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Cancer Epidemiology, Biomarkers & Prevention
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Does Exposure to Asbestos Cause Ovarian Cancer? A Systematic Literature Review and Meta-analysis

Alison Reid, Nick de Klerk and Arthur W. (Bill) Musk
Alison Reid
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Nick de Klerk
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Arthur W. (Bill) Musk
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DOI: 10.1158/1055-9965.EPI-10-1302 Published July 2011
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    Figure 1.

    Forest plot of fixed summary effect for ovarian cancer and asbestos exposure.

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    Figure 2.

    Relationship between mesothelioma and ovarian cancer-standardized mortality ratios for 9 cohort studies presented in Table 1 (3–6, 9, 27, 28, 31, 36)

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  • Table 1.

    Cohort and case–control studies of women exposed occupationally or environmentally to asbestos that examine ovarian cancer mortality or incidence as an outcome

    StudyAuthor (ref)Publication yearNumber of women exposedType of asbestos exposurePeriod of follow-upPeritoneal mesothelioma cases (n)Pleural mesothelioma cases (n)Ovarian cancer cases (n)SMR (95% CI)Ovarian cancers confirmed
    Cohort studies
     Leyland gas mask workersAcheson et al. (25)1982757Crocidolite1951–1980215a (5)122.75 (1.42–4.81)No
     Blackburn gas mask workersAcheson et al. (25)1982570Chrysotile1951–198007a (1)51.48 (0.48–3.44)No
     Employees on central register, GermanyRosler et al. (32)1994616Chrysotile and crocidolite1977–19884921.09b (0.13–3.95)No
     Italian women compensated for asbestosisGermani et al. (27)1999631Chrysotile and crocidolite1980–1997121494.77 (2.18–9.06)No
     Population of Finnish female workersVasama- Neuvonen et al. (33)1999892,591 (born between 1906 and 1945)Not stated1971–1995N/AN/A5,072SIR = 1.3 (0.9–1.8)eYes
     East London asbestos factory workersBerry et al. (3)2000700Crocidolite and chrysotile1951–1980111492.53 (1.16–4.80)Yes— earlier report (13)
     Polish women diagnosed with asbestosisSzeszenia- Dabrowska et al. (24)2002490Not stated1970–199903d10.79No
     Turin asbestos textile factory workersMamo et al. (29)2004645Chrysotile1981–199501011.28 (0.02–7.12)No
     Polish asbestos cement products factory workersWilczynska et al. (34)20051,470Not stated1945–19990381.76 (0.76–3.47)No
    63.76f (1.38–8.18)
     Italian asbestos textile workersPira et al. (30)20051,077Mixed with crocidolite1946–19969c11d52.61 (0.85–6.09)No
     Nottingham gas mask workersMcDonald et al. (12)20061,154Crocidolite1940–20021847101.8 (0.9–3.3)Yes– earlier report (14)
     Italian asbestos cement factory workersMagnani et al. (28)2007777Chrysotile and crocidolite1965–200316c39d92.27 (1.04–4.32)Yes
     Italian wives of asbestos factory workersFerrante et al. (26)20071,780Chrysotile and crocidolite1965–20033c21d111.42 (0.71–2.54)No
     Wittenoom womenReid et al. (31)20092,968Crocidolite1982–200614611SIR = 1.27 (0.52–2.02)Yes
    Case–control studies
     Johns Hopkins Hospital patientsgRosenblatt et al. (36)199277 cases 46 controlsNot stated1981–1985N/AN/A691.3 (0.3–3.6) respiratory exposureYes
    182.8 (0.9–8.8) relatives exposed to fibers
     Norwegian pulp and paper workers (nested case–control study)Langseth et al. (35)200446 cases 184 controlsNot stated1953–1999N/AN/A62.02 (0.72–5.66)Yes
    • ↵aLung and pleural cancers combined (number of mesotheliomas listed on death certificates in this cohort).

    • ↵bStandardized proportionate mortality ratio.

    • ↵cPeritoneal cancers.

    • ↵dPleural cancers.

    • ↵eMedium/high exposure.

    • ↵fAmong women who worked in asbestos yarn and cloth production areas (high exposure).

    • ↵gFibers include asbestos, talc, and fiberglass.

  • Table 2.

    Summary statistics for asbestos exposure and incidence or mortality from ovarian cancer

    Number of studiesNumber of casesFixed-effects size (95% CI)Random-effects size (95% CI)Heterogeneity, χ2Heterogeneity, degrees of freedomHeterogeneity, P
    All studies combined165,2401.75 (1.45–2.10)1.80 (1.45–2.24)17.91150.268
    Cohort studies only145,1651.75 (1.45–2.12)1.83 (1.44–2.33)17.61130.173
    Case–control studies only2751.69 (0.76–3.73)1.69 (0.76–3.73)0.2910.593
    All studies that reviewed ovarian pathology75,1861.54 (1.22–1.95)1.54 (1.22–1.95)5.7260.455
    Cohort studies that reviewed ovarian pathology55,1021.53 (1.20–1.95)1.59 (1.17–2.15)5.3840.251
    Studies that examined cancer incidence45,1581.29 (0.97–1.73)1.29 (0.97–1.73)1.0830.781
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Cancer Epidemiology Biomarkers & Prevention: 20 (7)
July 2011
Volume 20, Issue 7
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Does Exposure to Asbestos Cause Ovarian Cancer? A Systematic Literature Review and Meta-analysis
Alison Reid, Nick de Klerk and Arthur W. (Bill) Musk
Cancer Epidemiol Biomarkers Prev July 1 2011 (20) (7) 1287-1295; DOI: 10.1158/1055-9965.EPI-10-1302

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Does Exposure to Asbestos Cause Ovarian Cancer? A Systematic Literature Review and Meta-analysis
Alison Reid, Nick de Klerk and Arthur W. (Bill) Musk
Cancer Epidemiol Biomarkers Prev July 1 2011 (20) (7) 1287-1295; DOI: 10.1158/1055-9965.EPI-10-1302
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