Mesothelioma Attorneys

COPYRIGHT 2001 British Medical Association

British Thoracic Society Standards of Care Committee

Introduction

Malignant mesothelioma is one of the more difficult diseases that doctors, patients, and families have to face. It is almost always caused by inhalation of asbestos fibre many years before presentation. Diagnosis can be difficult, there is little hope of a cure, and the disease has the potential for extremely unpleasant symptoms.

The incidence is increasing rapidly and the position of mesothelioma in the league table of cancer related deaths is rising. However, few doctors have managed sufficient numbers of patients to have acquired comprehensive clinical experience of the disease. Furthermore, the relative rarity of the condition and lack of extensive research mean that clinicians do not have reliable evidence on which to base their practice.

The British Thoracic Society (BTS) Standards of Care Committee was asked by the National Health Executive in England to consider what could be done to improve management in the light of the increasing incidence. A Working Party was established, comprising clinicians with interest and experience of the condition, with a view to compiling guidelines to assist in the management of mesothelioma (both pleural and peritoneal) in the UK. The Working Party was supplemented by co-opted specialists. These included radiologists, pathologists, and oncologists and full details are given in Appendix 1.

The draft was reviewed by the whole membership of the BTS from whom extensive comments were gratefully received. The document was also sent to expert groups and representatives of patients and the government for opinion, and the statement is the result of this consultation process. It is compiled primarily for clinicians who may be involved in the care of patients with mesothelioma, and is based on literature searches and reviews by members of the Working Party responsible for particular sections. However, it is not strictly evidence based as we did not attempt to review comprehensively all the epidemiological, pathology and medicolegal papers and also because, in many aspects of the subject, there are insufficient randomised trials upon which to base guidelines so we have not used this word in the final document. The Working Party recognises that many aspects of mesothelioma are currently subject to debate and variations in practice. Thus, the statement is offered for guidance and is not an attempt dogmatic ally to dictate management.

Epidemiology

The incidence of mesothelioma has been rapidly increasing since its first description in 1960. It is expected to increase over the next 20 years from the present total of 1300 to more than 3000 cases per year in Britain. [1] For the worst affected cohorts–that is, men born in the 1940s–mesothelioma may account for around 1% of all deaths.

Asbestos fibres are the cause of most cases. In subjects without exposure to asbestos spontaneous cases are rare, [2] accounting for about one in 10 000 deaths. [3] However, mesothelioma can be induced by non-asbestos fibres such as erionite found in rocks in certain areas of Turkey. Other contributory causes have been suggested such as the Simian virus 40 (SV 40), although the evidence is weak. Mesothelioma also results from non-industrial environmental contact with asbestos fibres and paraoccupational exposure occurs–for example, women who have laundered their husband’s overalls. The most recent well documented series suggests that a history of occupational asbestos exposure can be obtained in about 90% of cases in the UK. [4] In subjects heavily exposed to asbestos early in their working life, more than one in 10 may die of mesothelioma. [5] Epidemiological trends throughout Europe are consistent.

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