely to be mesothelioma or lung
cancer.) He was reported to have engaged in demolition,
shipyard, and insulation work while living with the patient; she had no other reported history of asbestos exposure. A man with pleural mesothelioma whose brother
was reported to have also had mesothelioma worked for
20 years as a heavy equipment mechanic on a railroad
Mesothelioma and Family History of Cancer/Heineman et al.
553
TABLE 3
Relative Risk of Mesothelioma with Several Measures of Asbestos Exposure among Study Patients With and Without Self-reported History of
Cancer in First-Degree Relatives
Men with pleural mesothelioma
No family history
Family history of cancer
~~
~~
~
Ca
co
OR
95%CI
Ca
co
OR
95%CI
1
1.0
28.5
270.9
33.4
16.5
55.2
89.9
-
5
86
62
73
1
36
99
22
74
39
17
5
24
5
101
170
51
135
60
34
7
1.0
11.0
24.9
11.8
7.0
15.9
19.8
4.3-28.41
9.2-67.4
4.5-30.8
2.4-20.9
5.5-46
3.5-1 13.9
15
26
32.5
19
40
12.4
3.9-39.43
~~
Never expo’ied
Any asbestos exposure
Ever exposed
Any of 9 activities
NOHS likelihood 1-19%
‘OtW
Cohabitant exposed
Cohabitant involved in
any of 9 activities
61
41
52
15
23
3.7-221.5
17.2-4262.1
4.2-263.0
2-137.2
6.6-465.3
6-1350.4
18
3.4-307.2
-
Women
Family history of cancer
Never exptrsed
Any asbestos exposure
Every expoed
Any of 9 activities
NOHS likelihood 1- 19%
20+%
Cohabitant exposed
Cohabitant involved in
any of 9 activities
Ca
co
2
6
3
1
1
0
2
18
27
9
I1
3
0
6
3
20
OR
1.0
2.0
6.8
1.2
No family history
95% c1
-
0.3-13.8
0.5-97
0-26.8
Ca
9
I
2
3
co
33
27
6
10
OR
1.o
1.3
1.o
2.3
95% CI
-
0.4-4.4
0.1-6.7
0.4-14.8
1.8
-
-
-
-
0
0
5
-
0
-
-
Zld
-
0
5
-
-
5
21
4.1
0.2-93.9
1.0
0.2-4
rA: number of caws: Co: number of controls; OR: odds ratio; CI:confidence interval; NOHS: National Occupational Hazard Survey,
Patientjsl and controls are in mutally exclusive strata.
”
with duties that included wrapping pipes with asbestos
insulation: we have no information on the potential exposures of the brother of this patient. The mother of a male
patient diagnosed with peritoneal mesothelioma was reported to have had the “same cancer as the [case]”.This
man worked for 37 years, beginning at age 19, as a pipefitter in the same small midwestern town. Because of
his residential stability, it is possible that his mother could
have been exposed to asbestos on his work clothing.
These reports should be viewed cautiously because, as
noted earlier, only 39% of patients identified from tumor
registries were confirmed as having probable or definite
mesothelioma.
DISCUSSION
Asbestos clearly accounts for the vast majority of mesothelioma cases, particularly among men, in whom the
attributable risk ranges from 45% to 75% for occupational
exposure or 85% for any known exposure to asbestos.’ In
this large case-control study, we evaluated whether a
family cancer history plays an independent role in meso-
thelioma and whether such a history, which might indicate heightened cancer susceptibility, augments the effect
of asbestos. We found suggestive but limited evidence of
such effects. In men exposed to asbestos, a statistically
significant elevation in risk for cancer in two or more
FDRs was not accompanied by a significant trend with
number of relatives, although numbers of patients with
multiple relatives were small. In women, a family history
of cancer was not significantly related to the risk of mesothelioma. In men with pleural mesothelioma, associations of asbestos with mesothelioma appeared to be
stronger among those with a family history of cancer than
those without one. However, the asbestos associations
comparing individuals with a family history with those
without such a history do not differ statistically, so the
appearance of effect modification may be due to chance.
It is important to note that our statistical power to identify
a modest risk with family history, and particularly assess
interaction, was limited by small numbers of patients and
controls (especially patients without asbestos exposure).
We could not confirm a threefold risk of mesotheli-
554
CANCER February 1, 1996 / Volume 77 / Number 3
oma among individuals whose parents had gastrointestinal malignancies, as reported in the previous epidemiologic study that evaluated family cancer history,” although men whose relatives were reported to have liver
cancer did have a significantly increased risk of mesothelioma. Apparent increases in risk with numbers of relatives with cancers that are part of the Li-Fraumeni syndrome (leukemia, soft tissue sarcoma, or cancer of the
breast, brain, bone, or adrenal cortex) are intriguing, but
could be explained by chance. We are not aware of any
reason why liver cancers or the “Li-Fraumeni” cancers
might be particularly associated with mesothelioma. Mesothelioma is not considered a typical “Li-Fraumeni”
cancer, although at least one mesothelioma has been reported in family members with this cancer syndrome.’“
Site-specific analyses are only suggestive because, as
noted earlier, fanlily members’ cancers could not be validated, and some common sites of metastases, such as
the liver, may have been overreported among both patients and controls.
