W.R. Grace & Company operated the mine. In 2009, the company and several of its officers were brought up on criminal charges, but a jury returned a verdict of “not guilty.” Many following the trial closely said the government botched its case against the company, and others argued Grace’s deep pockets simply outpaced the efforts of a handful of government lawyers.

The aquittal was another in a long line of emotional blows for Libby residents, who hoped to see W.R. Grace finally brought to justice for the devastation of their hometown, their families and loved ones. Generations of Libby residents have already died of mesothelioma, and many more are currently suffering from mesothelioma, asbestosis, lung cancer, and a host of other ailments caused by longterm exposure to asbestos.

On June 17, the U.S. Environmental Protection Agency finally declared a public health emergency in Libby. This designation – the first of its kind in American history – will allow the government to increase funds to provide for medical treatment for Libby residents, and for research into asbestos disease. According to the Missoulian, Libby has already received $6 million, which is designated for patient screening and care, and the town is set to receive an additional $2 million for health care and home care assistance. The paper reports the asbestos health care clinic – the Center for Asbestos Related Diseases (CARD) – and the local hospital are planning expansions.

At the beginning of December, a series of town hall meetings were held, hoping to address important questions about safety and health, including whether or not the government’s clean-up efforts are truly making any difference.

For residents who already have seen husbands, fathers, brothers, sisters, husbands and wives die terrible deaths from asbestos disease, it is too little too late. They try to remain strong, but they are angry, and sad, and it’s hard to hold onto hope.

Read the full article by Missoulian reporter Micheal Jamison.

SOURCE: myMeso › Future tied up in past as asbestos deaths continue in Libby

The town hall meeting, which was held Dec. 6, featured a panel discussion about the deadly fallout from town’s vermiculite asbestos mine, which was operated for years by W.R. Grace & Company. Even those who didn’t work in the mine were exposed to asbestos, as dust from the mine covered the surrounding area, railroad tracks and roads used to transport the materials. Asbestos was even used as filler for gardens and ballparks.

According to the Daily Inter Lake report, more than 300 deaths have been linked to asbestos exposure from the vermiculite mine. A special health clinic established by the EPA after the story broke about the widespread asbestos disease affecting Libby area residents is currently treating about 2,800 patients with varying levels of asbestos disease.

Dr. Brad Black, who oversees patient care at the clinic, called the Center for Asbestos Related Disease (CARD), says it’s impossible to really determine how many people have been affected by asbestos in Libby, because around 80,000 people “came and went in Libby while the mine was operating,” the paper reports.

Because of the long latency period of asbestos disease – which includes conditions such as asbestosis, a severe scarring of the lungs that impedes lung function and limits breathing, and mesothelioma, a deadly cancer that affects the lining of the lungs or, more rarely, the abdomen or heart – which is sometimes as long as 30 or 40 years, Black estimates cases will continue to emerge well into the future, through the year 2030.

Since the asbestos contamination of Libby was brought to light, it has been a roller-coaster ride for area residents. The EPA has spent more than $206 million to date to clean up residential and commercial properties. In June, Libby was declared a public health emergency, which is the first time the agency has made such a determination under the 1980 Superfund law. This will allow more money to be put into the town’s cleanup efforts.

However, there are still lingering questions about just how effective these cleanup efforts really are. The EPA has divided the Libby Superfund site into eight geographical units, and has so far only completed cleanup on two of those units. However, some scientists argue that the type of asbestos affecting Libby – amphibole – is much more toxic than chrysotile asbestos, and that cleanup efforts are being conducted using old research on the wrong type of asbestos.

The Daily Inter Lake reports that EPA officials have admitted they are using toxicology assessments from 1985 data on less toxic asbestos, not Libby asbestos. This is despite a more recent study completed in 2003, which “established exposure benchmarks for mesothelioma and lung cancer based on asbestos epidemiologic studies,” the news agency reports.

According to the paper, federal government risk assessment standards say cleanup efforts are necessary when there is evidence of one death per 10,000 people. In Libby, where the population is around 10,000 people, there have already been 31 deaths just from mesothelioma. This doesn’t even take into account the suffering and death from other asbestos-related diseases.

The asbestos contamination also has been a see-saw on the legal front. In May, W.R. Grace & Co. and several of its top leaders were acquitted of criminal charges related to the widespread asbestos disease affecting its residents. Nearly 800 people still have pending civil suits against the company, which have been delayed by bankrupcy claims on the part of Grace. The company is expected to emerge from bankruptcy in January.

Testimony resulting from the bankruptcy trial in October revealed that there is a 59 percent probability of death for Libby residents exposed to asbestos dust.

