Smoking, Asbestos Exposure and Mesothelioma Risk Explained
Author: Ian C. Langtree - Writer/Editor for Disabled World (DW)
Published: 8 Oct 2009 - Updated: 2 Oct 2026
Publication Type: Informative
Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content
Synopsis
This information explains how tobacco smoking and asbestos exposure interact, a question that matters to anyone who has worked around asbestos and also smoked. Smoking on its own does not cause mesothelioma, but it weakens the lungs and leaves them more vulnerable to damage from asbestos fibers, and when the two exposures occur together the effect is synergistic, multiplying the risk of lung cancer well beyond what either would produce alone. The material is useful because it separates two diseases that are often confused, describes how asbestos does its harm, and sets out practical steps on stopping smoking and discussing treatment with a doctor. It is particularly relevant to seniors, who make up most of the people now living with the consequences of workplace exposure decades ago, and to people with disabilities or chronic respiratory conditions whose lung function is already reduced.
At a Glance
- 1 - Mesothelioma forms in the mesothelium, the thin membrane that surrounds and protects the internal organs.
- 2 - A history of smoking does not necessarily prevent an asbestos-exposed worker from pursuing a personal injury claim.
- 3 - Asbestos has been woven into cloth and added to insulation, ceiling tiles, flooring, pipes, boilers and automotive parts.
- 4 - Symptoms can resemble emphysema, bronchitis or even influenza, which is one reason the disease is often found at an advanced stage.
Topic Definition
- Mesothelioma
Mesothelioma is a rare and aggressive cancer that begins in the mesothelium, the thin protective membrane lining the chest cavity, abdomen and the space around the heart. Most cases are pleural, meaning they start in the lining around the lungs, and the great majority are linked to breathing in asbestos fibers, usually at work. The disease is distinct from lung cancer, which starts inside the lung tissue itself. It develops slowly, often surfacing several decades after the exposure that caused it, and tobacco smoking is not considered a cause, although smoking sharply raises the risk of lung cancer in people who have also been exposed to asbestos.
Overview
Smoking cigarettes is one of the most damaging habits a person can have. It is a leading cause of lung cancer, emphysema, chronic obstructive pulmonary disease (COPD) and heart disease. One deadly cancer that smoking does not cause, however, is mesothelioma. Even so, anyone who has both smoked and worked around asbestos has good reason to pay attention, because the two exposures together are far more dangerous to the lungs than either one alone.
Does Smoking Cause Mesothelioma?
No. According to the National Cancer Institute, smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma [National Cancer Institute, 2021]. Asbestos is by far the leading cause of the disease. A small number of cases are tied to other factors, including erionite (a fibrous mineral found in some volcanic rock), earlier radiation therapy to the chest or abdomen, and an inherited mutation in the BAP1 gene [Canadian Cancer Society, n.d.].
Where smoking does matter is lung cancer. Asbestos causes lung cancer as well as mesothelioma, and in a person who smokes, that lung cancer risk climbs steeply.
What Asbestos Is and Where It Was Used
Asbestos is the name given to a group of naturally occurring silicate minerals that form long, thin fibers. The fibers are durable, lightweight, strong and fireproof, and they resist heat and chemical breakdown. Asbestos can be woven into fabric or mixed into building materials such as cement. It is best known as insulation and in acoustical ceiling tiles, but it has also been used in cloth, blankets, flooring, wiring, pipes, boilers, automotive brakes and thousands of other commercial and residential products.
The danger comes when asbestos is mined, processed, installed, disturbed or demolished. Fibers released into the air can be inhaled or swallowed, and the body has great difficulty removing them. Over time they can cause asbestosis (scarring of the lung tissue), lung cancer and mesothelioma.
How Mesothelioma Differs From Lung Cancer
Mesothelioma is not lung cancer. It starts in the mesothelium, the thin membrane that surrounds and protects the internal organs. The most common form is pleural mesothelioma, which develops in the pleura, the lining around the lungs and chest wall. Less common forms affect the lining of the abdomen (peritoneal mesothelioma) and, rarely, the lining around the heart. Lung cancer, by contrast, begins inside the lung tissue itself.
The Combined Effect of Smoking and Asbestos
Smoking damages the airways and is thought to weaken the lungs' ability to clear inhaled particles, leaving them more vulnerable to asbestos and other toxins. When a smoker is also exposed to asbestos, the two risks build on each other. The National Cancer Institute describes the combination as particularly hazardous, with a lung cancer risk greater than the individual risks from asbestos and smoking added together [National Cancer Institute, 2021].
A study of 2,377 long-term North American insulators, published in the American Journal of Respiratory and Critical Care Medicine, measured how each factor changed the rate of death from lung cancer [Markowitz et al., 2013]:
- Asbestos exposure alone, in non-smokers, raised the rate 3.6 times.
- Smoking alone, without asbestos exposure, raised it 10.3 times.
- Smoking combined with asbestos exposure raised it 14.4 times.
- Smoking combined with asbestosis raised it 36.8 times.
In other words, the heaviest toll fell on smokers whose lungs were already scarred by asbestos, where the combined effect was greater than the sum of its parts.
Some physicians liken the combination of smoking and asbestos to that of alcohol and prescription drugs: each dangerous on its own, and more deadly together.
