Evaluation of antihypertensive medications use and survival in patients with ovarian cancer: a population-based retrospective cohort study.

BACKGROUND: Despite declining mortality in most countries and in Lithuania, ovarian cancer burden has remained high. Studies have indicated that antihypertensive medications use may help to improve ovarian cancer survival, however findings remain controversial. The aim of the study was to analyse the association between post-diagnosis antihypertensive medications intake and cancer-specific survival in ovarian cancer patients. METHODS: This retrospective cohort study included 588 ovarian cancer cases diagnosed between 2013 and 2015. Hazard ratios (HR) and corresponding 95% confidence intervals (95%CI) were estimated using multivariable Cox proportional hazards models to assess associations between antihypertensive medications and ovarian cancer-specific mortality. RESULTS: In total, 279 (47%) patients died during the follow-up; 242 (87%) of them died due to ovarian cancer. The risk of ovarian cancer death was reduced in angiotensin-converting enzyme inhibitors (ACE inhibitors) users vs. non-users (HR 0.55, 95% CI: 0.36-0.83). Subgroup analysis showed better ovarian cancer survival in higher dose ACE inhibitors users (HR 0.46, 95% CI: 0.28-0.77, p for trend 0.002); the effect was also stronger in age 51-65 years, stage I-III, surgery or chemotherapy treatment, pre-diagnosis ACE inhibitor users' and pre-diagnosis hypertension subgroups. The risk of cancer-specific death was slightly lower among calcium-channel blocker and angiotensin-receptor blocker users and higher among beta-blocker users as compared to non-users, however chance and confounding could not be ruled out. We found no association between the use of centrally and peripherally acting antiadrenergic agents and diuretics and risk of ovarian cancer-specific mortality. CONCLUSIONS: Our findings imply that post-diagnosis use of ACE inhibitors may be associated with reduced ovarian cancer-specific mortality; however, further research is needed for the comprehensive assessment.

An analysis of time trends in breast and prostate cancer mortality rates in Lithuania, 1986-2020.

BACKGROUND: Breast cancer (BC) and prostate cancer (PC) mortality rates in Lithuania remain comparatively high despite the ongoing BC and PC screening programmes established in 2006. The aim of this study was to investigate time trends in BC and PC mortality rates in Lithuania evaluating the effects of age, calendar period of death, and birth-cohort over a 35-year time span. METHODS: We obtained death certification data for BC in women and PC in men for Lithuania during the period 1986-2020 from the World Health Organisation database. Age-standardised mortality rates were analysed using Joinpoint regression. Age-period-cohort models were used to assess the independent age, period and cohort effects on the observed mortality trends. RESULTS: Joinpoint regression analysis indicated that BC mortality increased by 1.6% annually until 1996, and decreased by - 1.2% annually thereafter. The age-period-cohort analysis suggests that temporal trends in BC mortality rates could be attributed mainly to cohort effects. The cohort effect curvature showed the risk of BC death increased in women born prior to 1921, remained stable in cohorts born around 1921-1951 then decreased; however, trend reversed in more recent generations. The period effect curvature displayed a continuous decrease in BC mortality since 1991-1995. For PC mortality, after a sharp increase by 3.0%, rates declined from 2007 by - 1.7% annually. The period effect was predominant in PC mortality, the curvature displaying a sharp increase until 2001-2005, then decrease. CONCLUSIONS: Modestly declining recent trends in BC and PC mortality are consistent with the introduction of widespread mammography and PSA testing, respectively, lagging up to 10 years. The study did not show that screening programme introduction played a key role in BC mortality trends in Lithuania. Screening may have contributed to favourable recent changes in PC mortality rates in Lithuania, however the effect was moderate and limited to age groups < 65 years. Further improvements in early detection methods followed by timely appropriate treatment are essential for decreasing mortality from BC and PC.

Effectiveness of the cervical cancer prevention programme: a case-control mortality audit in Lithuania.

