The MesotheliomaCenter is dedicated to providing those who suffer from the asbestos-related cancer malignant mesothelioma also known as asbestos cancer—or from asbestos-related lung cancer, or who know someone who does, with the most up to date information and support.
The Occupational Safety and Health Administration (OSHA) has maintained that “there is no ‘safe’ level of asbestos exposure for any type of asbestos fiber,” but despite these warnings, asbestos is still legal and still used in the United States. Different government agencies have their own rules and regulations for asbestos control to maintain exposure levels in the workplace and the environment. Those who work directly with asbestos consistently have a higher chance of contracting an asbestos-related disease than those who do not. Regulations and guidelines have been installed to keep the level of asbestos exposure at a minimum and are necessary among those who are in danger of being exposed in the work place.
Permissible Exposure Limit (PEL)
The PEL is determined by OSHA with the purpose to protect workers against chemical exposures and other harmful substances he or she may be exposed to while on the job. The limit refers to the maximum amount of exposure that is allowed for a given substance and is calculated based upon OSHA’s air contaminant standard and the standard eight-hour work shift. There are approximately 470 PELs for an estimated 300 chemical substances that are considered health hazards.
The PEL for asbestos exposure is 0.1 fibers per cubic centimeter of air over an eight-hour time period, or 1.0 asbestos fiber per cubic centimeter of over a 30-minute period. OSHA has reduced the permissible exposure limits four times since setting them in 1971; from 12 fibers per cubic centimeter to what it is today, 0.1.
For more information regarding OSHA regulations on asbestos, refer to the OSHA fact sheet.
Threshold Limit Value (TLV)
The TLV is a guideline set by the American Conference of Governmental Industrial Hygienists. It is meant to provide a limit as to how much a person can be exposed to a certain chemical daily, and not have any adverse health effects. A TLV is based upon the known toxicity of substance in a human or animal and determined by published scientific research and journals that typically focus on occupational medicine, industrial hygiene, and toxicology. The TLV is not a legal limit, therefore not enforceable, but as for the case of asbestos exposure the TLV is the same as the PEL – 0.1 fibers per cubic centimeter.
February is National Cancer Prevention month, and to prevent cancers like lung cancer and mesothelioma, it is important to educate yourself with the facts regarding where and how you can be exposed to asbestos, and the limits in which you can legally be exposed to. As mentioned before, there is no safe level of asbestos exposure, but studies have shown the amount and frequency of asbestos exposure contributes to your overall cancer risk. Those exposed to higher amounts of asbestos over longer periods of time have a higher chance of developing an asbestos-caused disease.
Gregg Bako, “Exposure limits: PELs and TLVs,” Safety and Health (August 1, 2012). [Link]
For a cancer than claims more lives than breast, colon, and prostate cancer combined, Lung Cancer is severely underfunded, leaving scientists and researchers reliant on private funding and donations. Funding for lung cancer, as with many other cancers, plays a critical role in developing and investigating research that could eventually lead to a cure. Donating to cancer research is not just about the race to find a cure, but to also understand the disease itself. Determining risk factors – such as diet – for cancer is a preventative measure that scientists can provide for us, but research is still needed to determine what other instances can contribute to the development of lung cancer. It’s common knowledge that smokers have a higher chance of developing lung cancer than non-smokers, but there are many instances where fit, active, and relatively healthy non-smokers are still diagnosed with the disease.
In the early stages of investigating a new treatment, biomarker, surgical technique, or risk factor, funding is mostly reliant upon research charities, because pharmaceutical companies won’t profit from early research that could potentially have a negative outcome. However, the initial stages of research are critical in laying the groundwork for future investigations and trials, as many experiments are compounded on one another.
Where Can I Donate?
There are many organizations that will accept donations for cancer. Here are just a few that are dedicated to raising awareness and committed to finding a cure for specifically lung cancer.
