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American Journal of Epidemiology Advance Access published online on September 21, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi285
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received September 29, 2004
Accepted June 1, 2005

ORIGINAL CONTRIBUTIONS

Evidence for Excess Colorectal Cancer Incidence among Asbestos-exposed Men in the Beta-Carotene and Retinol Efficacy Trial

Oluremi A. Aliyu 1, Mark R. Cullen 1*, Matt J. Barnett 2, John R. Balmes 3, Brenda Cartmel 1, Carrie A. Redlich 1, Carl A. Brodkin 4, Scott Barnhart 5, Linda Rosenstock 6, Leslie Israel 7, Gary E. Goodman 8, Mark D. Thornquist 2, and Gilbert S. Omenn 9

1 Yale Occupational and Environmental Medicine Program and the Cancer Center, Yale University School of Medicine, New Haven, CT
2 Fred Hutchinson Cancer Research Center, Seattle, WA; Occupational and Environmental Medicine Program, University of Washington, Seattle, WA
3 Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA; Center for Occupational and Environmental Health, University of California, Berkeley, Berkeley, CA
4 Occupational and Environmental Medicine Program, University of Washington, Seattle, WA
5 Occupational and Environmental Medicine Program, University of Washington, Seattle, WA; Harborview Medical Center, Seattle, WA
6 School of Public Health, University of California, Los Angeles, Los Angeles, CA
7 Center for Occupational and Environmental Health, University of California, Irvine, Irvine, CA
8 Fred Hutchinson Cancer Research Center, Seattle, WA; Occupational and Environmental Medicine Program, University of Washington, Seattle, WA; Swedish Medical Center Cancer Institute, Seattle, WA
9 Departments of Internal Medicine and Human Genetics, School of Medicine, University of Michigan, Ann Arbor, MI; Department of Public Health, School of Public Health, University of Michigan, Ann Arbor, MI

* To whom correspondence should be addressed.
Mark R. Cullen, E-mail: mark.cullen{at}yale.edu


  Abstract

The relation between asbestos exposure and colorectal cancer remains controversial. The authors of this 1984-2004 US study examined the association among 3,897 occupationally exposed participants in the Beta-Carotene and Retinol Efficacy Trial (CARET) for chemoprevention of lung cancer, followed prospectively for 10-18 years. When a Cox stratified proportional hazards model was used, risks of colorectal cancer were elevated among male heavy smokers exposed to asbestos. Their relative risk was 1.36 (95% confidence interval: 0.96, 1.93) when compared with that for CARET heavy smokers not exposed to asbestos, after adjusting for age, smoking history, and intervention arm. The presence of asbestos-induced pleural plaques at baseline was associated with a relative risk of 1.54 (95% confidence interval: 0.99, 2.40); colorectal cancer risk also increased with worsening pulmonary asbestosis (p = 0.03 for trend). A dose-response trend based on years of asbestos exposure was less evident. Nonetheless, these data suggest that colorectal cancer risk is elevated among men occupationally exposed to asbestos, especially those with evidence of nonmalignant asbestos-associated radiographic changes.

Keywords: asbestos; asbestosis; colorectal neoplasms; environmental exposure; prospective studies; randomized controlled trials; smoking.
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