Asbestos exposure. An update on pleuropulmonary hazards

Our plain-English summary of Asbestos exposure. An update on pleuropulmonary hazards, by B. Varkey (Postgraduate Medicine, 1983).

The study

• Author: B. Varkey
• Journal: Postgraduate Medicine
• Published: 1983;74(4):93-9, 102-3
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001739).

Abstract

Asbestos exposure is causally related to the development of asbestosis, bronchogenic carcinoma, malignant mesothelioma, and nonmalignant pleural disorders. Clinical and roentgenographic manifestations of asbestosis mimic other diffuse fibrotic lung diseases. However, a concomitant finding of pleural plaques strongly suggests the diagnosis. The manifestations of bronchogenic carcinoma related to asbestos exposure are varied and do not differ from those unrelated to asbestos exposure. Malignant mesothelioma signals previous asbestos exposure. Nonmalignant pleural disorders may not cause any symptoms but should alert the physician to other concurrent or potential asbestos-related diseases. To diagnose asbestos-related diseases, physicians should bear in mind the long latent period and should take a careful, comprehensive occupational and environmental history. Cigarette smoking markedly increases the risk for development of bronchogenic carcinoma in asbestos workers and increases the mortality due to asbestosis.

In plain English

This 1983 article is a narrative review for primary care physicians of lung and pleural diseases linked to asbestos. It did not report a new study. The author described the main fiber types and stated that crocidolite has the highest cancer-causing potential, especially for malignant mesothelioma, while all types can cause asbestosis. Citing other research, the review stated that in some studies the combined lung cancer risk from smoking and asbestos was multiplicative rather than just additive. It also stated that malignant mesothelioma has a latent period of 30 to 40 years or more and has been reported even after casual domestic or environmental exposure. It described pleural plaques as the most common asbestos-related disorder and said about one third of patients with plaques may also have asbestosis. The article was illustrated with patient cases. One of them was a mesothelioma patient from the author's teaching hospital whose past exposure came to light only after four separately taken histories. The author concluded that diagnosis requires keeping the long latent period in mind and taking a careful, comprehensive occupational and environmental history.

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 (clinical update) for primary care physicians, illustrated with patient cases; no original study
• Who was studied: No study population of its own. The review covers asbestos-related disease in exposed people, mainly in the United States. It is illustrated with patient cases: a 60-year-old man with asbestosis, a 57-year-old man with malignant mesothelioma, and a 70-year-old former boiler-room worker with pleural plaques. Only the mesothelioma case is identified as coming from the author's teaching hospital.
• Exposure: Asbestos in general: chrysotile (white), crocidolite (blue), amosite (brown) and anthophyllite. Sources discussed include occupational, household, environmental and product exposures, such as asbestos cement products, paper products and insulating sprays.
• Main results:
  • The review stated that crocidolite has the highest oncogenic potential, especially for malignant mesothelioma
  • The review stated that all fiber types can produce asbestosis
  • Citing other studies, the review stated that for bronchogenic carcinoma the combined risk of smoking and asbestos exposure was, in some studies, multiplicative rather than just additive
  • The review stated that malignant mesothelioma has been reported even after casual domestic or environmental exposure, with a latent period of 30 to 40 years or more
  • The review stated that about one third of patients with pleural plaques may also have asbestosis
  • The review cited a source stating that relatives of fewer than 40% of insulation workers who died from asbestos-related diseases had received compensation
  • In one mesothelioma case from the author's teaching hospital, four separately taken histories were needed to uncover past asbestos exposure
  • The review reported the workplace limit of the time: no more than 2 fibers (5 micrometers or longer) per cubic centimeter of air over an eight-hour period. It noted that NIOSH had recommended a reduction to 0.1 fiber per cc.
• The authors' conclusion: The author concluded that, to diagnose asbestos-related diseases, physicians should keep the long latent period in mind and take a careful, comprehensive occupational and environmental history

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Bronchogenic Carcinoma, Malignant Mesothelioma, Pleural Plaques.

Related studies

• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)
• Asbestos-related pleuropulmonary diseases: benign and malignant — A. Lazarus, A. Massoumi, et al. (2012)
• Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases — B. Varkey, U.N. Kumar (1978)
• Thoracic surgical problems in asbestos-related disorders — E.A. Gaensler, T.C. McLoud, et al. (1985)
• Genetic susceptibility to asbestos-related fibrotic pleuropulmonary changes — M.K. Kukkonen, S. Hämäläinen, et al. (2011)
• Asbestos-related pleuropulmonary diseases: evaluation with low-dose four-detector row spiral CT — M. Remy-Jardin, A. Sobaszek, et al. (2004)

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