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

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.