Asbestos lung cancer refers to lung carcinomas where exposure to asbestos is a major cause of the disease. People with a history of asbestos exposure are several times more likely to develop lung cancer. Smoking significantly increases this risk.
What Is Asbestos Lung Cancer?
The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program estimates 6,000 Americans die of asbestos-related lung cancer each year. These are cancer where the main cause is exposure to asbestos.
All forms of malignant mesothelioma, which is also linked to asbestos exposure, kill roughly 2,500 Americans each year, according to the Centers for Disease Control and Prevention.
That’s roughly 2.4 times more people dying each year due to asbestos lung cancer than dying of all forms of malignant mesothelioma.
The combination of smoking and long-term asbestos exposure is particularly harmful to lung tissue. Together, they significantly increase disease risk beyond the risk associated with either factor alone.
How Does Asbestos Cause Lung Cancer?
When microscopic asbestos fibers are inhaled, they can become lodged in lung tissue. Over time, these fibers cause inflammation, cellular damage and genetic changes that lead to cancer.
The time between asbestos exposure and cancer diagnosis — typically 20 to 50 years — is called the latency period.
The connection between asbestos and lung cancer is well known. The National Cancer Institute confirmed the connection in 1942.
- Duration and intensity of asbestos exposure
- Overall health
- Smoking history
Symptoms of Asbestos-Related Lung Cancer
The symptoms of asbestos-related lung cancer are similar to those of lung cancer caused by smoking.
Common symptoms include:
- Shortness of breath or difficulty breathing
- Persistent, dry cough
- Chest pain
- Coughing up blood
- Hoarseness or wheezing
- Fatigue and loss of appetite
- Low blood oxygen levels and anemia (low blood iron levels)
- Unexplained weight loss
Diagnosing Asbestos Lung Cancer
Reaching an accurate lung cancer diagnosis can take time. If you do not have a history of smoking, your doctor may not suspect asbestos-related lung cancer. They may initially diagnose you with a less serious condition such as pneumonia or bronchitis.
This is why it’s important to share your history of asbestos exposure with your doctor. Do this at the first sign of symptoms. If your doctor is aware of this potential lung cancer cause, they can push the diagnosis process along more quickly.
Steps to Reaching a Definitive Lung Cancer Diagnosis
- Rule out common issues: Your primary care doctor may treat you first for lung infections, allergies or less serious conditions linked with your symptoms.
- Referral: If you don’t respond to initial treatments, your doctor may refer you to a pulmonologist for a full work up of your lung function.
- Scans and images: Your primary doctor or the pulmonologist will order imaging tests such as X-rays, CT scans, MRIs and PET scans.
- Check for abnormalities: If your images show abnormalities, you will be referred for biopsies and blood tests.
- Blood tests: Blood tests may show signs of cancer such as anemia or changes in blood cell counts.
- Tissue biopsies: You will be referred to a surgeon who can collect samples of tissue from the abnormal lung areas on your imaging studies.
- Biopsy-confirmed diagnosis. Tissue is sent to a lab for a final, accurate cancer diagnosis.
Lung Cancer Treatment Options
Treatment options for asbestos-related lung cancer include surgery, chemotherapy, radiation therapy and emerging medications such as immunotherapy.
Patients diagnosed in the earlier cancer stages tend to have more treatment options and respond better to treatment.
- Surgery: Depends on how localized the tumors are in the body. Can vary from a small section of the lung to the removal of the entire affected lung (pneumonectomy).
- Chemotherapy: The most common chemotherapy drugs used for lung cancer include cisplatin, carboplatin and Taxotere (docitaxel).
- Radiation Therapy: May be used before or after surgery or in combination with chemotherapy to shrink tumors and prevent cancer recurrence.
There are several FDA-approved immunotherapy drugs to treat non-small cell lung cancer (NSCLC). About 85% of all lung cancer cases are NSCLC.
Approved Immunotherapy Drugs for NSCLC
Many asbestos-related lung cancer patients can access these immunotherapies and other treatments through established treatment protocols, clinical trials and compassionate-use programs.
- Keytruda (pembrolizumab)
- Opdivo (nivolumab)
- Tecentriq (atezolizumab)
These three drugs are used alone, in combination with one another, or with other chemotherapy medications to treat non-small cell lung cancer. They are offered to patients even if their lung cancer has spread (metastasized) to other parts of the body.
According to a 2019 paper in Expert Reviews in Respiratory Medicine, lung cancer experts confirmed that “immune checkpoint inhibitors have been established as the new standard of care for patients with advanced NSCLC.”
They often are less toxic and more effective than chemotherapy alone.
Results from the KEYNOTE-010 clinical trial of more than 1,000 patients with advanced NSCLC were published May 2019 in Journal of Thoracic Oncology.
The authors reported health-related quality of life and symptoms were the same or better when patients were treated with Keytruda compared with docetaxel chemotherapy.
Who Is Most at Risk for Asbestos-Related Lung Cancer?
People who have experienced occupational asbestos exposure are more at risk of developing asbestos-related lung cancer than people without this job history. This risk increases further in people with a heavy smoking history, too.
A 2017 study published in Molecular and Clinical Oncology analyzed 147 male patients with asbestos-related lung cancer.
- Ship repair: 69.9%
- Building construction: 7.5%
- Electricity generation: 4.8%
- Maintenance and repair: 38 cases
- Electricity and cable setting: 31 cases
- Welder: 27 cases
- Boiler-related jobs: 7 cases
Former smokers represented 79.5% of patients in the cohort, followed by current smokers (10.3%) and nonsmokers (5.5%).
Patients had a median duration of asbestos exposure of 28.3 years and a mean latency period of 10.5 years. The shorter-than-average latency period may have been observed because nearly all of these patients were former or current smokers.
Former workers in these occupations also are at risk for other asbestos-related diseases such as asbestosis and pleural scarring.