Lung cancer related to onboard asbestos exposure common among naval veterans
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Key takeaways:
- Naval veterans who served in the 1950s and 1960s had higher rates of mesothelioma vs. army and air force veterans.
- The higher lung cancer incidence among these veterans is unlikely due to smoking.
Compared with army and air force veterans in the U.K. and Australia, naval veterans more frequently had lung cancers linked to asbestos exposure, according to results published in Scientific Reports.
“Asbestos-related diseases are still around,” Richard T. Gun, MBBS, of the school of public health at The University of Adelaide in Australia, told Healio. “[Clinicians should] obtain detailed information on possible asbestos exposures on all subjects presenting with lung cancer. For that matter, bear in mind the possibility of asbestos and/or other hazardous dusts as possible causes of interstitial lung disease.”
In this study, Gun and Gerry M. Kendall, BSc, MSc, PhD, of the cancer epidemiology unit at University of Oxford, analyzed data of veterans from the U.K. and Australia who served in the 1950s and 1960s to determine the prevalence of cancer due to asbestos exposure among naval veterans compared with army and air force officers.
The study comprised four individual cohorts, including U.K. participants (n = 6,305; officers: 7.7% navy; 9.7% army; 19.1% air force) and Australian participants (n = 73,43; officers: 9% navy; 24% army; 22% air force) of the British atmospheric nuclear tests that occurred in the 1950s, as well as a U.K. control cohort of civilians and service personnel who served overseas but had not participated in the nuclear testing (n = 2,613; officers: 7.9% navy; 12.1% army; 20.7% air force), and a contemporary cohort of Australian Korean War veterans (n = 5,102).
Mesothelioma occurred more frequently among veterans who served in the navy vs. other military branches, as demonstrated by standardized incidence ratios (SIRs). For instance, in the Australian test participant cohort, SIRs were 2.79 (95% CI, 1.59-4.52) for navy veterans compared with 0.98 (95% CI, 0.12-3.54) for army veterans and 0 for air force veterans. The same pattern was seen across the other cohorts, with SIRs for those in the navy ranging from 1.75 (95% CI, 0.83-2.67) in the Australian Korean War cohort to 2.62 (95% CI, 2.04-3.31) in the U.K. test participant cohort.
Additionally, SIRs for lung cancer were higher among naval personnel than for the other military branches in the Australian test participant cohort (navy SIR =1.5; 95% CI, 1.26-1.77; army SIR = 1.09; 95% CI, 0.78-1.49; air force SIR = 1.04; 95% CI, 0.84-1.28), the U.K. test participant cohort (navy SIR = 1.16; 95% CI, 1.05-1.27; army SIR = 1.02; 95% CI, 0.91-1.14; air force SIR = 0.94; 95% CI, 0.86-1.03) and the U.K. control cohort (navy SIR = 1.15; 95% CI, 1.05-1.25; army SIR = 1.01; 95% CI. 0.9-1.13; air force SIR = 0.82; 95% CI, 0.86-1.03).
In the Australian Korean War cohort, lung cancer incidence was highest in army personnel (SIR = 1.59; 95% CI, 1.44-1.74), followed by naval personnel (SIR = 1.25; 95% CI, 1.08-1.42).
Looking at SIRs and standardized mortality ratios (SMRs) of smoking-related conditions in the two British test and control cohorts combined, researchers found comparable rates between navy and army personnel for ischemic heart disease (SMR: 0.92 vs. 0.91), COPD (SMR: 0.93 vs. 0.97) and bladder cancer (SIR: 1 vs. 1.05). Air force veterans had lower estimates of these conditions compared with navy and army veterans.
In demonstrating similar rates of smoking-related conditions between navy and army veterans, Gun and Kendall wrote that the higher incidence of lung cancer in naval personnel is likely not linked to smoking.
Among Australian test participants, army veterans vs. navy veterans more frequently had laryngeal cancer (SIR: 1.82 vs. 1.51) and bladder cancer (SIR: 1.14 vs. 1.07). These data again show that the elevated incidence of lung cancer observed among those who served in the navy is unlikely related to smoking, according to researchers.
The cohort of Korean War veterans also showed that more veterans who served in the army vs. navy had laryngeal cancer (SIR: 2.05 vs. 1.4) and died of ischemic heart disease (SMR: 1.18 vs. 1.04) and COPD (SMR: 1.69 vs. 1.3).
“Previous studies on sailors have found excess mesotheliomas, which are nearly all caused by asbestos, but findings of excess lung cancers due to asbestos have been inconsistent,” Gun told Healio. “We have used several lines of evidence which we believe point strongly to the occurrence of excess lung cancers in sailors caused by onboard asbestos exposure.”
Researchers further found that more navy veterans from the two British cohorts died of asbestosis than those in the army or air force (12 vs. 2 vs. 4).
Overall, researchers estimated that 27% of lung cancers among Australian navy veterans and 12% among British navy veterans could be linked to asbestos exposure.
“It is important to realize that although asbestos imports have been prohibited for several years, it is still around,” Gun told Healio. “We also need to consider the potential health effects of other airborne hazards, including engineered stone used in kitchen benchtops, diesel exhaust and other respirable urban pollutants.
“Clinicians should always get an occupational history, and if the significance of an exposure is not clear, do not hesitate to get the services of an occupational hygienist,” he added.
Reference:
- High lung cancer rates in naval veterans linked to asbestos. https://www.adelaide.edu.au/newsroom/news/list/2023/11/13/high-lung-cancer-rates-in-naval-veterans-linked-to-asbestos. Published Nov. 15, 2023. Accessed Nov. 20, 2023.