Does asbestos exposure cause lung cancer?

Although exposure to asbestos alone can lead to lung cancer, the risk increases dramatically in smokers of cigarettes or other forms of tobacco.

♦  In nonsmokers who have been exposed to asbestos, the risk of lung cancer is five times that of unexposed workers.

♦  Smokers who are exposed to asbestos have a 50 to 84 times greater risk of lung  cancer, according to the Agency for Toxic Substances Disease Registry.

Lung cancer in asbestos-exposed and unexposed individuals is similar in both the type of cancer and its signs and symptoms. The link between cigarette smoking, asbestos and cancer of the lung itself does not apply to cancer of the lining of the lung. Diagnosis and treatment of lung cancer is a complex topic and a pulmonary specialist should be involved in the workup of a suspected lung cancer.

 

General Information

Significant exposure to any type of asbestos will increase the risk of lung cancer, mesothelioma and nonmalignant lung and pleural disorders, including asbestosis, pleural plaques, pleural thickening, and pleural effusions. This conclusion is based on observations of these diseases in groups of workers with cumulative exposures ranging from about 5 to 1,200 fiber-year/mL. Such exposures would result from 40 years of occupational exposure to air concentrations of 0.125 to 30 fiber/mL. See Detecting Asbestos, for typical levels of concentration. The conclusion is supported by results from animal and mechanistic studies.

 

Diseases from asbestos exposure take a long time to develop. Most cases of lung cancer or asbestosis in asbestos workers occur 15 or more years after initial exposure to asbestos. Tobacco smokers who have been exposed to asbestos have a “far greater-than-additive” risk for lung cancer than do nonsmokers who have been exposed, meaning the risk is greater than the individual risks from asbestos and smoking added together. The time between diagnosis of mesothelioma and the time of initial occupational exposure to asbestos commonly has been 30 years or more. Cases of mesothelioma have been reported after household exposure of family members of asbestos workers and in individuals without occupational exposure who live close to asbestos mines.

Asbestos Facts

• When asbestos fibers are inhaled, most fibers are expelled, but some can become lodged in the lungs and remain there throughout life.  Fibers can accumulate and cause scarring and inflammation. Enough scarring and inflammation can affect breathing, leading to disease.
• The term “naturally occurring asbestos” refers to the mineral as a natural component of soils or rocks as opposed to asbestos in commercial products, mining or processing operations. Naturally occurring asbestos can be released from rocks or soils by routine human activities, such as construction, or natural weathering processes. If naturally occurring asbestos is not disturbed and fibers are not released into the air, then it is not a health risk.
• People are more likely to experience asbestos-related disorders when they are exposed to high concentrations of asbestos, are exposed for longer periods of time, and/or are exposed more often.
• Inhaling longer, more durable asbestos fibers (such as tremolite and other amphiboles) contributes to the severity of asbestos-related disorders.
• Exposure to asbestos can increase the likelihood of lung cancer, mesothelioma, and non-malignant lung conditions such as asbestosis (restricted use of the lungs due to retained asbestos fibers) and changes in the pleura (lining of the chest cavity, outside the lung).
• Changes in pleura such as thickening, plaques, calcification, and fluid around the lungs (pleural effusion) may be early signs of asbestos exposure. These changes can affect breathing more than previously thought. Pleural effusion can be an early warning sign for mesothelioma (cancer of the lining of the lungs).
• Most cases of asbestosis or lung cancer in workers occurred 15 years or more after the person was first exposed to asbestos.
• Most cases of mesothelioma are diagnosed 30 years or more after the first exposure to asbestos.
• Asbestos-related disease has been diagnosed in asbestos workers, family members, and residents who live close to asbestos mines or processing plants.
• Health effects from asbestos exposure may continue to progress even after exposure is stopped.
• Smoking or cigarette smoke, together with exposure to asbestos, greatly increases the likelihood of lung cancer. See Cigarette Smoking, Asbestos Exposure, and your Health.

 

Health Risks of Asbestos Exposure

Chronic exposure to asbestos may increase the risk of lung cancer, mesothelioma, and nonmalignant lung and pleural disorders. Evidence in humans comes from epidemiologic studies as well as numerous studies of workers exposed to asbestos in a variety of occupational settings. Tremolite asbestos exposure has been associated with an increased incidence of disease in vermiculite miners and millers from Libby, Montana. This evidence is supported by reports of increased incidences of nonmalignant respiratory diseases, lung cancer, and mesothelioma in villages in various regions of the world that have traditionally used tremolite-asbestos whitewashes in homes or have high surface deposits of tremolite asbestos and by results from animal studies.

 

Risk Factors

Various factors determine how exposure to asbestos affects an individual:

• Exposure concentration – what was the concentration of asbestos fibers?
• Exposure duration – how long did the exposure time period last?
• Exposure frequency – how often during that time period was the person exposed?
• Size, shape and chemical makeup of asbestos fibers:

Long and thin fibers are expected to reach the lower airways and alveolar regions of the lung, to be retained in the lung longer, and to be more toxic than short and wide fibers or particles. Wide particles are expected to be deposited in the upper respiratory tract and not to reach the lung and pleura, the sites of asbestos-induced toxicity. Short, thin fibers, however, may also play a role in asbestos pathogenesis. Fibers of amphibole asbestos such as tremolite asbestos, actinolite asbestos, and crocidolite asbestos are retained longer in the lower respiratory tract than chrysotile fibers of similar dimension.

• Individual risk factors, such as a person’s history of tobacco use (smoking) and      other pre-existing lung disease, etc.

Note, cigarette smoke and asbestos together significantly increase your chances of getting lung cancer. Therefore, if you have been exposed to asbestos you should stop smoking. This may be the most important action that you can take to improve your health and decrease your risk of cancer.

Conditions Associated with Asbestos

 

Asbestosis

Asbestosis is a serious, progressive, long-term disease of the lungs. Asbestosis is not a cancer. Inhaling asbestos fibers that irritate and inflame lung tissues, causing the lung tissues to scar, causes asbestosis. The scarring makes it hard to breathe and difficult for oxygen and carbon dioxide pass through the lungs. Asbestosis generally progresses slowly. The latency period for the onset of asbestosis is typically 10-20 years after the initial exposure. The disease can vary from asymptomatic (no symptoms) to disabling and potentially fatal.

Signs and Symptoms of asbestosis can include:

• Shortness  of breath is the primary symptom
• A persistent and productive cough (a cough that expels mucus)
• Chest tightness
• Chest pain
• Loss of appetite
• A dry, crackling sound in the lungs while inhaling.

Pleural Abnormalities

Persons with significant exposure to asbestos are at risk for developing various types of pleural (lining of the chest cavity, outside the lungs) abnormalities. These abnormalities include pleural plaques, pleural thickening, pleural calcification, and pleural mesothelioma.

Mesothelioma

Mesothelioma is a rare cancer, which may affect the lining of the chest cavity, outside the lung (pleura) or the abdominal contents (peritoneum). Most mesotheliomas are caused by exposure to asbestos.

Lung Cancer

Lung cancer is a malignant tumor that invades and obstructs the lung’s air passages. Cigarette smoking greatly increases the likelihood of a person developing lung cancer as the result of asbestos exposure. The most common symptoms of lung cancer are cough, wheezing, unexplained weight loss, coughing up blood, and labored breathing. Other symptoms of lung cancer include shortness of breath, persistent chest pain, hoarseness, and anemia. People who develop these symptoms do not necessarily have lung cancer, but they should consult a physician for advice.

 

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