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Asbestos Toxicity
What Other Health Conditions Are Associated with Asbestos?

Course: WB 2344
CE Original Date: January 29, 2014
CE Expiration Date: January 29, 2016
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Learning Objectives

Upon completion of this section, you will be able to

  • Identify non-respiratory conditions that might be associated with exposure to asbestos.

Introduction

Evidence indicates that exposure to asbestos leads to conditions outside the respiratory system, including

  • Peritoneal mesothelioma,
  • Other extra-thoracic cancers, and
  • Cardiovascular conditions secondary to pulmonary fibrosis.

Peritoneal Mesothelioma

Peritoneal mesothelioma is similar to pleural mesothelioma except that it arises in peritoneal membranes. Like pleural mesothelioma, this tumor is rapidly locally invasive and often rapidly fatal after it is diagnosed.

Peritoneal mesothelioma is rare. In men, 90% of all mesotheliomas are pleural [Weill et al. 2004]. In addition, the sex difference in incidence is smaller with peritoneal mesothelioma than for pleural mesothelioma [Hillerdal 1999].

The table below shows male to female incidence ratios for the two different types of mesothelioma.

Table 9. Sex Ratios for Different Types of Mesothelioma

Type of Mesothelioma Male:Female Incidence Ratio
Pleural 5:1
Peritoneal 1.5:1
Source: Hillerdal 1999

Other Extra-thoracic Cancers

Researchers and regulators have not been able to reach a consensus on the effects of asbestos on extra-thoracic cancers. Both the Institute of Medicine (IOM) and the International Agency for Research on Cancer (IARC) have reviewed the state of the evidence regarding the role of asbestos in causing selected extra-thoracic cancers. The recent IARC panel determinations are presented below.

Table 10. Other Extra-thoracic Cancers

Type of Cancer Evidence for Causality by Asbestos
Laryngeal Sufficient evidence for increased risk in asbestos-exposed workers
Ovary Sufficient evidence for increased risk in asbestos-exposed women
Pharyngeal Evidence for associated risk from asbestos exposure is suggestive but not sufficient. More research is needed.
Stomach Evidence for associated risk from asbestos exposure is suggestive but not sufficient.
Colorectal Evidence for risk from asbestos exposure is suggestive but not sufficient. More research is needed. The IARC working group was evenly divided on whether the evidence was sufficient to designate causality.
Esophageal Inadequate evidence exists to determine the risk from asbestos exposure.
Source: IARC 2012

Despite the lack of scientific consensus on the role of asbestos in gastrointestinal cancers, ATSDR and the National Toxicology Program (NTP) concur that it is prudent to consider increased risk of gastrointestinal cancer a possible effect of asbestos exposure [ATSDR 2001a; American Thoracic Society 2004; National Toxicology Program 2011]. Colon cancer screening starting at age 50 is recommended using accepted guidelines [Agency for Healthcare Research and Quality, 2008] but on the basis of current evidence, screening for other extrathoracic cancers in people exposed to asbestos is not currently recommended [American Thoracic Society 2004; Griffith and Maloney 2003].

Cardiovascular Conditions

Cor pulmonale occurs in many forms of far advanced lung disease when fibrosis of the lungs leads to increased resistance to blood flow through the capillary bed. This condition is most commonly seen in patients with severe asbestosis, though it can also occur with less severe fibrotic disease, especially if chronic obstructive pulmonary disease is simultaneously present, as is often the case with asbestos workers who have been smokers.

Constrictive pericarditis rarely occurs secondary to severe asbestos-induced fibrosis or calcification of the pericardium.

Key Points

  • Pleural and peritoneal mesothelioma is a rare, rapidly invasive tumor caused by asbestos exposure.
  • Asbestos exposure is a known risk factor for laryngeal cancer and ovarian cancer.
  • Asbestos exposure might be associated with some other extrathoracic cancers, especially colon cancer.
  • Cor pulmonale can occur secondary to pulmonary fibrosis, mainly in patients with severe asbestosis.
  • Rarely, constrictive pericarditis can occur secondary to asbestos-associated disease.
   

Progress Check

14. Exposure to asbestos is indicated by

A. Malignant mesothelioma of the pleura or peritoneum.
B. Gastrointestinal cancer.
C. Other extra-thoracic cancers.
D. All of the above.

Answer:

To review relevant content, see "Peritoneal Mesothelioma" in this section.

15. The cardiovascular condition most likely to occur secondary to pulmonary fibrosis is

A. Endocarditis.
B. Constrictive pericarditis.
C. Cor pulmonale.
D. All of the above.

Answer:

To review relevant content, see "Cardiovascular Conditions" in this section.

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