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Diagnosing Mesothelioma: How Can You Identify its Stages?

Diagnosing Mesothelioma Early On

Though there is no one clear path to a mesothelioma diagnosis for each patient, it is very important that this rare disease is caught in its early stages of development. After possible exposure to asbestos, seeing your primary care physician for possible testing is the best chance to confirm or deny the contraction of the disease.

Symptoms of Mesothelioma

Symptoms of the disease are late arrivals, only becoming noticeable when the cancer is in the later stages of development. This is why testing after possible exposure to asbestos is critical. Symptoms include a dry cough or wheezing, dyspnea or shortness of breath, complications breathing, fever or night sweats, fatigue, muscles weakness, pain in the chest and/or abdomen, and pleural effusion or fluid around the lungs. Preliminary symptoms such as coughing, wheezing, and shortness of breath appear in the third or fourth stage of the disease’s development when tumors begin to press against the chest wall and abdominal cavity. Secondary symptoms include increased pain, anemia, weight loss, loss of appetite, and difficulty breathing, swallowing, and bowel movements.

Testing from Primary Care Physician

Testing for this disease is a long, complex process that involves multiple stages of tests from numerous physicians and specialists. The battery of tests for Mesothelioma is completed in an average of 89 days. Being that the preliminary symptoms of this disease are similar to a number of other illnesses, there is a long list of tests that must be completed before confirmation of diagnosis. Your primary care physician will order an X-ray to determine the amount of fluid in your lungs then prescribe an antibiotic for pneumonia and/or drain fluid in lungs, however, no cancer cells will be detected in the fluid. After a follow-up X-ray has shown more fluid the doctor will most likely order a Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) scan, and a Computed Tomography (CT) scan. If scans show underlying cause, the patient is referred to a specialist.

Testing from a Specialist/Surgeon

Once referred to a specialist it may take 10-15 days to make an appointment and schedule a biopsy. The biopsy is done via Video-assisted thoracoscopic surgery (VATS) and usually requires a minimum of three days in the hospital. VATS is a minimally invasive surgical technique that uses a tiny camera called a thoracoscope and other surgical tools. These tools are inserted into your chest cavity via a tiny incision in your chest wall. Results of the biopsy and lab work ordered by a specialist may take up to 10 days to diagnose. Even though in some cases mesothelioma can be diagnosed by any one of the scans ordered by the physician or specialist, the most accurate and definitive form of testing is a biopsy.

Signs Mesothelioma has Spread

Mesothelioma usually does not spread distantly throughout the body, normally spreading throughout the chest or abdominal cavity. Common signs that cancer has spread include Dysphagia (difficulty swallowing), Laryngeal nerve palsy (hoarseness), Horner’s syndrome (nerve damage to face), Nerve damage to the arm, and Superior vena cava syndrome (obstruction in superior vena cava).

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Asbestos Cleanups

Safe Asbestos Cleanups – What You Need to Know

Asbestos, which is present in millions of homes, schools and other public building across the United States, is notoriously toxic. It is the only definitively known cause of mesothelioma, a virulent cancer that causes thousands of death annually. Experts on public health and safety have determined that there is no safe level of exposure to asbestos. Even the slightest exposure can result in serious illnesses, including lung cancer, asbestosis, and a number of other cancers. However, the mere presences of asbestos isn’t a hazard. Rather, it only becomes dangerous when it is friable – a word that means easily crumbled – or when it is disturbed or broken, such as often happens during renovations in older homes and buildings. Asbestos “dust” contains tiny fibers, far finer than the finest human hair. When it is inhaled, these fibers can become trapped in the lungs, bronchia and other cells in your body. Once there, they may stay for decades, causing scarring of the surrounding tissues, and in some cases, mesothelioma, one of the most deadly types of cancer. Because of this, the EPA and OSHA have specific regulations about how to handle asbestos in the environment to prevent it from becoming a health hazard, either to workers or to the community. Here is what you need to know about asbestos cleanups in order to keep yourself and your family safe.

