{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:50:47Z","timestamp":1791841847592,"version":"4.3.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T00:00:00Z","timestamp":1372636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Asbestos, smoking, and asbestosis increase lung cancer risk in incompletely elucidated ways. Smoking cessation among asbestos-exposed cohorts has been little studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To measure the contributions of asbestos exposure, asbestosis, smoking, and their interactions to lung cancer risk in an asbestos-exposed cohort and to describe their reduction in lung cancer risk when they stop smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We examined lung cancer mortality obtained through the National Death Index for 1981 to 2008 for 2,377 male North American insulators for whom chest X-ray, spirometric, occupational, and smoking data were collected in 1981 to 1983 and for 54,243 non\u2013asbestos-exposed blue collar male workers from Cancer Prevention Study II for whom occupational and smoking data were collected in 1982.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Lung cancer caused 339 (19%) insulator deaths. Lung cancer mortality was increased by asbestos exposure alone among nonsmokers (rate ratio = 3.6 [95% confidence interval (CI), 1.7\u20137.6]), by asbestosis among nonsmokers (rate ratio = 7.40 [95% CI, 4.0\u201313.7]), and by smoking without asbestos exposure (rate ratio = 10.3 [95% CI, 8.8\u201312.2]). The joint effect of smoking and asbestos alone was additive (rate ratio = 14.4 [95% CI, 10.7\u201319.4]) and with asbestosis, supra-additive (rate ratio = 36.8 [95% CI, 30.1\u201345.0]). Insulator lung cancer mortality halved within 10 years of smoking cessation and converged with that of never-smokers 30 years after smoking cessation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Asbestos increases lung cancer mortality among nonsmokers. Asbestosis further increases the lung cancer risk and, considered jointly with smoking, has a supra-additive effect. Insulators benefit greatly by quitting smoking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201302-0257oc","type":"journal-article","created":{"date-parts":[[2013,5,15]],"date-time":"2013-05-15T16:35:30Z","timestamp":1368635730000},"page":"90-96","source":"Crossref","is-referenced-by-count":159,"title":["Asbestos, Asbestosis, Smoking, and Lung Cancer. New Findings from the North American Insulator Cohort"],"prefix":"10.1093","volume":"188","author":[{"given":"Steven B.","family":"Markowitz","sequence":"first","affiliation":[{"name":"Center for the Biology of Natural Systems, Queens College, City University of New York, Flushing, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Miller","sequence":"additional","affiliation":[{"name":"Center for the Biology of Natural Systems, Queens College, City University of New York, Flushing, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Morabia","sequence":"additional","affiliation":[{"name":"Center for the Biology of Natural Systems, Queens College, City University of New York, Flushing, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2013,7,1]]},"reference":[{"key":"2026032100493610900_bib1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/j.1749-6632.1979.tb18749.x","article-title":"Asbestos exposure, cigarette smoking and death rates","volume":"330","author":"Hammond","year":"1979","journal-title":"Ann N Y Acad Sci"},{"key":"2026032100493610900_bib2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1136\/oem.58.3.145","article-title":"Relation between exposure to asbestos and smoking jointly and the risk of lung cancer","volume":"58","author":"Lee","year":"2001","journal-title":"Occup Environ Med"},{"key":"2026032100493610900_bib3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0003-4878(00)00060-0","article-title":"The interaction of asbestos and smoking in lung cancer","volume":"45","author":"Liddell","year":"2001","journal-title":"Ann Occup Hyg"},{"key":"2026032100493610900_bib4","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/ajim.4700200505","article-title":"Evaluation of selection bias in a cross-sectional survey","volume":"20","author":"Selikoff","year":"1991","journal-title":"Am J Ind Med"},{"key":"2026032100493610900_bib5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/ajim.4700100504","article-title":"Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking","volume":"10","author":"Lilis","year":"1986","journal-title":"Am J Ind Med"},{"key":"2026032100493610900_bib6","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1164\/ajrccm.156.1.9610108","article-title":"Clinical predictors of mortality from asbestosis in the North American Insulator Cohort, 1981 to 1991","volume":"156","author":"Markowitz","year":"1997","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032100493610900_bib7","author":"International Labour Organization","year":"1980"},{"key":"2026032100493610900_bib8","first-page":"589","article-title":"Mean and instantaneous expiratory flows, FVC and FEV1: prediction equations from a probability sample of Michigan, a large