beta-carotene and Asbestosis

Despite numerous published studies, debate continues regarding the risk of developing lung cancer among men exposed occupationally to asbestos, particularly those without radiographic or functional evidence of asbestosis. The beta-Carotene and Retinol Efficacy Trial (CARET), a study of vitamin supplementation for chemoprevention of lung cancer, has followed 4,060 heavily exposed US men for 9-17 years. Lung cancer incidence for 1989-2002 was analyzed using a stratified proportional hazards model. The study confirmed excessive rates of lung cancer among men with radiographic asbestosis. Comparison of study arms revealed a strong, unanticipated synergy between radiographic profusion category and the active intervention. In the large subgroup of men with normal lung parenchyma on chest radiograph at baseline, there was evidence of exposure-related lung cancer risk: Men with more than 40 years' exposure in high-risk trades had a risk approximately fivefold higher than men with 5-10 years, after adjustment for covariates. The effect in these men was independent of study intervention arm, but pleural plaques on the baseline radiograph and abnormal baseline flow rate were strong independent predictors of subsequent lung cancer. Residual confounding by subclinical asbestosis, exposure to unmeasured lung carcinogens, or differences in smoking are unlikely to explain these observations better than a carcinogenic effect of asbestos per se.

Topics: Adult; Aged; Anticarcinogenic Agents; Asbestosis; beta Carotene; Humans; Incidence; Lung Neoplasms; Male; Middle Aged; Occupational Diseases; Occupational Exposure; Predictive Value of Tests; Proportional Hazards Models; Radiography, Thoracic; Risk Factors; Smoking; Spirometry; United States; Vitamin A

The Carotene and Retinol Efficacy Trial (CARET), a randomized, placebo-controlled lung cancer chemoprevention trial of 30 mg of beta-carotene and 25,000 IU of retinyl palmitate, was prematurely terminated when a 46% excess lung cancer mortality was found in subjects on the active arm. Before the CARET intervention ended, 21 men were recruited to participate in a 6-month biomarker study using the same intervention as CARET that determined the effect of this supplementation on lung nutrient levels. Plasma and bronchoalveolar lavage (BAL) cell nutrient levels were measured before and after the intervention. The group in the active arm (n = 10) had plasma carotene level increases of over 10-fold, with a small increase in plasma retinol levels BAL cell levels of beta-carotene in the active group also increased 10-fold, from 4.5 to 46.3 pmol/10(6) cells (P = 0.0008), with no change in BAL cell retinol levels. Surgically obtained lung tissue from three CARET subjects in the active arm showed elevated carotene lung tissue levels but no increase in lung retinol levels compared to a group of surgical controls. Combined with our previous work showing a strong correlation between BAL and lung tissue nutrient levels, these findings suggest that supplementation with beta-carotene and vitamin A results in increased lung tissue as well as BAL cell levels of beta-carotene, with little change in lung retinol.

Topics: Aged; Anticarcinogenic Agents; Asbestosis; beta Carotene; Bronchoalveolar Lavage Fluid; Bronchoscopy; Carotenoids; Diterpenes; Double-Blind Method; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Retinyl Esters; Risk Factors; Smoking; Vitamin A

Topics: Asbestosis; beta Carotene; Dietary Supplements; Female; Humans; Lung Neoplasms; Male; Mortality; Sex Factors; Smoking

Topics: Animals; Anticarcinogenic Agents; Antioxidants; Asbestosis; beta Carotene; Cocarcinogenesis; Cohort Studies; Down-Regulation; Ferrets; Gene Expression Regulation; Genes, fos; Genes, jun; Humans; Incidence; Lung; Lung Neoplasms; Metaplasia; Nicotiana; Plants, Toxic; Proliferating Cell Nuclear Antigen; Receptors, Retinoic Acid; Smoke; Smoking; Transcription Factor AP-1; Tretinoin