Asbestos Is Only Dangerous When the Fibers Become Airborne

Because of that, most experts recommend covering or “encapsulating” asbestos rather than attempting to remove it. When a surface is encapsulated, it’s far less likely to be damaged in a way that can release asbestos fibers into the air, and accidental exposures are far less likely.

Asbestos May Be Present in Any Building Constructed Before 1980 in the U.S.

Asbestos-containing products were ubiquitous in construction in the early parts of the 20th century. If you live or work in an older building, there’s a good chance that there is asbestos present in the floors, the walls, the insulation or other parts of the building. Because of that, renovations and repairs to older homes and buildings carry a higher than normal likelihood of exposing people to airborne asbestos fibers. Property owners of older buildings should have their properties examined by a certified expert to determine if asbestos is present, whether it presents a danger, and the best course of action to prevent accidental exposure. This is especially important before beginning any renovations to older homes and buildings.

Asbestos Cleanups, Removal & Abatement Should Be Done By Trained Experts

Because of the dangers of releasing asbestos fibers into the air, property owners should not attempt to remove asbestos on their own. All asbestos removal should be done by trained, certified contractors who are legally required to follow specific procedures to ensure that any fibers released during demolition  or removal are contained to a small area.

Older Schools Must Have an Asbestos Abatement Plan on File and Publicly Accessible

Every older school in the U.S. must have a record of their most recent asbestos evaluation, as well as an abatement plan explaining how asbestos contamination is being dealt with in their building. That plan must be available for viewing by the general public upon request.

Accidental Exposures Are More Likely to Happen During Renovations or When a Building Is Damaged

Something as simple as a minor plumbing emergency can become far more dire if it damages materials containing asbestos. In older school buildings, for example, a roof leak or burst pipe can damage pipe insulation or wall boards that contain asbestos. When that happens, there are specific rules and procedures that must be followed during and after the cleanup to ensure that there is little to no exposure risk to children, teachers and others who use the building. In addition, owners of public buildings may be required to notify people who live and work in the building if there is or was a risk of asbestos exposure during an asbestos cleanup.

Tips for Preventing Asbestos Exposure During Abatement

To keep yourself and your family safe during renovations or asbestos abatement, always follow the procedures prescribed by the EPA or by the contractors working on the removal. In general, that means:

  • Seal the area around the work area with plastic sheeting to prevent the spill of asbestos fibers to the surrounding rooms.
  • Always wear HEPA-approved filter masks when working in the affected area.
  • If possible, leave the home while the work is being done, and only return after the work has been completed.
  • Always consult a certified contractor before beginning any renovation in an older home.
  • Ask to see the asbestos abatement plan at your children’s school, and be aware of construction, demolition or renovation work happening in your neighborhood. In many states, contractors must post prominent signs warning the public that there is a danger of exposure to asbestos.

There is no safe level of exposure to asbestos, but by being aware of its presence and following basic safety procedures, you can greatly reduce the risk of exposure for yourself and your family during asbestos cleanups.

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Mesothelioma Places To Stay

Places to Stay During Mesothelioma Treatment for Patients and Their Families

Many patients diagnosed with mesothelioma face an additional challenge – finding an appropriate cancer treatment center for their particular diagnosis. Because mesothelioma is one of the rarer types of cancer, those seeking specialist treatment may have to travel some distance to access the best care. This is especially true for those who qualify for clinical trials and experimental treatments for mesothelioma. Travel and lodging expenses can present a logistical and financial challenge for patients who have to travel more than a few hours from home for treatment. Fortunately, there are a number of organizations that provide financial and logistical assistance to make travel and lodging for cancer patients less of a burden. These steps can help you find affordable transportation and places to stay for cancer patients and their families.

