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Committee for Finance and Personnel
Damages (Asbestos-Related Conditions) Bill
Written Evidence from Dr Robin Rudd
DR R M RUDD MA MD FRCP
RMR 1st February 2011
Dear Ms Jardine
Re: Pleural Plaques
I reply to your request for my medical view on pleural plaques. As a physician who has specialised in asbestos related diseases of all types for nearly 30 years and who has treated thousands of patients with mesothelioma and lung cancer, I should like to draw the attention of Members of the Northern Ireland Assembly to the following points.
1. Pleural plaques are pathological change in the membrane which surrounds the lung, caused by inhalation of asbestos fibres. They vary in size from a few millimetres to many centimetres.
2. The plaques themselves usually do not cause symptoms, although in exceptional cases when they are very extensive they may cause discomfort, pain and breathlessness.
3. Pleural plaques are detected on chest x-ray in less than 1% of the general population and when they are present enquiry almost always reveals a history of asbestos exposure.
4. Because of their past asbestos exposure, people with pleural plaques are at risk of developing diffuse pleural thickening causing breathlessness, asbestosis of the lungs causing breathlessness, lung cancer which is usually fatal and mesothelioma, a cancer which can occur in the lining of the chest cavity or in the lining of the abdominal cavity, which is almost invariably fatal, usually within 12 to 18 months of the first symptoms.
5. People with pleural plaques who have been heavily exposed to asbestos at work have a risk of mesothelioma more than one thousand times greater than the general population. The risk for those more lightly exposed is less but still substantially greater than that of the general population.
6. People with pleural plaques commonly experience considerable anxiety about the risk of mesothelioma and other serious asbestos diseases. It has been suggested that the anxiety is a result of lack of information about the true nature of plaques and that all that is needed to dispel the anxiety is a full explanation. It has also been suggested that the anxiety has been caused or contributed to by the fact that damages were payable in respect of plaques. While these factors may come into play, they are not responsible for all or even most of the anxiety.
7. Explanation that the future risks arise from the asbestos exposure which caused the plaques and not from the plaques themselves is a fine distinction that means little to the person without scientific training. It is the discovery of the plaques that has led to the situation in which an explanation of the future risks is necessary. For those who have been heavily exposed to asbestos the truth about their future risks is not in fact reassuring. To be told your present condition is benign but there is a 10% risk that you will die prematurely of mesothelioma and that your risk of lung cancer may be 40% or more, as in the case of a heavily exposed smoker, is not likely to set your mind at rest.
8. Despite the best intentioned and comprehensive reassurance offered by doctors that plaques are harmless, often the person diagnosed with plaques knows of former work colleagues who have gone on to die of mesothelioma after being diagnosed with pleural plaques. Patients have sometimes been told to look out for new symptoms and report them to their doctor. Every ache or pain or feeling of shortness of breath renews the fear that this may be the onset of mesothelioma. The anxiety is real for all and for some has a serious adverse effect on quality of life.
DR ROBIN RUDD