Other Ways to Contribute
Not everyone has the financial means to contribute to various cancer organizations, but that doesn’t mean you are unable to help! Volunteering at a facility, donating tissue, or participating in a research study are all effective ways to contribute to the cause and aid scientists in their research.
Asbestos and Lung Cancer
One of the contributing factors to lung cancer is exposure to asbestos. For decades, this popular building material was used in households, major construction sites, shipyards, steel mills, chemical plants, textile factories, and within the military. Families of workers who handled this carcinogen can be at risk of bystander exposure, as the nearly invisible and sharp fibers become airborne and easily transferred into homes. Workers were not always informed they were working with asbestos and for decades companies knew about the dangers of the material but downplayed and ignored the issue. It wasn’t until a series of lawsuits in the 1970s that companies were forced to admit their responsibility.
When one thinks of acupuncture, one may envision a nice relaxing trip to a day spa, where after a long massage or a relaxing facial, tension in body can be further relieved through this ancient practice where thin needles are inserted into the body. However, this traditional Chinese medicine may benefit cancer patients by helping reduce symptoms of the cancer itself, or side effects to the treatment administered. An article published in the Hematology/Oncology Clinics of North America in 2008 explained the potential benefits of acupuncture after randomized clinical trials found the treatment was effective in reducing nausea, fatigue, neutropenia, and xerostomia associated with cancer.
Archaeological evidence suggests that acupuncture practice dates back to 100 B.C. in China, making it one of the oldest practices in Chinese medicine that is widely used today. This medicine was founded on the basis that disease is caused by disruptions in the flow of energy in the body. To release this flow of energy, needles are inserted into acupressure points, and left in place for between 10 and 20 minutes. This helps the body reestablish the body’s own self-healing mechanisms. As a recognized treatment for chronic pain, scientists and researchers have been testing acupuncture as a complementary therapy for cancer patients, to not only help alleviate pain but to also manage side effects from cancer treatments such as chemotherapy and radiation.
A more recent study presented to the American Society of Clinical Oncology from the MD Anderson Cancer Center in Texas focused on 375 cancer patients who were reported to have nausea, pain, fatigue, dry mouth, hot flashes, and poor sleep from either their disease or the side effects of their cancer treatments. Patients included in this study suffered from breast cancer, or cancer in the chest, head, or neck. After the acupuncture treatment, 75 percent felt their symptoms alleviated, and were more likely to return for follow up treatments. Even though the study did not include those diagnosed with mesothelioma, scientists and researchers hope that because there is a similarity in symptoms, acupuncture can also help manage the fatigue, nausea, and chest pain associated with mesothelioma.
According to the National Cancer Institute, acupuncture is considered to be Complementary and Alternative Medicine, meaning that it is a practice that is not part of standard medical care. Scientists and researchers have noted that it has been especially challenging in choosing the control for acupuncture clinical trials because the varying techniques of the practice may lead to inaccurate results.
The pain associated with mesothelioma can be devastating and debilitating. Those who are suffering in the later stages of the disease may choose palliative care for pain and symptom management, as standard mesothelioma treatment can have serious side effects. Acupuncture side effects tend to be minor and are generally considered to be safe if done correctly.
Weidong Lu, et. al., “The Value of Acupuncture in Cancer Care” Hematology/Oncology Clinics of North America (August 2008). [Link]
Gabriel Lopez, et.al., Outpatient Acupuncture Effects On Patient Self-Reported Symptoms In Oncology Care: A Retrospective Analysis Of Real-World Data,” American Society of Clinical Oncology (November 16, 2018). [Link]
On the rare instance that mesothelioma is diagnosed in the early stages of the disease, patients have the option for surgery. There are several surgical procedures used to treat mesothelioma. Some mesothelioma surgeries aim to provide a curative effect, while others are performed for palliative purposes. Pleurectomy/decortication (P/D) and extra pleural pneumonectomy (EPP) are two or many procedures for mesothelioma patients that can be successful given the right circumstances.
