How many cases of lung cancer caused by asbestos are never recognized as occupational disease? And why is asbestos-attributable lung cancer so often hidden behind the much more familiar story of smoking? In this episode of Asbestos Insight, we investigate the often-overlooked global burden of asbestos-attributable lung cancer, a disease that causes far more deaths than mesothelioma, yet remains substantially under-recognized, under-reported, and under-compensated. Unlike mesothelioma, lung cancer has many possible causes, making the occupational contribution of asbestos exposure much harder to identify, document, and officially recognize. From the biology of asbestos carcinogenesis to international systems for occupational disease attribution, this episode explores why millions of workers exposed to asbestos may develop lung cancer decades after their exposure, and why their occupational history can be the missing piece in understanding the disease. You'll learn: • How inhaled asbestos fibers contribute to lung carcinogenesis through chronic inflammation, cellular injury, oxidative stress, and other biological mechanisms. • Why asbestos exposure can cause lung cancer independently of smoking, and why distinguishing occupational asbestos-related cases from other lung cancers remains such a major challenge. • How smoking and asbestos exposure interact synergistically, producing a substantially greater risk of lung cancer than either exposure alone. • Why smoking cessation is one of the most important interventions for people with a history of occupational asbestos exposure. • Why asbestos-attributable lung cancer is believed to be dramatically under-reported compared with mesothelioma, and how this affects workers, families, compensation systems, and public health statistics. • How occupational attribution frameworks, including the Helsinki Criteria, help determine when a lung cancer can reasonably be attributed to asbestos exposure. • Why taking a detailed occupational history is essential, particularly for people who worked in construction, shipbuilding, manufacturing, mining, insulation, maintenance, and other asbestos-exposed occupations. • How medical surveillance and low-dose CT screening can play a role in detecting lung cancer among people at elevated risk, and why screening decisions must be based on individual risk and appropriate clinical guidelines. • How national compensation systems differ in their recognition of asbestos-related lung cancer, creating a significant gap between the estimated global disease burden and the number of officially recognized occupational cases. • Why the continued mining, trade, and use of chrysotile asbestos means that future generations will continue to face the consequences of exposure. More than a discussion of lung cancer, this episode examines a critical problem in occupational medicine: what happens when the disease is visible, but its occupational cause is not? Asbestos-related lung cancer is not simply a historical consequence of twentieth-century industry. Its exceptionally long latency means that workers exposed decades ago are still developing disease today, while continued asbestos use in parts of the world is creating new exposure and future cases. Join us as we uncover the hidden burden of asbestos-attributable lung cancer and explore why better occupational histories, medical surveillance, smoking cessation, scientific attribution, and effective prevention remain essential to confronting one of the world's most under-recognized occupational cancers. Asbestos Insight is an educational podcast developed as part of amianto.info, a global, multilingual platform dedicated to asbestos awareness, science, geology, occupational health, medicine, risk assessment, education, and environmental protection.