Asbestos Exposure and Leukemia Incidence: A Systematic Review and Meta-analysis

Our plain-English summary of Asbestos Exposure and Leukemia Incidence: A Systematic Review and Meta-analysis, by K. Dodos, T.V. Kalamara, P. Papalexis, et al (In Vivo, 2025).

The study

• Authors: K. Dodos, T.V. Kalamara, P. Papalexis, D.A. Keramydas, E.G. Papageorgiou, V.E. Georgakopoulou
• Journal: In Vivo
• Published: 2025;39(5):2739-2751
• Type of article: Systematic review, Meta-analysis
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background/aim: Asbestos comprises six naturally occurring fibrous minerals known for their health risks, particularly in occupational settings. This systematic review evaluates the association between asbestos exposure and leukemia incidence, synthesizing findings from various studies.

Materials And Methods: We conducted a comprehensive literature search in PubMed, Cochrane Library, and Web of Science, adhering to PRISMA guidelines. Studies included participants exposed to asbestos compared to matched controls, focusing on leukemia incidence. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale.

Results: A total of 1,751,580 participants were included, with 257,572 (14.7%) exposed to asbestos. The incidence of leukemia varied across studies, ranging from 0.02% to 0.45%. Meta-analysis revealed an overall risk ratio of 1.25 (95% confidence interval=0.81-1.94) with significant heterogeneity (I2=86%), indicating no statistically significant difference between exposed and non-exposed cohorts.

Conclusion: The findings highlight the complexity of the relationship between asbestos exposure and leukemia, influenced by factors such as exposure type, duration, and confounding variables like smoking. While some studies suggest a potential link, the evidence remains inconclusive, necessitating further research. This review underscores the need for high-quality studies to clarify the association between asbestos and leukemia, informing public health policies to reduce exposure risks and protect vulnerable populations.

Copyright © 2025, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

In plain English

This article was a systematic review and meta-analysis of whether people exposed to asbestos developed leukemia more often than people who were not exposed. The authors searched three databases (PubMed, Cochrane Library and Web of Science) up to April 14, 2025. The pooled analysis covered 1,751,580 participants, 257,572 of them exposed to asbestos. The included studies assessed chrysotile, crocidolite (blue asbestos), and a mix of chrysotile, amosite and crocidolite, from environmental and occupational exposure. Among exposed participants, leukemia incidence ranged from 0.02% to 0.45% across studies. The pooled risk ratio was 1.25 (95% confidence interval 0.81 to 1.94). This was not statistically significant, and results varied widely between studies (I2 of 86%). Only one included study adjusted for smoking. The authors concluded that the evidence was inconclusive and needed cautious interpretation. They listed several limitations: the small number of eligible studies, possible misclassification of exposure, missing data on leukemia subtypes, and co-exposures that were not controlled.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review and meta-analysis of observational studies (random-effects Mantel-Haenszel risk ratios), searching PubMed, Cochrane Library and Web of Science up to April 14, 2025
• Who was studied: 1,751,580 participants in the pooled studies: 257,572 exposed to asbestos and 1,494,008 not exposed. The studies were Polissar et al. 1982 (USA), Sadler et al. 1984 (USA), Reid et al. 2012 (Australia) and Würtz et al. 2020 (Denmark), the last listed separately for environmental and occupational exposure.
• Exposure: Asbestos exposure, environmental and occupational. Fibers were chrysotile, crocidolite (blue asbestos), and a mix of chrysotile, amosite and crocidolite. Exposure was assessed by methods including interviews, transmission electron microscopy, historical measurements, questionnaires and job exposure matrices.
• Main results:
  • The pooled risk ratio for leukemia in asbestos-exposed compared with non-exposed participants was 1.25 (95% CI 0.81 to 1.94). The difference was not statistically significant.
  • Heterogeneity between studies was high (I2 = 86%, p less than 0.01).
  • Leukemia incidence among exposed participants ranged from 0.02% (Polissar et al., chrysotile) to 0.45% (Reid et al., blue asbestos).
  • Only one included study (Reid et al.) adjusted for smoking.
  • None of the included studies gave robust evidence of a dose-response relationship between asbestos exposure and leukemia.
  • The funnel plot and Egger's test (p = 0.763) did not indicate publication bias.
• The authors' conclusion: The authors concluded that, although the pooled risk ratio suggests a potential association, the lack of statistical significance, high heterogeneity and limited control for confounders call for cautious interpretation and further research.
• Limitations the authors state:
  • Few eligible studies, mostly retrospective designs, and variable exposure and outcome assessment.
  • Reliance on job-exposure matrices or participant recall raises the risk of exposure misclassification.
  • Most included studies did not break results down by leukemia subtype.
  • Possible co-exposures to other leukemia-causing agents (benzene, solvents, radiation) were not consistently reported or controlled.
  • High heterogeneity limits confidence in the pooled estimate.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Systematic Review, Meta-Analysis, confidence interval, Confounding.

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