“No other place on the planet has that,” the Daily Inter Lake quotes attorney John Heberling, who is representing asbestos clients.

This is a fascinating and tragic series of stories, and I encourage you to visit the Daily Inter Lake online to read the full series. It includes a feature on Gayla Benefield, who, along with compatriot Les Skramstad, began the campaign to expose the Libby contamination and lobby for justice for the town. Here are just a few of the links:

What is a safe dose for Libby?
What’s next for Libby?
Asbestos victims try to stay upbeat
Advocate’s work for asbestos victims spans 35 years
Grace lawsuit claimants still in limbo

SOURCE: myMeso › Montana newspaper series takes a look at Libby today

In addition to providing educational information, advocacy support, a special remembrance ceremony and networking opportunities, each year the conference honors individuals or organizations that have demonstrated outstanding work and dedication to asbestos awareness related activities. ADAO has announced this year’s honorees:

• The Honorable Richard Durbin, United States Senator – Tribute of Hope Award
• Dr. Hedy Kindler – Selikoff Lifetime Achievement Award
• Center for Asbestos Related Disease (CARD), Libby, Montana – Tribute of Unity Award
• Fernanda Giannasi – Tribute of Inspiration Award
• June Breit (posthumous) – The Alan Reinstein Memorial Award

At the conference, the ADAO also will announce the recipient of the Warren Zevon “Keep Me in Your Heart” Memorial Tribute.

“I’ve received countless requests for my father’s song, ‘Keep Me in Your Heart,’ to be used at memorials for asbestos victims,” said ADAO Spokesperson Jordan Zevon. Jordan is the son of Warren Zevon, acclaimed singer and songwriter, who died of mesothelioma in 2003. “You can imagine how proud it makes me to know that my father’s Grammy winning song has touched so many families, but it is bittersweet because of the nature of those requests. In his honor, I will continue to work with ADAO to ban asbestos to spare future generations from the same fate.”

“As we get closer to a full asbestos ban, we are encouraged, yet simultaneously reminded that the reverberations of asbestos exposure can last decades,” said Linda Reinstein, Co-Founder and Executive Director of ADAO. “Our annual conferences drive home the importance of the need for increased awareness, education and research.”

Additional conference details are available on the ADAO web site, and online registration is available at http://www.adao.eventbrite.com.

The International Asbestos Awareness Conference is made possible with the support and collaborative efforts of the Barbara Ann Karmanos Cancer Institute and the International Ban Asbestos Secretariat (IBAS).

SOURCE: myMeso › Registration now open for ADAO Sixth Annual International Asbestos Awareness Conference

Asbestos exposure causes serious disease, including asbestosis, a severe scarring of the lungs that worsens with time and impairs the ability of its victims to breathe, and mesothelioma, a deadly cancer that affects the lining of the lungs and, more rarely, the stomach and heart.

According to the report in The Missoulian, statistics compiled by the Center for Asbestos Related Disease (CARD), located in Libby, indicate that to date 227 community members have died from asbestos disease, and there are more than 1,800 active cases resulting from exposure to the deadly fiber. The newspaper notes that “the study also attributes scores of deaths to non-occupational asbestos exposures, and finds that 77 people who never worked at Grace’s mine in Libby have died of asbestos disease since 1998.”

David Uhlmann, who is former chief of the Justice Department’s environmental crimes section, who was instrumental in developing much of the early indictment against Grace, said the Government’s case against Grace was severely limited by the court, which did not allow much of the evidence to be presented to the jury. This included some of the most incriminating internal memos, he said.

The Post quotes Uhlmann as saying, “The verdict is a fair reflection of the evidence that jurors were allowed to hear. But the question that hangs over this case is what would have happened if the government were allowed to present all of the evidence that it had amassed in this multi-year investigation.”

According to a report in The Washington Post, in a court filing the government acknowledged it “has committed discovery violations in this case,” which led to many rulings excluding its evidence and weakening its case against Grace.

The Missoulian reported the reaction of two Libby residents familiar to our readers – Gayla Benefield, who was perhaps the first to raise the outcry about the dangers of deadly asbestos in the town, said the company has “gotten away with murder.” And the paper quotes our friend Mike Crill, who worked in the asbestos mine and has lost family members to asbestos related disease and suffers himself from asbestos disease.

The Missoulian says Mike cried upon hearing the verdict. The paper quotes him: “What did they die for? What am I dying for?” Crill sobbed. “They are guilty of killing us.”