Why Quitting Still Matters
The same study found that stopping smoking made a real difference. Lung cancer deaths among insulators halved within 10 years of quitting, and 30 years after quitting the rate matched that of insulators who had never smoked [Markowitz et al., 2013]. Quitting will not lower the risk of mesothelioma, but it does reduce the risk of lung cancer, protects remaining lung function, and can help a person tolerate surgery and other treatment if cancer is ever diagnosed.
Smoking History and Legal Claims
If you were exposed to asbestos at work, you may worry that having been a smoker will hurt your chances in a personal injury lawsuit against a former employer or the manufacturer of an asbestos-containing product. For mesothelioma, this is generally not the case, because smoking is not a cause of the disease and doctors attribute it to asbestos exposure. Asbestos-related lung cancer claims can be more complicated, since smoking may be raised as a contributing factor. The rules differ from state to state, so it is worth speaking with an attorney who handles asbestos cases.
Diagnosis and the Long Latency Period
The sooner mesothelioma is diagnosed, the better the outlook and the wider the range of treatment choices. Unfortunately, the disease has an extremely long latency period. It typically appears 20 to 40 years after the first exposure and can take as long as 71 years, which is why most deaths occur in people aged 65 and older. In the United States, annual deaths from malignant mesothelioma rose from 2,479 in 1999 to 2,597 in 2015 [Centers for Disease Control and Prevention, 2017].
Diagnosis is made harder by the fact that the early symptoms - shortness of breath, chest pain, a persistent cough and fatigue - look much like those of more common conditions such as emphysema, bronchitis and even influenza. Anyone with a history of asbestos exposure should tell their doctor about it, including jobs held decades ago, and should mention any history of smoking as well.
Treatment Options
Although mesothelioma is currently considered incurable, it can be treated and managed. If you smoke, the first step is to stop. From there, talk with your health care provider about surgery, radiation, chemotherapy, immunotherapy, or a combination of these. Immunotherapy has become a standard option in recent years: the U.S. Food and Drug Administration approved the combination of nivolumab and ipilimumab for pleural mesothelioma that cannot be removed by surgery in October 2020, and approved pembrolizumab with chemotherapy in September 2024 [U.S. Food and Drug Administration, 2020, 2024].
How well any treatment works depends on the stage and type of the disease and on a person's overall health, but many patients have been able to extend their lives or ease their symptoms with the right approach.
Frequently Asked Questions
How long after asbestos exposure does mesothelioma usually develop?
Mesothelioma typically appears 20 to 40 years, and can take as long as 71 years after the first exposure to asbestos. This long delay is why most people are diagnosed later in life, often decades after leaving the job where the exposure took place.
Does quitting smoking lower lung cancer risk for people exposed to asbestos?
Yes. Research on asbestos insulation workers found that lung cancer death rates fell by about half within 10 years of quitting and kept falling over the following decades. Stopping at any age is worthwhile for anyone with a history of asbestos exposure.
What are the main types of mesothelioma?
The four types are named for where the cancer starts. Pleural mesothelioma forms in the lining around the lungs and accounts for most cases, peritoneal mesothelioma forms in the lining of the abdomen, and the rare pericardial and testicular forms affect the lining of the heart and the testes.
What are the early symptoms of pleural mesothelioma?
Common early signs include shortness of breath, chest or lower back pain, a persistent dry cough, fatigue and unexplained weight loss. Many people also develop a buildup of fluid around the lung, known as a pleural effusion.
Can secondhand asbestos exposure cause mesothelioma?
Yes. Family members of asbestos workers have developed mesothelioma after breathing fibers carried home on work clothes, hair and tools. People living near asbestos mines or processing plants have also been affected.
What is the difference between asbestosis and mesothelioma?
Asbestosis is a non-cancerous scarring of the lung tissue caused by inhaled asbestos fibers, which makes breathing progressively harder. Mesothelioma is a cancer of the lining around the lungs, abdomen or heart. Both are caused by asbestos, and a person can have both conditions.
Which jobs carry the highest risk of asbestos exposure?
Workers in construction, demolition, shipbuilding, insulation, plumbing, pipefitting, electrical work, mining, power plants and automotive brake repair have historically had the highest exposure. Military veterans, especially those who served on Navy ships, and firefighters are also at increased risk.
How is mesothelioma diagnosed?
Doctors usually begin with a chest X-ray or CT scan to look for fluid or thickening in the lining of the lungs. A biopsy, in which a small tissue sample is examined under a microscope, is needed to confirm the diagnosis and identify the cell type.
Insights, Analysis, and Developments
Editorial Note: The hard part about asbestos disease is the wait. Someone who installed insulation or tore out old pipework in their twenties may not see a single symptom until retirement, and by then the illness is frequently well established. Mesothelioma is still considered incurable, but surgery, radiation, chemotherapy, or a combination of the three have helped many patients live longer and with less discomfort, and results are better the earlier the disease is caught. That makes an honest conversation with a doctor about past jobs worth having, including the ones that ended decades ago, so that a cough or breathlessness is not written off as an ordinary chest complaint.
Author Credentials: Ian is the founder and Editor-in-Chief of Disabled World, a leading resource for news and information on disability issues. With a global perspective shaped by years of travel and lived experience, Ian is a committed proponent of the Social Model of Disability, a transformative framework developed by disabled activists in the 1970s that emphasizes dismantling societal barriers rather than focusing solely on individual impairments. His work reflects a deep commitment to disability rights, accessibility, and social inclusion. To learn more about Ian's background, expertise, and accomplishments, visit his full biography.