Brazilian Thoracic Society recommendations for the diagnosis and monitoring of asbestos-exposed individuals

Our plain-English summary of Brazilian Thoracic Society recommendations for the diagnosis and monitoring of asbestos-exposed individuals, by U.P. Santos, E. Algranti, E.M. Capitani, et al (Jornal Brasileiro de Pneumologia, 2024).

The study

• Authors: U.P. Santos, E. Algranti, E.M. Capitani, G.F. Prado, A.P.S. Carneiro, S.C.S. Rodrigues, J.B.P. Freitas, R.C. Chate, R.F. Mizutani, H.A. Castro, M.A. Arbex, P.C. Ribeiro, C.N. Tietboehl Filho, M.V.C.O. Castellano, G.W. Leite, G.C. Almeida, Committee on Environmental and Occupational Diseases
• Journal: Jornal Brasileiro de Pneumologia
• Published: 2024;50(3):e20240156
• Type of article: Guideline
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos was largely used in Brazil. It is a mineral that induces pleural and pulmonary fibrosis, and it is a potent carcinogen. Our objective was to develop recommendations for the performance of adequate imaging tests for screening asbestos-related diseases. We searched peer-reviewed publications, national and international technical documents, and specialists' opinions on the theme. Based on that, the major recommendations are: Individuals exposed to asbestos at the workplace for ≥ 1 year or those with a history of environmental exposure for at least 5 years, all of those with a latency period > 20 years from the date of initial exposure, should initially undego HRCT of the chest for investigation. Individuals with pleural disease and/or asbestosis should be considered for regular lung cancer monitoring. Risk calculators should be adopted for lung cancer screening, with a risk estimate of 1.5%.

In plain English

This is a Brazilian Thoracic Society committee position document, not a study of patients. It combined a narrative literature review with a specialist panel's recommendations. The panel recommended chest high-resolution CT (HRCT) as the first imaging test after at least one year of occupational, or five years of domestic or environmental, asbestos exposure, with 20 years' latency or more. Exposed people aged 50 to 75 with pleural plaques, diffuse pleural thickening, round atelectasis or asbestosis should have lung function testing, including DLCO if available. Exposed people aged 50 to 75 meeting the same exposure and latency criteria, even without asbestos-related disease, should be assessed with the Liverpool Lung Project or CanPredict risk calculators. The text recommended low-dose CT screening for occupationally exposed people meeting these criteria whose estimated lung cancer risk is at least 1.5%. The summary table lists annual screening for exposed people at a risk above 1.5%. Scans should be read using Lung-RADS, and screening services should have smoking cessation support. The authors called it the committee's position, aimed at improving recognition and monitoring.

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 recommendations (position statement) based on a narrative literature review and an expert panel
• Who was studied: No patients were studied. A panel of Brazilian pulmonologists and a radiologist from the Brazilian Thoracic Society's Committee on Environmental and Occupational Diseases wrote recommendations for asbestos-exposed individuals in Brazil.
• Exposure: Asbestos in general; no fiber type is specified. The document covers three kinds of exposure: occupational exposure; domestic exposure, meaning relatives exposed through contaminated clothes or asbestos products used at home; and environmental exposure, meaning people living near asbestos mines or factories.
• Main results:
  • Recommendation 1: people with at least one year of occupational exposure, or at least five years of domestic or environmental exposure, with 20 years' latency or over, should have chest HRCT as the first imaging test.
  • Recommendation 1.1 and Table 1: exposed people aged 50 to 75 with pleural plaques, diffuse pleural thickening, round atelectasis and/or asbestosis should have pulmonary function testing. The text says this testing should be thorough whenever possible. The table specifies plethysmography and DLCO assessment if available.
  • Recommendation 1.2: annual lung cancer screening is recommended, carried out by services that meet the requirements set out in published studies and recommendations.
  • Recommendation 2: people aged 50 to 75 should be considered significantly exposed even without current asbestos-related disease if they have one of two exposure histories: at least one year of occupational exposure, or at least five years of domestic and/or environmental exposure. They must also have 20 years' latency or over. These people should be assessed with risk calculators for inclusion in low-dose CT screening.
  • Recommendation 3 applies to people with a history of occupational exposure who meet the criteria above. For them, low-dose CT screening should be performed if their lung cancer risk estimate is at least 1.5% on the Liverpool Lung Project or CanPredict calculators. Table 1 states the criteria differently: it recommends annual low-dose CT screening for people aged 50 to 75 with asbestos exposure (with or without nonmalignant asbestos-related disease), latency of 20 years or more, and a risk estimate of more than 1.5%.
  • Recommendation 4: findings on screening CT scans should be classified using Lung-RADS (Lung Imaging Reporting and Data System).
  • Recommendation 5: screening services should have the support of smoking cessation programs.
• The authors' conclusion: The authors stated that the document represents the position of the Brazilian Thoracic Society's Committee on Environmental and Occupational Diseases on screening, diagnosis and follow-up of asbestos-related diseases. They gave its main objective as improving recognition and monitoring of these diseases.
• Limitations the authors state:
  • The authors noted that the radiation risk from repeated low-dose CT is not zero and cannot be estimated accurately.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Pulmonary Fibrosis, Environmental Exposure, Latency, High-Resolution CT (HRCT), Lung Cancer, Low-Dose CT Screening.

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