SOURCE: myMeso › Jury aquits W.R. Grace & Co. of criminal charges

Dr. Whitehouse, along with four other physicians including CARD’s Dr. Brad Black, studied 31 mesothelioma cases, including 11 cases not previously reported. The study focused specifically on non-occupational asbestos exposure, including exposure to contamination of the community, the surrounding forested area, and areas in proximity to the Kootenai river and the railroad tracks used to haul vermiculite.

It is estimated that more than 200 people in Libby have died from asbestos-related disease, and CARD is following 2,000 additional asbestos cases. CARD primarily serves Libby residents who were affected by the W.R. Grace-operated vermiculite mine, which was in operation for many years, and at high capacity from the 1940s to the 1970s.

Focus has recently shifted to include people suffering from asbestos disease and mesothelioma who never came into direct contact with the vermiculite mining operation. In June, the U.S. Department of Health and Human Services and the Environmental Protection Agency announced an $8 million grant to fund a five-year study of the effects of low-level asbestos exposure.

SOURCE: myMeso › CARD physician predicts mesothelioma epidemic

The Libby program, dubbed the Libby Amphibole Health Risk Initiative, is funded by the Environmental Protection Agency and the Department of Health and Human Services’ Agency for Toxic Substances and Disease Registry. The study is expected to span 5 years with a goal of expanding knowledge about the potential and real health issues of asbestos exposure.

Libby already has proved a tragically rich source of knowledge about long-term exposure to high levels of asbestos, as the EPA’s initial examination and cleanup of the town focused on miners with direct exposure to the substance in their jobs, as well as people who handled asbestos mineral and were exposed to asbestos dust secondarily on a daily basis.

But, the Gazette reports, too little is know about exposure to lower levels of asbestos. EPA officials hope that results of the study will benefit not only the residents of Libby, but people throughout the country.

In April, the Minnesota state legislature approved $4.9 million for its own five-year study, to be conducted under the direction of the University of Minnesota, in connection with unusually high levels of mesothelioma affecting Iron Range mine workers. A large question in the area is whether dust from the taconite mined there – a fibrous mineral similar to asbestos – could also cause mesothelioma.

A key part of the Minnesota research will be an examination of previous asbestos exposure among mine workers, which will expand the base of knowledge about the affect of asbestos on health, in addition to the new studies about the effect of taconite.

According to the Billings Gazette, among tests to be included in the Libby study are a comparison of film and digital chest X-rays to determine which is best for assessing the lungs, a comparison of the health of people exposed to Libby asbestos in childhood versus people who weren’t, an expanded evaluation of Libby residents who were exposed to asbestos, an assessment of whether the health problems related to asbestos exposure extend beyond lung disease.

Researchers in Libby also hope to make improvements to public health tracking systems and patient health record databases, to better link exposure information to health conditions, the Gazette reports.

Gayla Benefield, perhaps one of the best-known residents of Libby for her early outcry about the health effects of asbestos on the people in her town, says she is happy to see an emphasis on research.

She was a charter member of the board of directors of the Center for Asbestos Related Disease (CARD), a not-for-profit clinic governed by a volunteer community board and devoted to healthcare, outreach, and research to benefit all people impacted by exposure to Libby amphibole asbestos. She only recently retired from her position with that organization.

“This is something I’ve wanted from the onset – more study and more research,” she says. “I’ve been especially interested in how much or how little of the (asbestos) fiber can cause meso, and I’ve been really concerned about the schools having been contaminated.”

The key, Benefield says, is to detect mesothelioma at its earliest stage, when there is still time for treatment to prolong life. When people around her in Libby began being diagnosed, she says, their mesothelioma was so advanced that many died within days of the diagnosis.

“We all – everyone in Libby – live under the threat of developing mesothelioma,” she says. “They’re never going to get all that (asbestos) fiber out of Libby, or anywhere for that matter, homes with asbestos insulation, so the research is the big thing. Any and all research having to do with mesothelioma is fantastic. A dream come true.”

SOURCE: myMeso › $8 million asbestos study in Libby

A special focus of this year’s conference was lung cancer, which is the leading cause of cancer deaths in the United States. Mesothelioma affects the lining of the lungs, and may also affect the abdomen or the pericardium (the sac around the heart).

There was a great deal of hope for a new drug, Erbitux, which doctors hoped would prove to have significant results in prolonging survival for lung cancer patients (it didn’t), as well as review of a currently popular lung cancer drug, Avastin, which in its Phase III trial was shown to help keep the disease from progressing.

But among the reports of facts and figures and products and treatments, was a report by Robert Bazell at MSNBC.com. Why, he wondered, are we not further along in the War on Cancer, which was declared as a national health priority in 1971, when President Richard Nixon signed the National Cancer Act.

