Pleural plaques and the role of exposure to mineral particles in the Asbestos Post-Exposure Survey


Background: Previous studies have inconsistently reported associations between Refractory Ceramic Fibers (RCF) or Mineral Wool Fibers (MWF) and the presence of pleural plaques (PP). Moreover, all these studies were based on Chest X-Ray, known to be associated with a poor sensitivity for the diagnosis of PP.

Research question: Does the risk of pleural plaques increase with cumulative exposure to RCF, MWF and silica? and if yes, do these dose-response relationships depend on the co-exposure to asbestos or conversely, are the dose-response relationships for asbestos modified by co-exposure to RCF, MWF and silica?

Study design and methods: Volunteer workers were invited to participate in a CT-scan screening program for asbestos-related diseases in France. Asbestos exposure was assessed by industrial hygienists and exposure to RCF, MWF and silica was determined by using Job-Exposure Matrices. A Cumulative Exposure Index (CEI) was then calculated for each subject and separately for each of the 4 mineral particle exposures. All available CT-scans were submitted to randomized, double reading by a panel of radiologists.

Results: In this cohort of 5,457 subjects, we found a significant dose-response relationships, after adjustment for asbestos exposure between CEI to RCF or MWF and the risk of PP (OR= 1.29 [1.00-1.67] and OR= 1.84 [1.49-2.27] for the highest CEI quartile respectively). Moreover, significant interactions were found between asbestos on one side and respectively MWF or RCF on the other side.

Interpretation: This study suggests the existence of a significant association between exposure to RCF and MWF and the presence of PP in a large population previously exposed to asbestos and screened by CT-scan.

Authors: Christophe Paris, Isabelle Thaon, François Laurent, Anastasia Saade, Pascal Andujar, Patrick Brochard, Julia Benoist, Benedicte Clin, Gilbert Ferretti, Antoine Gislard, Cecile Gramond, Pascal Wild, Aude Lacourt, Fleur Delva, Jean-Claude Pairon
; Full Source: Chest 2023 Feb 9;S0012-3692(23)00176-9. doi: 10.1016/j.chest.2023.02.004.