Exposure and Environmental Risk of Lung Cancer and Mesothelioma

Gunnar Hillerdal, M.D., Department of Lung Diseases, Karolinska Hospital, Stockholm, and Akademic Hospital, Uppsala, Sweden

Introduction That certain mineral fibers can cause disease has been known since the early 20th century, when the first cases of asbestosis were described. In the 1940ies the risk of lung cancer was first described and later malignant mesothelioma.

It is now well known that mineral fibers can cause diseases and changes in the lung parenchyma and the pleura, which are the main targets since the fibers are inhaled, but also in many other parts of the body. The medical studies come mainly from occupational exposures, but environmental exposure is also possible and can pose grave dangers.

There are many hundred different fibers in the mineral world, both naturally occurring and man-made ones. Only a few do, however, occur in amounts and environments that make it possible for humans to be exposed.

Those that are known are the ones collectively known as asbestos and a fibrous zeolite called erionite. There might well exist other fibers in various parts of the world that could lead to human disease but has not yet been recognized.

This review will first describe the benign pleural lesions which can be caused by asbestos and discuss whether they can be used as “sentinel signs” of such exposure, and then give a short review of findings and diseases in “endemic areas”, i e places in the world where lesions and/or diseases due to environmental exposure to asbestos have been reported. The different asbestos fibers can give different medical findings.