By Samantha Dalby
Mesothelioma is a cancer that is most commonly caused by exposure to asbestos. Canadians typically come into contact with asbestos through their jobs but can also be exposed when they work or live in buildings where asbestos is disturbed by renovations.
Occupations most at risk for mesothelioma are workers in mines and mills, the automotive industry, shipyards, cement plants, and anyone who works in demolition and construction including carpenters, electricians, painters, insulation workers, and plumbers. A gene mutation called BAP1 (“BRCA1 associated protein 1 gene”) is a rare gene mutation that increases the risk for both mesothelioma and melanoma. People with this gene mutation who are also exposed to asbestos have a higher risk of mesothelioma than people without the gene mutation.
In 2013, 595 Canadians (470 men & 125 women) were diagnosed with mesothelioma and 485 Canadians (383 men & 102 women) died of mesothelioma. In areas where there is a higher concentration of the occupations described above and where there are older asbestos-containing buildings we need to watch for the signs and symptoms of mesothelioma.
The Mesothelioma Center (USA) has provided their website, www.asbestos.com , since 2005. They act as an advocacy center for patients and their families. Their mandate is to provide people with current information and to assist them with resources and advocacy services. I interviewed Public Outreach Coordinator, David Sides, on mesothelioma cancer and the services provided by his organization.
NPSD: Hi David. Can you tell readers a what mesothelioma is and what causes it?
DS: Mesothelioma is a rare cancer caused by the exposure to asbestos. It forms on the protective tissue covering the lungs, abdomen, and heart.
NPSD: Are there different types?
DS: There are 4 types of mesothelioma. Pleural Mesothelioma is the most common. It forms on the soft tissue covering the lungs. Peritoneal Mesothelioma is less than 20% of all mesothelioma cases. It develops on the lining surrounding the abdomen. Pericardial Mesothelioma is the 2nd rarest type of mesothelioma and it forms on soft tissue around the heart. Testicular Mesothelioma is the rarest type of mesothelioma. It develops on lining of the testicles.
NPSD: On your website you speak specifically to military veterans. Do they have an increased risk of asbestos exposure and if so why? Are there other groups that have a high risk for asbestos exposure?
DS: Yes, veterans have a higher chance of developing mesothelioma due to the heavy reliance on asbestos by the military between 1940-1980. Navy veterans have the highest risk among all branches because they relied on asbestos the most, using it throughout their ships. Other groups that have a high risk of mesothelioma include people whose occupations exposed them to asbestos. These occupations include construction worker, firefighter, shipyard worker, and industrial workers to name a few.
NPSD: How long can it take between asbestos exposure and development of mesothelioma? If someone was exposed to asbestos 20 or 30 years ago do they still need to worry about this?
DS: Yes, mesothelioma has a very long latency period of 20-50 years, meaning somebody can develop mesothelioma anywhere between 20-50 years after exposure.
NPSD: What are the symptoms of mesothelioma that people should watch for?
DS: Symptoms of mesothelioma include dry coughing, shortness of breath, chest pain, fatigue, and weakness.
NPSD: Which diagnostic tests look for mesothelioma?
DS: A mesothelioma diagnosis can only be confirmed by a biopsy, but imaging scans are performed before to check for tumours and fluid and [if diagnosed] to monitor the cancer.
NPSD: If a patient has an increased risk for mesothelioma but no symptoms, is there a screening test that they can request from their physician or nurse practitioner?
DS: Unfortunately, [in the United States] there are no widely recommended screening tests for people with no symptoms. Some doctors recommend getting chest X-rays and CT scans to look at changes in the lungs that might signal mesothelioma and/or lung cancer, but it’s not certain how effective these tests are. (Editorial note: please see end of article for lung cancer screening programs in Ontario).
NPSD: Are there treatments for mesothelioma? If so, how successful are they?
DS: For advanced mesothelioma, the life-expectancy without treatment is only around 4-6 months so while a curative treatment is rare, treatment can extend your lifespan. The most common types of mesothelioma treatments include chemotherapy, surgery, and radiation therapy. Chemotherapy, the first line of treatment, has found to make patients live three times longer than patients without chemotherapy, but surgery offers the greatest chance of survival. Patients with strong health and limited cancer spread make the best candidates. Radiation therapy is used primarily to reduce pain from growing tumors, but when combined with surgery and chemotherapy it reduces the risk of local recurrence.
NPSD: Your website (asbestos.com) and organization is based in the United States. Can Canadians access your services? Is there a charge? Are there any equivalent Canadian websites or organizations that you feel people should look at?
DS: Yes, Canadians can access our information just like Americans, completely free of charge. Though we are based in the USA, we feel strongly that asbestos and its consequences don’t discriminate across borders. We have a page focusing exclusively on mesothelioma in Canada, however in addition, the Canadian Cancer Society offers great information on mesothelioma.
NPSD: Are there resources available to patients with mesothelioma and their families?
DS: There are definitely resources available to mesothelioma sufferers and their families. Also, mesothelioma is a compensable disease in Canada, meaning patients can receive payment from provincial governments if they can prove their exposure happened in the workplace.
NPSD: Is there anything else that you want people with mesothelioma or a risk of mesothelioma to know?
DS: The fact that you are reading this and researching mesothelioma is a great first step. If you believe that you are at risk the first thing you should do is to let your physician [or nurse practitioner] know and go through the necessary steps with them to monitor and/or diagnose any cancer.
There is now a Lung Cancer Screening Pilot Project in Ontario. This is a screening program for people aged 55 to 74 years old who have smoked cigarettes (current or ex-smoker) for 20 years or more (not necessarily consecutive) and have no symptoms of disease. If you meet these criteria you can be referred for a low dose CT scan of the chest by your health care provider. Screening tests are done in Sudbury, Oshawa, Ottawa and Renfrew.
If you do not meet the criteria but have other risk factors (e.g. asbestos exposure) or if you currently have signs and symptoms of disease (e.g. chronic cough, shortness of breath, weight loss, night sweats) please book an appointment with your health care provider. If you do not have a health care provider, please contact the Ministry of Health – Health Care Connect program.
Thanks for reading Getting Healthy with NP Sam. Comments welcome.
More places to learn about mesothelioma:
Pleural mesothelioma (@ asbestos.com): https://www.asbestos.com/mesothelioma/pleural/
Mesothelioma in Canada (@asbestos.com): https://www.asbestos.com/mesothelioma/canada/
Mesothelioma (@ Canadian Cancer Society): http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/statistics/?region=sk
Symptoms of mesothelioma (@ Canadian Cancer Society): http://www.cancer.ca/en/cancer-information/cancer-type/mesothelioma/signs-and-symptoms/?region=sk
Lung Cancer Screening Pilot Project (@ Lakeridge Health) https://www.lakeridgehealth.on.ca/en/central-east-regional-cancer-program/lung-cancer-screening-pilot.asp
Health Care Connect: https://hcc3.hcc.moh.gov.on.ca/HCCWeb/faces/layoutHCCSplash.jsp