More than ten years ago, The Journal published information that some cancer deaths associated with prior asbestos exposure might be related to more than asbestos alone and could be multifactorial in origin.1 It had been found that inhalation of the mineral fibers greatly increased the already high lung cancer risk for cigarette smokers. In the group studied, it was calculated that asbestos workers who smoked cigarettes had roughly 90 times the risk for similar men who neither smoked nor worked with asbestos. In the decade since, this has been amply confirmed,2 and the observations made provide much clinical guidance in the care and surveillance of those who have been exposed in the past and who are now in the future at risk of asbestos-associated disease.
The two most common asbestos-induced cancers are lung cancer and mesothelioma. The former is usually related to cigarette smoking; the latter is not.