Nonpulmonary outcomes of asbestos exposure

Our plain-English summary of Nonpulmonary outcomes of asbestos exposure, by M. Bunderson-Schelvan, J.C. Pfau, R. Crouch, et al (Journal of Toxicology and Environmental Health. Part B, Critical Reviews, 2011).

The study

• Authors: M. Bunderson-Schelvan, J.C. Pfau, R. Crouch, A. Holian
• Journal: Journal of Toxicology and Environmental Health. Part B, Critical Reviews
• Published: 2011;14(1-4):122-52
• Type of article: Review
• Cited by: 43 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The adverse pulmonary effects of asbestos are well accepted in scientific circles. However, the extrapulmonary consequences of asbestos exposure are not as clearly defined. In this review the potential for asbestos to produce diseases of the peritoneum, immune, gastrointestinal (GIT), and reproductive systems are explored as evidenced in published, peer-reviewed literature. Several hundred epidemiological, in vivo, and in vitro publications analyzing the extrapulmonary effects of asbestos were used as sources to arrive at the conclusions and to establish areas needing further study. In order to be considered, each study had to monitor extrapulmonary outcomes following exposure to asbestos. The literature supports a strong association between asbestos exposure and peritoneal neoplasms. Correlations between asbestos exposure and immune-related disease are less conclusive; nevertheless, it was concluded from the combined autoimmune studies that there is a possibility for a higher-than-expected risk of systemic autoimmune disease among asbestos-exposed populations. In general, the GIT effects of asbestos exposure appear to be minimal, with the most likely outcome being development of stomach cancer. However, IARC recently concluded the evidence to support asbestos-induced stomach cancer to be "limited." The strongest evidence for reproductive disease due to asbestos is in regard to ovarian cancer. Unfortunately, effects on fertility and the developing fetus are under-studied. The possibility of other asbestos-induced health effects does exist. These include brain-related tumors, blood disorders due to the mutagenic and hemolytic properties of asbestos, and peritoneal fibrosis. It is clear from the literature that the adverse properties of asbestos are not confined to the pulmonary system.

In plain English

This article was a review, not a new study. The authors drew on several hundred published human, animal and laboratory studies of asbestos effects outside the lungs. These covered the peritoneum (the abdominal lining), the immune system, the digestive tract and the reproductive system. The authors concluded that the literature supports a strong association between asbestos exposure and peritoneal tumors, and that crocidolite and other amphiboles pose the greatest risk compared with chrysotile. They judged that positive antinuclear antibody tests were more frequent among asbestos-exposed people, and that there appears to be a higher-than-expected risk of systemic autoimmune disease. Digestive-tract effects appeared minimal, though a link to stomach cancer remained possible. For reproduction, the strongest evidence concerned ovarian cancer, while effects on fertility and the fetus were under-studied. They also raised possible brain tumors, blood disorders and peritoneal fibrosis, the last documented only in animals. The authors noted that they depended on the original studies' own interpretations and that studies were scarce on some topics. They concluded that asbestos's adverse effects are not confined to the lungs.

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: Literature review of epidemiological, animal (in vivo) and laboratory (in vitro) studies
• Who was studied: Several hundred published epidemiological, in vivo and in vitro studies that monitored outcomes outside the lungs after asbestos exposure; no search dates or exact count given
• Exposure: Asbestos in general. Most reviewed studies concerned chrysotile and/or crocidolite; routes considered included inhalation and ingestion of contaminated food and water
• Main results:
  • The authors concluded that the literature supports a strong association between asbestos exposure and peritoneal tumors (neoplasms)
  • The authors concluded that occupational exposure to crocidolite and other amphiboles poses the greatest risk of peritoneal tumors compared with chrysotile
  • The authors concluded that positive antinuclear antibody (ANA) tests are more frequent among asbestos-exposed individuals than in the general population
  • The authors concluded that there appears to be a higher-than-expected risk of systemic autoimmune disease among asbestos-exposed populations
  • The authors concluded that gastrointestinal effects of asbestos appear minimal but the data are inconclusive, with a possible link to stomach cancer
  • The authors concluded that a link to stomach cancer remains possible
  • The authors judged that the strongest evidence for reproductive disease from asbestos concerns ovarian cancer
  • The authors stated that effects on fertility and the developing fetus are under-studied
  • The authors raised possible other effects, including brain-related tumors, blood disorders and peritoneal fibrosis
  • The authors noted that peritoneal fibrosis has been documented only in animals
  • The authors noted that there is little evidence linking asbestos to brain-related tumors
• The authors' conclusion: The authors concluded that the adverse properties of asbestos are not confined to the lungs, and called for large prospective studies of different asbestos exposures
• Limitations the authors state:
  • The review depended on the original authors' interpretations and conclusions
  • Few studies were available on some outside-the-lung effects
  • Studies of amphiboles other than crocidolite were too few to draw conclusions
  • In the autoimmune literature, few studies used an appropriate age-matched comparison group

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Peritoneum, Neoplasm, Stomach Cancer, IARC, Ovarian Cancer, Fibrosis.

Related studies

• Analysis of news of the Japanese asbestos panic: a supposedly resolved issue that turned out to be a time bomb — Y. Takahashi, K. Miyaki, et al. (2007)
• Environmental exposure to asbestos: A factor in the rising rate of cancer in the industrialized world? — M.R. Becklake (1979)
• Assessing the power and quality of epidemiologic studies of asbestos-exposed populations — D.L. Davis, B. Mandula, et al. (1985)
• Non-neoplastic and neoplastic pleural endpoints following fiber exposure — V.C. Broaddus, J.I. Everitt, et al. (2011)
• Factors that impact susceptibility to fiber-induced health effects — J.E. Below, N.J. Cox, et al. (2011)
• After a Century of Research into Environmental Mutagens and Carcinogens, Where Do We Stand? — J.D. Vitorino, P.M. Costa (2023)

Browse more research in Journal of Toxicology and Environmental Health. Part B, Critical Reviews, or return to medical research.