Mesothelioma is a form of cancer that is almost always caused by previous exposure to asbestos. In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart).
Most people who develop mesothelioma have worked on jobs where they inhaled
asbestos particles, or they have been exposed to asbestos dust and fibre in
other ways, such as by washing the clothes of a family member who worked with
asbestos. Unlike lung cancer, there is no association between mesothelioma and
smoking.[1] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma
The symptoms of mesothelioma include shortness of breath due to pleural effusion
(fluid between the lung and the chest wall) or chest wall pain, and general
symptoms such as weight loss. The diagnosis can be made with chest X-rays and a
CT scan, and confirmed with a biopsy (tissue sample) and microscopic
examination. A thoracoscopy (inserting a tube with a camera into the chest) can
be used to take biopsies. It allows the introduction of substances such as talc
to obliterate the pleural space (called pleurodesis), which prevents more fluid
from accumulating and pressing on the lung. Despite treatment with chemotherapy,
radiation therapy or sometimes surgery, the disease carries a poor prognosis.
Research about screening tests for the early detection of mesothelioma is
ongoing.
Signs and symptoms
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to
asbestos. Shortness of breath, cough, and pain in the chest due to an
accumulation of fluid in the pleural space are often symptoms of pleural
mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal
swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood
clotting abnormalities, anemia, and fever. If the cancer has spread beyond the
mesothelium to other parts of the body, symptoms may include pain, trouble
swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious
conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
* chest wall pain
* pleural effusion, or fluid surrounding the lung
* shortness of breath
* fatigue or anemia
* wheezing, hoarseness, or cough
* blood in the sputum (fluid) coughed up (hemoptysis)
In severe cases, the person may have many tumor masses. The individual may
develop a pneumothorax, or collapse of the lung. The disease may metastasize, or
spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they
are at a late stage. Symptoms include:
* abdominal pain
* ascites, or an abnormal buildup of fluid in the abdomen
* a mass in the abdomen
* problems with bowel function
* weight loss
In severe cases of the disease, the following signs and symptoms may be
present:
* blood clots in the veins, which may cause thrombophlebitis
* disseminated intravascular coagulation, a disorder causing severe bleeding in
many body organs
* jaundice, or yellowing of the eyes and skin
* low blood sugar level
* pleural effusion
* pulmonary emboli, or blood clots in the arteries of the lungs
* severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands.
Pleural tumors are usually found only on one side of the lungs.
Diagnosis
CT scan of a patient with mesothelioma, coronal section (the section follows the
plane the divides the body in a front and a back half). The mesothelioma is
indicated by yellow arrows, the central pleural effusion (fluid collection) is
marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left
lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney,
(8) right kidney, (9) liver.
CT scan of a patient with mesothelioma, coronal section (the section follows the
plane the divides the body in a front and a back half). The mesothelioma is
indicated by yellow arrows, the central pleural effusion (fluid collection) is
marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left
lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney,
(8) right kidney, (9) liver.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to
those of a number of other conditions. Diagnosis begins with a review of the
patient's medical history. A history of exposure to asbestos may increase
clinical suspicion for mesothelioma. A physical examination is performed,
followed by chest X-ray and often lung function tests. The X-ray may reveal
pleural thickening commonly seen after asbestos exposure and increases suspicion
of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large
amount of fluid is present, abnormal cells may be detected by cytology if this
fluid is aspirated with a syringe. For pleural fluid this is done by a pleural
tap or chest drain, in ascites with an paracentesis or ascitic drain and in a
pericardial effusion with pericardiocentesis. While absence of malignant cells
on cytology does not completely exclude mesothelioma, it makes it much more
unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis,
heart failure).
If cytology is positive or a plaque is regarded as suspicious, a biopsy is
needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of
tissue for examination under a microscope by a pathologist. A biopsy may be done
in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this
procedure, the doctor makes a small cut through the chest wall and puts a thin,
lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy
allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain
tissue for examination, the doctor makes a small opening in the abdomen and
inserts a special instrument into the abdominal cavity. If these procedures do
not yield enough tissue, more extensive diagnostic surgery may be necessary.
