Document wKL7Qjkk759OBJxpaL7Jg00p6

ASBESTOS RELATED LUNG DISEASES 189 I. Amoiltt Anttiofliy'lii* ) I S.*!>*" | TKtWA | sprinted by permission e it is mined and where ised on world consump3,000,000 tons. The figat 5,100,000 tons, with .passing the production ..ysician is often help for the exposed fected, particularly if the use, rather than aducts, or if exposure by neighborhood or ss (17) that "the dinagainst his memories ar constellation of abin his apperceptive on to what he recalls ' written by peers with vision" and that he inclusions because he reetty in front of him." ogist sees "the sick pat in relation to a popunisses a truth because data." Perhaps these bad clinician and the theless, the differences ufficient to merit a redge the gap; thus, the Fig. 2. Diagrammatic representation of (he growth of the asbestos industry and the recognition of the associated biologic effects. The following symbols indicate the association with asbestos: ? = 1= probable; = established. purpose of the present review is to evaluate cur rent information, particularly that obtained from epidemiologic studies, in light of the impli cations of this knowledge for clinical practice. The Asbestos Minerals Physical Characteristics and Fiber Types The physician may well question the relevance of the physics and chemistry of the asbestos min erals to the state of his art. The answer is con tained in Gilson's summary of the 1964 New York Conference on the "Biological Effects of Asbestos" (5), in which he identified one of the questions requiring further investigation: "Is the type of asbestos an important factor in the risk of asbestosis, bronchial carcinoma, mesothe lioma, and other tumors?" Because subsequent observations have suggested that this is so (see lateT in this review), knowledge of the type of asbestos to which a person has been exposed should guide the practicing physician in estab lishing a diagnosis and estimating a prognosis. Asbestos is the general term given to a group of minerals that are fibrous in character and re sistant to high temperatures, the two qualities on which their industrial use depends. The most important commercial fibers (shown in table TABLE 1 PATHOLOGIC EFFECTS OF ASBESTOS EXPOSUFIE IN MAN Organ Effect Skin Larynx Lungs Pleura Peritoneum Gastrointestinal tract Ovary Breast Asbestos corns Carcinoma "Asbestos" bodies and/or fibers Diffuse interstitial tlbrosli (asbestosls) Carcinoma (bronchial) Hyaline plaques and calcification Malignant meaottielionrta Pleural effusion Malignant mesothelioma Neoplasia Carcinoma Carcinoma 'Association thought to be causal* except where indicated. t Association, not causo/ettebHshed. Association with Asbestos Exposure* Established Possible Established Established Cofactor with cigarettes Established Established t Possible Establishedf Established Remotely possible Remotely possible Reference 6-9 11-14 5-9 6-9 5-9 6-9 5-9 10 5-9 5-9 16 16