Asbestosis

Required screening

Workplace regulations promulgated by the Occupational Safety and Health Administration (OSHA) require that workers exposed to asbestos at or above 0.1 fibres/cm³ have an annual examination that consists of a medical and occupational history, a physical examination focused on the respiratory system and spirometry. Chest x-ray is required at baseline every 5 years within the first 10 years from the onset of asbestos exposure and for those aged ≤35 years. After 10 years of latency, it is required every 2 years for those aged >35 years through 45 years and every year for those aged >45 years.

OSHA: asbestos standard for general industry Opens in new window

In the UK, the Health and Safety Executive (HSE) has published guidance for physicians undertaking medical monitoring of workers who do licensed or unlicensed asbestos work.

HSE: guidance for appointed doctors on medical surveillance of workers doing licensed work with asbestos Opens in new window

HSE: guidance for doctors on medical surveillance of workers doing non-licensed work with asbestos Opens in new window

There is an increased risk of lung cancer among both cigarette smokers and never smokers with asbestos exposure.[25]Selikoff IJ, Seidman H. Asbestos-associated deaths among workers in the United States and Canada, 1967-1987. Ann NY Acad Sci. 1991 Dec 31;643:1-14. http://www.ncbi.nlm.nih.gov/pubmed/1809121?tool=bestpractice.com [26]Markowitz SB, Levin SM, Miller A, et al. Asbestos, asbestosis, smoking, and lung cancer. New findings from the North American insulator cohort. Am J Respir Crit Care Med. 2013 Jul 1;188(1):90-6. http://www.ncbi.nlm.nih.gov/pubmed/23590275?tool=bestpractice.com [27]Lee PN. Relation between exposure to asbestos and smoking jointly and the risk of lung cancer. Occup Environ Med. 2001 Mar;58(3):145-53. https://oem.bmj.com/content/58/3/145.long http://www.ncbi.nlm.nih.gov/pubmed/11171926?tool=bestpractice.com [28]Frost G, Darnton A, Harding AH. The effect of smoking on the risk of lung cancer mortality for asbestos workers in Great Britain (1971-2005). Ann Occup Hyg. 2011 Apr;55(3):239-47. https://academic.oup.com/annweh/article/55/3/239/150776 http://www.ncbi.nlm.nih.gov/pubmed/21252055?tool=bestpractice.com [29]Olsson AC, Vermeulen R, Schüz J, et al. Exposure-response analyses of asbestos and lung cancer subtypes in a pooled analysis of case-control studies. Epidemiology. 2017 Mar;28(2):288-99. https://journals.lww.com/epidem/Fulltext/2017/03000/Exposure_Response_Analyses_of_Asbestos_and_Lung.19.aspx http://www.ncbi.nlm.nih.gov/pubmed/28141674?tool=bestpractice.com ​ Low dose chest computed tomography is advisable for:​​[30]​Markowitz SB. Lung cancer screening in asbestos-exposed populations. Int J Environ Res Public Health. 2022 Feb 25;19(5):2688. https://www.mdpi.com/1660-4601/19/5/2688 http://www.ncbi.nlm.nih.gov/pubmed/35270380?tool=bestpractice.com

• Those aged ≥50 years with a history of ≥5 years of asbestos exposure in combination with either a history of smoking at least 10 pack-years with no limit on time since quitting, or

• A history of asbestos-related parenchymal fibrosis.

General population

Screening of former workers with asbestos exposure or residents of areas where there is either natural or industrially derived asbestos contamination should be advised to minimise any future exposure, to emphasise the importance of smoking cessation, to identify people who are at increased risk of asbestos-associated cancers and to identify individuals who can take legal action for compensation.[1]American Thoracic Society. Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med. 2004 Sep 15;170(6):691-715. https://www.atsjournals.org/doi/full/10.1164/rccm.200310-1436ST#.U7_nqvldVlw http://www.ncbi.nlm.nih.gov/pubmed/15355871?tool=bestpractice.com There are no medicines that are known to be useful after early identification to prevent progression. Medical and occupational history, spirometry and chest x-ray are used for screenings. Lung volumes, diffusing capacity, oblique x-rays, and high-resolution computed tomography are all more sensitive and, although used in a clinical setting for individual patients, typically have not been used in mass population-based screenings.