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Pleural Plaques

The Facts

Pleural plaques are described as discrete localised areas of fibrosis which can be found in the lining of the inner chest wall and are caused by exposure to asbestos. Often referred to as ‘lung scarring’ and ‘thickening of the linings of the lung’ they represent the most common of all asbestos-related conditions for which no treatment is required.  Plaques are benign and do not develop into anything cancerous but their existence represents a future risk of lung cancer and mesothelioma because they are a marker of exposure to asbestos.

Generally associated to workplace settings where asbestos materials were produced, used or handled plaques evolve slowly over time and tend to be detected many years later after they have increased in size.  Plaques can arise from low as well as high levels of exposure and are diagnosed by means of a chest x-ray or CT scan and often incidentally found during investigations into other health issues.  Over time, the plaques might become calcified taking on a chalky appearance which makes them more obvious than non-calcified plaques.

Whilst recognised as a potential source of distress and anxiety pleural plaques rarely cause any significant impairment of lung function or other symptoms and are not therefore recognised by the Industrial Injuries Advisory Council as a prescribed condition for the purposes of Industrial Injuries Disablement Benefit (IIDB).

Other asbestos-related diseases include pleural thickening, asbestosis, pleural effusion, lung cancer and mesothelioma which are similarly caused by inhalation of asbestos fibres. Compensation for these conditions remains unchanged as too is the position in terms of IIDB whereby an award is made to a claimant in line with the severity of their disability.

Compensation for pleural plaques had been a long standing right for the many thousands of former workers’ which was challenged by the insurance industry through a series of court cases which culminated in October 2007 by a landmark decision of the Appellate Committee of the House of Lords (now the Supreme Court) in the case of Johnstone v NEI International Combustion Ltd and conjoined cases who ruled to remove compensation for pleural plaques.  The basis of their decision was due to the fact that plaques cause no symptoms therefore no damage had been caused which is an essential element in a negligence claim for damages. This ruling prompted wide debate and led to the Ministry of Justice introducing a short term no fault payment scheme in England and Wales known as the ‘pleural plaques former claimants payment scheme’.

The purpose of that scheme was to recognise those people who had started compensation claims for their pleural plaque condition which had not settled prior to 17th October 2007 (date of ruling in Johnstone). Payments to successful applicants was then limited to £5000.

Scotland and Northern Ireland legislated and reversed the decision but in England and Wales the situation remains unchanged in that compensation is not available for asymptomatic pleural plaques.

In order to make a compensation claim in Scotland or Ireland for pleural plaques action should normally be taken within three years of diagnosis.  Instances do arise where a historical diagnosis was never mentioned to a patient and in these circumstances it is important to understand why this might have been the case. If a person was not previously aware of such a diagnosis it might still be possible to bring a claim for compensation providing action is taken within three years of learning of the condition.

Pleural plaques, what pleural plaques?

There are instances where pleural plaques are not routinely commented upon in x-ray findings which otherwise state ‘the lungs are clear’. One reason behind this is due to the fact that plaques (sometimes calcified) are found within the lining of the lungs and not in the lungs themselves. Depending upon the clinical question being asked it appears pleural plaques are not regarded as an asbestos-related lung disease or pleural disease by the medical fraternity and therefore it is important to seek reassurance by asking the question of your GP/Consultant;  Do my lungs show any features in keeping with asbestos exposure?

Mr Jeffery Perkins contacted the Scottish Asbestos Helpline to speak of his personal experience following a discussion with his GP in 2014.  At that time Mr Perkins was told about pleural plaques which had first been diagnosed several years earlier albeit he had not been told of the condition. Once he had come to terms with the shock of learning of his asbestos-related condition he requested his x-rays be reviewed only to learn an initial diagnosis of pleural plaques had first been made in 2003. A subsequent chest x-ray in 2010 also failed to mention his pleural plaques and when commented upon in a chest x-ray of 2011, and disclosed to him, he found himself ‘technically out of time’ to make a claim for compensation under the Ministry of Justice scheme former claimant payment scheme.

He further commented, “Given the benign nature of pleural plaques I believe many GP’s and Consultant’s also avoid telling elderly patients of their diagnosis for fear of causing them unnecessary worries, particularly if they are dealing with far worse health issues.  If the condition is harmless and without treatment why would you upset somebody?  That said, I was disappointed not to have been told of my diagnosis after it had been identified on a chest x-ray and believe in the right to know everything about my health.  People in Scotland and Northern Ireland who have been exposed to asbestos need to be made aware that pleural plaques might not always be commented upon in a chest x-ray.  From my personal experience it is important to discuss your x-ray results fully and seek clarification that there are no pleural plaques or other evidence of asbestos exposure within your lungs”.

What should I do about my pleural plaques then?

Sufferers of pleural plaques are advised to be vigilant in terms of monitoring their health and are encouraged to discuss any health concerns or changes in their condition or symptoms with their GP. Further investigations including a repeat chest x-ray or CT scan are not helpful unless there are symptoms which might include shortness of breath, persistent cough, chest pains, fatigue and weight loss.  In any event a GP must make a decision balancing the risk of any harmful radiation associated to chest x-rays and CT scans.  When visiting your GP it is important you outline details of your work, exposure to asbestos and those health issues which might be worrying you.

Having pleural plaques does NOT put an individual at any greater risk of developing a serious lung disease than those individuals who have had the same level of asbestos exposure.

Compensation for pleural plaques in England and Wales was removed in 2007 but reinstated in Scotland and Northern Ireland. Importantly if you have worked for a Scottish or Northern Ireland registered company or been exposed to asbestos whilst working in Scotland or Northern Ireland and have been diagnosed with pleural plaques within the last three years it is important you seek legal advice immediately. The Scottish Asbestos Helpline will ensure you get the right advice. Call us on FREEPHONE 0808 164 7740. If you have been diagnosed with pleural plaques and you fail to take any action it is likely you will be legally barred from other compensation in the future should you develop a more serious asbestos-related lung disease such as pleural thickening, pleural effusion, asbestosis, lung cancer or mesothelioma.

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