SynthesisPloS one2015
Additive Synergism between Asbestos and Smoking in Lung Cancer Risk: A Systematic Review and Meta-Analysis.
Synthesis in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it, 109 citations in OpenAlex.
- Environmental risk factors, protective factors and lifestyles for lung cancer: an umbrella review.Frontiers in public health · 2025Pooled it
- Absence of multiplicative interactions between occupational lung carcinogens and tobacco smoking: a systematic review involving asbestos, crystalline silica and diesel engine exhaust emissions.BMC public health · 2017Pooled it
- Elemental analysis of histological specimens: a method to unmask nano asbestos fibers.European journal of histochemistry : EJH · 2016Trial
- Potential to improve early detection of lung cancer through expansion of focused and opportunistic screening approaches: a scoping review focusing on potential expansion of screening risk factors and adoption of artificial intelligence models.Lung cancer management · 2026Review
- Lung cancer risk prediction models and asbestos exposure: a validation study on the Western Australia Asbestos Review Program.Occupational and environmental medicine · 2026Article
- An Evaluation of Mortality Rates and Their Determinants in a Cohort of Former Asbestos Miners in South Africa.American journal of industrial medicine · 2026Article
- Lung cancer in never-smoking females: epidemiology, risk factors and screening.Frontiers in public health · 2026Review
- Risk of cancer associated with residential exposure to asbestos insulation: updated evidence.The Lancet regional health. Western Pacific · 2025Article
- Mortality from Pleural and Lung Cancer in Railway Maintenance Workers.Life (Basel, Switzerland) · 2025Article
- Cigarette smoking decreases macrophage-dependent clearance to impact the biological effects of occupational and environmental particle exposures.Frontiers in public health · 2025Review
- Role of Nanoformulations in the Treatment of Lung Cancer.Recent patents on nanotechnology · 2025Review
- Cancer burden attributable to risk factors, 1990-2019: A comparative risk assessment.iScience · 2024Article
- Lung cancer in patients who have never smoked - an emerging disease.Nature reviews. Clinical oncology · 2024Review
- Article
- Review
- Occupation as a risk factor of small cell lung cancer.Scientific reports · 2023Article
- Dual inhibition of EGFR‑VEGF: An effective approach to the treatment of advanced non‑small cell lung cancer with EGFR mutation (Review).International journal of oncology · 2023Review
- Lung cancer risk in relation to jobs held in a nationwide case-control study in Iran.Occupational and environmental medicine · 2022Article
- Causes of Outcome Learning: a causal inference-inspired machine learning approach to disentangling common combinations of potential causes of a health outcome.International journal of epidemiology · 2022Article
- Agent Orange Exposure and Risk of Idiopathic Pulmonary Fibrosis among U.S. Veterans.American journal of respiratory and critical care medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Smoking and asbestos exposure are important risks for lung cancer. Several epidemiological studies have linked asbestos exposure and smoking to lung cancer. To reconcile and unify these results, we conducted a systematic review and meta-analysis to provide a quantitative estimate of the increased risk of lung cancer associated with asbestos exposure and cigarette smoking and to classify their interaction. Five electronic databases were searched from inception to May, 2015 for observational studies on lung cancer. All case-control (N = 10) and cohort (N = 7) studies were included in the analysis. We calculated pooled odds ratios (ORs), relative risks (RRs) and 95% confidence intervals (CIs) using a random-effects model for the association of asbestos exposure and smoking with lung cancer. Lung cancer patients who were not exposed to asbestos and non-smoking (A-S-) were compared with; (i) asbestos-exposed and non-smoking (A+S-), (ii) non-exposure to asbestos and smoking (A-S+), and (iii) asbestos-exposed and smoking (A+S+). Our meta-analysis showed a significant difference in risk of developing lung cancer among asbestos exposed and/or smoking workers compared to controls (A-S-), odds ratios for the disease (95% CI) were (i) 1.70 (A+S-, 1.31-2.21), (ii) 5.65; (A-S+, 3.38-9.42), (iii) 8.70 (A+S+, 5.8-13.10). The additive interaction index of synergy was 1.44 (95% CI = 1.26-1.77) and the multiplicative index = 0.91 (95% CI = 0.63-1.30). Corresponding values for cohort studies were 1.11 (95% CI = 1.00-1.28) and 0.51 (95% CI = 0.31-0.85). Our results point to an additive synergism for lung cancer with co-exposure of asbestos and cigarette smoking. Assessments of industrial health risks should take smoking and other airborne health risks when setting occupational asbestos exposure limits.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.