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7475067 
Journal Article 
Asbestos, Smoking and Lung Cancer: An Update 
Klebe, S; Leigh, J; Henderson, DW; Nurminen, M 
2020 
Yes 
International Journal of Environmental Research and Public Health
ISSN: 1661-7827
EISSN: 1660-4601 
17 
1 
258-258 
English 
CCC:000509391500258 
This review updates the scientific literature concerning asbestos and lung cancer, emphasizing cumulative exposure and synergism between asbestos exposure and tobacco smoke, and proposes an evidence-based and equitable approach to compensation for asbestos-related lung cancer cases. This update is based on several earlier reviews written by the second and third authors on asbestos and lung cancer since 1995. We reevaluated the peer-reviewed epidemiologic studies. In addition, selected in vivo and in vitro animal studies and molecular and cellular studies in humans were included. We conclude that the mechanism of lung cancer causation induced by the interdependent coaction of asbestos fibers and tobacco smoke at a biological level is a multistage stochastic process with both agents acting conjointly at all times. The new knowledge gained through this review provides the evidence for synergism between asbestos exposure and tobacco smoke in lung cancer causation at a biological level. The evaluated statistical data conform best to a multiplicative model for the interaction effects of asbestos and smoking on the lung cancer risk, with no requirement for asbestosis. Any asbestos exposure, even in a heavy smoker, contributes to causation. Based on this information, we propose criteria for the attribution of lung cancer to asbestos in smokers and non-smokers. 
Environmental Sciences & Ecology; Health Care Sciences & Services; Public, Environmental & Occupational Health; asbestosis, carcinoma, cumulative exposure, mesothelioma, multiplicative; model, pathogenesis, smoking, synergism; bronchial epithelial-cells, chrysotile asbestos, helsinki-criteria,; pleural plaques, amosite asbestos, cigarette-smoke, malignant; mesothelioma, occupational-exposure, consensus statement, confounding