CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(05): 555-561
DOI: 10.1055/a-1361-1715
GebFra Science

Asbestos Exposure and Ovarian Cancer – a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach

Article in several languages: English | deutsch
Dennis Nowak
1   Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Germany
Barbara Schmalfeldt
2   Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
Andrea Tannapfel
3   Institut für Pathologie der Ruhr-Universität Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
Sven Mahner
4   Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Klinikum, München, Germany
› Author Affiliations


In 2017, ovarian cancer due to asbestos exposure was designated a new, and thereby the first, gynaecological occupational disease in Germany. Asbestos is a naturally occurring mineral fibre with an annual usage in Germany of 160 000 – 180 000 metric tonnes in the 1960s and 1970s. The carcinogenicity of asbestos for the target organs lungs, larynx, pleura including pericardium, and peritoneum including tunica vaginalis testis has been clearly established for many years. Recent meta-analyses of data from cohort studies have demonstrated that the risk of ovarian cancer roughly doubles in women with occupational exposure to asbestos. Since the group of people with double the risk of developing lung cancer due to work-related asbestos exposure has a 2.25-fold increased risk of mortality from ovarian cancer on average, work-related ovarian cancer has been assigned the same recognition requirements as in occupational lung (and laryngeal) cancer. Thus, gynaecologists must obtain a thorough history of occupational exposure to asbestos, even if it may have taken place long in the past. The law mandates that suspected such cases must be reported to the Statutory Accident Insurance carrier or the State Occupational Safety and Health Agency.

Publication History

Received: 15 April 2020

Accepted after revision: 18 January 2021

Article published online:
20 May 2021

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  • References/Literatur

  • 1 BMAS, Bundesministerium für Arbeit und Soziales. Empfehlung des Ärztlichen Sachverständigenbeirats „Berufskrankheiten“ – Ovarialkarzinom (Eierstockkrebs) durch Asbest – Bek. d. BMAS v. 1.12.2016 – IVa 4-45222 – Ovarialkarzinom durch Asbest – GMBl. 31.01.2017, S. 15–28; redaktionell berichtigt: GMBl 2019, S. 1294. Accessed April 9, 2021 at:
  • 2 AWMF, Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften. S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, November 2019. Accessed April 9, 2021 at:
  • 3 Saad AF, Hu W, Sood AK. Microenvironment and pathogenesis of epithelial ovarian cancer. Horm Cancer 2010; 1: 277-290
  • 4 Ness RB, Cottreau C. Possible role of ovarian epithelial inflammation in ovarian cancer. J Natl Cancer Inst 1999; 91: 1459-1467
  • 5 Altinoz MA, Korkmaz R. NF-kappaB, macrophage migration inhibitory factor and cyclooxygenase-inhibotions als likely mechanisms behind the acetaminophen- and NSAID-prevention of the ovarian cancer. Neoplasma 2004; 51: 239-247
  • 6 DGUV, Deutsche Gesetzliche Unfallversicherung. BK-Report Faserjahre 1/2013. Accessed April 9, 2021 at:
  • 7 IARC, International Agency for the Research on Cancer. IARC Monographs, Volume 100 C. A Review of Human Carcinogens. Arsenic, Metals, Fibres, and Dusts. Accessed April 9, 2021 at:
  • 8 Camargo MC, Stayner LT, Straif K. et al. Occupational exposure to asbestos and ovarian cancer: a meta-analysis. Environ Health Perspect 2011; 119: 1211-1217
  • 9 Großgarten K, Woitowitz HJ. Tödliche Peritonealmesotheliomerkrankungen bei Frauen infolge Asbesteinwirkung am Arbeitsplatz. Gynäkologe 1991; 21: 261-264
  • 10 Marten M, Dirksen M, Püschel K. et al. Verteilung von Asbestkörpern in menschlichen Organen. Pathologe 1989; 10: 114-117
  • 11 Huncharek M, Geschwind JF, Kupelnick B. Perineal application of cosmetic talc and risk of invasive epithelial ovarian cancer: a meta-analysis of 11,933 subjects from sixteen observational studies. Anticancer Res 2003; 23: 1955-1960
  • 12 Terry KL, Karageorgi S, Shvetsov YB, et al. for the Australian Cancer Study (Ovarian Cancer), and the Australian Ovarian Cancer Study Group, Rossing MA, Schildkraut J, Risch H. et al. on behalf of the Ovarian Cancer Association Consortium. Genital powder use and risk of ovarian cancer: A pooled analysis of 8525 cases and 9859 controls. Cancer Prev Res 2013; 6: 811-821
  • 13 Gross AJ, Berg PH. A meta-analytical approach examining the potential relationship between talc exposure and ovarian cancer. J Expo Anal Environ Epidemiol 1995; 5: 181-195
  • 14 Schildkraut JM, Abbott SE, Alberg AJ. et al. Association between body powder use and ovarian cancer: The African American Cancer Epidemiology Study (AACES). Cancer Epidemiol Biomarkers Prev 2016; 25: 1411-1417 DOI: 10.1158/1055-9965.EPI-15-1281.
  • 15 Trabert B. Body powder and ovarian cancer risk – what is the role of recall bias?. Cancer Epidemiol Biomarkers Prev 2016; 25: 1369-1370 DOI: 10.1158/1055-9965.EPI-16-0476.
  • 16 Paalani M, Lee JW, Haddad E. et al. Determinants of inflammatory markers in a bi-ethnic population. Ethn Dis 2011; 21: 142-149
  • 17 Reid A, de Klerk N, Musk AW. Does exposure to asbestos cause ovarian cancer? A systematic literature review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2011; 20: 1287-1295
  • 18 Bounin A, Charbotel B, Fervers B. et al. Professional risk factors associated with the cancer of the ovary. Literature review. Bull Cancer 2014; 101: 1089-1108
  • 19 Nowak D, Brandenburg S. Zusammenhangsbegutachtung von Berufskrankheiten – die Rolle des Arztes. Dtsch Med Wochenschr 2019; 144: 1487-1495
  • 20 Nowak D. Verdacht auf Berufskrankheit. Darauf kommt es beim Berufskrankheiten-Verfahren an! 3. Aufl. Landsberg: Ecomed; 2018
  • 21 Nowak D, Ochmann U. Essentials Arbeitsmedizin. Das Wichtigste für Ärzte aller Fachrichtungen. München: Elsevier; 2018
  • 22 Rajput Z, Hering KG, Kraus T. et al. Investigating the association between occupational exposure to asbestos and ovarian carcinoma: results from a pilot study in Germany. BMC Public Health 2019; 19: 1341 DOI: 10.1186/s12889-019-7590-7.