Lodging Resources at Cancer Treatment Centers

Most cancer treatment centers have a social services component that helps families deal with the many challenges that come with a difficult cancer diagnosis. The first step in finding affordable places to stay near your chosen cancer clinic is to check with the treatment center. Some, such as the Sidney Kimmel Cancer Center at Johns Hopkins in Baltimore, MD, maintain long-term residential housing for the families of patients undergoing treatment.

Some of the hospitality centers associated with cancer treatment centers have specific criteria that families must meet in order to be approved for a stay. The most common include:

  • Proximity to the treatment center – for example, at least an hour’s travel away
  • Patient being in treatment, either outpatient or inpatient, at the center
  • No infectious diseases or conditions that might affect others
  • Referral from the social services department of the hospital

On premises lodging may be the ideal option for many families, but they can’t accommodate all patients that need nearby lodging while they are undergoing treatment. For that reason, many cancer treatment centers have worked out special rates with nearby motels and hotels, and will help families arrange lodging (places to stay), and even make travel arrangements.Taking advantage of these resources can free you and your family to focus on your treatment and coping with it.

Private Lodging (Places To Stay) for Cancer Patients

In addition to resources maintained by cancer clinics and treatment centers, there are a number of non-profit organizations that help families of cancer patients find lodging so that they can be there with their loved one during these difficult times.

The Healthcare Hospitality Network is a nationwide network of homes that offer lodging and support to families dealing with cancer. While most of their website is devoted to helping hospitality hosts manage their homes, there is a lodging search that lets you find homes by geographical area.

Hospitality Homes maintains a list of 60+ private homes that volunteer to host family members of patients who are undergoing treatment in the Boston area. The organization will match requesters with trained hosts who will provide a place to sleep and access to a bathroom. Hosts with Hospitality Homes do not provide meals or transportation, but most homes are located near to public transportation. Host homes can accommodate up to four people, and require that a patient in treatment be accompanied by an adult support person. There is an application process, and there may be a waiting list, so be aware of that when making plans.

Joe’s House is named for Joe Callahan, who battled cancer for six years, and accessed treatment in New York and Texas. After Joe’s death, his wife Ann created Joe’s House, a non-profit organization, to help other families dealing with cancer find affordable lodgings for themselves and their loved ones undergoing treatment. The comprehensive, searchable database at the Joe’s House website lists thousands of motels, hotels, and other types of lodging that offer discounts for traveling cancer patients and their families.

Hope Lodge, the American Cancer Society’s hospitality program, manages more than 30 locations across the U.S., including Puerto Rico. Each Hope Lodge has its own eligibility requirements, but all are open to patients 18 and over who are undergoing cancer treatment at nearby cancer treatment centers, and all are available at no charge to the patients or their families. As with many other programs, there may be waiting lists or other restrictions, and patients should contact individual Hope Lodge locations to learn more about eligibility and requirements.

In addition to Hope Lodge, the American Cancer Society partners with hotels, motels and inns across the country to provide free or deeply discounted lodgings for cancer patients and families traveling for cancer treatment. The  Hotel Partnership program includes both overnight and extended stay accommodations.

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Asbestos Lautenberg Act

Lautenberg Act and Asbestos – EPA Evaluation of Asbestos Risk

The passage of the Frank R. Lautenberg Chemical Safety for the 21st Century Act in June 2016 was widely lauded for providing the first real chance to advance a total ban on asbestos-containing products in the United States since 1989. While most people believe that the use of asbestos has been banned in the U.S. since the 1970s, in reality, U.S. manufacturers still import and use hundreds of tons of asbestos each year. The Lautenberg Act empowers the U.S. Environmental Protection Agency to evaluate the risks of new and existing toxic chemicals, and provides guidance for creating rules and restrictions for their use. On the first anniversary of its passing, the EPA released a final rule establishing the criteria and process it will use to identify high priority chemicals for risk evaluation, establishes its process and criteria for evaluating risks, and clarifies its authority in determining which uses of a chemical are appropriate for evaluation. According to the EPA press release posted on that day, the new rules will ensure that the EPA focuses its efforts on the chemicals and uses that present the greatest risk to the public.

