Asbestos Fibers and Other Elongate Mineral Particles: State of the ...

In addition to epidemiological studies that
address etiology and that quantify exposure-
related risk, epidemiological studies can be
used to better understand the pathogenesis of
lung diseases caused by asbestos fibers and other
EMPs. For example, appropriately designed
or reconstructed epidemiological studies could
be used to assess the relationship between the
physicochemical properties of EMPs, lung fibrosis,
and lung cancer.
3.5.4 Improve Clinical Tools and
Practices for Screening,
Diagnosis, Treatment, and
Secondary Prevention of
Diseases Caused by Asbestos
Fibers and Other EMPs
Given the huge human and economic impact of
asbestos-related disease and litigation, Congress
has considered asbestos-related legislation on
several occasions in recent years. To date, bills
with provisions to require private industry to
fund an asbestos victims’ trust fund have not
succeeded in Congress. Most recently, the Ban
Asbestos in America Act, which was passed by
the U.S. Senate in 2007 but was not acted on
in the House of Representatives, would have
authorized and funded a network of asbestosrelated
disease research and treatment centers
to conduct studies, including clinical trials, on
effective treatment, early detection, and prevention
[U.S. Senate 2007]. This bill also called for
the establishment of a mechanism for coordinating
and providing data and specimens relating
to asbestos-caused diseases from cancer
registries and other centers, including a recently
funded virtual biospecimen bank for mesothelioma
[Mesothelioma Virtual Bank 2007].
Various research objectives relevant to clinical
aspects of asbestos-related diseases are worthy
NIOSH CIB 62 • Asbestos
of pursuit by NIOSH and other federal agencies,
along with their partners, to improve
screening, diagnosis, secondary prevention, and
treatment. These include but are not limited to
the following objectives:
• Continue to develop and validate technical
standards for the assessment of digital
chest radiographs with the ILO classification
system. The ILO system for classifying
chest radiographs of the pneumoconioses
is widely used as a standard throughout the
world. Although initially intended for use
in epidemiological studies, the ILO system
is now also commonly used as a basis for
describing severity of disease in clinical
care and for awarding compensation to
individuals affected by nonmalignant diseases
of the chest caused by asbestos and
other airborne dusts. To ensure that digital
chest radiographic methods used in future
clinical and epidemiological studies can
be compared with past studies based on
conventional film radiography, there is a
critical need to continue ongoing research
to validate use of the ILO system for classification
of digital chest images.
• Develop and promote standardized assessment
of nonmalignant dust-induced
diseases, including asbestos-related pleural
and parenchymal disease, on computed
tomography (CT) images of the chest.
Over the past several decades, CT scanning
of the chest has been increasingly
used for assessing chest disease, and highresolution
CT scanning is often done in
clinical settings. Although approaches for
standardizing classifications of CT images
for dust-related diseases have been
proposed, none have yet been widely adopted
or authoritatively promoted.
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