Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Stomach cancer mortality among workers exposed to asbestos: a meta-analysis



The relationship between asbestos and stomach cancer is not well understood because of small number of cases. This study aimed to determine the incidence and mortality of stomach cancer among workers exposed to asbestos based on a systematic review and meta-analysis approach.


Relevant English electronic databases were systematically searched for published studies characterizing the risk of developing stomach cancer as a result of asbestos exposure. Standardized mortality rate (SMR) for stomach cancer with its 95 % confidence interval (CI) was pooled using a fixed-/random-effect model in STATA.


A total of 32 independent studies were included for the analysis. The overall SMR for stomach cancer was 1.19 (95 % CI 1.06–1.34), with a moderate degree of heterogeneity across the studies (I 2 = 37.6 %, P = 0.011). Being male, exposure to crocidolite, miners, studies conducted in Europe and Oceania, and long study follow-up (≥25 years) all contribute to significantly higher SMR. Significant publication bias was observed.


Elevated risk of stomach cancer mortality was evidenced among workers exposed to crocidolite, especially male miners.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. Acheson ED, Gardner MJ, Pippard EC, Grime LP (1982) Mortality of two groups of women who manufactured gas masks from chrysotile and crocidolite asbestos: a 40-year follow-up. Br J Ind Med 39(4):344–348

  2. Ames RG (1983) Gastric cancer and coal mine dust exposure: a casecontrol study. Cancer 52:1346–1350

  3. Armstrong BK, de Klerk NH, Musk AW, Hobbs MS (1988) Mortality in miners and millers of crocidolite in Western Australia. Br J Ind Med 45(1):5–13

  4. Battista G, Belli S, Comba P, Fiumalbi C, Grignoli M, Loi F, Orsi D, Paredes I (1999) Mortality due to asbestos-related causes among railway carriage construction and repair workers. Occup Med (Lond) 49(8):536–539

  5. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

  6. Berry G, Newhouse ML, Wagner JC (2000) Mortality from all cancers of asbestos factory workers in east London 1933–80. Occup Environ Med 57(11):782–785

  7. Brown DP, Dement JM, Okun A (1994) Mortality patterns among female and male chrysotile asbestos textile workers. J Occup Med 36(8):882–888

  8. Clin B, Morlais F, Dubois B, Guizard AV, Desoubeaux N, Marquignon MF, Raffaelli C, Paris C, Galateau-Salle F, Launoy G, Letourneux M (2009) Occupational asbestos exposure and digestive cancers-a cohort study. Aliment Pharmacol Ther 30(4):364–374

  9. Committee on Asbestos: Selected Health Effects (2006) Asbestos: selected cancers. National Academies Press, New York

  10. de La Provôté S, Desoubeaux N, Paris C, Letourneux M, Raffaelli C, Galateau-Salle F, Gignoux M, Launoy G (2002) Incidence of digestive cancers and occupational exposure to asbestos. Eur J Cancer Prev 11(6):523–528

  11. Dement JM, Brown DP, Okun A (1994) Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses. Am J Ind Med 26(4):431–447

  12. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

  13. Driscoll T, Nelson DI, Steenland K, Leigh J, Concha-Barrientos M, Fingerhut M (2005) The global burden of disease due to occupational carcinogens. Am J Ind Med 48(6):419–431

  14. Du L, Wang X, Wang M, Lan Y (2012) Analysis of mortality in chrysotile asbestos miners in China. J Huazhong Univ Sci Technolog Med Sci 32(1):135–140

  15. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

  16. Frost G, Harding AH, Darnton A, McElvenny D, Morgan D (2008) Occupational exposure to asbestos and mortality among asbestos removal workers: a Poisson regression analysis. Br J Cancer 99(5):822–829

  17. Germani D, Belli S, Bruno C, Grignoli M, Nesti M, Pirastu R, Comba P (1999) Cohort mortality study of women compensated for asbestosis in Italy. Am J Ind Med 36(1):129–134