The Act, Bazell points out, created the National Cancer Institute as a separate entity from the National Institutes of Health, with a dedicated budget for curing cancer. The NCI started with $230 million per year, and now has a budget of $5 billion.

Certainly, progress has been made, and there have been steady declines in breast, colon and prostate cancers, most due to better methods for early detection, Bazell points out. But, overall, he says, the death toll from cancer has declined only 5 percent between 1950 and 2005. FIVE percent!

What are the challenges? Why are we not winning this war?

Certainly, the nature of cancer itself has something to do with it – there are more than 200 diseases that fit into the definition of “cancer,” uncontrolled cell growth, he points out. And, even though funding has increased, if you adjust that $5 billion budget for inflation, spending on cancer research has actually been falling in recent years, he says.

But I was intrigued by his most compelling argument, which seems so simple. He notes that “it would be very useful to have a discussion on how much we spend on BASIC RESEARCH and PREVENTION, compared to how much we spend on marginally useful treatments.”

Is it possible that we can no longer see the forest for the trees?

SOURCE: myMeso › Why haven’t we won the war?

Compassionate Communications will operate a web site, which will be launched sometime this month, that will feature photos and information about people struggling with cancer, including mesothelioma, and other life-threatening illnesses. Visitors to the site can view profiles, and if they choose to register (for a fee of $25), they will receive five Hallmark greeting cards with pre-paid postage, to send to patients to encourage them, and other support materials. Twenty-five percent of the registration fee will benefit patient-serving organizations.

There is no charge for a patient to register his or her profile. The program operates in cooperation with Hallmark Business Expressions (a subsidiary of Hallmark Cards, Inc.).

Patients may download an “opt-in” registration form and waiver directly from the web site, or call 888-337-6416. The waiver must be completed and returned by mail or fax to Compassionate Communications, which will then provide participants with an account so they can set up their personal profile on the site. There is a place on the waiver form for patients to designate the patient-assistance organization they would like card-sender registration fees to benefit.

You may also get more information or ask questions by emailing Amy at the Lung Cancer Alliance at apearson@lungcanceralliance.org.

SOURCE: myMeso › Compassionate Communications for the sick

Frustrated, in the fall of 2006 she tried a new medication for a two-week protocol, plus a gluten-free diet for six months, and finally experienced some relief. But then, six months later, the pain and discomfort returned.

Since she had been off Crohn’s medications during the experiment with her diet, doctors decided it would be a good time to try some new tests, and included a CT scan. In March 2007, tests showed nothing wrong with Charlene’s stomach, but something odd at the base of her left lung. The doctor conducting the scan didn’t think it was anything serious, but recommended that she follow up with her primary care physician anyway.

In May 2007, Charlene received a chest CT scan, which revealed three spots on her left lung. Doctors suspected lymphoma. A cardio-thoracic specialist followed up with a PET scan, which showed the same three spots. He recommended a “wait and see” approach, suggesting they could check the area again in three to six months.

“I didn’t want to wait,” Charlene said.

At her request, doctors did a lung biopsy in July, and she was told she has mesothelioma.

The actual number of tiny tumors inside her chest were “too numerous to count,” and obviously most of those had not shown up on her scans.

“I’d never heard of it,” she says. “There are a few commercials on TV, but other than hearing the word, I was not familiar with it. Most people I tell just look at me, and they’ve never heard of it either.”

The diagnosis was particularly surprising, since the average median age of onset of symptoms is 70, according to most studies, and mesothelioma usually affects men more frequently than women. Charlene said she was exposed to asbestos when she was a child, but she cannot discuss the details because she is currently pursuing legal action.

“When you think of the numbers of people that have been exposed to asbestos in their lives, you wonder why there are few people that get [mesothelioma], as compared to other types of cancer. It’s still pretty rare,” Charlene said.

In the U.S. current statistics show between 2,000-3,000 people are diagnosed with malignant pleural mesothelioma each year. However, 10,000 Americans die each year from all asbestos-related diseases, according to statistics compiled by the Environmental Working Group. And, mesothelioma was not tracked as a specific cause of death by federal health officials until 1999, EWG points out, so actual totals for mesothelioma may be much higher.

“There is a possibility that my brother and my parents could be at risk of mesothelioma, because they would have been exposed at the same time as me,” Charlene worries. “You just don’t know what causes you to get it, and not someone else.”

