Revue des maladies respiratoires
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Asbestos-related benign pleural lesions can involve the parietal pleura (pleural plaques), and/or visceral pleura as focal or diffuse (diffuse pleural thickening) fibrosis. Benign asbestos pleurisy and rounded atelectasis are linked with visceral pachypleuritis, the former as a cause, the latter as a consequence. The prevalence of these lesions, particularly pleural plaques, is very high, reaching 25% in populations of workers exposed intermittently to asbestos. ⋯ The cost and the risk of diagnostic procedures induced by the screening, as well as the anxiety provoked by the detection of radiologic abnormalities are to be considered. Finally it is difficult today to justify the screening of benign pleural lesions by arguing an improvement of the life expectancy or of the quality of life of former asbestos exposed workers. It is probable that benefit of a screening will be of a social type, at an individual or a collective level.
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Despite the lack of precision of asbestos exposure assessments and the limitations of the main diagnostic epidemiological tool for asbestos-related diseases (i.e. standard X ray films), several issues concerning the risk of development of asbestos-related diseases are well established. For asbestosis, now a rare disease, the existence of a positive dose-response relationship, with a threshold or no-effect level, has been clearly demonstrated. The slope of the relationship curve is steeper for amphiboles than for chysotile, as it is for increased fiber length. ⋯ They have no prognostic significance in asbestos-exposed workers, but are associated with an increased risk for the subsequent development of mesothelioma and bronchial carcinoma when compared to the risk of the general population. Diffuse pleural thickening is associated with higher levels of asbestos exposure than those associated with pleural plaques. It usually follows a benign pleural effusion, which is a less frequent but earlier consequence of asbestos exposure than the other asbestos-related diseases documented above.