Typical immunohistochemistry results Positive Negative
EMA (epithelial membrane antigen) in a membranous distribution CEA (carcinoembryonic
antigen)
WT1 (Wilms' tumour 1) B72.3
Calretinin MOC-3 1
Mesothelin-1 CD15
Cytokeratin 5/6 Ber-EP4
HBME-1 (human mesothelial cell 1) TTF-1 (thyroid transcription factor-1)
Screening
There is no universally agreed protocol for screening people who have been
exposed to asbestos. Screening tests might diagnose mesothelioma earlier than
conventional methods thus improving the survival prospects for patients. The
serum osteopontin level might be useful in screening asbestos-exposed people for
mesothelioma. The level of soluble mesothelin-related protein is elevated in the
serum of about 75% of patients at diagnosis and it has been suggested that it
may be useful for screening.[2] Doctors have begun testing the Mesomark assay
which measures levels of soluble mesothelin-related proteins (SMRPs) released by
diseased mesothelioma cells.[3]
Staging
Mesothelioma is described as localized if the cancer is found only on the
membrane surface where it originated. It is classified as advanced if it has
spread beyond the original membrane surface to other parts of the body, such as
the lymph nodes, lungs, chest wall, or abdominal organs.
Pathophysiology
The mesothelium consists of a single layer of flattened to cuboidal cells
forming the epithelial lining of the serous cavities of the body including the
peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in
the parenchyma of the lung may result in the penetration of the visceral pleura
from where the fibre can then be carried to the pleural surface, thus leading to
the development of malignant mesothelial plaques. The processes leading to the
development of peritoneal mesothelioma remain unresolved, although it has been
proposed that asbestos fibres from the lung are transported to the abdomen and
associated organs via the lymphatic system. Additionally, asbestos fibres may be
deposited in the gut after ingestion of sputum contaminated with asbestos fibres.
Pleural contamination with asbestos or other mineral fibres has been shown to
cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are
more potent carcinogens than "feathery fibers" (chrysotile or white asbestos
fibers).[4] However, there is now evidence that smaller particles may be more
dangerous than the larger fibers.[1][2] They remain suspended in the air where
they can be inhaled, and may penetrate more easily and deeper into the lungs.
"We probably will find out a lot more about the health aspects of asbestos from
[the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of
pulmonary and critical-care medicine at North Shore-Long Island Jewish Health
System. Dr. Fein has treated several patients for "World Trade Center syndrome"
or respiratory ailments from brief exposures of only a day or two near the
collapsed buildings.[3]
Mesothelioma development in rats has been demonstrated following intra-pleural
inoculation of phosphorylated chrysotile fibres. It has been suggested that in
humans, transport of fibres to the pleura is critical to the pathogenesis of
mesothelioma. This is supported by the observed recruitment of significant
numbers of macrophages and other cells of the immune system to localised lesions
of accumulated asbestos fibres in the pleural and peritoneal cavities of rats.
These lesions continued to attract and accumulate macrophages as the disease
progressed, and cellular changes within the lesion culminated in a
morphologically malignant tumour.
Experimental evidence suggests that asbestos acts as a complete carcinogen with
the development of mesothelioma occurring in sequential stages of initiation and
promotion. The molecular mechanisms underlying the malignant transformation of
normal mesothelial cells by asbestos fibres remain unclear despite the
demonstration of its oncogenic capabilities. However, complete in vitro
transformation of normal human mesothelial cells to malignant phenotype
following exposure to asbestos fibres has not yet been achieved. In general,
asbestos fibres are thought to act through direct physical interactions with the
cells of the mesothelium in conjunction with indirect effects following
interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibres and DNA has shown that
phagocytosed fibres are able to make contact with chromosomes, often adhering to
the chromatin fibres or becoming entangled within the chromosome. This contact
between the asbestos fibre and the chromosomes or structural proteins of the
spindle apparatus can induce complex abnormalities. The most common abnormality
is monosomy of chromosome 22. Other frequent abnormalities include structural
rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the
tumor suppressor genes:
* Neurofibromatosis type 2 at 22q12
* P16INK4A
* P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target
cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis
by several possible mechanisms:
* Inactivation of tumor suppressor genes
* Activation of oncogenes
* Activation of proto-oncogenes due to incorporation of foreign DNA containing a
promoter region
* Activation of DNA repair enzymes, which may be prone to error
* Activation of telomerase
* Prevention of apoptosis
Asbestos fibres have been shown to alter the function and secretory properties
of macrophages, ultimately creating conditions which favour the development of
mesothelioma. Following asbestos phagocytosis, macrophages generate increased
amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic
metabolism. However, these free radicals are also known clastogenic and
membrane-active agents thought to promote asbestos carcinogenicity. These
oxidants can participate in the oncogenic process by directly and indirectly
interacting with DNA, modifying membrane-associated cellular events, including
oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile
fibres have been shown to depress the in vitro proliferation of
phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural
killer cell lysis and significantly reduce lymphokine-activated killer cell
viability and recovery. Furthermore, genetic alterations in asbestos-activated
macrophages may result in the release of potent mesothelial cell mitogens such
as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β)
which in turn, may induce the chronic stimulation and proliferation of
mesothelial cells after injury by asbestos fibres.
