Mesothelioma, Asbestos Lung Cancer, Asbestosis, Pleural Thickening & Pleural Plaques

There are five main asbestos diseases including asbestos cancers that can develop following exposure to asbestos fibres These are malignant asbestos mesothelioma cancer, asbestos lung cancer, asbestosis, asbestos pleural thickening and asbestos pleural plaques, however,

Doctors who do not regularly diagnose asbestos disease can misdiagnose (or be slow to give a diagnosis) what the condition is because:-

A history of asbestos exposure may not be volunteered to the doctor at an early stage as it may have occurred 30, 40, 50 or even more years prior to seeing the doctor and may have been forgotten about. A striking feature of asbestos disease is this long latency period between exposure and onset of symptoms, the fibres laying dormant for many years before causing asbestos disease or symptoms for which medical advice is sought.

Some asbestos diseases require exposure to only very few asbestos fibres to cause illness, especially mesothelioma which can be caused by just one fibre being inhaled into the lungs! This adds to the above mentioned difficulty of no, or only poor, recollection of exposure to asbestos fibres and accurate diagnosis.

As chest physicians become more aware of asbestos disease, due to its increasing incidence, and the need to ask patients at an early stage if they have ever been exposed to asbestos fibres, these difficulties become less and less of an issue, however, in addition to early history taking the following further difficulties regularly arise.

The radiological evidence (shown on x-ray films) is often misunderstood. This can often lead to a incorrect diagnosis being made in asbestos disease cases of pleural plaques and pleural thickening. This is usually due to inexperience and the fact that radiological evidence of asbestos pleural plaques is similar, to the inexperienced eye, to asbestos pleural thickening and vice versa.

This is important in the context of asbestos UK disease litigation as asbestos pleural plaques is currently not considered to be an "injury" by the UK courts for which compensation can be awarded! This is in spite of the fact that pleural plaques sufferers were routinely awarded compensation for twenty years prior to a Court of Appeal ruling in 2006.

Accurate diagnosis in cases of asbestos pleural thickening can be difficult due to the fact that apart from the potential for it to be radiologically confused with pleural plaques, it can also be confused with other non-asbestos related injuries or illnesses. For example, as part of the careful history taking in cases of suspected pleural thickening, it is important to ask the patient if they have ever had a fractured rib or ribs. The healing process of a fractured rib can leave behind radiological evidence that shows up on x-rays as pleural thickening. Other prior lung complications and conditions can also leave behind such evidence.

Difficulties can also arise when trying to arrive at an accurate diagnosis in cases of asbestosis. Asbestosis is the scarring of lung tissue caused by asbestos fibres in the lungs. The difficulty here is that scarring of lung tissue can be caused by other factors or foreign bodies entering the lungs and not just asbestos fibres. Lung scarring or fibrosis appears the same on x-ray films regardless of what has caused it. It is therefore crucial, perhaps more so than with any other asbestos disease, to ensure an early and very detailed history of significant exposure to asbestos fibres is taken and recorded as lung fibrosis can only be diagnosed as asbestosis if the patient has suffered significant and heavy exposure to asbestos fibres in the past.