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Address for correspondence: Gaetano Rocco, MD, FRCSEd, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, Via Semmola 81, 80131, Naples, Italy
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 1Chest radiograph demonstrating diffuse pleural plaques like tongues of flames arising from the diaphragm.
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).
Contrary to self-reported asbestos exposure, objective estimation of asbestos exposure may also reliably serve as predictor of lung cancer development.
The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers.
However, the latter entails significant allocation of resources and expertise and may be difficult to incorporate in a public health screening program.
whether the concomitant detection of pleural plaques in asymptomatic patients with history of asbestos exposure may justify screening remains to be seen.
The beta-carotene and retinol efficacy trial (CARET) for chemoprevention of lung cancer in high risk populations: smokers and asbestos-exposed workers.
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