Report on Mesothelioma Deaths 1999 - 2005

The July issue of the Journal of the American Medical Association (JAMA) has a report on mesothelioma mortality for the first five years of the new millenium. The article is based on a report from the Centers for Disease Control (CDC) analyzing mesothelioma deaths from 1999 - 2005. For that period 18,068 deaths attributed to mesothelioma cancer were reported; increasing from 2,482 deaths in 1999, to 2,704 in 2005. This death rate is considered “stable” because the ratio of deaths to total population remains more or less constant over the period analyzed. The fact that the latency period for mesothelioma ranges from twenty to forty years would seem to skew this assumption somewhat.

The CDC report goes on to note that asbestso usage peaked in the United States in 1973 at 803,000 metric tons. By 2007, asbestos use in this country had declined to 1,700 metric tons. It is interesting to note that the histories written about asbestos use in the latter half of the twentieth century often indicate that as the result of action by the Congress and the EPA, asbestos products were essentially off the shelves by 1975, and that increasing awareness of the health problems associated with asbestos had caused manufacturing usage of the mineral to begin slowing prior to federal action. The fact that asbestos usage peaked in 1973 suggests that the reduction in asbestos products began in the mid seventies and tapered off rather than dropped precipitously.

80.8% of the mesothelioma deaths over this period occurred among males. The six states where death rates were the highest are Maine, Wyoming, West Virginia, Pennsylvania, New Jersey, and Washington. The report goes on to speculate that mesothelioma deaths in the United States will peak in 2010 and will be reduced to “background levels” by 2055. On a cautionary note, the report estimates that 1.3 million American workers are still working in the presence of asbestos. Most of these are construction workers, and the report goes on to state that new exposure to asbestos is going to occur when existing structures are either remodeled or demolished. The statistical analysis projecting peak death rates and reductions is based on minimal cases of exposure in the future. New cases may develop, according to the CDC, if proper protective measures aren’t used during demolition and remediation.

The CDC reports that based over the years, professions found to be most at risk based on the mortality figures are plumbers, steamfitters, mechanical engineers, electricians and elementary school teachers. Regarding continued exposure, the report notes that in 1971, OSHA established an acceptable level of asbestos in the air on industrial sites, and that levels had been reduced across the board over the years.

The exception to this trend was a notation that in 2003, twenty percent of all construction sites tested had asbestos pollution that was above the OSHA benchmark. Many legal experts in the asbestos liability field remain skeptical about the effective end of asbestos exposure in the U.S. as long as the level of exposure on construction sites remains elevated to a significant degree. Asbestos claims will continue to be filed against asbestos manufacturers present and past; not only mesothelioma but asbestosis andCOPD continue to take their toll among workers and military veterans regardless of statistical speculation.

Mesothelioma Lawyers

- Important Information for Patients


Deciding to pursue legal recourse and selecting an attorney to represent you in a mesothelioma or asbestos lawsuit are important decisions that should be made carefully. I have seen some families receive $500,000 and others be awarded nearly $30 million. I have seen some lawyers reject a case only to have another firm accept it and make a big success of it. And I have seen some families wait nearly three years to receive their first check while others received large checks within three months of filing a claim. The main reasons for these differences are the facts of the patient's situation and the law firm chosen.

The Facts of Your Situation

Some mesothelioma patients know they worked around asbestos, but many do not know how they were exposed or how often. In fact, many people are not sure if they were ever near this carcinogen. Unfortunately, there have been thousands of products that contained asbestos - cigarette filters, hair dryers, brakes, basement and roof materials, pipes, boilers, insulation, and many other products found throughout the home and at work. If you were diagnosed with mesothelioma it is more than likely that you were exposed to asbestos multiple times in your life and that this happened decades before your diagnosis.

In general, the value of your case depends on how many asbestos containing products you were exposed to, the number of identifiable defendants that still exist (many have declared bankruptcy), your age and earning capacity. And the speed of your case can depend on a number of variables including the state where you worked and lived when you were exposed to asbestos.

The Law Firm You Choose

When you have been given the news about this terrible disease, you may not feel that you have the time to deal with the legal questions - Should I talk to a lawyer? Should I file a claim? However, you should not wait too long to learn about your legal rights for at least three reasons:

Statutes of Limitations - There are statute of limitations which means you only have a limited time to file your case after diagnosis. The statute of limitations time period is set by individual states and varies. The clock usually starts ticking on the day of diagnosis.