Epidemiology
Incidence
Although reported incidence rates have increased in the past 20 years,
mesothelioma is still a relatively rare cancer. The incidence is approximately
one per 1,000,000. For comparison, populations with high levels of smoking can
have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant
mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized
Western nations, depending on the amount of asbestos exposure of the populations
during the past several decades.[5] It has been estimated that incidence may
have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is
expected to continue increasing in other parts of the world. Mesothelioma occurs
more often in men than in women and risk increases with age, but this disease
can appear in either men or women at any age. Approximately one fifth to one
third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally
exposed to asbestos in the United States [4]. Between 1973 and 1984, there has
been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian
males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA
increased from 2,000 per year to 3,000, with men four times more likely to
acquire it than women. These rates may not be accurate, since it is possible
that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung,
which is difficult to differentiate from mesothelioma.
Risk factors
Working with asbestos is the major risk factor for mesothelioma. Mesothelioma is
now known to occur in those who are genetically pre-disposed to it. A history of
asbestos exposure exists in almost all cases. However, mesothelioma has been
reported in some individuals without any known exposure to asbestos. In rare
cases, mesothelioma has also been associated with irradiation, intrapleural
thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as
erionite.
Asbestos is the name of a group of minerals that occur naturally as masses of
strong, flexible fibers that can be separated into thin threads and woven.
Asbestos has been widely used in many industrial products, including cement,
brake linings, roof shingles, flooring products, textiles, and insulation. If
tiny asbestos particles float in the air, especially during the manufacturing
process, they may be inhaled or swallowed, and can cause serious health
problems. In addition to mesothelioma, exposure to asbestos increases the risk
of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other
cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a
person's risk of developing cancer of the airways (lung cancer, bronchial
carcinoma). The Kent brand of cigarettes used asbestos in its filters for the
first few years of production in the 1950s and some cases of mesothelioma have
resulted. Smoking modern cigarettes does not appear to increase the risk of
mesothelioma.
Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the
development of mesothelioma.[6]
Exposure
Asbestos was known in antiquity, but it wasn't mined and widely used
commercially until the late 1800s. Its use greatly increased during World War
II. Since the early 1940s, millions of American workers have been exposed to
asbestos dust. Initially, the risks associated with asbestos exposure were not
publicly known. However, an increased risk of developing mesothelioma was later
found among shipyard workers, people who work in asbestos mines and mills,
producers of asbestos products, workers in the heating and construction
industries, and other tradespeople. Today, the U.S. Occupational Safety and
Health Administration (OSHA) sets limits for acceptable levels of asbestos
exposure in the workplace, and created guidelines for engineering controls and
respirators, protective clothing, exposure monitoring, hygiene facilities and
practices, warning signs, labeling, recordkeeping, and medical exams. By
contrast, the British Government's Health and Safety Executive (HSE) states
formally that any threshold for mesothelioma must be at a very low level and it
is widely agreed that if any such threshold does exist at all, then it cannot
currently be quantified. For practical purposes, therefore, HSE does not assume
that any such threshold exists. People who work with asbestos wear personal
protective equipment to lower their risk of exposure. Recent findings have shown
that a mineral called erionite has been known to cause genetically pre-dispostioned
individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned
genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey
have death rates of 51% attributed to erionite related mesothelioma.
Occupational
Exposure to asbestos fibres has been recognised as an occupational health hazard
since the early 1900s. Several epidemiological studies have associated exposure
to asbestos with the development of lesions such as asbestos bodies in the
sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of
the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the
pleura and peritoneum.
The documented presence of asbestos fibres in water supplies and food products
has fostered concerns about the possible impact of long-term and, as yet,
unknown exposure of the general population to these fibres. Although many
authorities consider brief or transient exposure to asbestos fibres as
inconsequential and an unlikely risk factor, some epidemiologists claim that
there is no risk threshold. Cases of mesothelioma have been found in people
whose only exposure was breathing the air through ventilation systems. Other
cases had very minimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between
1945 and 1966. A cohort study of miners employed at the mine reported that while
no deaths occurred within the first 10 years after crocidolite exposure, 85
deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported
deaths due to mesothelioma had been reported in Western Australia.