The cervical cancer burden in Lithuania has remained high, and there are no previous effectiveness studies of cervical cancer prevention programme in the country. We investigated the effect of a prevention programme on the risk of mortality from cervical cancer in Lithuania by conducting a mortality audit study. The register-based case-control study included 715 cervical cancer deaths that occurred during 2010-2015 in Lithuania and their 2145 matched controls. Screening histories for cases and controls were obtained from the National Health Insurance Fund database. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression and corrected for self-selection bias. Index screening was associated with a 56% reduction in the cervical cancer death risk, OR: 0.44; 95% CI 0.26-0.74. The ORs for stage I and stage II+ cancers were 0.80; 95% CI 0.32-2.00 and 0.36; 95% CI 0.21-0.62, respectively. The preventive effect was statistically significant for women aged ≥40 years, while nonsignificant for younger. In women who died of cervical cancer, 71% were not invited and 88% were not screened within the recommended 36 months prior to index date. Among cases with index invitation, 32% had index screening compared to 70% in controls. In conclusion, participation in screening has been effective in reducing cervical cancer mortality in Lithuania. The study shows poor screening attendance, emphasizing the importance of greater efforts at the national level to improve the effectiveness of the screening.

Trends in Mortality Rates of Corpus Uteri and Ovarian Cancer in Lithuania, 1987-2016.

Background: The corpus uteri and ovarian cancers burden in Lithuania has remained high. The aim of this study was to investigate time trends in mortality rates of corpus uteri and ovarian cancer in Lithuania across age groups and time periods over a 30-year time span. Materials and Methods: Data on numbers of deaths from corpus uteri cancer during the period 1987-2016 and ovarian cancer during the period 1993-2016 were obtained from the WHO mortality database. Trends in age-standardized mortality rates (ASR, world standard), and age-specific rates were analyzed by calculating annual percentage change using Joinpoint regression. In addition, age-period-cohort analysis was performed for each cancer type. Results: Mortality from corpus uteri cancer decreased by -1.2% (95% CI: -1.8; -0.7) annually from 1987 to 2016. Decrease was most pronounced in youngest age group of 40-49 years; annual percentage change was -2.4 (95% CI: -4.0; -0.9). Mortality rates for ovarian cancers decreased by -1.2% (95% CI: -1.6; -0.8) annually from 1993 to 2016. Corpus uteri and ovarian cancer ASRs in 2016 were 3.5/100,000 and 7.4/100,000, respectively. The age-period-cohort analysis suggests that temporal trends in corpus uteri cancer mortality rates could be attributed to period and cohort effects. Conclusion: A reduction in mortality rate was observed for corpus uteri and ovarian cancer over the entire study period. Similar decreasing pattern for corpus uteri and ovarian cancer mortality indicate effect of shared factors.

Body mass index and other risk factors for kidney cancer in men: a cohort study in Lithuania.

OBJECTIVES: Previous studies have observed notable unexplained geographic differences in incidence of kidney cancer in Europe. Lithuania is among the countries with the highest incidence and mortality. Our objective was to investigate the effect of different lifestyle, anthropometric and biological factors on the risk of kidney cancer in Lithuanian men. METHODS: This population-based cohort study included 6,849 men initially free from cancer. During the follow-up (1978-2008), 79 incident cases of kidney cancer were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: Risk of kidney cancer was significantly associated with increasing body mass index (BMI), the adjusted HR for ≥ 35 vs. < 25 kg/m2 was 3.00, 95% CI 1.10-8.19 and the HR per 1 unit increment of BMI was 1.07, 95% CI 1.01-1.14. In overweight men (BMI ≥ 25 kg/m2), the HRs for kidney cancer per 10 mmHg increment of systolic or diastolic blood pressure were 1.10, 95% CI 0.96-1.25 and 1.26, 95% CI 1.01-1.56, respectively. We found no significant association between smoking, alcohol consumption or total serum cholesterol level and kidney cancer risk. CONCLUSIONS: This study supports a link between increased BMI and the development of kidney cancer among men in Lithuania. Hypertension appears to be associated with risk of kidney cancer in overweight men, although the assessment was limited by the lack of statistical power.

Trends in cervical cancer mortality rates in Lithuania, 1987-2016.

