Challenges in Identifying and Diagnosing Asbestos-Related Diseases in Emerging Economies: A Global Health Perspective

Our plain-English summary of Challenges in Identifying and Diagnosing Asbestos-Related Diseases in Emerging Economies: A Global Health Perspective, by P. Roy, A. Raheja, K. Prajapati, et al (Annals of Global Health, 2025).

The study

• Authors: P. Roy, A. Raheja, K. Prajapati, S. Roy, M. Bardhan, A.L. Frank
• Journal: Annals of Global Health
• Published: 2025;90(1):65
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestos, a durable fibrous silicate once widely used for its thermal resistance, remains in use in countries like India and China despite being banned in over 70 nations and classified as a Group 1 carcinogen by IARC. Prolonged occupational exposure causes asbestosis, lung cancer, and malignant pleural mesothelioma, but in Low and Middle-Income Countries (LMICs) the true burden is underreported due to weak regulation, low awareness, limited diagnostics, and inadequate occupational health systems. Objectives: This review aimed to examine the epidemiological patterns and diagnostic challenges of Asbestos-Related Disease (ARDs) in emerging economies, with a focus on the applicability and limitations of existing and emerging diagnostic strategies. Methods: We conducted a narrative review of peer-reviewed literature, global databases (WHO, IARC), and recent cohort and cross-sectional studies, sourcing articles through structured keyword searches in PubMed, Scopus, and Google Scholar. Diagnostic approaches were compared across diverse healthcare settings, emphasizing radiological, histopathological, and functional tools. The review also assessed the utility of newer technologies, including low-dose CT (LDCT), ultra-low-dose CT (ULDCT), magnetic resonance imaging (MRI), FDG-PET is Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), breath biomarkers using gas chromatography-mass spectrometry (GC-MS), and digital tomosynthesis (DTS). Findings: LDCT and ULDCT showed superior sensitivity for early detection of pleural abnormalities like circumscribed pleural plaques and diffuse thickening, yet distinguishing benign from malignant lesions remains difficult without biopsy. Diffusion capacity of the lungs for carbon monoxide (DLCO) emerged as a sensitive but nonspecific pulmonary function marker. Histopathological confirmation of mesothelioma remains the gold standard but is rarely accessible in low-resource settings. Conclusion: Addressing the diagnostic gap in ARDs in LMICs requires systemic strengthening of occupational health surveillance, better regulatory enforcement, expanded access to advanced diagnostic tools, and targeted clinician training. Without urgent intervention, the burden of asbestos exposure will remain an escalating public health crisis.

Copyright: © 2025 The Author(s).

In plain English

This article was a narrative review, not a new study of patients. The authors searched PubMed, Scopus and Google Scholar and used WHO and IARC data to examine how asbestos-related diseases are diagnosed in low- and middle-income countries such as India and China, where asbestos is still used. Citing 2020 figures, they reported age-standardized mesothelioma rates of 1.4 per 100,000 in Northern Europe and 1.3 in Australia/New Zealand, versus 0.10 in South-Central Asia and 0.06 in parts of Africa. They attributed the gap to underdiagnosis and underreporting rather than to true differences in exposure. The review found advanced imaging and pathology confined largely to big urban hospitals and a few academic centers. It also described little physician training in taking occupational histories, and frequent confusion of asbestos disease with tuberculosis, idiopathic pulmonary fibrosis or smoking-related lung disease. It called ultrasound a potentially cost-effective option that depends on operator skill. The authors concluded that stronger surveillance, regulatory enforcement, access to diagnostic tools and clinician training are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature and global databases
• Who was studied: No participants were studied directly. The review covered literature on asbestos-related diseases in emerging economies and low- and middle-income countries (LMICs), with examples from India, China and Southeast Asia.
• Exposure: Asbestos in general, occupational and environmental. The review did not analyse specific fiber types or doses. It describes asbestos as chrysotile plus five amphiboles: crocidolite, amosite, anthophyllite, tremolite and actinolite.
• Main results:
  • Citing 2020 data, the review reported age-standardized mesothelioma rates of 1.4 per 100,000 in Northern Europe and 1.3 per 100,000 in Australia/New Zealand. The comparable figures were 0.10 in South-Central Asia and 0.06 in parts of Africa.
  • The authors interpreted these regional differences as reflecting diagnostic undercapacity and underreporting, not true differences in exposure.
  • Advanced imaging (HRCT, LDCT, PET, MRI) was described as generally restricted to large urban hospitals in LMICs.
  • Confirming mesothelioma requires specialized pathology services and trained personnel. The review described these as concentrated in a handful of academic centers.
  • Most physicians were described as having little occupational medicine training, and occupational history-taking as rarely routine.
  • Asbestos-related changes were described as easily mistaken for tuberculosis, idiopathic pulmonary fibrosis (IPF) or smoking-related chronic lung disease.
  • Ultrasonography was described as a potentially cost-effective option for detecting pleural abnormalities, but one that depends on operator expertise.
  • The authors judged that emerging technologies, such as breath biomarkers and digital tomosynthesis, were likely to have only modest immediate impact in LMICs without investment in training and infrastructure.
• The authors' conclusion: The authors concluded that closing the diagnostic gap in LMICs requires stronger occupational health surveillance, better regulatory enforcement, wider access to advanced diagnostic tools, and targeted clinician training.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Silicate, IARC, Occupational Exposure, Lung Cancer, Pleural Mesothelioma, Biomarker, Pleural Plaques, Biopsy.

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• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• Health inequality and the global burden of mesothelioma: insights from the global burden of disease study 2021 — L. Lv, W. Gao, et al. (2025)
• Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008 — V. Delgermaa, K. Takahashi, et al. (2011)

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