As she continued to research her new diagnosis, Charlene was disheartened to find that the outlook for most mesothelioma patients is bleak. The Center for Mesothelioma and Asbestos-Related Diseases at the University of Maryland Medical Center estimates median survival time between 4-12 months after discovery.

Next: Charlene begins her fight.

SOURCE: myMeso › Living with Meso – Charlene’s story, Part 1

What is Mesothelioma?

Mesothelioma cancer, or malignant mesothelioma, is an extremely rare disease generally affecting the lining of the lungs, and, more rarely, the abdominal cavity and/or the heart. Mesothelioma cancer is most strongly associated with exposure to asbestos, and can remain latent in those exposed for 30 to 40 years.

There are three types of mesothelioma cancer: pleural, in which the cancer affects the lining of the lungs/chest;  peritoneal, which affects the lining of the abdominal cavity; and pericardial, which affects the lining of the heart.

Pleural mesothelioma is the most common form of malignant mesothelioma, accounting for approximately three out of every four cases. The pleura is defined as the outer lining of the lungs and chest cavity. Pleural mesothelioma typcially has a latency period of 30-40 years or longer.

Peritoneal mesothelioma generally accounts for about 25 percent of maglignant mesothelioma cases diagnosed each year. It can have a shorter latency period than pleural mesothelioma, developing in 20-30 years or shorter. It affects the peritoneum, which is the lining of the abdominal cavity. Peritoneal mesothelioma generally occurs more often in males than females.

Pericardial mesothelioma, which affects the pericardium, the lining of the heart, is extremely rare. This form of malignant mesothelioma is usually fatal, due to its difficulty in diagnosis and treatment. It is generally diagnosed in a very late stage, and surgical or other treatment options are dangerous and difficult.

Mesothelioma in general is fairly rare in the United States. There are an estimated 2,000 to 3,000 new cases of mesothelioma each year in the United States. However, in European countries, especially the UK, as well as in Australia, the rate of mesothelioma is increasing.

For years, mesothelioma was thought to be  rare in people under age 55. Traditionally seen primarily in older men, usually with a background of working in a factory, shipyard, mine or other environment with heavy asbestos exposure, today more and more cases of secondary exposure are being diagnosed, and it is affecting greater number of women.

The average age for someone with mesothelioma used to be around 72, but each year it seems mesothelioma affects younger people, and a greater number of women. Last year, a 3-year-old girl was diagnosed with mesothelioma, stunning the physicians who were treating her.

Mesothelioma is a serious disease. By the time the symptoms appear and cancer is diagnosed, the disease is often advanced. The average survival time is about 1 year. The 5-year relative survival rate is around 10%, but this rate has been slowly improving.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Many of these patients live much longer than 5 years after diagnosis, and 5-year rates are used to produce a standard way of discussing prognosis.

Five-year relative survival rates do not include patients dying of other diseases and are considered to be a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. That means that relative survival only talks about deaths from mesothelioma. Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago. They may no longer be accurate. Improvements in treatment result in a more favorable outlook for recently diagnosed patients.

Symptoms of Mesothelioma

Early symptoms of mesothelioma can be very general. Thus, they are often ignored.

Symptoms of pleural mesothelioma (lining of the chest) can include:

* pain in the lower back or at the side of the chest

* shortness of breath

* trouble swallowing

* hoarseness

* cough

* fever

* sweating

* tiredness

* weight loss

* swelling of the face and arms

* muscle weakness

Symptoms of peritoneal mesothelioma (lining of the abdominal cavity) include:

* belly pain

* weight loss

* nausea

* vomiting

* fluid or a lump in the abdomen

Symptoms of pericardial mesothelioma (lining of the heart) include:

* constrictive pericarditis

* pericardial effusion

* cardiac tamponade

* heart failure caused by myocardial infarction

Of course, these same symptoms can also be caused by other minor ailments. But if you have worked with asbestos and you have any of these symptoms, you should see your doctor right away.

Diagnosing Mesothelioma

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, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. As a rule, a chest x-ray is not useful in finding mesothelioma early.

One test being studied is a blood test. This test measures the levels in the blood of a certain protein that is higher in people who have lung damage due to asbestos. It is even higher if the person has mesothelioma.

A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) 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 peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity.

If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

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.

New developments in Diagnosis of Mesothelioma

A recently published report in the Journal of the American Medical Association holds out hope for earlier detection of mesothelioma, a deadly cancer linked to asbestos exposure.

Researchers compared three types of endoscopic collection for accuracy in detecting cancerous cells in the lymph nodes to determine their accuracy.

Typically, doctors use several different techniques to diagnose lung cancers, including mesothelioma. Those techniques include physical exams, chest X-rays, CT scans and surgical biopsies to examine the cells in the lungs and the lymph nodes.

