Primary prevention
Elimination of exposure through substitution with other materials will eliminate the risk of developing asbestosis and pleural-related changes.[7] Minimization of exposure through engineering controls (i.e., enclosing work process or exhaust hoods) is the next best approach after substitution to reduce the risk of disease. Respirators with high protection factors (i.e., positive pressure or full face mask) are used for work where the location and conditions vary, although the effectiveness of these vary according to the type of respirator and the asbestos concentration in the environment.[15] Provision to ensure that asbestos is not tracked home, such as laundering work clothes at work and lockers for clean (street) and dirty (work) clothes separated by a shower, are required to reduce exposure to workers' family members.
Secondary prevention
Patients with asbestosis should receive immunization against pneumococcal pneumonia, influenza, and coronavirus disease 2019 (COVID-19). Vaccination schedules vary by location; consult local guidance for recommendations, including special patient populations.[42]
Among the asbestos-related cancers, screening for colon cancer is the most beneficial. Colon cancer screening should follow standard guidelines.[43][44] The United States Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low density CT scan in adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have stopped within the past 15 years.[45] They also recommend that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits their life expectancy or the ability or willingness to have curative lung surgery. The guidelines do not address screening in individuals who have never smoked or those who do not meet the minimum cigarette smoking cut-off but who are at increased risk of lung cancer because they have a history of asbestos exposure or asbestos-related scarring. Lung cancer mortality is increased in individuals with asbestos exposure and is even greater in individuals with asbestosis. The rate ratio is 3.6 in nonsmokers with asbestos exposure, 7.4 in nonsmokers with asbestosis, 10.3 in smokers without asbestos exposure, 14.4 in smokers with asbestos exposure, and 36.8 in smokers with asbestosis.[26] The risk of lung cancer in a person with asbestosis, whether or not they smoked cigarettes, is greater than the risk level used in the USPSTF guidelines to indicate which smokers would benefit from the use of low-dose CT scans for screening for lung cancer. It therefore follows that the USPSTF screening recommendations should be applied to patients with asbestosis regardless of their smoking history. Pleural thickening from asbestos exposure indicates past asbestos exposure but its presence (unlike the presence of asbestosis) does not indicate the need for screening for lung cancer.[26]
If a patient with asbestosis indicates that he or she brought work clothes home to be washed and/or wore work boots home, then the patient's spouse, children, or other relatives living in the home were potentially exposed to asbestos. If that time period is more than 15-20 years ago, a chest x-ray of those family members is recommended.
Randomized control studies of beta-carotene supplementation of asbestos-exposed workers have not been effective in reducing the incidence of lung cancer. In fact, beta-carotene supplementation increased the risk of developing lung and gastric cancer in asbestos-exposed workers.[46]
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