Asbestos and the lung in the 21st century: an update

Our plain-English summary of Asbestos and the lung in the 21st century: an update, by S. Prazakova, P.S. Thomas, A. Sandrini, et al (The Clinical Respiratory Journal, 2014).

The study

• Authors: S. Prazakova, P.S. Thomas, A. Sandrini, D.H. Yates
• Journal: The Clinical Respiratory Journal
• Published: 2014;8(1):1-10
• Type of article: Review
• Cited by: 94 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The asbestos-related disorders (ARDs) are currently of significant occupational and public health concern. Asbestos usage has been banned in most developed countries, but asbestos is still used in many developing countries and the number of cases of ARDs worldwide is rising. Many countries are now experiencing an epidemic of ARDs that is the legacy of occupational exposure in the 1960s-1980s because of the long latency period between asbestos exposure and manifestation of disease. It is likely that asbestos-related mortality and morbidity will continue to increase. Although the most feared complications of asbestos inhalation are the malignant conditions such as mesothelioma and lung cancer, asbestos inhalation more frequently results in benign conditions such as pleural plaques, diffuse pleural thickening, and asbestosis (pulmonary fibrosis due to asbestos exposure). Over recent years, there have been changes in the epidemiology of mesothelioma, in clinical management of ARDs and developments in new techniques for early detection of malignancy. This review provides an update on the respiratory manifestations of asbestos exposure and also considers advances in screening methods that may affect future management in the workplace.

© 2013 John Wiley & Sons Ltd.

In plain English

This article was a narrative review, not an original study. The authors summarised published research and statistics on asbestos-related disorders: asbestosis, pleural plaques, benign asbestos pleural effusion, diffuse pleural thickening, rounded atelectasis, lung cancer and malignant mesothelioma. They also covered newer detection methods. Citing a World Health Organisation estimate, they reported that 125 million people are exposed to asbestos at work each year and more than 107 000 die each year of asbestos-related diseases. Australian figures showed 612 new mesothelioma cases in 2011. Pleural plaques were described as the commonest manifestation, affecting up to 58% of asbestos-exposed workers. For mesothelioma, the review gave a median latency of about 40 years (range 15 to 67) and a median survival of 8 to 14 months. The authors noted that the blood marker SMRP had a high rate of false-positives. They also cited a British study in which former smokers who had quit for 40 or more years had the same lung cancer risk as asbestos workers who had never smoked. The authors concluded that primary prevention remains the key to controlling asbestos-related disorders.

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 and statistics
• Who was studied: No study population of its own; the review drew on published studies, registry figures and guidelines, including from Great Britain, Australia, the United States and global estimates
• Exposure: Asbestos in general. The review describes the amphiboles (crocidolite, amosite, anthophyllite, tremolite) and chrysotile, the only serpentine. It also discusses occupational, take-home (para-occupational) and home-renovation exposure.
• Main results:
  • Citing World Health Organisation officials: 125 million people worldwide are exposed to asbestos at work each year, and more than 107 000 people die each year of asbestos-associated diseases
  • Citing World Health Organisation officials: more than 107 000 deaths per year
  • Australia, 2011 (cited registry report): 612 new malignant mesothelioma cases, an incidence of 2.7 per 100 000 population overall (5.0 per 100 000 men and 0.8 per 100 000 women)
  • Pleural plaques are the commonest manifestation of asbestos exposure, affecting up to 58% of asbestos-exposed workers and up to 8% of general environmentally exposed populations
  • Asbestosis requires relatively high levels of asbestos inhalation (cumulative exposure of 25 fibres/mL-years or more), although some reports record asbestosis after lower exposure
  • Malignant mesothelioma has a median latency of approximately 40 years (range 15 to 67)
  • Malignant mesothelioma has a median survival of 8 to 14 months
  • The biomarker SMRP, when evaluated, was found to have a high rate of false-positives
  • Asbestos-related lung cancers account for about 3 to 8% of all lung cancers
  • In a cited British study of asbestos workers, former smokers who had stopped smoking for 40 or more years had the same lung cancer risk as asbestos workers who had never smoked
  • The authors stated that, on current evidence, radical surgery should be used with caution in malignant mesothelioma
  • No new treatments have been developed for the benign asbestos-related disorders
• The authors' conclusion: The authors concluded that, until better detection and treatment are available, primary prevention remains the key to controlling asbestos-related disorders

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Latency, Asbestos Exposure, Mesothelioma, Lung Cancer, Pleural Plaques, Diffuse Pleural Thickening, Pulmonary Fibrosis.

Related studies

• Asbestos: old foe in 21st century developing countries — L.V. Harris, I.A. Kahwa (2003)
• Asbestos bodies in bronchoalveolar lavage in the 21st century: a time-trend analysis in a clinical population — V. Nuyts, H. Vanhooren, et al. (2017)
• Soluble mesothelin-related protein in an asbestos-exposed population: the dust diseases board cohort study — E.K. Park, A. Sandrini, et al. (2008)
• Contribution of positron emission tomography in pleural disease — B. Duysinx, J.L. Corhay, et al. (2010)
• Imaging the pleura — C. Mortensen, R. Bhatnagar, et al. (2012)
• Epidemiology of mesothelioma in the 21st century in Europe and the United States, 40 years after restricted/banned asbestos use — N. Alpert, M. van Gerwen, et al. (2020)

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