  18. Harding AH, Darnton A, Wegerdt J, McElvenny D (2009) Mortality among British asbestos workers undergoing regular medical examinations (1971–2005). Occup Environ Med 66(7):487–495

  19. Hein MJ, Stayner LT, Lehman E, Dement JM (2007) Follow-up study of chrysotile textile workers: cohort mortality and exposure–response. Occup Environ Med 64(9):616–625

  20. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

  21. IARC (1977) Monographs on the evaluation of carcinogenic risk of chemicals to man. Vol. 14, Asbestos. International Agency for Research on Cancer, Lyon

  22. IARC (1987) Overall evaluations of carcinogenicity. International Agency for Research on Cancer, Lyon

  23. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

  24. Kang SK, Burnett CA, Freund E, Walker J, Lalich N, Sestito J (1997) Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures. Am J Ind Med 31(6):713–718

  25. Kjaerheim K, Ulvestad B, Martinsen JI, Andersen A (2005) Cancer of the gastrointestinal tract and exposure to asbestos in drinking water among lighthouse keepers (Norway). Cancer Causes Control 16(5):593–598

  26. Kogan FM, Vanchugova NN, Frasch VN (1987) Possibility of inducing glandular stomach cancer in rats exposed to asbestos. Br J Ind Med 44(10):682–686

  27. Kurumatani N, Natori Y, Mizutani R, Kumagai S, Haruta M, Miura H, Yonemasu K (1999) A historical cohort mortality study of workers exposed to asbestos in a refitting shipyard. Ind Health 37(1):9–17

  28. Li L, Ying XJ, Sun TT, Yi K, Tian HL, Sun R, Tian JH, Yang KH (2012) Overview of methodological quality of systematic reviews about gastric cancer risk and protective factors. Asian Pac J Cancer Prev 13(5):2069–2079

  29. Loomis D, Dement JM, Wolf SH, Richardson DB (2009) Lung cancer mortality and fibre exposures among North Carolina asbestos textile workers. Occup Environ Med 66(8):535–542

  30. Magnani C, Ferrante D, Barone-Adesi F, Bertolotti M, Todesco A, Mirabelli D, Terracini B (2008) Cancer risk after cessation of asbestos exposure: a cohort study of Italian asbestos cement workers. Occup Environ Med 65(3):164–170

  31. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748

  32. McDonald JC, Liddell FDK, Gibbs GW, Eyssen GE, McFonald AD (1980) Dust exposure and mortality in chrysotile mining, 1910–75. Br J Ind Med 37:11–24

  33. Menegozzo S, Comba P, Ferrante D, De Santis M, Gorini G, Izzo F, Magnani C, Pirastu R, Simonetti A, Tùnesi S, Menegozzo M (2011) Mortality study in an asbestos cement factory in Naples, Italy. Ann Ist Super Sanita 47(3):296–304

  34. Musk AW, de Klerk NH, Reid A, Ambrosini GL, Fritschi L, Olsen NJ, Merler E, Hobbs MS, Berry G (2008) Mortality of former crocidolite (blue asbestos) miners and millers at Wittenoom. Occup Environ Med 65(8):541–543

  35. Pesch B, Taeger D, Johnen G, Gross IM, Weber DG, Gube M, Müller-Lux A, Heinze E, Wiethege T, Neumann V, Tannapfel A, Raithel HJ, Brüning T, Kraus T (2010) Cancer mortality in a surveillance cohort of German males formerly exposed to asbestos. Int J Hyg Environ Health 213(1):44–51

  36. Pira E, Pelucchi C, Buffoni L, Palmas A, Turbiglio M, Negri E, Piolatto PG, La Vecchia C (2005) Cancer mortality in a cohort of asbestos textile workers. Br J Cancer 92(3):580–586

  37. Pira E, Pelucchi C, Piolatto PG, Negri E, Bilei T, La Vecchia C (2009) Mortality from cancer and other causes in the Balangero cohort of chrysotile asbestos miners. Occup Environ Med 66(12):805–809