Some History of Asbestos Bans for Perspective

In 1989, the U.S. Environmental Protection Agency issued what it believed to be its final rule under the Toxic Substances Control Act of 1976, implementing a phase-out and eventual complete ban on all uses of asbestos in the United States. It followed a series of restrictions that limited or banned certain specific uses of asbestos, including most spray-on asbestos products, and gradually broadened the types of asbestos products that would be banned in the U.S. The asbestos industry challenged that rule in court, and in 1991, a U.S. Circuit Court struck down the rule, effectively removing most of the ban on importing, processing, distribution or manufacture of asbestos and asbestos-containing products included in that rule. While earlier bans on asbestos remained in place, the court ruling effectively stalled further actions to ban asbestos for nearly a quarter of a century. Repeated attempts to widen the ban to include more products and uses of asbestos have failed time and time again, stymied by the lobbying efforts of those who profit from the sale and distribution of products that contain asbestos.

One Year In – Scope Documents on Asbestos Released

One of the most important pieces to come out of the first year of work under the Lautenberg Act is the release of scope documents for the first ten chemicals that will be evaluated. Needless to say, asbestos tops the list of priority chemicals to be evaluated for new regulations. The scope document for asbestos lays out which uses of asbestos will be evaluated, how the evaluations will be conducted, and how new regulations concerning those uses will be established. In addition, the EPA asbestos scope document provides a great deal of information about current and projected future uses of asbestos and asbestos-containing materials. These are some of the most important findings in that EPA document.

  • The EPA will not consider “legacy” uses of asbestos. The agency will not be examining the risk of asbestos exposure in old buildings and the environment, nor risks arising from the removal or disposal of those legacy uses of asbestos. Rather they will be focusing on currently allowed uses of asbestos and determining the risk each of those uses carries to those who work with it, live near it or may be otherwise exposed to asbestos through it.
  • The working groups will be using the agreed-upon definition of asbestos from the Toxic Substances Control Act, specifically,  “asbestiform varieties of six fiber types – chrysotile (serpentine), crocidolite (riebeckite), amosite (cummingtonite-grunerite), anthophyllite, tremolite or actinolite.”
  • In formulating the rules and regulations for the importation, handling, processing, and distribution of asbestos and related products, the EPA will consider all known current or anticipated uses of asbestos in products that are in use or expected to be developed in the future. As of June 2017, the EPA has identified the use of asbestos in the chlor-alkali industry, specifically in the membranes used in the making of chlorine and lye, as well as in sheet gaskets, friction products in the oil industry, auto brakes, roofing products, adhesives and sealants, and imported cement.
  • The U.S. imported 340 million metric tonnes of asbestos in 2016, mostly from Brazil.
  • The EPA will be considering several different types of exposure risk – occupational exposure, consumer exposure and population (or bystander) exposure.
    • Occupational exposure – workers who deal directly with asbestos and asbestos-containing products
    • Consumer exposure – people who use asbestos-containing products
    • Bystander exposure – people who may be exposed to asbestos fibers because of proximity to manufacturing and other sites where asbestos is used
  • The EPA will be taking public commentary on asbestos and its uses specific to this scope document, as well as the other 9 priority toxic chemicals, and may further refine the document based on that commentary.

Lautenberg Act Full Asbestos Ban

It’s important to note that the new regulations are likely to face considerable pushback from those in the industries affected, and that the current regulatory atmosphere may make it more difficult for the EPA to create and enforce more restrictions on the use of asbestos. However, the Lautenberg Act presents the first and best path forward to a complete ban on the use of asbestos in the United States.