BACKGROUND: The aim of this study was to investigate time trends in cervical cancer mortality rates in Lithuania across age groups and time periods over a 30-year time span. METHODS: Data on numbers of deaths from cervical cancer during the period 1987-2016 were obtained from the WHO mortality database. Trends in age-standardised mortality rates (ASR, world standard), and age-specific rates were analysed by calculating annual percentage change (APC) using Joinpoint regression. In addition, age-period-cohort analysis was performed. RESULTS: Joinpoint regression analysis indicated that mortality from cervical cancer increased by 2.0% (95% CI: 1.2, 2.9) annually from 1987 to 2002 and decreased by 2.3% (95% CI: 3.2, 1.3) annually thereafter. In age groups 20-39 and 40-49 years after a sharp increase by 5.6% (95% CI: 2.6, 8.7) and 5.9% (95% CI: 2.7, 9.2), respectively, mortality rates declined since around 2000 with slopes of -4.8% (95% CI: -7.6, -1.9) and -2.7% (95% CI: -4.7, -0.6), respectively. Among women aged 50-59 years there was an increase in mortality (APC = 2.6%; 95% CI: 0.8, 4.5) followed by decrease with a not statistically significant slope (APC = -2.2%; 95% CI: -5.1, 0.7) since 2004. For older women mortality rates moderately declined during the entire time span. The age-period-cohort analysis suggests that temporal trends in cervical cancer mortality rates could be attributed to period and cohort effects. CONCLUSIONS: Opportunistic screening may have contributed to favourable recent changes in cervical cancer mortality rates in Lithuania, however not to the extent seen in most European countries.

Non-pulmonary cancer risk following tuberculosis: a nationwide retrospective cohort study in Lithuania.

BACKGROUND: Lithuania remains one of the highest tuberculosis burden countries in Europe. Epidemiological studies have long pointed to infections as important factors of cancer aetiology, but the association between tuberculosis and the risk of non-pulmonary cancers has rarely been tested and results have been inconsistent. The aim of this population-based cohort study was to examine the risk of cancer among patients diagnosed with tuberculosis using data from Lithuanian Tuberculosis, Cancer and Resident's Registries. METHODS: The study cohort included 21,986 tuberculosis patients yielding 1583 cancers diagnosed during follow-up (1998-2012). Standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) were calculated to compare the incidence of cancer among cohort participants with the general population for overall, non-pulmonary, site-specific cancers, as well as for subgroups of smoking-related, alcohol-related, hormone-related and haematological cancers. RESULTS: The SIRs of all cancers combined were 1.89, 95% CI: 1.79-2.00 in men and 1.34, 95% CI: 1.19-1.50 in women. Risk was increased 3-fold within the first year following diagnosis; it decreased during later years, although remained significantly elevated for ≥5 years. Elevated long-term increased risks persisted for non-pulmonary cancers overall, and for cancers of mouth and pharynx, oesophagus, stomach, larynx, cervix uteri and leukaemias. Tuberculosis was associated with a decreased risk of melanoma. Increased risks were observed for smoking-related cancers in men (SIR 1.95, 95% CI: 1.79-2.13) and women (SIR 1.46, 95% CI: 1.22-1.73), alcohol-related cancers in men (SIR 2.40; 95% CI: 2.14-2.68) and haematological cancers in men (SIR 1.73, 95% CI: 1.33-2.23). The risk of hormone-related cancers was 18% lower (SIR = 0.82, 95% CI: 0.66-0.997) among women, the inverse association was weaker among men (SIR = 0.95, 95% CI: 0.84-1.07). CONCLUSIONS: The risk of total and several non-pulmonary cancers was elevated in a cohort of tuberculosis patients. The recommendation for the awareness of this association among physicians is warranted. Analysis suggests a reduction in risk of hormone-related cancers and melanoma.

Hypertension, serum lipids and cancer risk: A review of epidemiological evidence.

Although the association between blood pressure, serum lipids and cancer risk has been investigated, the results are controversial. The aim of this literature review was to examine the epidemiological evidence and provide overview of the association between blood pressure, serum lipids and cancer risk. The arterial hypertension is closely linked with renal cell cancer development. Risk of renal cell cancer was 2-4 times higher for persons with arterial hypertension, independently of sex. In some studies arterial hypertension as one of the components of the metabolic syndrome, was associated with a higher risk of colorectal, prostate cancer and malignant melanoma. Studies suggest that a higher total serum cholesterol level is linked with higher risk of colorectum, colon, prostate and testicular cancer and lower risk of stomach, liver and hematopoietic and lymphoid tissues cancer. There was positive association between serum triglycerides and esophageal, colorectal, lung, renal, thyroid cancer. Given that hypertension is a common risk factor worldwide and its control remains inadequate, our analysis supports the relevance of public health programs aimed at reducing hypertension to reduce the incidence of a number of cancers including renal cell cancer. Effective cholesterol control may lower the risk of cancer, but further studies with longer follow-up and repeated measurements of cholesterol and other lipids are needed.

Body mass index, cholesterol level and risk of lung cancer in Lithuanian men.

