Asbestos-related diseases: a historical and mineralogic perspective.

Abstract

T HE PAST HALF-CENTURY witnessed a remarkable feat: the medical and scientific community identified one of nature’s deadliest killers, investigated it thoroughly, learned how to prevent it, and is on the verge of eradicating it. Asbestos-related disease is also unique as the first nonbiologic entity to almost fulfill Koch’s postulates, in which asbestos fibers were “isolated” in the lungs of workers suffering from mesothelioma, and are capable of producing mesotheliomas in experimental animals. Historically, asbestos has been suspected of causing lung disease since antiquity (Table 1). Well known for its resistance and insulating properties, asbestos was used primarily as a cloth-like material, from which garments and purses were made in the 19th century (Fig 1). However, after the Industrial Revolution, the uses of asbestos multiplied and production reached staggering proportions. Soon, reports of ill-effects were made, but they did not take hold in the scientific community until 1960, when Wagner et al’ described mesothelioma in South African asbestos workers. Subsequent clinical, pathologic, and epidemiologic studies have amply linked asbestos with asbestosis, lung cancer, and mesothelioma. All of these are covered in this issue of the Seminars, with emphasis on diagnostic challenges and medicolegal implications of asbestosrelated diseases. The evidence connecting asbestos to pulmonary diseases accumulated rapidly, linking asbestos to mesothelioma in the United States,*v3 Canada,4 and the United Kingdom. 5,6 However, epidemiologic studies showed that prevalence of asbestos exposure ranged from as low as 10% to 30%,4,7-9 to as high as 80% to 100% ‘,2,‘o-‘3 among patients with mesothelioma (Table 2). This discrepancy may be due to the varying methodology of obtaining history related to occupation, residence, and hobbies, and the fact that the data are frequently supplied by the next-of-kin of deceased victims. However, as reviewed by Roggli,14 elevated asbestos body content is noted in between two