  38. Raffn E, Lynge E, Juel K, Korsgaard B (1989) Incidence of cancer and mortality among employees in the asbestos cement industry in Denmark. Br J Ind Med 46(2):90–96

  39. Reid A, Ambrosini G, de Klerk N, Fritschi L, Musk B (2004) Aerodigestive and gastrointestinal tract cancers and exposure to crocidolite (blue asbestos): incidence and mortality among former crocidolite workers. Int J Cancer 111(5):757–761

  40. Reid A, Heyworth J, de Klerk N, Musk AW (2008) The mortality of women exposed environmentally and domestically to blue asbestos at Wittenoom, Western Australia. Occup Environ Med 65(11):743–749

  41. Smailyte G, Kurtinaitis J, Andersen A (2004) Cancer mortality and morbidity among Lithuanian asbestos-cement producing workers. Scand J Work Environ Health 30(1):64–70

  42. Sun J, Shibata E, Hisanaga N, Kamijima M, Ichihara G, Huang J, Toida M, Takeuchi Y (1997) A cohort mortality study of construction workers. Am J Ind Med 32(1):35–41

  43. Sun T, Li L, Shi N, Zhang X (2003) A 40-year cohort study on cancer mortality among female workers with manual spinning of chrysotile asbestos. Wei Sheng Yan Jiu 32(6):511–513

  44. Szeszenia-Dabrowska N, Urszula W, Szymczak W, Strzelecka A (2002) Mortality study of workers compensated for asbestosis in Poland, 1970–1997. Int J Occup Med Environ Health 15(3):267–278

  45. Tarchi M, Orsi D, Comba P, De Santis M, Pirastu R, Battista G, Valiani M (1994) Cohort mortality study of rock salt workers in Italy. Am J Ind Med 25(2):251–256

  46. Tobias A (1999) Assessing the influence of a single study in meta-analysis. STB 47:15–17

  47. Tomioka K, Natori Y, Kumagai S, Kurumatani N (2011) An updated historical cohort mortality study of workers exposed to asbestos in a refitting shipyard, 1947–2007. Int Arch Occup Environ Health 84(8):959–967

  48. Tsai SP, Waddell LC, Gilstrap EL, Ransdell JD, Ross CE (1996) Mortality among maintenance employees potentially exposed to asbestos in a refinery and petrochemical plant. Am J Ind Med 29(1):89–98

  49. Wang X, Lin S, Yano E, Qiu H, Yu IT, Tse L, Lan Y, Wang M (2012) Mortality in a Chinese chrysotile miner cohort. Int Arch Occup Environ Health 85(4):405–412

  50. Wang X, Lin S, Yu I, Qiu H, Lan Y, Yano E (2013) Cause-specific mortality in a Chinese chrysotile textile worker cohort. Cancer Sci 104(2):245–249

  51. WHO (World Health Organization) (2006) Elimination of asbestos-related diseases. Geneva: WHO. Available: http://www.who.int/occupational_health/publications/asbestosrelateddisease/en/index.html. Accessed 27 April 2010

  52. Wilczyńska U, Szymczak W, Szeszenia-Dabrowska N (2005) Mortality from malignant neoplasms among workers of an asbestos processing plant in Poland: results of prolonged observation. Int J Occup Med Environ Health 18(4):313–326

Download references


This work was financially supported by National Natural Science Foundation of China (71103002/41071064).

Conflict of interest

The authors have declared that no conflict of interest exists.

Author information

Correspondence to Xian-jie Jia or Lei Zhang.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 299 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Peng, W., Jia, X., Wei, B. et al. Stomach cancer mortality among workers exposed to asbestos: a meta-analysis. J Cancer Res Clin Oncol 141, 1141–1149 (2015). https://doi.org/10.1007/s00432-014-1791-3

Download citation


  • Asbestos
  • Stomach cancer
  • Standardized mortality rate
  • Meta-analysis