EPA Evaluation Sparks Regulatory Pushback

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Genetics May Affect Mesothelioma

How Genetics May Affect Mesothelioma

Mesothelioma is a particularly virulent type of cancer with one known cause – exposure to asbestos fibers. Approximately 80 percent of diagnosed mesothelioma cases can be definitively linked to asbestos exposure, generally over a long period of time, and usually in an occupational setting. However, not everyone who was exposed to asbestos develops the deadly cancer but genetics may affect mesothelioma. Researchers estimate that between 2 and 10 percent of those with heavy, long-term exposure to asbestos eventually develop pleural mesothelioma, which is the most common type of the cancer.

Genetics May Affect Mesothelioma

Because of this, cancer researchers have long believed that there must be other risk factors that make certain people more susceptible to the harm caused by inhaled asbestos fibers. Over the past 20 years, a number of studies have focused on finding a genetic factor that might increase the risk of developing mesothelioma. In the past few years, researchers have zeroed in on several specific gene clusters that appear to be implicated as a risk factor for the deadly disease.

Early Genetic Research in Mesothelioma

Scientists first became interested in finding a genetic risk factor for mesothelioma in the 1960s, when they noted that the cancer appeared to be more prevalent in families. Over the years, genetic research has identified several gene clusters that appear to influence whether or not a person exposed to asbestos eventually develops the cancer. Researchers have found that abnormalities in genes that suppress tumors can increase the risk of mesothelioma in people who are heavily exposed to asbestos. In the same way, abnormalities in the genes that help combat carcinogens, including glutathione-S-transferase M1 (GSTM1) and N-acetyltransferase (NAT2) , can greatly increase the risk of developing mesothelioma after exposure to asbestos fibers.

The BAP1 Gene and Mesothelioma

In 2011, researchers at University of Hawaii Cancer Center and Fox Chase Cancer Center in Philadelphia, Pennsylvania found a clear connection between family members with malignant mesothelioma and a specific gene, known as BAP1. The study focused on two families with a high incidence of mesothelioma. Researchers found that every one of the family members who were diagnosed with the illness also had a specific mutation of the BAP1 gene. They also studied 26 people who were diagnosed with the disease, but who had no family history of mesothelioma. They found that 25 percent of that group also carried the BAP1 mutation. Since that study, other researchers have confirmed the results. The implications for mesothelioma treatment are enormous.

Genetic Testing for Mesothelioma

One of the reasons that mesothelioma is so deadly is that it often goes undiagnosed until the cancer is too advanced to respond to most conventional treatments. As with other cancers, the earlier it is diagnosed, the more positive the prognosis will be. Because the symptoms of mesothelioma are so similar to many more common diseases, it often goes undetected until it is too late to treat it effectively. A simple screening test can identify the the mutated gene, which is also associated with the development of several other types of cancer. If the test identifies the mutation, doctors could advise patients on ways to avoid other risk factors – cautioning them against asbestos exposure, for example – and arrange for a schedule of screenings to watch for symptoms and changes to the mesothelial tissues that signal the development of mesothelioma.

BAP1 and Mesothelioma Prognosis

While the existence of the mutated BAP1 gene adds to the risk of developing meshothelioma, there is a silver lining. Researchers have also discovered that the presence of the mutation also seems to improve the prognosis of those diagnosed with malignant mesothelioma. In 2014, a mesothelioma study published in Carcinogenesis found that mesothelioma patients with the BAP1 mutation had significantly better survival rates than those without the mutation. Specifically, researchers at the University of Hawaii Cancer Center found that 47 percent of patients who carried the gene mutation reached the five year survival rate in comparison to 6.7% of the control group, who had been diagnosed with the cancer but did not carry the mutated gene. Even more dramatically, the researchers found that the median survival rate for the BAP1 patients diagnosed with peritoneal mesothelioma was 10 years, while the median survival rate for the same cancer in non-BAP1 patients is 6-12 months after diagnosis.

The University of Hawaii Cancer Center research has led to new medical protocols for cancer patients, including more frequent screenings for those who carry the BAP1 gene mutation, which is also associated with a number of other cancers. The more frequent screenings may lead to earlier diagnosis of the killer cancers, and improve the possibility of more successful treatment.

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