Paraoccupational Secondary Exposure
Family members and others living with asbestos workers have an increased risk of
developing mesothelioma, and possibly other asbestos related diseases. This risk
may be the result of exposure to asbestos dust brought home on the clothing and
hair of asbestos workers. To reduce the chance of exposing family members to
asbestos fibres, asbestos workers are usually required to shower and change
their clothing before leaving the workplace.
Asbestos in buildings
Many building materials used in both public and domestic premises prior to the
banning of asbestos may contain asbestos. Those performing renovation works or
diy activities may expose themselves to asbestos dust. In the UK use of
Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was
banned in the UK around 1985. Buildings built or renovated prior to these dates
may contain asbestos materials.
Environmental exposures
Incidence of mesothelioma had been found to be higher in populations living near
naturally occurring asbestos. For example, in Cappadocia, Turkey, an
unprecedented mesothelioma epidemic caused 50% of all deaths in three small
villages. Initially, this was attributed to erionite, however, recently, it has
been shown that erionite causes mesothelioma mostly in families with a genetic
predisposition[7].
Treatment
Treatment of malignant mesothelioma using conventional therapies has not proved
successful and patients have a median survival time of 6 - 12 months after
presentation[citation needed]. The clinical behaviour of the malignancy is
affected by several factors including the continuous mesothelial surface of the
pleural cavity which favours local metastasis via exfoliated cells, invasion to
underlying tissue and other organs within the pleural cavity, and the extremely
long latency period between asbestos exposure and development of the disease.
Surgery
Surgery, either by itself or used in combination with pre- and post-operative
adjuvant therapies, has proved disappointing. A pleurectomy/decortication is the
most common surgery, in which the lining of the chest is removed. Less common is
an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of
the chest, the hemi-diaphragm and the pericardium are removed. It is not
possible to remove the entire mesothelium without killing the patient.
Radiation
Wikibooks
Wikibooks has a book on the topic of
Radiation Oncology/Lung/Mesothelioma
For patients with localized disease, and who can tolerate a radical surgery,
radiation is often given post-operatively as a consolidative treatment. The
entire hemi-thorax is treated with radiation therapy, often given simultaneously
with chemotherapy. This approach of using surgery followed by radiation with
chemotherapy has been pioneered by the thoracic oncology team at Brigham &
Women's Hospital in Boston.[8] Delivering radiation and chemotherapy after a
radical surgery has led to extended life expectancy in selected patient
populations with some patients surviving more than 5 years. As part of a
curative approach to mesothelioma, radiotherapy is also commonly applied to the
sites of chest drain insertion, in order to prevent growth of the tumor along
the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with
radiotherapy alone, palliative treatment regimens are sometimes used to relieve
symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation therapy when given alone with curative intent has never been shown to
improve survival from mesothelioma. The necessary radiation dose to treat
mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy
In February 2004, the United States Food and Drug Administration approved
pemetrexed (brand name Alimta) for treatment of malignant pleural mesothelioma.
Pemetrexed is given in combination with cisplatin. Folic acid is also used to
reduce the side-effects of pemetrexed.
Immunotherapy
Treatment regimens involving immunotherapy have yielded variable results. For
example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an
attempt to boost the immune response, was found to be of no benefit to the
patient (while it may benefit patients with bladder cancer). Mesothelioma cells
proved susceptible to in vitro lysis by LAK cells following activation by
interleukin-2 (IL-2), but patients undergoing this particular therapy
experienced major side effects. Indeed, this trial was suspended in view of the
unacceptably high levels of IL-2 toxicity and the severity of side effects such
as fever and cachexia. Nonetheless, other trials involving interferon alpha have
proved more encouraging with 20% of patients experiencing a greater than 50%
reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy
A procedure known as heated intraoperative intraperitoneal chemotherapy was
developed by Paul Sugarbaker at the Washington Cancer Institute.[8] The surgeon
removes as much of the tumor as possible followed by the direct administration
of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The
fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected
drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment
increases the penetration of the drugs into tissues. Also, heating itself
damages the malignant cells more than the normal cells.
Notable people who died from mesothelioma
Mesothelioma, though rare, has had a number of notable patients. Hamilton
Jordan, Chief of Staff for President Jimmy Carter and life long cancer activist,
died in 2008. Australian anti-racism activist Bob Bellear died in 2005. British
science fiction writer Michael G. Coney, responsible for nearly 100 works also
died in 2005. American film and television actor Paul Gleason, perhaps best
known for his portrayal of Principal Richard Vernon in the 1985 film The
Breakfast Club, died in 2006. Mickie Most, an English record producer, died of
mesothelioma in 2003. Paul Rudolph, an American architect known for his cubist
building designs, died in 1997.
