Asbestos-Related Lung Disease

Our plain-English summary of Asbestos-Related Lung Disease, by R.L. Attanoos (Surgical Pathology Clinics, 2010).

The study

• Author: R.L. Attanoos
• Journal: Surgical Pathology Clinics
• Published: 2010;3(1):109-27
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos is a high-profile health hazard. This article examines the assessment asbestos-related malignant mesothelioma and lung cancer. The risk of developing these diseases increases in proportion to the cumulative dose. As persons with heavy occupational asbestos exposures are diminishing, the observed latent period for asbestos-related disease extends making the assessment of an individual's cumulative dose is now more problematic.

Copyright © 2010 Elsevier Inc. All rights reserved.

In plain English

This article was a narrative review by a pathologist of asbestos-related lung and pleural disease. It reported no new study data. The author described the benign conditions (pleural effusion, pleural plaques, diffuse pleural thickening and asbestosis), the malignant ones (malignant mesothelioma and lung cancer), and how pathologists diagnose them and judge whether asbestos caused them. The author stated that pleural changes appear at cumulative doses well below those needed for asbestosis and lung cancer. Amphiboles were described as more carcinogenic than chrysotile, with debate over whether pure chrysotile can cause mesothelioma. Citing earlier sources, the review gave clinical asbestosis as emerging after lifetime exposures of 25 fibers/mL-yrs, and pathologic asbestosis at around 10 to 20 fiber/mL-yrs. It discussed the limits of mineral analysis of lung tissue and the Helsinki criteria attribution dose of 25 fiber/mL-yrs for lung cancer. The author stated that pleural plaques or diffuse pleural thickening are an insufficient basis to attribute a lung cancer to asbestos. The author concluded that the pathologist has a central role in diagnosing asbestos-related disease.

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 asbestos-related benign and malignant lung and pleural disease, focused on pathology diagnosis and causal attribution; no original data
• Who was studied: none; the article reviews published literature and diagnostic guidelines rather than studying a group of people
• Exposure: asbestos in general: the amphiboles (commercial crocidolite and amosite; noncommercial tremolite, anthophyllite and actinolite) and the serpentine chrysotile, considered in terms of cumulative dose
• Main results:
  • The author stated that pleural changes such as plaques and malignant mesothelioma appear at cumulative doses well below the minimum dose needed to induce asbestosis and lung cancer
  • The author stated that amphiboles are more fibrogenic and far more carcinogenic than chrysotile in causing asbestosis, lung cancer and mesothelioma
  • The author noted debate over whether pure chrysotile, without contaminant tremolite, can induce mesothelioma
  • Citing an earlier report, the review stated that clinical degrees of asbestosis emerge after lifetime occupational exposures of 25 fibers/mL-yrs
  • The review stated that pathologic (subclinical) degrees of asbestosis occur at around 10 to 20 fiber/mL-yrs cumulative exposure
  • Under the updated CAP-PPS guidance described in the review, fibrosis of the bronchiolar walls alone with asbestos bodies is no longer called asbestosis but asbestos airways disease
  • The author stated that a negative mineral analysis result does not prove the absence of significant exposure, especially for chrysotile
  • Citing national registries, the review stated that about 90% of male mesothelioma patients have a history of prior asbestos exposure
  • The review stated that the Helsinki criteria set a causal attribution dose for lung cancer at 25 fiber/mL-yrs exposure. The author noted this value has been criticized as unlikely to apply across all populations, industries and fiber types
  • The author stated that subclinical (pathologic) asbestosis may carry a small relative increase in lung cancer risk, likely less than twofold
  • The author stated that pleural plaques or diffuse pleural thickening are an insufficient basis to conclude that a lung cancer was caused by asbestos
• The authors' conclusion: The author concluded that the pathologist has a central role in accurately diagnosing asbestos-related disease and in evaluating its cause, and that nonspecialist pathologists should work closely with analytical laboratories

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Lung Cancer, Cumulative Dose, Asbestos Exposure.

Related studies

• Yellow Nail Syndrome with Bilateral Pleural Plaques and Diffuse Pleural Thickening: A Mimic of Asbestos Related Disease — A. Dallmann, R.L. Attanoos (2018)
• Asbestos-related diseases of the lung and other organs: their epidemiology and implications for clinical practice — M.R. Becklake (1976)
• Diagnosis and initial management of nonmalignant diseases related to asbestos — American Thoracic Society (2004)
• The worldwide pandemic of asbestos-related diseases — L. Stayner, L.S. Welch, et al. (2013)
• Ecological association between asbestos-related diseases and historical asbestos consumption: an international analysis — R.T. Lin, K. Takahashi, et al. (2007)
• Mass and number of fibres in the pathogenesis of asbestos-related lung disease in rats — J.M. Davis, S.T. Beckett, et al. (1978)

Browse more research in Surgical Pathology Clinics, or return to medical research.