industrial state","volume":"22","author":"Miller","year":"1986","journal-title":"Bull Eur Physiopathol Respir"},{"key":"2026032100493610900_bib9","first-page":"1057","article-title":"Smoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women","volume":"76","author":"Stellman","year":"1986","journal-title":"J Natl Cancer Inst"},{"key":"2026032100493610900_bib10","first-page":"861","article-title":"Epidemiological research at the American Cancer Society","volume":"9","author":"Thun","year":"2000","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2026032100493610900_bib11","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1136\/bmj.1.6063.746","article-title":"Unsuspected exposure to asbestos and bronchogenic carcinoma","volume":"1","author":"Martischnig","year":"1977","journal-title":"BMJ"},{"key":"2026032100493610900_bib12","first-page":"257","article-title":"Radiological findings as predictors of mortality in Quebec asbestos workers","volume":"37","author":"Liddell","year":"1980","journal-title":"Br J Ind Med"},{"key":"2026032100493610900_bib13","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S0140-6736(95)90817-X","article-title":"Is lung cancer associated with asbestos exposure when there are no small opacities on the chest radiograph?","volume":"345","author":"Wilkinson","year":"1995","journal-title":"Lancet"},{"key":"2026032100493610900_bib14","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1002\/ajim.20881","article-title":"Absence of radiographic asbestosis and the risk of lung cancer among asbestos-cement workers: extended follow-up of a cohort","volume":"53","author":"Finkelstein","year":"2010","journal-title":"Am J Ind Med"},{"key":"2026032100493610900_bib15","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1093\/aje\/kwi034","article-title":"Predictors of lung cancer among asbestos exposed men in the {beta}-carotene and retinol efficacy trial","volume":"161","author":"Cullen","year":"2005","journal-title":"Am J Epidemiol"},{"key":"2026032100493610900_bib16","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1002\/ajim.20725","article-title":"Mortality among sheet metal workers participating in a medical screening program","volume":"52","author":"Dement","year":"2009","journal-title":"Am J Ind Med"},{"key":"2026032100493610900_bib17","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1136\/oem.2005.025379","article-title":"The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking","volume":"63","author":"Reid","year":"2006","journal-title":"Occup Environ Med"},{"key":"2026032100493610900_bib18","first-page":"239","article-title":"The effect of smoking on the risk of lung cancer mortality for asbestos workers in Great Britain (1971\u20132005)","volume":"55","author":"Frost","year":"2011","journal-title":"Ann Occup Hyg"},{"key":"2026032100493610900_bib19","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1080\/10937404.2011.556047","article-title":"Pulmonary endpoints (lung carcinomas and asbestosis) following inhalation exposure to asbestos","volume":"14","author":"Mossman","year":"2011","journal-title":"J Toxicol Environ Health B Crit Rev"},{"key":"2026032100493610900_bib20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.abb.2010.06.015","article-title":"Biopersistent fiber-induced inflammation and carcinogenesis: lessons learned from asbestos toward safety of fibrous nanomaterials","volume":"502","author":"Nagai","year":"2010","journal-title":"Arch Biochem Biophys"},{"key":"2026032100493610900_bib21","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S1357-2725(02)00315-1","article-title":"Cell signaling and transcription factor activation by asbestos in lung injury and disease","volume":"35","author":"Shukla","year":"2003","journal-title":"Int J Biochem Cell Biol"},{"key":"2026032100493610900_bib22","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1002\/ajim.20712","article-title":"Asbestos-related disease among sheet metal workers 1986-2004: radiographic changes over time","volume":"52","author":"Welch","year":"2009","journal-title":"Am J Ind Med"},{"key":"2026032100493610900_bib23","first-page":"4","article-title":"Mortality of factory workers in east London 1933-80","volume":"42","author":"Newhouse","year":"1985","journal-title":"Br J Ind Med"},{"key":"2026032100493610900_bib24","first-page":"96","article-title":"Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation","volume":"44","author":"Kipen","year":"1987","journal-title":"Br J Ind Med"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/188\/1\/90\/67241228\/ajrccm_188_1_90.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/188\/1\/90\/67241228\/ajrccm_188_1_90.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:52:02Z","timestamp":1774068722000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/188\/1\/90\/8506965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7,1]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2013,7,1]]},"published-print":{"date-parts":[[2013,7,1]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201302-0257oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2013,7]]},"published":{"date-parts":[[2013,7,1]]}}}