Diseases associated with asbestos exposure. Diagnostic perspectives in forensic pathology

Our plain-English summary of Diseases associated with asbestos exposure. Diagnostic perspectives in forensic pathology, by T. Ehrenreich, I.J. Selikoff (The American Journal of Forensic Medicine and Pathology, 1983).

The study

• Authors: T. Ehrenreich, I.J. Selikoff
• Journal: The American Journal of Forensic Medicine and Pathology
• Published: 1983;4(1):63-72
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000605).

Abstract

Asbestos, a fibrous mineral, has unique physical and chemical properties, including resistance to heat, acids, and other chemicals; flexibility; and great tensile strength. The fibers subdivide into unit fibrils of molecular dimensions, resulting in a vast mineral surface area which has a direct bearing on its unusual features and its numerous applications. Its biological effects, which include fibrogenesis and carcinogenesis, may be related to the cellular reaction, to its large specific surface, or to the size and shape of the fibers. Its oncogenic action may be multiplied by other carcinogens, principally cigarette smoking. There is clinical, pathologic, and epidemiologic evidence that exposure to asbestos, following a long latent period, constitutes an important health hazard. Direct occupational exposure, followed by a long lapsed period after the initial exposure, is associated with pleural plaques and pleural effusion, pulmonary parenchymal fibrosis (asbestosis), pulmonary carcinoma, pleural and peritoneal mesothelioma, and other neoplasms. Indirect exposure may also entail an increased risk of lung disease or mesothelioma or both. Medicolegal investigation of suspected cases includes a lifetime occupational history, clinical history including smoking habits, radiological findings, clinical evidence of asbestosis, and may require detection of asbestos tissue burden.

In plain English

This article was a narrative review of diseases associated with asbestos exposure, written for forensic pathologists. It reported no new study data and drew on earlier published work. The authors described the commercial fiber types (chrysotile, and the amphiboles amosite, anthophyllite, crocidolite and tremolite), how fibers behave in the body, and how asbestos bodies form. They stated that disease follows a latent period that may be as short as 5–15 years but is usually much longer, up to 30–40 years. They ranked types of exposure from highest to lowest risk: direct occupational, indirect occupational, neighborhood, and household and family. They said the risk from general environmental exposure was not known. They described pleural effusions, pleural plaques, asbestosis, pleural and peritoneal mesothelioma, lung cancer and other cancers. Citing earlier studies, they said cigarette smoking multiplies the lung cancer effect in asbestos workers. They called mesothelioma and pleural plaques "signal" lesions of past exposure. The authors concluded that medicolegal investigation includes occupational and smoking history and clinical findings, and may require measuring asbestos in tissue. Parts of the scanned text were scrambled.

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 (no original data; a diagnostic overview for forensic pathology drawing on published literature)
• Exposure: Asbestos in general: chrysotile (white asbestos) and the amphiboles amosite (brown), anthophyllite, crocidolite (blue) and tremolite. Direct and indirect occupational, neighborhood, household and family, and environmental exposure.
• Main results:
  • The authors stated that the latent period before disease may be as little as 5–15 years but is usually much longer, as much as 30–40 years.
  • The authors listed types of exposure in order of decreasing risk. The order was: direct occupational (for example miners, asbestos factory workers, insulation workers), indirect occupational (for example construction, shipyards, automobile repair), neighborhood (within about one-half mile of asbestos factories, shipyards or construction sites), and household and family. They said the risk from general environmental exposure and consumer products was not known.
  • The authors stated that the risk of disease from general environmental air pollution and consumer use of asbestos-containing products was not known at that time.
  • Citing earlier studies, the authors stated that cigarette smoking has a synergistic, multiplicative effect on lung cancer in asbestos workers.
  • The authors stated that benign asbestos-related pleural effusion usually appears less than 20 years after first exposure, a shorter interval than for other asbestos-related diseases.
  • The authors stated that the interstitial lung fibrosis of asbestosis is not specific and may be caused by other agents. Diagnosis is helped by finding asbestos bodies, or by special techniques to show coated and uncoated fibers when bodies are absent.
  • The authors described mesothelioma and pleural plaques as 'signal' lesions whose presence indicates that asbestos exposure has occurred, however transient, remote or minimal.
  • The authors stated that lungs may be scarred enough to cause death while containing only about 0.5 g of asbestos.
• The authors' conclusion: The authors concluded that medicolegal investigation of suspected cases includes a lifetime occupational history, clinical history including smoking habits, radiological findings and clinical evidence of asbestosis, and may require detection of asbestos tissue burden.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pathology, Flexibility, Tensile Strength, Fibril, Carcinogenesis, Occupational Exposure, Pleural Plaques.

Related studies

• Forensic detection and investigation of occupational-environmental disease — T. Ehrenreich, I.J. Selikoff (1980)
• Widening perspectives of occupational lung disease — I.J. Selikoff (1973)
• 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 diseases. Algorithm for forensic pathological diagnosis — T. Ehrenreich, T. Espinosa, et al. (1982)
• Clinical presentation of asbestosis with intractable pleural pain in the adult child of a taconite miner and radiographic demonstration of the probable pathology causing the pain — M.R. Harbut, C. Endress, et al. (2009)
• Global perspectives of emerging occupational and environmental lung diseases — S. Moitra, R. Puri, et al. (2015)

Browse more research in The American Journal of Forensic Medicine and Pathology, or return to medical research.