We did not have information on family size or composition, or the age at which the relative was diagnosed
with cancer, which would have allowed a more sophisticated analysis. These limitations, along with modest statistical power, might have diminished our ability to detect
a true effect. Because we could not validate family histories, it is possible that reporting bias may be responsible
in part for some of the apparent increases. Patients’ nextof-kin were slightly more likely than controls’ next-ofkin to volunteer cancers in more distant relatives, about
whom the interviewer did not inquire (5% vs. 3%). The
exposure of interest, however, was limited to cancers in
FDRs to reduce this potential bias. Next-of-kin of both
patients and controls are likely to have better knowledge
about first-degree relatives than about more distant relatives, tending to equalize their ability to report cancers
in these relatives.
Although two or three patients (and no controls) reported mesothelioma in other family members, it is not
possible to determine from the available data whether
they are due to a familial tendency or shared exposures.
In two of the patients, it is plausible that mesothelioma
(or “asbestos cancer”) in one family member was due to
asbestos exposure in the workplace, and asbestos carried
home by that person might explain the second mesothelioma. As mentioned earlier, mesothelioma is difficult to
diagnose, and these reported familial cases may not have
been true niesotheliomas.
Although our results provide limited evidence that
family history of cancer may be a risk factor for mesothelioma, we cannot rule out a modest effect or specific associations with cancer in particular family members or with
certain tumor types. The tendency for risks with asbestos
exposure to be higher among individuals with a family
history of cancer might indicate an increased susceptibility to mesothelioma, as suggested by Vianna and Polan,”
but could also be a chance result. As heavy and prolonged
exposure to asbestos becomes increasingly less common,
it may be possible to separate the overwhelming impact
of asbestos from that of other factors that contribute to
this rare disease.
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
McDonald AD, McDonald JC. Epidemiology of malignant
mesothelioma. In: Antman K, Aisner 7, editors. Asbestosrelated malignancy. New York Grune & Stratton, Inc., 1986.
Spirtas R, Heineman EF, Bernstein L, Beebe GW, Keehn RJ,
Stark A, et al. Malignant mesothelioma: attributable risk of
asbestos exposure. Occup Environ Med 1994;51:804- 11.
Stanton MF, Wrench C. Mechanisms of mesothelioma induction with asbestos and fibrous glass. / Nut1 Cancer Inst
1972;48:797-82 1.
Warren S, Brown CE, Chute RN, Federman M. Mesothelioma
relative to asbestos, radiation, and methylcholanthrene.
Arch Padiol Lab Med 1981;105:305-12.
Peterson JT, Greenberg SD, Buffler PA. Non-asbestos-related
malignant mesothelioma: a review. Cancer 1984;54:951-60.
Krousel T, Garcas N, Rothschild H. Familial clustering of
mesothelioma: a report on three affected persons in one
family. Am / Prev Med 1986;2:186-8.
Hammar SP, Bockus D, Remington F, Freidman S, LaZerte
G. Familial mesothelioma: a report of two families. Hum
Padlo1 1989;20:107- 12.
Otte KE, Sigsgaard TI, Kjaerulff 1. Malignant mesothelioma:
clustering in a family producing asbestos cement in their
home. B r / Ind Med 1990;47:10-3.
Dawson A, Gibbs A, Browne K, Pooley F, Griffiths M. Familial
mesothelioma. Details of 17 cases with histopathologic
findings and mineral analysis. Cancer 1992;70:1183-7.
Bianchi C, Brollo A, Zuch C. Asbestos-related familial mesothelioma. Eur J Cancer Prev 1993;2:247-50.
Vianna NJ, Polan AK. Nonoccupational exposure to asbestos
and malignant mesothelioma in females. Lancet
1978;I: 1061-3.
Spirtas R, Keehn RJ, Beebe GW, Wagner IC, Hochholzer L,
Davies JNP, et al. Results of a pathology review of recent US
mesothelioma cases. Accompl Oncol 1986;1:144-52.
National Occupational Hazard Survey, Vol 111: survey analysis and supplemental tables. Cincinnati, (OH): National Institute for Occupational Safety and Health; 1977 X DHEW
Publication No. (NIOSH) 78-114.
Li FP, Fraumeni JF Jr., Mulvihill JJ, Blattner WA, Dryfus MG,
Tucker MA, et al. A cancer family syndrome in twenty-four
kindreds. Cancer Res 1988;48:5358-62.
Kleinbaum DK, Kupper LL, Morgenstern H. Epidemiologic
research. Belmont, CA: Lifetime Learning Publications, 1982.
Документ
Категория
Без категории
Просмотров
4
Размер файла
509 Кб
Теги
473
1/--страниц
Пожаловаться на содержимое документа