An overview of how asbestos exposure affects the lung

Our plain-English summary of An overview of how asbestos exposure affects the lung, by G.P. Currie, S.J. Watt, N.A. Maskell (BMJ, 2009).

The study

• Authors: G.P. Currie, S.J. Watt, N.A. Maskell
• Journal: BMJ
• Published: 2009;339:b3209
• Type of article: Review
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Summary points
The risk of asbestos related lung disease is dose related and depends on fibre type
Joiners, plumbers, electricians, painters, shipyard workers, builders, engineers, and asbestos miners are at greatest risk
Asbestos exposure can cause benign disease (pleural plaques, pleural thickening, benign pleural effusions), malignant disease (mesothelioma, lung cancer), and interstitial lung disease (asbestosis)
Mesothelioma will peak in incidence between 2011 and 2015; it should be considered in all patients with a pleural effusion, chest pain, and history of asbestos exposure
Treatment options in asbestosis are limited
Some patients are entitled to compensation and should seek advice from the Department of Work and Pensions or dedicated charity organisations

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This article was a clinical review, not a new study. Writing for UK doctors, the authors searched PubMed and Medline for articles published up to February 2009 and summarised who is at risk from asbestos, the lung diseases it can cause, and UK compensation routes. They described curved chrysotile fibres as carrying a slightly lower risk than straight amphibole fibres such as crocidolite and amosite, and stated that no safe threshold exists for any type. Citing earlier work, the review reported that pleural plaques occur in 20-60% of exposed people. It reported that an analysis of 23 studies found asbestos raised lung cancer risk by a similar factor in smokers and non-smokers, with a multiplicative interaction. In one study of 622 mesothelioma patients, disease was caused by occupational or domestic exposure in 86% of men and 38% of women. UK mesothelioma register data showed deaths rising from 153 in 1968 to 1848 in 2001, with a predicted peak of 1950-2450 a year between 2011 and 2015. The authors stated that risk is dose related and depends on fibre type.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical review (narrative, described as evidence based) of literature found by searching PubMed and Medline up to February 2009; no new data collected
• Who was studied: No study population of its own. The review drew on published articles and UK statistics and was written for doctors in primary and secondary care.
• Exposure: Asbestos in general, including serpentine (chrysotile) and amphibole (crocidolite, amosite, anthophyllite) fibres, from jobs such as mining, milling, textiles, building, plumbing, electrical work and shipyards, and from domestic exposure
• Main results:
  • The review stated that curved (chrysotile) fibres carry a slightly lower risk of lung disease than straight (amphibole) fibres, but that no safe threshold of exposure exists for any type.
  • Citing earlier work, the review stated that pleural plaques occur in 20-60% of people exposed to asbestos.
  • Citing an earlier analysis of 23 epidemiological studies, the review reported that asbestos increased lung cancer risk by a similar factor in non-smokers and smokers, with a synergistic (multiplicative) interaction with smoking.
  • Citing UK mesothelioma register data, the review reported that annual mesothelioma deaths rose from 153 in 1968 to 1848 in 2001. Deaths were predicted to peak at 1950-2450 cases a year between 2011 and 2015.
  • Citing an earlier study of 622 mesothelioma patients (512 men), the review reported that disease was caused by occupational or domestic asbestos exposure in 86% of men and 38% of women.
  • Citing an earlier retrospective analysis of 1105 patients with definite mesothelioma, the review reported a median latency of 32 years, with 96% of cases occurring after at least 20 years.
  • Citing an earlier trial of 448 patients, the review reported a median survival of 12 months with pemetrexed plus cisplatin versus nine months with cisplatin alone (P=0.002). Citing a variety of studies, it reported a median survival of between eight and 14 months from diagnosis of malignant mesothelioma.
• The authors' conclusion: The authors stated that the risk of asbestos related lung disease is dose related and depends on fibre type. They stated that asbestos exposure can cause benign pleural disease, malignant disease (mesothelioma, lung cancer) and asbestosis.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pleural Plaques, Pleural Thickening, Pleural Effusion, Mesothelioma, Lung Cancer, Interstitial Lung Disease.

Related studies

• Man-made vitreous fibers and workers' health. An overview of the epidemiologic evidence — R. Saracci, L. Simonato (1982)
• Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships — G. Mastrangelo, M.N. Ballarin, et al. (2009)
• Asbestos-related focal lung masses: manifestations on conventional and high-resolution CT scans — D.A. Lynch, G. Gamsu, et al. (1988)
• Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence-The Pre-Adult Latency Study (PALS) — J. Szeinuk, C.W. Noonan, et al. (2017)
• The prevalence of pleural plaques and/or pulmonary changes among construction workers in Okayama, Japan — T. Kishimoto, K. Morinaga, et al. (2000)
• Asbestos-related diseases in automobile mechanics — J. Ameille, N. Rosenberg, et al. (2012)

Browse more research in BMJ, or return to medical research.