Background: Asbestos is a well-established occupational carcinogen, with strong evidence linking its exposure to lung cancer. Despite increasing awareness of its health risks, asbestos continues to be used in many countries. We aimed to evaluate the global burden of lung cancer attributable to occupational asbestos exposure and to analyze its epidemiological patterns across time and by regions, sex, and age.
Methods: We utilized lung cancer data from the Global Burden of Disease (GBD) 2021 database, including information on new cases, deaths, and disability-adjusted life-years (DALYs), along with their age-standardized rates by gender and age groups. Temporal trends were examined using Joinpoint regression models with 95% confidence intervals (CIs). The timeline data on global asbestos bans were retrieved from the International Ban Asbestos Secretariat.
Results: We observed, approximately 25 years after the complete ban on asbestos use, a declining trend for lung cancer incidence, as well as for mortality and DALYs due to asbestos exposure. In 2021, occupational asbestos exposure accounted for 9.4% of global lung cancer deaths and 7.2% of DALYs. Between 1990 and 2021, the number of asbestos-related lung cancer deaths increased from 0.13 million to 0.19 million, while DALYs rose from 2.58 million to 3.34 million. The highest deaths and DALYs were observed in regions with high Socio-demographic Index (SDI), though the most rapid increases occurred in lower SDI regions. Over time, lung cancer burden shifted towards older populations, especially those aged over 70.
Conclusions: We found, for the first time, that a complete ban on asbestos with a lag time of 25 years could effectively reduce lung cancer incidence along with asbestos-related deaths and DALYs. These findings underscore the urgent need for a complete ban on asbestos (especially chrysotile).
Lung cancer remains the most prevalent cancer globally and the most common cause of death from cancer [1]. Despite advances in medical research and treatment, the overall 5-year relative survival rate for lung cancer has shown minimal improvement in decades, making it one of the cancers with the lowest survival [2, 3]. In 2022, there were 2,480,301 new lung cancer cases and 1,817,172 deaths worldwide [4]. According to 2021 statistics, lung cancer ranked as the seventeenth cause of disability-adjusted life-years (DALYs), a position it has maintained since 2010 [5]. The International Agency for Research on Cancer (IARC) has identified 32 agents with sufficient evidence and 19 agents with limited evidence of carcinogenicity for lung cancer in humans [6]. Specifically, these carcinogens include cigarette smoking; environmental exposures such as environmental tobacco smoke, air pollution, and radon; and occupational carcinogens such as asbestos, crystalline silica, diesel exhaust, polycyclic aromatic hydrocarbons, nickel, chromium, and other metals. Findings from the SYNERGY project have demonstrated that occupational factors and smoking can act synergistically in the causation of lung cancer [7, 8]. Specifically, previous studies have shown that the interaction effects of asbestos exposure and tobacco smoke conform to a multiplicative model for lung cancer risk, which is typical for exposure to almost all types of industrial dusts, especially dust containing crystalline silica [9, 10].
Asbestos, a collective term for a group of fibrous silicates, possesses properties such as heat resistance, acid and alkali resistance, and sound insulation, which led to its extensive use in products such as friction products, thermal insulation, electrical wiring, and building materials [11]. However, asbestos, including all six types (chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite), has been classified as a Group 1 carcinogen by IARC, with sufficient evidence in humans for causing lung cancer, mesothelioma, and other cancers [12, 13]. The Link between asbestos and lung cancer was first discovered in 1930 [14], and afterwards many studies have confirmed [15,16,17,18]. In countries with historically high asbestos use, especially crocidolite, amosite and anthophyllite (amphibole group of asbestos), lung cancer attributable to occupational asbestos exposure has been estimated to account for approximately 3–8% of all lung cancer cases [19].
Although some developed countries have implemented a complete ban on asbestos use, BRIC countries (Brazil, Russia, India, and China) are still producing and using large amounts of chrysotile asbestos [20,21,22,23]. Therefore, this study aims to investigate the burden of lung cancer and its association with occupational exposure to asbestos using the most recent data from the Global Burden of Disease (GBD) 2021 database. These findings may provide valuable insights into the association of asbestos exposure with lung cancer burden and underscore the urgent need for a complete ban on asbestos (especially chrysotile).
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