Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study)

Joachim Schüz; Evgeny V. Kovalevskiy; Ann Olsson; Monika Moissonnier; Evgenia Ostroumova; Gilles Ferro; Eleonora Feletto; Sara J. Schonfeld; Graham Byrnes; Iraklii M. Tskhomariia; Kurt Straif; Tatiana V. Morozova; Hans Kromhout; Igor V. Bukhtiyarov

doi:10.31089/1026-9428-2024-64-2-70-90

Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study)

https://doi.org/10.31089/1026-9428-2024-64-2-70-90

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Abstract

Background. We investigated mortality in workers of the world’s largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation.

Methods. This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers’ complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models.

Results. A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR=7.64, 95% CI=1.18 to 49.5, to at least 80 fibers per cm³ years and RR=4.56, 95% CI=0.94 to 22.1, to at least 150 mg/m³ years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer.

Conclusion. In this large-scale epidemiological study in the world’s largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.

Primary source. The original article in English was published on January 22, 2024, in the Journal of the National Cancer Institute (USA), license number for publication of the Russian version is 5722671193983.

For citation (primary source): Schüz J., Kovalevskiy E., Olsson A., Moissonnier M., Ostroumova E., Ferro G., Feletto E., Schonfeld S.J., Byrnes G., Tskhomariia I., Straif K., Morozova T., Kromhout H., Bukhtiyarov I. Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study). Journal of the National Cancer Institute. 2024; 00(0): 1–10. https://doi.org/10.1093/jnci/djad262

Author contributions:
Joachim Schüz — conceptualization, formal analysis, investigation, methodology, project administration, resources, supervision, writing — original draft, writing — review & editing;
Evgeny Kovalevskiy — conceptualization, data curation, funding acquisition, investigation, methodology, project administration, resources, supervision, writing — original draft, writing — review & editing;
Ann Olsson — data curation, investigation, methodology, project administration, supervision, writing — original draft, writing — review & editing;
Monika Moissonnier — data curation, formal analysis, methodology, software, validation, visualization, writing — review & editing;
Evgenia Ostroumova — data curation, investigation, methodology, supervision, validation, writing — review & editing;
Gilles Ferro — data curation, formal analysis, methodology, software, validation, visualization, writing — review & editing;
Eleonora Feletto — data curation, formal analysis, methodology, visualization, writing — review & editing;
Sara J. Schonfeld — conceptualization, data curation, investigation, methodology, project administration, writing — review & editing;
Graham Byrnes — formal analysis, methodology, writing — review & editing;
Iraklii Tskhomariia — data curation, investigation, project administration, writing — review & editing;
Kurt Straif — conceptualization, methodology, writing — review & editing;
Tatiana Morozova — investigation, project administration, resources, validation, writing — review & editing;
Hans Kromhout — conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, writing — original draft, writing — review & editing;
Igor Bukhtiyarov — conceptualization, funding acquisition, investigation, project administration, resources, supervision, validation, writing — original draft, writing — review & editing.

Funding. The work was supported by the Ministry of Health of the Russian Federation in the framework of the Federal target programme, National System of Chemical and Biological Safety of the Russian Federation of 2009–2014 and of 2015–2020 under a general framework of action between the Federal State Budgetary Scientific Institution, Izmerov Research Institute of Occupational Health (IRIOH) and the International Agency for Research on Cancer–World Health Organization (IARC‑WHO) (2015–2023). The work by Dr Schonfeld on this manuscript was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

Conflicts of interest. Dr Kovalevskiy reported receiving, on behalf of his institute and personally through consulting firms, payments from companies to evaluate exposure to asbestos and risk of asbestos-related disease in those workplaces. All other authors have no competing interests to declare.

For full transparency, Dr Kovalevskiy reported participation as an occupational and environmental health expert as part of the delegation of the Russian Ministry of Health at multiple World Health Assembly meetings as well as at the Conference of the Parties to the Basel and Rotterdam Conventions. Dr Kovalevskiy reported attending meetings organized by the International Chrysotile Association and reported that all expenses for attendance were paid by his institute.

Dr Schüz, who is a JNCI Associate Editor and co-author on this paper, was not involved in the editorial review or decision to publish the manuscript.

Acknowledgements. The study team mourns the loss of their dear colleague Dr Sergey Kashanskiy (SK) from the Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Yekaterinburg, Russian Federation, who was instrumental in the conduct of the study but passed away on February 9, 2023, before the draft of this manuscript was completed.

We also acknowledge the work conducted by the extended study team. The late Dr Nikolai Izmerov, director (1971–2012) and scientific supervisor (2012–2016) of the Federal State Budgetary Scientific Institution, Scientific Research Institute of Occupational Health, made a large contribution to the organization and implementation of the study at its initial stages. The data entry team in Asbest town rigorously entered written information into electronic format: the late Isolina Smirnova, Zoya Lapuhina, and Yulia Nurdinova. Dr Valerie McCormack of the International Agency for Research on Cancer — World Health Organization (IARC-WHO) helped tremendously in setting up the study and writing the study protocol. Dr Madar Talibov and Dr Dana Kristjansson supported specific activities of the study during their stay at IARC-WHO. Dr Veronika Fedirko, while at IARC-WHO, was involved in pilot activities preparing for the full-scale study, and Dr Paolo Boffetta was IARC-WHO section head when the initial contact about the study was made. Ms Christine Bassier and Ms Catherine Chassin, IARC-WHO secretaries, were involved in organizing study-related travels and meetings. Dr Kirsten Frederiksen, a senior statistician at the Danish Cancer Institute, Copenhagen, Denmark, conducted selected independent analyses of the data as an additional quality assurance measure.

The study is monitored by an independent scientific advisory board, which oversees the progress of the study. The scientific advisory board members are Professor Franco Merletti (chair), Professor Mads Melbye (until 2017), Professor Julian Peto, Professor Martin Röösli (from 2017), and Dr Antti Tossavainen. Scientific advisory board members provided their reviews of this manuscript, but the integration of their comments remained at the discretion of the authors. The authors like to express their gratitude to the scientific advisory board for many years of advice and their helpful comments on the manuscript.

Where authors are identified as personnel of the IARC-WHO, the authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions, policy, or views of the IARC-WHO. The study sponsors had no role in the design of the study; the collection, analysis, and interpretation of the data; or the writing of the manuscript.

Received: 06.12.2023 / Accepted: 12.02.2024 / Published: 15.03.2024