Lung cancer is one of the most common cancers worldwide, and the outcomes are typically unpromising. The low survival rates for lung cancer are often attributed to the difficulty of diagnosing the disease early enough for effective treatment.

This is especially true of mesothelioma, a disease that affects the tissues of the lining between the chest wall and the lungs. Often, by the time mesothelioma is detected, the cancer has reached untreatable stages.

Because of this, researchers are increasingly turning to new methods of detection that may identify deadly cancers at earlier stages when chemotherapy, surgery and other treatments may be effective.

The most accurate methods of diagnosis to date involve collecting cell samples from the lungs or lymph nodes for examination under a microscope. The most common method for collecting these cells is a mediastinoscopy, which is an invasive surgery that involves anesthesia and incision. The surgeon makes an incision at the top of the breast bone and inserts a thin, lighted tube into the chest cavity to withdraw cell and fluid samples.

Mediatinoscopy is typically used to determine whether fluids in the chest cavity contain cancerous cells or asbestos fibers.

In the past few years, doctors have developed less invasive procedures to collect tissue samples from the chest. These procedures use an endoscope, a small medical device that consists of a camera mounted on a flexible tube. Ultrasound probes, needles and other instruments can be inserted through the tube to remove samples for biopsy. These endoscopic procedures are far less invasive than more traditional methods, reducing the risks to patients who undergo them.

In the study reported in JAMA, researchers compared three different procedures using an endoscope, each of them considered minimally invasive:

• Transbronchial needle aspiration (TBNA)

• Endobronchial ultra-sound guided fine needle aspiration (EBUS-FNA)

• Transesophegeal endoscopic ultrasound-guided fine needle biopsy (EUS-FNA)

In each procedure, an endoscope was used to remove tissues or fluids with a fine needle. The researchers then compared the findings among the three methods to determine which was the most sensitive for detecting the presence of cancerous cells in the lymph nodes of the chest.

The study consisted of tests taken on 138 patients in the U.S. who were believed to have lung cancer. Each patient underwent all three procedures in sequence.

The results of the study showed:

- 30% (42) of the patients had malignant lymph nodes

- EBUS-FNA detected 29 of the cancers. TBNA only detected 15

- EUS-FNA and EBUS-FNA used in combination detected 93% of the cancers.

The combination was also able to detect malignancies in patients who would not have been identified by CT scans of the chest. The results of the study suggest that the minimally invasive procedures may be a viable alternative to more invasive standard procedures for evaluation patients believed to have lung cancer.

The lower risks associated with the procedure will make the diagnostic process more comfortable for patients and provide for a shorter recovery time.

Reference: Wallace, M, Pascual, J, Raimondo, M, et al. Minimally invasive endoscopic staging of suspected lung cancer. Journal of American Medical Association. 2008. 299(5) 540-546. Source: www.asbestos.com

New System May Give Lung Cancer Patients Hope

The Associated Press Aug. 31, 2007 http://www.msnbc.msn.com/id/20533486

Thousands more lung cancer patients each year could be offered surgery or other aggressive therapy under a new system that classifies many tumors as more treatable than in the past.

It is the first big overhaul of a decades-old method used to predict survival and help determine whether a lung cancer patient will have surgery, chemotherapy or be treated at all.

The new guidance is to be presented at a conference of lung cancer specialists in Seoul, South Korea, that starts Saturday. It is expected to be adopted by policy-making groups in the next year. Lung cancer is the world’s top cancer killer, claiming 1.3 million lives each year.

In the United States, 213,380 new cases and 160,390 deaths from the disease are expected this year. Nearly 60 percent of people die within one year of diagnosis, and nearly 75 percent die within two years, American Cancer Society statistics show.

In treating it, doctors use a formula called tumor staging. It is based on a tumor’s size, how far it has spread and other factors to predict a patient’s survival odds and to guide treatment.

More precise sorting

The current system was developed from about 5,000 tumor samples from University of Texas M.D. Anderson Cancer Center in Houston decades ago — before improved scanning technology was available to evaluate a cancer’s spread.

The new plan is based on 100,000 tumor samples from around the world including Asia, where lung cancer rates are projected to climb because of trends in smoking, unhealthy lifestyles and aging populations. It keeps four broad groupings but sorts people more precisely based on refined understanding of tumor characteristics.

The result: “There will clearly be shifting of patients from categories not operable to operable” — as many as 10,000 a year in the United States, said Dr. David Johnson, a lung cancer specialist at Vanderbilt University in Nashville, Tenn. He reviewed the plan, which was partly published in a medical journal recently.

