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Lungs on Fire

      An 85-year-old man, formerly heavy smoker, was referred after a 6-month history of weight loss and increasing weakness. The patient reported an occupational exposure to asbestos due to working over 30 years in a shipyard. The chest radiograph showed bilateral pleural calcifications distributed unevenly from the lung base to the apex (Fig. 1). Chest computed tomography demonstrated a left lower lobe mass suspicious for lung cancer (Fig. 2). After detailed discussion of possible therapeutic options, the patient refused further diagnostic work-up and treatment.
      Figure thumbnail gr1
      FIGURE 1Chest radiograph demonstrating diffuse pleural plaques like tongues of flames arising from the diaphragm.
      Figure thumbnail gr2
      FIGURE 2Chest computed tomography showing a left lower lobe mass suspicious for lung cancer surrounded by pleural plaques.
      Lung cancer can be caused by asbestos exposure.
      • Hieckel HG
      • Hering KG
      [Asbestos-related diseases of the thorax].
      The association between lung cancer and asbestos plaques has been considered at best controversial.
      • Pairon JC
      • Andujar P
      • Rinaldo M
      • et al.
      Asbestos exposure, pleural plaques and the risk of death from lung cancer.
      However, recent evidence obtained from a study on more than 5400 male individuals enrolled in an asbestos-related disease screening program confirmed that, after adjustment for smoking, lung cancer mortality was associated with the detection of pleural plaques (hazard ratio = 2.41; 95% confidence interval = 1.21–4.85).
      • Pairon JC
      • Andujar P
      • Rinaldo M
      • et al.
      Asbestos exposure, pleural plaques and the risk of death from lung cancer.
      Contrary to self-reported asbestos exposure, objective estimation of asbestos exposure may also reliably serve as predictor of lung cancer development.
      • Omenn GS
      • Goodman G
      • Thornquist M
      • et al.
      The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers.
      • Field JK
      • Smith DL
      • Duffy S
      • Cassidy A
      The Liverpool lung project research protocol.
      However, the latter entails significant allocation of resources and expertise and may be difficult to incorporate in a public health screening program.
      • Bach PB
      • Kattan MW
      • Thornquist MD
      • et al.
      Variations in lung cancer risk among smokers.
      • Cassidy A
      • Myles JP
      • van Tongeren M
      • et al.
      The LLP risk model: an individual risk prediction model for lung cancer.
      In conclusion, although the presence of pleural plaques could be an independent risk factor for lung cancer,
      • Pairon JC
      • Andujar P
      • Rinaldo M
      • et al.
      Asbestos exposure, pleural plaques and the risk of death from lung cancer.
      whether the concomitant detection of pleural plaques in asymptomatic patients with history of asbestos exposure may justify screening remains to be seen.

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