Financial Pressure - A mesothelioma diagnosis can bring financial stress, less income, more expenses, and treatments that are not covered by insurance. Knowing that money may be on the way from filing a claim can bring financial relief.


Lawyers Can be Excellent Resources - The more experienced mesothelioma lawyers and law firms can often be excellent sources of information about various doctors and treatment options available for this disease.

But, picking a lawyer is serious business and you should not use TV ads as the reason to hire an attorney. Actual credentials are what counts. For example, what type of accomplishments has the law firm achieved? How committed are they to mesothelioma/asbestos cases? Are these cases a substantial part of their practice or just a small piece? How many other cases like yours have they handled?

Also, make sure you understand the fees being charges. Contingency is the term that means that the lawyer gets paid only after they collect money for you. The amount of the contingency fee that your lawyer can charge varies and is usually between 33% and 40%. It is important to discuss fees openly, ask what services they cover, how they are calculated, and whether there will be any extra charges.

Finally, for something as important as a mesothelioma lawsuit, your attorney should not only be experienced, skilled, and dedicated, but also a trusted partner who understands that your health needs always take precedence. The best lawyers are those that are not only expert at what they do, but are also caring, supportive, thoughtful and compassionate.

Mesothelioma Common Questions

What is Mesothelioma? What is the difference between pleural mesothelioma and peritoneal mesothelioma?
Malignant mesothelioma is a disease in which a cancerous tumor grows on the mesothelium - the sac lining the internal body cavities. The specific type of mesothelioma is named for the tissue where the cancer started. Pleural mesothelioma starts in the chest, in the pleura that surrounds the lungs (outer lining of the lungs and internal chest wall). It makes up about 70% of mesothelioma cases. Peritoneal mesothelioma starts in the lining of the abdominal cavity.

Although sometimes referred to as "asbestos lung cancer", mesothelioma is not the same as lung cancer. Lung cancers occur inside the lung itself; mesothelioma occurs in the lining of the lung. Mesothelioma is rare, striking fewer than 3000 Americans per year.

How do you get malignant mesothelioma?
Mesothelioma is caused by asbestos exposure. Asbestos, once regarded as a miracle mineral, was popular due its lightweight but tough characteristics as well as for its heat-resistant properties. This naturally occurring mineral was used in many commercial and consumer products, from construction materials such as cement, roofing shingles and insulation, to consumer and industrial applications such as hair dryers, automobile brake pads and pipe insulation.



Most people with malignant mesothelioma worked on jobs where they breathed asbestos. Others were exposed to asbestos in a household environment, often without knowing it.

How much exposure does it take to get the disease? What is the latency period?
Very little exposure can result in mesothelioma. Sometimes people who worked with asbestos for as little as one or two months get mesothelioma. The "latency period" refers to the time between asbestos exposure and diagnosis of the disease. For mesothelioma, the latency period can be decades long, and people exposed in the 1940s, 50s, 60s, and 70s are now being diagnosed.

What are the symptoms of mesothelioma?
Our mesothelioma symptoms page goes into detail about the signs of this cancer. Please note that it is important to seek professional medical advice when trying to diagnose for mesothelioma. The major symptoms include:

Shortness of breath caused by expanding pleural effusion
Persistent dry cough
Other symptoms may include:

Fatigue
Night sweats
Fever
Pain under the rib cage
Swelling or lumps in the abdomen
Unexpected weight loss
How do doctors treat malignant mesothelioma?
Each patient has an individualized treatment plan which takes into account the type and stage of the cancer as well as the patient's overall health. Traditional mesothelioma treatments include surgery, chemotherapy, radiation or a combination of these.




Is there any promising research or are there promising new drugs for mesothelioma?
Scientists and doctors are engaged in research at various cancer centers all over the United States. Researchers are constantly trying to develop new and more effective drugs as well as new treatment techniques. In the past few years, there have been several major advances in the management of mesothelioma, including more accurate staging, improvements in surgical techniques and postoperative care, new chemotherapy regimens, and new radiotherapy techniques such as intensity-modulated radiation therapy. Some of this research is being conducted through clinical trials, for which you may be eligible. Please call us if you need additional information on current trials.


What should I do if I think I've been exposed to asbestos but don't have mesothelioma?
You probably will not get this rare disease, but you should remain vigilant and get regular check-ups. Let your doctor know about your asbestos exposure.

Pathophysiology of mesothelioma

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 fibers 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.

Screening of mesothelioma

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.[4] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.[5]

Diagnosis of 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. 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 incision 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)

Signs and symptoms of mesothelioma

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.