Pleurectomy /decortication (P/D)
This two- part procedure removes all of the outer membrane of the lung (pleural lining) and then removes any visible tumors. The lung itself is left as is, but in some cases the surgeon may remove other lining located on the chest wall, the heart sac, or even the diaphragm. Ninety percent of patients who have the procedure do experience reduced symptoms, but complications like blood loss or an air leak can be common, occurring in 1 in 10 people. The average survival after surgery may be close to two years. P/D is less invasive than EPP.
Extra pleural pneumonectomy (EPP)
In addition to the pneumonectomy (the surgical removal of the lung), an extra pleural pneumonectomy also includes the removal of the pleura, diaphragm, and pericardium (mesothelial lining of the heart). When this approach is used, it allows for the maximum removal of tumor growth, especially when the cancer is confined to the chest cavity. Removing the lung in its entirety is risky, as the other remaining lung needs to be strong enough to be able to support the function of two organs. This is an aggressive surgery that many consider to be a bit outdated when compared to P/D, which focuses on saving the lung. However, in successful cases the average survival can be upwards of 38 months.
Each surgery has its own set of success and mortality rates, complications, and survival time. To find out which surgery is truly the more effective procedure, researchers from the Hofstra Northwell School of Medicine and the Ichan School of Medicine at Mount Sinai studied the quality of life of mesothelioma patients after they received either P/D or EPP treatment. This study, published in BMC Cancer, focused on which procedure had better survival rates, less complications, and a better quality of life.
To measure this, data was collected from 14 datasets (17 articles), which included 102 EPP and 432 P/D. These studies were cohort or randomized control trials that reported on the quality of life after surgery. Lung function was measured 6 months after surgery. Researchers found that physical function, social function and global health were better for those who had received a P/D, but admitted that that quality of the evidence provided was low, and data limited. Overall, the study suggests that P/D could be the better, more successful option and that the quality of life after surgery should continue to be a factor in deciding what procedure is best to consider.
Surgery continues to be one of the best treatment options for those suffering from mesothelioma; however, it is often not viable. Most patients diagnosed with this aggressive disease receive their diagnoses in the later stages, and are too weak to withstand surgery. Despite continual research for new diagnostic techniques, there are little approved methods for early detection. Chemotherapy remains the first line treatment.
Schwartz RM et. al., Systematic Review Of Quality Of Life Following Pleurectomy Decortication And Extrapleural Pneumonectomy For Malignant Pleural Mesothelioma,” BMC Cancer (November 2018). [Link]
Mesothelioma is a rare cancer affecting only about 3,000 Americans each year. Most of those diagnosed are diagnosed with pleural mesothelioma, but a small number (approx. 500 per year) are diagnosed with peritoneal mesothelioma, which is mesothelioma in the abdominal lining. With so few diagnosed with peritoneal mesothelioma, studying and evaluating the illness has been difficult, and treatments ineffective. However, scientists are researchers are continually exploring new techniques to treat peritoneal mesothelioma, and the latest development from MaxCyte and its collaborators from Johns Hopkins University have them hopeful they are on the right track, as clinical testing has begun for a new anti-tumor drug.
MaxCyte is a biotechnical company that has developed MCY-M11, which is a chimeric antigen receptor (CAR) and is evaluating its effect on mesothelin-expressing solid tumors. For those suffering from peritoneal mesothelioma, the immune system is often in a weakened or in a compromised state; unable to fight infections as the cancer spreads. CARs are proteins that are specifically altered to give T cells – white blood cells that allow the immune system to adapt when an illness strikes – the ability to target particular proteins. MCY-M11 has been administered in non-clinical settings on laboratory animals with tumor growth. Results from those studies showed an overall increase in survival rate after just one injection. Multiple injections over time increased survival further with zero toxic effects outside the tumors.
