Table 1
Brief overview of asbestos‑related diseases (ARDs).
| DISEASE | TYPE | KEY FEATURES | DIAGNOSTIC NOTES / CHALLENGES |
|---|---|---|---|
| Pleural plaques | Non‑malignant | Localized, often calcified pleural thickening; marker of exposure | Usually asymptomatic; easily identified on CT; not a risk factor by itself for mesothelioma but indicates exposure history |
| Benign asbestos‑related pleural effusion (BAPE) | Non‑malignant | Small, unilateral or bilateral pleural effusions | Often self‑resolving; may mimic infection or malignancy; requires exclusion of cancer |
| Diffuse pleural thickening (DPT) | Non‑malignant | Extensive pleural fibrosis; may restrict lung expansion | Can be misclassified as other pleural pathology; reduced specificity in plain radiographs |
| Asbestosis | Non‑malignant parenchymal fibrosis | Progressive pulmonary fibrosis with restrictive physiology | Radiologic features overlap with idiopathic pulmonary fibrosis; careful exposure history essential |
| Lung cancer | Malignant | Elevated risk in exposed workers, synergistic with smoking | Diagnosis follows standard oncologic pathways, but exposure attribution often overlooked in LMICs |
| Malignant pleural mesothelioma (MPM) | Malignant | Aggressive cancer of pleura, long latency | Histopathology with immunohistochemistry required for confirmation; diagnosis often delayed in LMICs due to lack of access to pathology |
Figure 1
Five pillars of diagnostic challenges in LMICs.
Table 2
Mesothelioma incidence in 2020 by region (ASR per 100,000 persons).
| REGION / COUNTRY GROUP | WHO INCOME GROUP | AGE‑STANDARDIZED RATE (ASR) | INTERPRETATION |
|---|---|---|---|
| Northern Europe | High‑income | 1.4 | Reflects strong surveillance and diagnostic capacity |
| Australia & New Zealand | High‑income | 1.3 | Comparable to Europe; robust reporting systems |
| Western Europe | High‑income | 0.79 | Consistent with historic asbestos use and effective case identification |
| Southern Europe | High‑income | 0.70 | Underlines strong reporting despite declining asbestos use |
| Southern Africa | Upper‑middle | 0.55 | Intermediate rate; may reflect partial underreporting |
| South‑Central Asia | Low‑/middle‑income | 0.10 | Artificially low; reflects diagnostic gaps, not absence of exposure |
| Middle Africa | Low‑income | 0.07 | Very likely underestimation due to lack of surveillance |
| Western Africa | Low‑income | 0.06 | Minimal reporting; cases likely unrecognized |
| Eastern Africa | Low‑income | 0.06 | Surveillance systems weak or absent |
| Caribbean | Upper‑middle | 0.05 | Likely underreporting despite asbestos exposure risks |
Figure 2
The algorithm of medical expert examination for the diagnosis of asbestosis or asbestos‐related pleural plaques/fibrosis according to the German guidelines.
Table 3
Established diagnostic modalities for asbestos‑related diseases: strengths, limitations, and LMIC applicability.
| MODALITY | PROS | CONS | ROLE IN LMICs |
|---|---|---|---|
| Imaging | |||
| CXR | Inexpensive, widely available; detects advanced plaques | Low sensitivity; misses early disease; superseded by HRCT | Widely available, poor for early detection |
| HRCT/LDCT | High sensitivity to early disease; detects small nodules | Costly; radiation exposure; not specific vs. IPF | Limited to tertiary lefts |
| PET (FDG‑PET) | Differentiates benign vs malignant; staging | False positives post‑pleurodesis; costly; rare availability | Rare outside research lefts |
| MRI | Sensitive for pleural malignancy | Expensive; adjunctive only | Very limited use |
| Ultrasound (US) | Sensitive for small effusions; safe, low‑cost | Operator dependent; limited for central lesions | Feasible low‑cost adjunct |
| Digital Tomosynthesis | More sensitive than CXR | Expensive; limited availability | Not yet adopted |
| Functional Tests | |||
| Lung Function (PFT/DLCO) | Non‑invasive; DLCO sensitive for early changes | Misclassification risk without lung volume measures | Feasible, underutilized |
| Invasive | |||
| Thoracoscopy | Helps exclude malignancy in BAPE | Invasive, expensive | Limited to specialized lefts |
| Pleural/Lung Biopsy | Gold standard; essential for compensation | Invasive, risky; requires hospitalization | Rarely accessible, often delayed |
| Bronchoscopy | Identifies inflammation, obtains tissue | Low sensitivity; invasive | Limited diagnostic value |
Figure 3
Mismatch between consumption and reported mesothelioma.
Table 4
Emerging diagnostic technologies: performance, feasibility, and LMIC applicability.
| TECHNOLOGY | ACCURACY (VS HRCT/ PATHOLOGY) | COST | PORTABILITY | TRAINING REQUIRED | FEASIBILITY IN LMICs |
|---|---|---|---|---|---|
| Breath Biomarkers* | High (pilot studies; VOC‑based approaches such as GC‑MS, eNose, PTR‑MS) | $$ | Portable | High | Low (early stage) |
| Digital Tomosynthesis | Moderate | $ | Moderate | Moderate | Medium (promising) |
| Ultrasound | Moderate | $ | Highly portable | Moderate | High (low‑cost option) |
[i] * For detailed comparison of specific VOC platforms, see Supplementary Table S1.
Figure 4
Key recommendation for LMICs.