OBJECTIVE: Our objective was to investigate the association between body mass index (BMI), total serum cholesterol (TSC) level and risk of lung cancer in a Lithuanian population-based cohort study. MATERIALS AND METHODS: The study included 6729 men initially free from cancer. During the follow-up (1978-2008), 358 lung cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: Following adjustment for age, smoking, alcohol consumption, and education, BMI 25-29.9 and ≥30.0kg/m(2) hazard ratios (HR) were significantly associated with decreasing risk for lung cancer, HR=0.73; 95% CI: 0.59, 0.91 and 0.62; 95% CI: 0.45, 0.87, respectively (ptrend=0.001) compared to BMI<25 kg/m(2). Inverse association between BMI and lung cancer was observed among current smokers. We found no evidence that BMI was associated with decreased lung cancer risk in never smokers, although small sample size precluded meaningful analysis. Not significantly lower risk of lung cancer among participants in the 5th quintile compared with the 1st quintile of TSC concentrations was observed. HR per 1 mmol/l increase of TSC was 0.90; 95% CI: 0.82, 1.00. Findings suggest consistent effects of BMI and TSC when follow-up was 1993-2008. CONCLUSION: Our results show an inverse dose-dependent association between lung cancer risk and BMI in Lithuanian men, especially among current smokers. The inverse association could not be attributed to preclinical cancer effect hypothesis. TSC level was not statistically significantly related to a lung cancer incidence.

Cigarette smoking, educational level and total and site-specific cancer: a cohort study in men in Lithuania.

Smoking is an established risk factor for cancer. However, most studies have been carried out on western populations, and less is known about the impact in central and eastern Europe. Our objective was to investigate the association between cigarette smoking, educational level and risk of cancer in a Lithuanian population-based cohort study. The study included 6976 men initially free from cancer. During the follow-up (1978-2008), 1780 cancer cases were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs). In addition, the burden of cancer attributable to smoking was assessed by the population attributable fraction. Following adjustment for age, education, alcohol consumption and BMI, for current compared with never smokers, highly significant and strongly elevated estimates were found for total (HR=1.79, 95% CI 1.59-2.02), tobacco-related (HR=2.52, 95% CI 2.16-2.95), upper aerodigestive tract (UADT) (HR=5.77, 95% CI 2.73-12.21), lung (HR=10.47, 95% CI 6.74-16.25), bladder (HR=3.31, 95% CI 1.71-6.41) and liver (HR=4.64, 95% CI 1.53-14.08) cancer. Findings suggest a lower risk of prostate cancer in current smokers. In addition, the occurrence of lung and UADT cancer was significantly elevated in men in the lowest educational attainment category. If smoking had not occurred, ∼23% of total cancer, 37% of tobacco-related, 77% of lung, 58% of UADT, 43% of liver and 45% of bladder cancer cases could have been prevented in this cohort of men. Cancer-control strategies focused on reducing smoking should be a public health priority.

Biomonitoring study of dry cleaning workers using cytogenetic tests and the comet assay.

Perchloroethylene (PCE) is the main solvent used in the dry cleaning industry worldwide. The aim of the present work was to evaluate the genotoxic potential of occupational exposure to PCE in dry cleaning workers. The study was carried out in 59 volunteers (30 workers, 29 controls). The genotoxic effect was evaluated by analyzing chromosome aberrations (CAs), and micronuclei (MN) and DNA damage (assessed by the comet assay) in peripheral blood lymphocytes. Environmental monitoring of exposure was carried out on personal breathing zone air samples collected during two consecutive working days by measuring the concentration of PCE air levels. The mean PCE concentration in workplace air of dry cleaning workers was 31.40 mg/m(3). There were no significant differences in CA frequency between dry cleaning workers and the controls, but analysis showed a significant association of CA frequency with employment duration and frequency of exposure to PCE. The MN frequency and DNA damage detected by alkaline comet assay were significantly increased in dry cleaning workers compared to the controls. The results suggest that (a) chronic occupational exposure to dry cleaning solvents below permissible occupational exposure limit of 70 mg/m(3) (i.e., ~10.3 ppm) may lead to an increased risk of genetic damage among dry cleaning workers, and (b) CA, MN tests, and comet assay are useful to monitor populations exposed to low doses of PCE.

Consumption of alcohol and risk of cancer among men: a 30 year cohort study in Lithuania.

