To the Editor: In a study carried out over two years, I attempted to assess the level of recognition among pathologists of asbestos-related pulmonary disease. The results show a striking degree of underdiagnosis, which may have serious implications for individual patients and in epidemiologic measurements of frequency of environmental lung diseases. Although the under-reporting on death certificates as compared with clinical and autopsy data has been documented in certain diseases (e.g., lung cancer [12 to 20 per cent],1,2 mesothelioma [72 per cent], and asbestosis [53 per cent]2), no prior assessment of the accuracy of the general pathologist's diagnoses in . . .