DIFFERENCES IN OCCUPATIONAL MORTALITY FROM PLEURAL CANCER, PERITONEALCANCER, AND ASBESTOSIS

Objective-To assess whether the increased risk of disease related to a sbestos in occupations from the construction and engineering industrie s applies equally to pleural cancer, peritoneal cancer, and asbestosis . Methods-Analysis was based on deaths among men aged 20-74 in England and Wales during 1979-80 and 1982-90. (n = 1656 096). Information abo ut cause of death and the last full time occupation of decedents was d erived from death certificates. Proportional mortality ratios (PMRs) b y occupation were calculated for each of pleural cancer, peritoneal ca ncer, and asbestosis. Results-Altogether, 2848 deaths were attributed to cancer of the pleura, 362 to cancer of the peritoneum, and 281 to a sbestosis. When occupations were ranked according to PMRs from these d iseases, striking differences were found. The category of construction workers which included laggers had the highest mortality from periton eal cancer (PMR 990, 64 deaths), but a PMR of only 160 (77 deaths) for pleural cancer, In contrast, several occupations with much higher mor tality from pleural tumours had no excess of peritoneal cancer. PMRs f or asbestosis related more closely to those for peritoneal than pleura l cancer. Conclusions-These findings suggest that the exposure-respons e relations for diseases related to asbestos are not all linear, and t hat risks of pleural mesothelioma may be underestimated by simple extr apolation from observations in cohorts with heavy exposure.