Asbestos and mesothelioma: A comment

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FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176708/ RELATED ARTICLES: https://www.researchgate.net/publication/321527973_Asbestos_mesothelioma_and_lung_cancer_a_comment IN RUSSIAN: https://www.umj.com.ua/article/65132 ABSTRACT Asbestos-related risks have been estimated on the basis of extrapolations from the past industrial settings, where exposures were three to four orders of magnitude higher than the current level of airborne fibers in the environment. The linear no-threshold dose-response pattern has been assumed for low exposure levels, although its applicability has never been proven. By analogy with radiation-related diseases, the screening must have contributed to the enhanced registered incidence of asbestos-related diseases in exposed populations and exaggeration of dose-response relationships. In particular, mesothelioma was sought in exposed populations, and accordingly more often found. Mesothelioma can be spontaneous and/or can occur when asbestos fibres are present in the pulmonary or pleural tissues, which does not necessarily imply a cause-effect relationship. The diagnosis of malignant mesothelioma (MM) remains difficult being one of the challenges faced by pathologists. Histologically, MM can resemble various cancers. Some cancers can undergo de-differentiation, becoming histologically similar to MM. Misdiagnosis of MM is a worldwide problem; revisions of archives regularly found inaccurately classified and questionable cases. Different kinds of bias can occur in asbestos research, e.g., detection of fibers in pulmonary or pleural tissues attributing the neoplasm to asbestos, although a cause-effect relationship remains unproven. Some studies rely on work or residence histories of questionable reliability, interviews with relatives, etc. Bias due to litigation may further compromise objectivity. Asbestos-related diseases have been broadly studied in the former Soviet Union; the prevailing opinion is that, if necessary precautions are observed, modern technologies of asbestos production and processing are acceptably safe. A substitution of asbestos by artificial fibers would not necessarily eliminate health risks. In conclusion, some epidemiological studies are biased due to the screening effect in asbestos-exposed populations, over-diagnosis, biased exposure histories, unclear demarcation of mesothelioma from other cancers, as well as industrial interests. It can be reasonably assumed that non-use of asbestos-containing materials (brake linings, fire-resisting, and thermal insulation) augmented the numbers of victims of traffic accidents, fires, terrorist attacks, etc. Bans and restrictions of asbestos should be revaluated on the basis of independent research.

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