Asbestos-related conditions can be difficult to identify. Healthcare providers usually identify the possibility of asbestos exposure and related health conditions, like lung and pleural disease, by taking a thorough medical history. This includes looking at the person's medical, work, cultural, and environmental history. After a physician suspects an asbestos-related health condition, he or she can use a number of tools to help make the actual diagnosis.
An accurate medical history is essential for an accurate diagnosis.
Ways to Detect Lung and Pleural Disease include
1. Physical Examination
2. Chest X-ray - The chest X-ray is the most common tool used to detect lung and pleural disease caused by chronic exposure to asbestos. X-rays often show pleural changes in people who have been exposed to asbestos. Although X-rays cannot specifically determine if a condition is asbestos-related, lung abnormalities can be noted. These changes include pleural plaques (the most frequent lesions): discrete, elevated, opaque, shiny fibrosis lesions that are currently more common than asbestosis in exposed persons; diffuse pleural thickening and pleural effusions, are early manifestations of inhalation exposure to high concentrations of asbestos. Pleural effusions can be an early indication of mesothelioma and warrant further evaluation. Early identification of mesothelioma and intervention can increase chances of survival
Chest X-Rays are the most common method of detecting asbestos-related disorders.
3. Pulmonary function tests
A patient performs a pulmonary function test.
4. Biopsy/Bronchoscopy - A lung biopsy to detect asbestos fibers in pieces of lung tissue, while not needed to make a clinical diagnosis, is the most reliable test to determine the presence of asbestos-related effects. Less invasive tests (e.g. bronchoscopy) can detect asbestos fibers or asbestos bodies in bronchoalveolar lavage fluid or in sputum. These tests, however, do not reliably indicate how much asbestos a person may have been exposed to or predict whether disease will develop.
5. Computed Tomography Scans (CT Scans) - Over the past 20 years, several investigators have evaluated the potential of conventional scans for detecting abnormalities in asbestos-exposed workers. During 2001, ATSDR completed a study examining the effectiveness of CT-scans in detecting asbestos-related lung abnormalities as a part of a medical testing program conducted in Libby, Montana, where asbestos exposure occurred. Click here to read the protocol for the ATSDR study. A CT scan is an image produced by an X-ray source that rotates around the patient. The beams pass through the patient and are detected on the other side. This information is analyzed by computer to generate a cross-sectional view of the patient at that level. Studies have shown that CT offers several advantages over routine chest radiography (X-ray). First, the use of cross-sectional images often makes it possible to distinguish between densities that would be superimposed on plain radiographs. Second, CT is far better than routine radiographic studies at characterizing tissue density, distinguishing subtle differences in density between adjacent structures, and providing accurate size assessment of lesions.
Treatment for Nonmalignant-Illnesses
Unfortunately, no cure exists for asbestosis or other lung or pleural diseases caused by chronic exposure to asbestos. Treatment involves preventing further complications and treating symptoms.
Preventing further exposure and ceasing any tobacco smoking activities are the most important steps individuals can take to minimize development of health problems. Once established, these diseases can remain stable or progress in severity in the absence of further exposure. The diseases rarely regress.
Treatment for Malignant Illnesses
Treatment options for patients diagnosed with asbestos-related cancer of the lung or pleura are limited to resection (surgical removal of a part), chemotherapy, or both.
Future research could help to develop therapeutic methods to interfere with the development of asbestos-induced lung and pleural disorders to cause the disorders to regress once they are established.
The National Jewish Medical and Research Center partnered with ATSDR in its asbestos investigations in Libby, Montana. The center treats asbestos-related illnesses. To learn more about the center and how to access its services, visit their Web site.
The National Cancer Institute web site also offers more information on treatment.
The following are important steps for minimizing risks of asbestos-related disorders:
ATSDR expects people who were exposed to asbestos and who smoke to be unusually susceptible to asbestos-related lung cancer and asbestosis. Studies of asbestos workers indicate that asbestos-exposed smokers have greater than additive risks for lung cancer and asbestosis than asbestos-exposed nonsmokers. These people are strongly encouraged to quit smoking. See the patient handout Cigarette Smoking, Asbestos Exposure, and your Health.
Individuals living or working in buildings with vermiculite insulation or other building materials that could contain asbestos are encouraged to ensure that the insulation material is in good repair and not disturbed in order to prevent the release of asbestos fibers. If the material is to be removed or disturbed for any reason, special procedures to minimize the generation of dust and specify appropriate locations for disposal must be followed. Individuals can obtain information about asbestos removal and disposal procedures from the 10 regional offices of the EPA.
ATSDR Medical Testing In Libby, Montana
ATSDR conducted face-to-face interviews with individuals to help determine the extent of asbestos-related illness in Libby, Montana.
This medical testing program was designed to
Participants were encouraged to consult their individual health care providers. ATSDR does not provide and is not authorized by Congress to provide medical diagnosis or treatment.
The medical testing consisted of (1) a face-to-face questionnaire designed to obtain exposure information, including detailed information about potential pathways of exposure and to collect information about respiratory symptoms, demographics, and smoking; (2) spirometry to provide an objective measurement of lung function and (3) chest radiograph (X-ray) to identify asbestos-related changes in the parenchyma and pleura of the lungs. Chest X-rays were evaluated and were interpreted by onsite clinical radiologists as well as a panel of three national experts in asbestos-related conditions.
Right: A chest X-ray is the most common tool used to detect asbestos-related illnesses.
Results of Medical Testing
The results of the asbestos medical testing conducted the summer of 2000 are available (Read the Year 2000 Medical Testing for more details), and the results from the 2001 testing will be released in 2002. Major findings of the medical testing completed in 2000 include:
Experts found that 994 of the 5,590 participants - or 18% of those X-rayed - had abnormalities in the lining of their lungs (pleural abnormalities). The risk of pleural abnormality increased with increasing age and increasing length of residence in the Libby area. In comparison, the rate of pleural abnormalities found in groups within the U.S. who have no known asbestos exposures ranges from 0.2% to 2.3%.
Lung Function Test Findings
Lung function tests (spirometry) were offered to all study participants. An on-site pulmonologist interpreted all tests. Some of the key findings are as follows:
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This page last updated on October 30, 2008