To follow-up the development of pleural plaques in the rural population of Almopia (a province in Northern Greece) where exposure to asbestos as an environmental pollutant had occurred in the past. In the two years’ period from 1988 through 1990, 1,086 people aged over 5 years, 818 of whom were over 40 years old, were examined with chest radiographs. These people were inhabitants of 7 villages in the province of Almopia with a total population of 3,931 people. Until 1935, the inhabitants of this area had been using rocks containing a high concentration of asbestos fibers as whitewash. Pleural plaques were found in 198 persons over 40 years; malignant lung neoplasm in 9; and malignant mesothelioma in 5 persons. Respiratory function was tested as well in 23 individuals. In 2003 (15 years later), follow-up examinations were performed, including: i) 126 survivors out of the 198 subjects initially presenting pleural plaques, underwent a chest x-ray examination; new radiological findings were compared to the previous ones (1988) using digitalization of radiological films and measurement of the area of shading; ii) respiratory function was re-evaluated in 18 out of the 23 individuals who had been evaluated 15 years ago. In addition, the cause of death of 72 persons who had passed away in the meantime was examined. A) Expansion of radiologically evident lesions was observed, despite the fact that exposure to asbestos had ceased long before. Not only was the area of previous plaques increased, but new plaques had appeared as well (total increase 1,091.1 cm2). B) Total lung capacity declined from 95.6±14.8 to 76.5±9.3 percent of the expected value. C) It was found that, of the 72 deaths in total, 11 people had died of malignant lung neoplasm and 4 of mesothelioma. The radiological appearance of pleural plaques in people with environmental exposure to asbestos in the past gets worse over time; respiratory function is proportionately affected as well. With reference to the total Greek population, prevalence of mesothelioma in the certain area was found to be higher than expected. Pneumon 2005, 18(2): 197-203.