The stage of the tumor at diagnosis is the best predictor of survival. Only 20 percent of cases are diagnosed in Stages 1 or 2, when tumors are small and confined to a lung, Johnson said. About 30 percent to 40 percent are found in Stage 4, after they have widely spread. The rest are in the middle.

Five-year survival rates are 47 percent for Stage 1 and 26 percent for Stage 2, but only 8 percent for Stage 3, and 2 percent for Stage 4, according to the American College of Surgeons.

Most lung cancers are the type called ”non-small cell,“ which is covered by the new staging system. The system was developed by the International Association for the Study of Lung Cancer, a group of lung cancer specialists from around the world.

Changing groupings

Dr. Peter Goldstraw, a surgeon at the Royal Brompton Hospital in London, led the project, and Canadian scientists independently validated the recommended changes by comparing survival across geographic regions.

Among the changes: creating more sub-stages for tumor size, reassigning some large tumors to a more advanced stage, reclassifying tumors that have spread into the fluid surrounding the lung, and recognizing that spread to certain lymph nodes is more dangerous than its spread to others.

“By changing some of these groupings, some patients will get moved to an earlier stage of disease for which we tend to be more aggressive” in treatment, said Dr. Joan Schiller, a lung cancer specialist at the University of Texas Southwestern Medical Center in Dallas .

“Before, a patient may have only been offered chemotherapy. They may now be offered chemotherapy and radiation,” or more intense radiation, she said. Conversely, some people thought to have earlier-stage tumors now will be grouped with those whose tumors have widely spread, and discouraged from undergoing therapies that have little chance of helping them.

“In some cases, patients were getting inappropriately aggressive treatment,” Schiller said.

Some people with very small tumors may get away with less therapy — taking out just a segment of lung instead of an entire lobe, said Dr. Stephen Swisher, a chest surgeon at M.D. Anderson.

The impact of the changes in Europe and Japan is unclear because doctors in those countries tend to remove whole lungs rather than lobes to treat lung cancer, Johnson noted. Doctors hope that ultimately survival will improve, but that won’t happen “unless we get patients into the right hands” and they get correct treatment, Johnson said.

Revising the staging system also will do little good if doctors don’t do the right tests to properly stage a tumor, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. Staging for lung and other types of cancer should become even more precise in the near future as biomarkers and gene tests are developed to better sort patients, he added.

© 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Risk Factors for Mesothelioma

The main risk factor for developing mesothelioma is exposure to asbestos.

Asbestos refers to a family of fibrous minerals made of silicate. Asbestos was once used in many products such as insulation, floor tiles, door gaskets, soundproofing, roofing, patching compounds, fireproof gloves and ironing board covers, and even brake pads.

As the link between asbestos and mesothelioma has become well known, the use of this material has almost stopped. Most use stopped after 1989, but it is still used in some products. Experts have linked this drop in asbestos use to the fact that the rate of development of mesothelioma is no longer increasing [in the U.S.].

Still, up to 8 million Americans may already have been exposed to asbestos. Exposure to asbestos particles suspended in air and building materials is much less hazardous except when they are being removed.

Since asbestos is a naturally occurring mineral, it can also be found in dust and rocks in certain parts of the United States as well as the world.

According to the U.S. Environmental Protection Agency, as many as 733,000 schools and public buildings in the country today contain asbestos insulation. As many as 10% to 15% of schools in the United States may contain asbestos insulation.

People who may be at risk for occupational asbestos exposure include some miners, factory workers, insulation manufacturers, railroad workers, ship builders, gas mask manufacturers, and construction workers, particularly those involved with installing insulation.

Several studies have shown that family members of people exposed to asbestos at work have an increased risk of developing mesothelioma, because asbestos fibers are carried home on the clothes of the workers.

The incidence rate for mesothelioma in men is dropping, probably because they are no longer being exposed directly to asbestos in their work. But the incidence rate for mesothelioma in women is steady, which suggests that they are being exposed in a way that is not directly tied to work, but more to their environment either at home or work. One example would be asbestos in buildings where they work or live.

A study from California also links mesothelioma to naturally occurring asbestos deposits in mountains.

Another important point about asbestos and mesothelioma is that the risk of mesothelioma does not drop with time after exposure to asbestos. The risk appears to be lifelong and undiminished.

