Gilham and colleagues conclude that there is a linear dose–response relationship between lung asbestos burden and the development of mesothelioma, and that the lung burden should be considered a reliable tool to predict future mesothelioma rates in participants born since 1965.
The paper and commentary are based on incorrect assumptions that generate both an invalid analysis and invalid conclusions:
The authors exclusively rely on asbestos fibre counts measured in lung tissue decades after exposures had taken place, as an indicator of asbestos dose.
Only 2% of the fibres identified were chrysotile, while chrysotile represented as much as 90% of the asbestos used in the UK. Chrysotile is not lung biopersistent; but biopersistence correlates with neither lung nor mesothelioma risk. For example, in 1978, Peto,1 one of the coauthors with Gilham and colleagues, wrote, ‘The epidemiologic evidence that pleural mesothelioma can be caused by chrysotile alone is supported by the observation...
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