Evaluating the QEAS-7 questionnaire as a predictor of asbestos burden in lung tissue among lung cancer patients: insights from the AMCANES study

Our plain-English summary of Evaluating the QEAS-7 questionnaire as a predictor of asbestos burden in lung tissue among lung cancer patients: insights from the AMCANES study, by G. Granados, A. Ferreiro, C. Gómez-Ollés, et al (Frontiers in Toxicology, 2026).

The study

• Authors: G. Granados, A. Ferreiro, C. Gómez-Ollés, F.J. González-Barcala, A. Navarro, R. Costa, F. Romero, B. Marín, M.E. Barroso, I. Urrutia, S. Dorado-Arenas, A. Uranga Echeverría, J.M. Marín, L. Garcia, S. Calero, M. Martín-Bustamante, C. Márquez, M.J. Cruz, J. Ferrer
• Journal: Frontiers in Toxicology
• Published: 2026;8:1733214
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Asbestos exposure is a known risk factor for lung cancer, and quantifying asbestos bodies (ABs) in lung tissue remains the gold standard for assessing cumulative exposure. However, histological analysis is not routinely available in many clinical settings. The validated QEAS-7 questionnaire was developed to evaluate occupational, domestic, and environmental asbestos exposure. This study examined the association between QEAS-7 exposure classifications and the asbestos burden in lung cancer patients.

Methods: A cross-sectional multicenter study was conducted across nine Spanish hospitals. Patients with histologically confirmed lung cancer undergoing surgical resection completed the QEAS-7 questionnaire. Non-tumoral lung tissue samples were analyzed for Abs and asbestos burden was categorized according to AB concentration (with elevated burden defined as >1000 AB/g). Diagnostic performance metrics were evaluated.

Results: Among 133 patients (median age 67 years; 77% male), ABs were detected in 61% of samples, with 5% showing an elevated asbestos burden (>1000 AB/g). Occupational exposure was reported by 36% of patients and accounted for 71.4% of cases with elevated burden. Domestic exposure was reported by 9% of patients and detected in 28.6% of elevated-burden cases. The combined occupational and domestic exposure domain achieved 100% sensitivity for detecting elevated asbestos burden, while occupational and domestic domains alone showed sensitivities of 71.4% and 28.6%, respectively. Specificity and positive predictive values remained modest. Notably, 29% of patients classified as 'non-exposed' by QEAS-7 had measurable ABs.

Conclusion: The QEAS-7 questionnaire demonstrated high sensitivity for detecting elevated asbestos burden when combining occupational and domestic exposures. While histological analysis remains the definitive method, QEAS-7 offers a practical screening alternative, when lacking access to tissue-based diagnostics or occupational hygiene expertise.

Copyright © 2026 Granados, Ferreiro, Gómez-Ollés, González-Barcala, Navarro, Costa, Romero, Marín, Barroso, Urrutia, Dorado-Arenas, Uranga Echeverría, Marín, Garcia, Calero, Martín-Bustamante, Márquez, Cruz and Ferrer.

In plain English

This multicenter cross-sectional study at nine Spanish hospitals tested whether answers to the QEAS-7 questionnaire on occupational, domestic and environmental asbestos exposure matched asbestos bodies counted in lung tissue. The 133 patients had lung cancer and underwent lung surgery. Tissue taken away from the tumor was analyzed. Asbestos bodies were found in 81 (61%) samples, and 7 patients (5%) had a high burden, above 1000 asbestos bodies per gram of dry tissue. Of those 7, 5 had reported 'certain' occupational exposure and 2 'certain' domestic exposure. When occupational and domestic answers were counted together, the questionnaire flagged all 7 high-burden patients (sensitivity 100%, 95% confidence interval 59.04 to 100%). Specificity was 33.6% (95% confidence interval 25.31 to 42.72%), meaning many patients without a high burden were also flagged. The authors reported that 29% of patients classified as 'non-exposed' had measurable asbestos bodies. The authors concluded that QEAS-7 is a sensitive and practical screening tool. Because of its modest specificity, they recommended complementary methods in medico-legal contexts. They noted the small number of high-burden patients and possible recall bias.

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: Multicenter, cross-sectional observational study
• Who was studied: 133 patients with histologically confirmed lung cancer undergoing pneumonectomy or lobectomy at nine tertiary care hospitals in Spain (median age 67, 77% male), within the AMCANES project; recruitment dates not given
• Exposure: Asbestos exposure as reported on the QEAS-7 questionnaire (occupational, domestic and environmental domains, reviewed by industrial hygienists), compared with asbestos bodies counted by phase-contrast light microscopy per gram of dry non-tumorous lung tissue. Fiber types were not identified in this study.
• Main results:
  • Asbestos bodies were detected in 81 of 133 lung tissue samples (61%)
  • 111 patients (84%) had 0 to 300 asbestos bodies per gram, 15 (11%) had 301 to 999, and 7 (5%) had more than 1000
  • 48 patients (36%) reported 'certain' occupational exposure, including 5 of the 7 patients with more than 1000 asbestos bodies per gram
  • 12 patients (9%) reported 'certain' domestic exposure, including 2 of the 7 high-burden patients
  • None of the high-burden patients reported 'certain' environmental exposure
  • Sensitivity for detecting more than 1000 asbestos bodies per gram was 100% for occupational and domestic combined (95% CI 59.04 to 100), 71.4% for the occupational domain alone and 28.6% for the domestic domain alone
  • Specificity was 43.2% (occupational), 60.3% (domestic) and 33.6% (combined)
  • In Table 4, specificity for the combined occupational and domestic domain was 33.61% (95% CI 25.31 to 42.72)
  • Positive predictive values were 8.5% (occupational), 6.9% (domestic) and 8.0% (combined)
  • 29% of patients classified as 'non-exposed' by QEAS-7 had measurable asbestos bodies in lung tissue
  • Estimated occupational exposure intensity showed no significant association with asbestos burden
  • Patients from hospitals in historically high-risk industrial areas made up 86% of the high-burden group
  • Asbestos burden did not differ significantly across lung cancer histological subtypes
• The authors' conclusion: The authors concluded that QEAS-7 is a sensitive and practical screening tool for identifying lung cancer patients at risk of elevated asbestos burden, particularly when occupational and domestic exposures are combined
• Limitations the authors state:
  • The study covered only lung cancer, not mesothelioma
  • Fibre characteristics such as aspect ratio were not evaluated
  • The cross-sectional design, with only lung cancer patients, cannot define a burden threshold above which lung cancer risk increases
  • Few patients had a high asbestos burden, which limited subgroup analyses
  • Self-reported exposure may have introduced recall bias
  • Counting asbestos bodies may underestimate total fiber burden because uncoated fibers are excluded
  • The study was not designed to reconstruct occupational exposure levels quantitatively
  • Because of the questionnaire's modest specificity, the authors recommended complementary diagnostic methods in medico-legal contexts
  • QEAS-7 needs validation in other populations

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, Asbestos Bodies, Cumulative Exposure, Surgical Resection, Occupational Exposure.

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