This has led to FDA approval of a Phase 1 clinical trial of MCY-M11 for those suffering from ovarian cancer and peritoneal mesothelioma. Clinical trials are divided into three phases, with the first phase typically focusing on procedure development and drug administration on a small number of participants. In this Phase 1 trial, which is already underway, MCY-M11 is administered as an intraperitoneal (through the abdomen) infusion for three weeks. Those eligible to participate must have the following:
Be able to undergo peripheral blood leukapheresis; have successful placement of an intraperitoneal catheter.
Be diagnosed with one of the following: metastatic or unresectable high grade serous adenocarcinoma involving the ovary, primary peritoneum, or fallopian tube with peritoneal involvement, not including mixed histologies, OR unresectable epithelioid or biphasic peritoneal mesothelioma
Be at least 4 weeks from previous anti-cancer therapy
Once administered, MCY-M11 will utilize messenger RNA (mRNA) to create new peripheral blood mononuclear cells (PBMCs). PBMCs are blood cells responsible for fighting infections in the immune system. Scientists are hopeful for a “controlled resistance” that if successful, could become the platform for targeted cell-based immune therapy development.
This Phase 1 clinical trial began in September 2018 and is currently recruiting. The study is expected to complete by December 2020.
For many patients who are suffering from malignant mesothelioma, their diagnosis came quickly after experiencing symptoms. In many cases, this is because symptoms of mesothelioma typically do not appear until the cancer has fully developed and it’s in the later stages. For those suffering from pleural mesothelioma – the most common type – 90 percent experience shortness of breath and chest pain as one of the first symptoms and 84 percent experience pleural effusions (fluid build-up between the linings of the lungs and chest). Weight loss, cough, fever, and loss of appetite also make up other symptoms, but since those symptoms are common of other ailments, it doesn’t often cause people to seek medical attention immediately. Successfully treating mesothelioma is difficult because of how far advanced the cancer typically is when it is first detected. Aggressive treatments have to begin immediately, but more often than not, it is already too late. The average life-expectancy for mesothelioma from the time of diagnosis is under one year, as health quickly deteriorates.
Scientists and researchers know that early detection is the key in effectively fighting mesothelioma. However, because the disease often takes decades to develop, it has been difficult to detect without the patient first experiencing symptoms. Researchers from the Institute for Prevention and Occupations Medicine in Germany recently published findings in Scientific Reports that early detection of mesothelioma could be in the near future with a simple blood test that examines two blood-based proteins, mesothelin and calretinin, that are often overexpressed in mesothelioma tumors.
Mesothelin is a protein found on in mesothelial cells. Scientists and researchers have theorized that mesothelin contributes to cell adhesion, but the overall the biological function of the protein is a bit of a mystery. Since mesothelin is found in the lining of lungs, heart, and abdomen, an over expression of the protein is linked to mesothelioma. Calretinin is a protein found throughout the body and is responsible for calcium signaling. It is also known to be found in mesothelioma cell lines.
This most recent study was 10 years in the making, as researchers kept a close eye on 2,769 patients who had asbestos-related diseases that at the time were non-threatening. This program was through the German Social Accident Insurance for Asbestos Workers and Ruhr University Bochum. Beginning in 2008, these participants submitted blood samples annually to the program. Blood was then tested to determine the mesothelin and calretinin levels. At the end of the study in 2018, 34 of the 2,769 participants had developed malignant mesothelioma. Within those 34, mesothelin and calretinin levels were rated at 46 percent, which means the blood test was able to detect mesothelioma in nearly half of those diagnosed, and could have been done so up to 15 months before the official diagnosis.
Relying on symptoms alone as the first signs of mesothelioma is often not enough if it is to be treated successfully. Results from this blood test have scientists and researchers hopeful that for those with known asbestos exposure, even if he or she is not experiencing symptoms, may have a better way of detecting the cancer before it is in full form.
Georg Johnen et. al. “Prediagnostic detection of mesothelioma by circulating calretinin and mesothelin – a case-control comparison nested into a prospective cohort of asbestos-exposed workers,” Scientific Reports (September 25, 2018). [Link]