Bernie Banton was an Australian workers' rights activist, who fought a long
battle for compensation from James Hardie after he contracted mesothelioma after
working for that company. He claimed James Hardie knew of the dangers of
asbestos before he began work with the substance making insulation for power
stations. Mesothelioma eventually took his life along with his brothers and
hundreds of James Hardie workers. James Hardie made an undisclosed settlement
with Banton only when his mesothelioma had reached its final stages and he was
expected to have no more than 48hrs to live. Australian Prime Minister-elect
Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after
winning the 2007 Australian Federal Election.
Steve McQueen was diagnosed with peritoneal mesothelioma on December 22, 1979.
He was not offered surgery or chemotherapy because doctors felt the cancer was
too advanced. McQueen sought alternative treatments from clinics in Mexico. He
died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer
surgery. He may have been exposed to asbestos while serving with the U.S.
Marines as a young adult—asbestos was then commonly used to insulate ships'
piping—or because of its use as an insulating material in car racing suits.[9]
(It is also reported that he worked in a shipyard during World War II, where he
might have been exposed to asbestos.[citation needed]
United States Congressman Bruce Vento died of mesothelioma in 2000. The Bruce
Vento Hopebuilder is awarded yearly by his wife at the MARF Symposium to persons
or organizations who have done the most to support mesothelioma research and
advocacy.
After a long period of untreated illness and pain, rock and roll musician and
songwriter Warren Zevon was diagnosed with inoperable mesothelioma in the fall
of 2002. Refusing treatments he believed might incapacitate him, Zevon focused
his energies on recording his final album The Wind including the song "Keep Me
in Your Heart," which speaks of his failing breath. Zevon died at his home in
Los Angeles, California, on September 7, 2003.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma
in 2007, and had stridently refused to accept the prognosis in the weeks before
his death.[10] His mesothelioma has been attributed to his younger years spent
working on building sites in London.[11][12]
Bob Miner, one of the founders of Software Development Labs, the forerunner of
Oracle Corporation died of mesothelioma in 1994.
Notable people that have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are
notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal
mesothelioma. After his diagnosis, Gould wrote the "The Median Isn't the
Message"[13] for Discover magazine, in which he argued that statistics such as
median survival are just useful abstractions, not destiny. Gould lived for
another twenty years eventually succumbing to metastatic adenocarcinoma of the
lung, not mesothelioma.
Author Paul Kraus was diagnosed with mesothelioma in June 1997 following an
umbilical hernia operation. His prognosis was "a few months." He continues to
survive using a variety of integrative and complementary modalities and has
written a book about his experience.
Legal issues
asbestos and the law
The first lawsuits against asbestos manufacturers were in 1929. Since then, many
lawsuits have been filed against asbestos manufacturers and employers, for
neglecting to implement safety measures after the links between asbestos,
asbestosis, and mesothelioma became known (some reports seem to place this as
early as 1898). The liability resulting from the sheer number of lawsuits and
people affected has reached billions of dollars.[citation needed] The amounts
and method of allocating compensation have been the source of many court cases,
and government attempts at resolution of existing and future cases.
Legal History
The first lawsuit against asbestos manufacturers was brought in 1929. The
parties settled that lawsuit, and as part of the agreement, the attorneys agreed
not to pursue further cases. It was not until 1960 that an article published by
Wagner et al first officially established mesothelioma as a disease arising from
exposure to crocidolite asbestos.[14] The article referred to over 30 case
studies of people who had suffered from mesothelioma in South Africa. Some
exposures were transient and some were mine workers. In 1962 McNulty reported
the first diagnosed case of malignant mesothelioma in an Australian asbestos
worker.[15] The worker had worked in the mill at the asbestos mine in Wittenoom
from 1948 to 1950.
In the town of Wittenoom, asbestos-containing mine waste was used to cover
schoolyards and playgrounds. In 1965 an article in the British Journal of
Industrial Medicine established that people who lived in the neighbourhoods of
asbestos factories and mines, but did not work in them, had contracted
mesothelioma.
Despite proof that the dust associated with asbestos mining and milling causes
asbestos related disease, mining began at Wittenoom in 1943 and continued until
1966. In 1974 the first public warnings of the dangers of blue asbestos were
published in a cover story called "Is this Killer in Your Home?" in Australia's
Bulletin magazine. In 1978 the Western Australian Government decided to phase
out the town of Wittenoom, following the publication of a Health Dept. booklet,
"The Health Hazard at Wittenoom", containing the results of air sampling and an
appraisal of worldwide medical information.
By 1979 the first writs for negligence related to Wittenoom were issued against
CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to
represent the Wittenoom victims.