Studies have indicated hazardous consumption of large quantities of alcohol among adults in Lithuania. We assessed the associations of alcohol consumption at baseline with cancer incidence among men in a population-based cohort study, using Cox models adjusted for smoking, education and body mass index. Attained age was used as a time-scale. During follow-up (1978-2008) 1,698 men developed cancer. A higher amount of alcohol consumption (≥140.1 g/week vs. 0.1-10.0 g/week) was positively associated with increased risk of total cancer [hazard ratio (HR) = 1.36, 95 % confidence interval (95 % CI) 1.11, 1.65], upper aerodigestive tract cancer (HR = 2.79, 95 % CI 1.23, 6.34) and alcohol-related cancers (i.e. oral cavity, pharynx, larynx, oesophagus, colorectal and liver cancer) (HR = 1.88, 95 % CI 1.25, 2.85). Compared to occasional drinkers (a few times/year), drinkers 2-7 times/week showed an increased risk of total (HR = 1.45, 95 % CI 1.16, 1.83), alcohol-related (HR = 1.83 95 % CI 1.14, 2.93) and other cancers (HR = 1.35, 95 % CI 1.04, 1.76). Our results showed no statistically significant associations between quantity of alcohol intake per one occasion and risk of cancer. About 13 % of total, 35 % of upper aerodigestive tract, 22 % of alcohol-related and 10 % of other cancer cases were due to alcohol consumption in this cohort of men.

Smoking and other risk factors for pancreatic cancer: a cohort study in men in Lithuania.

BACKGROUND: Cancer of the pancreas is a relatively rare, but highly fatal cancer worldwide. Cigarette smoking has been recognized as an important risk factor, but the relation to other potential determinants is still inconsistent. We investigated the association between different lifestyle, biological and anthropometric factors and the risk of pancreatic cancer in a prospective population-based cohort study from Kaunas, Lithuania. METHODS: Our study included 7132 urban men initially free from any diagnosed cancer, followed for up to 30 years. 77 incident cases of pancreatic cancer were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS: Compared to never smokers, current smokers had a significantly increased risk of pancreatic cancer, HR was 1.79 (95% CI 1.03-3.09) after adjustment for age, body mass index, education and alcohol consumption. Among smokers, a significant association with higher smoking intensity was shown (≥ 20 cigarettes/day: HR = 2.60; 95% CI 1.42-4.76, P(trend) = 0.046). We also observed a significantly increased risk for ≥ 30 pack-years of smoking (HR = 2.24; 95% CI 1.12-4.49, P(trend) = 0.16) and for age at starting smoking < 18 years (HR = 2.29; 95% CI 1.11-4.70, P(trend) = 0.43) as compared to never smokers. Alcohol consumption, body mass index and total cholesterol level were not significantly associated with pancreatic cancer. CONCLUSIONS: Smoking significantly increases pancreatic cancer incidence and its high prevalence in Lithuania may partly explain high incidence of the disease. No convincing evidence was found that alcohol consumption, body mass index or serum cholesterol level were associated with pancreatic cancer risk, although the assessment was limited by the lack of statistical power.

Alcohol consumption and risk of gastric cancer: a cohort study of men in Kaunas, Lithuania, with up to 30 years follow-up.

BACKGROUND: Gastric cancer is the second most common cause of death from cancer in the world. Epidemiological findings on alcohol use in relation to gastric cancer remain controversial. The aim of this study was to examine the effect of alcohol consumption on the risk of gastric cancer. METHODS: The association between alcohol intake and the risk of gastric cancer was examined in a population-based cohort of 7,150 men in Kaunas, Lithuania, who were enrolled during 1972-1974 or 1976-1980. After up to 30 years of follow-up, 185 gastric cancer cases were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). The attained age was used as a time-scale. RESULTS: After adjustment for smoking, education level and body mass index, the HR of gastric cancer was 2.00 (95% CI: 1.04-3.82) for the highest alcohol consumption frequency (2-7 times per week) compared with occasional drinking (a few times per year) and 1.90 (95% CI: 1.13-3.18) for ≥ 100.0 g ethanol/week versus 0.1-9.9 g ethanol/week. A stronger effect of alcohol consumption on gastric cancer risk was observed during the second half of the study (1993-2008). In the analysis of gastric cancer risk by alcoholic beverage type, all beverages were included simultaneously in the model. The multivariate HR for men who consumed ≥ 0.5 litre of wine per occasion (compared with those who consumed <0.5 litre) was 2.95 (95% CI: 1.30-6.68). Higher consumption of beer or vodka was not statistically significantly associated with gastric cancer risk. After adjustment for smoking, education level, body mass index and ethanol, we found no excess risk of gastric cancer in association with total acetaldehyde intake. CONCLUSIONS: This study supports a link between alcohol consumption (primarily from ethanol) and the development of gastric cancer in the Lithuanian population. Although an association with heavy wine consumption was observed, the effect of exposure to acetaldehyde on the development of gastric cancer in this cohort was not confirmed. Further research is needed to provide a more detailed evaluation of alcohol drinking and gastric cancer risk.