There are 2 main forms of asbestos — serpentine and amphiboles. Serpentine fibers are curly and pliable. Chrysotile is the only type of serpentine fiber and it is the most widely used form of asbestos. Amphiboles are thin, rod-like fibers. There are 5 main types — crocidolite, amosite, anthrophylite, tremolite, and actinolyte. Amphiboles (particularly crocidolite) are considered to be the most carcinogenic (cancer-causing).

However, even the more commonly used chrysotile fibers are associated with malignant (cancerous) mesotheliomas and should be considered dangerous as well.

When asbestos fibers are inhaled, most are cleared in the nose, throat, trachea (windpipe), or bronchi (large breathing tubes of the lungs). Fibers are cleared by sticking to mucus inside the air passages and being coughed up or swallowed. The long, thin, fibers are less readily cleared, and they may reach the ends of the small airways and penetrate into the pleural lining of the lung and chest wall. These fibers may then directly injure mesothelial cells of the pleura, and eventually cause mesothelioma.

Asbestos fibers can also damage cells of the lung and result in asbestosis (formation of scar tissue in the lung), and/or lung cancer.

The risk of lung cancer among people exposed to asbestos is increased by 7 times, compared with the general population. Indeed, asbestosis, mesothelioma, and lung cancer are the 3 most frequent causes of death and disease among people with heavy asbestos exposure.

Peritoneal mesothelioma, which forms in the abdomen, may result from coughing up and swallowing inhaled asbestos fibers. Cancers of the larynx, pancreas, esophagus, colon, and kidney may also come from asbestos exposure, but the increased risk is small.

The risk of developing a mesothelioma is related to how much asbestos a person was exposed to and how long this exposure lasted. People exposed at an early age, for a long period of time, and at higher levels are most likely to develop this cancer.

Mesotheliomas take a long time to develop. The time between first exposure to asbestos and diagnosis of mesothelioma is usually between 20 and 50 years.

Other Asbestos-Related Cancer

Asbestos Related Lung CancerLung cancer, or bronchial carcinoma, occurs in several forms. The most common causes of lung cancer are smoking and asbestos.

This web site has focused on the most lethal of the lung cancers – mesothelioma. Not every asbestos-related lung cancer, however, is a mesothelioma. Other thoracic carcinomas, such as adenocarcinoma, are also caused by exposure to asbestos.

The connection between asbestos exposure and lung cancer was noted as early as 1925, and confirmed over the next 70 years by many epidemiologic studies of asbestos-exposed workers.

The four main types of commercially used asbestos, chrysotile, amosite, anthophyllite, and mixtures containing crocidolite, have all been associated with an increased risk of lung cancer. About one in seven people who suffer from asbestosis, a lung disease resulting from high exposure to asbestos, eventually develop lung cancer.

Asbestos is estimated to account for 3,400 to 8,500 new lung cancer cases in the United States each year. Like mesothelioma, the latency period between asbestos exposure and the development of asbestos related lung cancer may be two, three, four, or even more decades.

Very often, asbestos-related cancer victims also suffer from asbestosis, a scarring of the lung tissue caused by asbestos exposure. About one in seven people with asbestosis will eventually develop lung cancer.

Although commonly associated with lung cancer, adenocarcinoma is a type of cancer that develops in cells lining glandular types of internal organs, such as the lungs, breasts, colon, prostate, stomach, pancreas, and cervix.

Another type of adenocarcinoma, mucinous adenocarcinoma, accounts for only 10-15% of all adenocarcinomas and is particular to aggressive carcinomas that are comprised of at least sixty percent mucus. Non-small cell lung cancers make up over three quarters of all new lung cancer cases in the United States.

While there is only one type of small cell lung cancer, there are three types of non-small cell lung cancer. The three types of non-small cell lung cancer are squamous carcinoma, large cell carcinoma, and adenocarcinoma. When adenocarcinoma develops in the lung’s air sacs, it is called bronchioalveolar adenocarcinoma. About forty percent of all lung cancer cases diagnosed today are adenocarcinoma.

The progression of adenocarcinoma is quite unpredictable. In most cases, adenocarcinoma spreads slowly and causes very few lung cancer symptoms. But it can also be extremely invasive, aggressively spreading through the body and causing death before it can be treated. Given the disease’s variability, the five-year prognosis for patients with adenocarcinoma is dim: most are given only a 10 percent chance of survival.

Sometimes, tumors spread to the liver, adrenal glands, and bones, making adenocarcinoma much more difficult to treat. Symptoms of adenocarcinoma lung cancer may include shortness of breath, the coughing up of blood, fatigue, chest pains, and unexplained weight loss. Adenocarcinoma is usually treated with surgery, radiation therapy, and chemotherapy.

SOURCE: myMeso › What is Mesothelioma?