Asbestos and benign pleural diseases: a narrative review

Our plain-English summary of Asbestos and benign pleural diseases: a narrative review, by L. Ferreiro, M.E. Toubes, N. Rodríguez-Núñez, et al (Breathe, 2025).

The study

• Authors: L. Ferreiro, M.E. Toubes, N. Rodríguez-Núñez, L. Valdés
• Journal: Breathe
• Published: 2025;21(2):240236
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The term "asbestos" is used to refer to a group of silicate minerals that often break down into fibres and whose inhalation over time can cause a number of diseases, especially pleuropulmonary diseases. While the most serious complications are malignant diseases, inhalation of these fibres can also cause benign pleural diseases such as round atelectasis, pleural plaques, diffuse pleural thickening and non-malignant asbestos pleural effusion. Although asbestos is banned in most developed countries (in the European Union, since 2002), it is still used in developing countries. Despite these restrictions, the prevalence of diseases due to inhalation remains high due to the long latency period between the onset of exposure and the onset of disease. In this paper we review benign pleural diseases induced by asbestos exposure, update the diagnostic criteria for these disorders, and describe the approaches suggested so far to differentiate them from malignant pleural diseases.

Copyright ©ERS 2025.

In plain English

This narrative review, by four authors from the Pulmonology Department of the University Clinical Hospital of Santiago de Compostela, Spain, described non-cancerous (benign) pleural diseases linked to asbestos: round atelectasis, pleural plaques, diffuse pleural thickening and non-malignant asbestos pleural effusion. It reported no new data of its own and summarised earlier studies. Citing that literature, the authors wrote that pleural plaques are seen in more than 50% of directly exposed workers, provided a long latency period of 20–30 years is considered. People with plaques were described as having a 5–10% probability that plaques extend and a 2–5% probability of developing diffuse pleural thickening. One cited series found an average of 34 years from first exposure to diffuse pleural thickening. Non-malignant asbestos pleural effusion was described as usually appearing within 10 years of first exposure. The authors also summarised studies that tested CT imaging and blood or pleural fluid markers to tell this effusion apart from malignant mesothelioma. They concluded that pleural fluid cytology or a pleural tissue biopsy is still required to make that distinction conclusively. They expected these diseases to remain common because of their long latency.

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: narrative review of published literature on benign pleural diseases related to asbestos exposure
• Who was studied: No study population of its own; the review drew on published studies of asbestos-exposed people with benign pleural diseases. The authors work in Santiago de Compostela, Spain.
• Exposure: Asbestos in general, described as amphiboles (crocidolite, amosite, anthophyllite, tremolite) and the serpentine chrysotile. Exposure routes discussed were direct occupational, building-related and para-occupational (household contacts of exposed workers).
• Main results:
  • From the reviewed literature: pleural plaques are observed in more than 50% of directly exposed workers, and to a lesser extent in environmentally exposed people (cohabitants and neighbours), provided a long latency period of 20–30 years is considered.
  • Citing a published source, the review gave the risk of progression in people with pleural plaques as: 5–10% probability that plaques extend, 2–5% probability of developing diffuse pleural thickening, and 1–2% probability of developing mesothelioma.
  • In a cited series by Jeebun et al., diffuse pleural thickening took more than 40 years from first exposure to appear in 40% of cases; the mean latency for the whole series was 34 years.
  • From the reviewed literature: non-malignant asbestos pleural effusion usually appears less than 10 years after first exposure, and an old study found that 21% of patients with asbestosis develop it.
  • The effusion was described as usually unilateral (80%), most often on the left side, and able to resolve on its own within an average of 3–4 months, with relapse in one-third of cases.
  • In a cited CT study by Kato et al., pleural plaques, round atelectasis and diffuse pleural thickening were significantly more common in the non-malignant effusion group. Thicker irregularities and mediastinal and interlobar fissure locations were more common in the mesothelioma group (p less than 0.001).
  • In a cited study, soluble mesothelin-related peptides in blood (AUC 0.872, sensitivity 80%, specificity 82.6%) and in pleural fluid (AUC 0.831, sensitivity 76.7%, specificity 76.2%) differentiated non-malignant asbestos pleural effusion from mesothelioma.
  • The review stated that attributing a benign pleural disease to asbestos requires at least 10 years of exposure, even if low intensity.
• The authors' conclusion: The authors concluded that imaging and biochemical markers have been tried, but pleural fluid cytology or pleural tissue biopsy is currently required to conclusively differentiate asbestos-related benign pleural diseases from malignant mesothelioma. They also concluded that the prevalence of asbestos-related diseases is expected to remain high because of long latency.
• Limitations the authors state:
  • The authors noted that the evidence on whether people with diffuse pleural thickening are at higher risk of lung cancer or malignant mesothelioma is insufficient.
  • The authors noted that only one study has addressed whether asbestos-related round atelectasis predisposes to malignancy.

Topics

Medical terms in this study, explained in our Lexicon: Silicate, Atelectasis, Pleural Plaques, Diffuse Pleural Thickening, Pleural Effusion, Latency, Asbestos Exposure.

Related studies

• Occupational lung disease: A narrative review of lung conditions from the workplace — M.I. Jumat, F. Hayati, et al. (2021)
• High-resolution CT of benign asbestos-related diseases: clinical and radiographic correlation — D.R. Aberle, G. Gamsu, et al. (1988)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)
• Asbestos-related benign pleural disease — C. Peacock, S.J. Copley, et al. (2000)
• Benign asbestos pleural diseases — S.J. Chapman, W.O. Cookson, et al. (2003)
• The additional risk of malignant mesothelioma in former workers and residents of Wittenoom with benign pleural disease or asbestosis — A. Reid, N. de Klerk, et al. (2005)

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