Cigarette smoking and trends in lung cancer incidence in Lithuania: an analysis by histological type.

OBJECTIVE: The aim of this study was to investigate time trends of lung cancer incidence by histological type in Lithuania during the period from 1996 to 2005. The results were evaluated in relation to tobacco smoking trends. MATERIAL AND METHODS: The incidence rates of the most common lung cancer cell types (squamous cell carcinoma, adenocarcinoma, small cell carcinoma, other types, and morphologically not specified cases) were studied using data from the Lithuanian Cancer Registry. The world standard population was used for age adjustment. Data on tobacco smoking in Lithuania were obtained from various published sources. RESULTS: Among men, squamous cell carcinoma was the most common type of lung cancer. The age-adjusted rates of squamous cell carcinoma decreased from 25 per 100,000 in 1998-1999 to 19.1 per 100,000 in 2004-2005; the incidence rates for adenocarcinoma and small cell carcinoma rose to around 7 per 100,000 in 2002-2003. Among women, adenocarcinoma was the most common histological type. The incidence rates for adenocarcinoma increased to 1.9 per 100,000 until 2002-2003 and thereafter did not change. The rates of squamous cell carcinoma in women were relatively stable at around 1.1 per 100,000. In 2000, the prevalence of regular smoking among men and women peaked at 51.5% and 15.8%, respectively; there was a significant change from smoking nonfilter cigarettes to filter cigarettes. CONCLUSIONS: The decreasing squamous cell carcinoma rates among men and increasing adenocarcinoma rates among men and women are similar to those reported in other European countries and may be due to a shift from nonfilter type cigarettes to filter type.

Occupational asbestos exposure among respiratory cancer patients in Lithuania.

BACKGROUND: Despite intensive use of asbestos, no cancer case has ever been diagnosed as asbestos related in Lithuania. This paper attempts to estimate the proportion of those occupationally exposed to asbestos among respiratory cancer patients. MATERIAL AND METHODS: Occupational exposure to asbestos was assessed retrospectively for 298 lung cancer and four mesothelioma patients, admitted to the Institute of Oncology, Vilnius. The evaluation was based on personal interview data using an internationally established questionnaire covering most likely activities of asbestos exposure at the workplace. Cumulative exposure to asbestos at work was estimated in fiber years. Lung tissue asbestos fiber burden analysis was conducted by scanning transmission electron microscopy on 23 samples. RESULTS: A cumulative asbestos exposure of > or =25 fiber years was found for 10 lung cancer patients (3.4%). They worked in foundries, construction, installation, shipyard, power plant, railway, asbestos cement, glass and chemical industry. In a further 56 lung cancer patients (18.8%) and for one (25%) mesothelioma patient, a cumulative exposure from 5 to 24.9 fiber years was assessed. Asbestos fibers were detected in 18 cases, the burden ranged from 0.1 to 4.1 million fibers/g dry lung tissue; concentrations exceeding 1 million f/g dry lung tissue were found in four cases. All fibers were chrysotile. CONCLUSIONS: Findings indicate that a fraction (3.4%) of the lung cancer cases could be attributed to heavy occupational exposure to asbestos using the Helsinki criterion of > or =25 fiber years. Therefore, approximately 50 lung cancer cases per year in Lithuania could be asbestos-related compensable occupational diseases.

Status of occupational cancer in Lithuania.

Because industrialization in Lithuania started only about 50 years ago, occupational cancer is only now becoming an important issue. This article describes the situation of occupational cancer in Lithuania: research, exposures to carcinogens, regulation, and legal practice. Epidemiologic studies of work-related cancers have shown increased risks among cement, textile, and asbestos-cement workers. In 1997, 28% of employed workers in Lithuania were exposed to carcinogens. A legislation system regulating exposures to carcinogens, harmonized with European Directives, has recently been created. In 1995-2003, there were 5,652 new cases of occupational diseases. However, occupational cancers are seriously underdiagnosed--only one case of cancer was diagnosed as occupational. Establishment of a system that would enable diagnosis, certification, and compensation of cases of occupational neoplasms is essential in Lithuania.