Diagnosis of asbestos-related lung diseases

Our plain-English summary of Diagnosis of asbestos-related lung diseases, by E.J.A. Harris, A. Musk, N. de Klerk, et al (Expert Review of Respiratory Medicine, 2019).

The study

• Authors: E.J.A. Harris, A. Musk, N. de Klerk, A. Reid, P. Franklin, F.J.H. Brims
• Journal: Expert Review of Respiratory Medicine
• Published: 2019;13(3):241-249
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The diagnosis of lung disease in asbestos-exposed individuals is a process that not only requires a detailed occupational and tobacco smoking history, but the correlation with physical signs, appropriate imaging, detailed lung function assessment and histology/cytology when required. Worldwide, the total quantity of asbestos mined is static, having decreased dramatically in developed countries but increased in countries where there is no restriction on mining: for example, Russia, China, Brazil, and Kazakhstan. The predominant diagnostic challenge in most cases of possible asbestos-related disease is the significant interval between exposure and development of the disease. Also challenging is the estimation of an individual's risk of disease, not least because asbestos-induced malignancy can be rapidly fatal, and, in the case of lung cancer, early detection can lead to treatment with curative intent. Areas covered: Discussion of quantitative asbestos exposure estimation and risk assessment, selection of the most appropriate imaging modality and frequency of imaging. Expert commentary: Consideration of the future for asbestos-related lung disease includes screening those at highest risk particularly in relation to ongoing mining operations and the management of in-situ asbestos. In the future, screening programs designed with estimation of risk of malignancy, based on quantitative estimates of asbestos exposure, and smoking history are indicated.

In plain English

This article is a narrative review, not an original study. The authors reviewed published work on diagnosing lung disease in asbestos-exposed people. It covered exposure history and estimation, imaging, lung function testing, and sampling of tissue or fluid. They described benign conditions (pleural plaques, benign pleural effusion, diffuse pleural thickening, asbestosis) and malignant ones (malignant pleural mesothelioma and lung cancer). Citing other studies, they reported that the relative risk of lung cancer after asbestos exposure in a never smoker has been estimated at between 1.18 and 2.8, and at between 5.6 and 25.2 times when combined with tobacco smoking. They noted that cytology of pleural fluid identifies only the epithelioid subtype of mesothelioma. They also described a separate Western Australian screening cohort of 1751 asbestos-exposed people, in which 5 of 17 lung cancers detected over a 5-year period were in never smokers. The authors concluded that these diseases are often challenging to diagnose and that there is no defined role for mesothelioma screening. They also concluded that future screening programs based on estimated asbestos exposure and smoking history are indicated.

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 (expert review article); not an original study
• Who was studied: No study population of its own; the authors reviewed published literature on asbestos-related lung diseases in asbestos-exposed people
• Exposure: Occupational and environmental asbestos exposure, including the amphiboles crocidolite, amosite and anthophyllite, and the serpentine chrysotile; Libby amphibole (tremolite) is also mentioned
• Main results:
  • Citing other studies, the authors reported estimates that the relative risk of lung cancer after asbestos exposure in a never smoker is between 1.18 and 2.8
  • Citing other studies, the authors reported that when asbestos exposure is combined with tobacco smoking, the estimated lung cancer risk rises to between 5.6 and 25.2 times
  • Citing another study, the authors gave suggested exposure-specific mesothelioma risk estimates of approximately 500:100:1 for crocidolite, amosite and chrysotile
  • The authors stated that pleural plaques are not considered to have enough physiological impact to cause shortness of breath
  • The authors stated that the CT findings of asbestosis cannot be told apart from usual interstitial pneumonitis
  • The authors stated that cytology of pleural fluid identifies only the epithelioid subtype of mesothelioma
  • The authors described a separate research cohort of 1751 asbestos-exposed individuals in Western Australia who have had annual low-dose CT screening since 2012
  • In that separate screening cohort, 5 (29%) of the 17 lung cancers detected over a 5-year period were in never smokers
  • The authors stated that there is no defined role for screening asbestos-exposed populations for mesothelioma
• The authors' conclusion: The authors concluded that asbestos causes a range of lung diseases that are often challenging to diagnose. They also concluded that future screening programs based on estimated malignancy risk, quantitative asbestos exposure estimates and smoking history are indicated.

Topics

Medical terms in this study, explained in our Lexicon: Histology, Cytology, Lung Cancer, Asbestos Exposure.

Related studies

• The diagnosis of nonmalignant diseases related to asbestos — A. Franzblau, R. Lilis (1987)
• Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data — S. Luo, X. Liu, et al. (2003)
• How conflicted authors undermine the World Health Organization (WHO) campaign to stop all use of asbestos: spotlight on studies showing that chrysotile is carcinogenic and facilitates other non-cancer asbestos-related diseases — X. Baur, C.L. Soskolne, et al. (2015)
• Asbestos use and asbestos-related diseases in Asia: past, present and future — G.V. le, K. Takahashi, et al. (2011)
• SWORD '94: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, B.A. Sallie, et al. (1995)
• Asbestos-related disease in railroad workers. A cross-sectional study — L.C. Oliver, E.A. Eisen, et al. (1985)

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