The Daily Mail reported last week that deaths from asbestos are likely to peak in 2015. It was revealed that senior doctors in the UK have warned that the number of cases of mesothelioma (asbestos related cancer) affecting workers exposed to asbestos before the 1980s has yet to reach a peak. A report in the British Medical Journal disclosed that a peak in the epidemic was unlikely to happen until 2015 at the earliest.
The time between first exposure to asbestos (usually from insulation and building materials) and people contracting the disease is rarely less than 25 years and is often more than 50 years. This will result in thousands of workers in the UK who were exposed to asbestos before the stringent regulations brought in during the 1980s are likely to become sufferers in the future. This means that the UK is a potential time bomb for mesothelioma. Doctors warn that the peak of the epidemic is expected between 2015 and 2020 and the death rate from this insidious disease is likely to be 2000 people a year in the UK.
Apparently the epidemic in the United States has already peaked as a result of earlier awareness and action taken on asbestos products. Many other countries around the world are now experiencing a rise in asbestos related disease as doctors are being trained to recognise and diagnose the symptoms.
Malignant mesothelioma is diagnosed by inspection of a biopsy of the pleura and this helps in planning treatment (and verifying claims for compensation). A reliable biopsy is obtained either by removal of fluid from the chest (pleural fluid cytology) or a needle biopsy which is carried out under local anaesthetic and guided by a CT or ultra sound scan. However, in the early stages of the disease, these tests are not always reliable and often return negative results.
A surgical biopsy may be necessary and there are two keyhole procedures that are used for this. A medical thoracoscopy is carried out under local anaesthetic and involves a small camera telescope introduced through a single cut. In cases where a general anaesthetic is used, the thoracic surgeon uses Video Assisted Thoracoscopic Surgery (VATS) which allows a larger biopsy to be performed in order to make a full assessment of the pleura (the membrane that lines the chest cavity).
Radical surgery is now being used to treat malignant mesothelioma – it involves the removal of all visible tumours and is only appropriate in a small number of patients as most will have progressed beyond this stage when diagnosed and many are not robust enough to undergo the procedure. Unlike other radical cancer surgeries which will often offer the chance of a cure, surgery to treat mesothelioma is generally palliative and can play an important role in improving and controlling the symptoms in order to maintain the quality of life.
This type of surgery is not provided in all areas of the UK and not all thoracic surgeons have experience of radical surgery for malignant pleural mesothelioma. Opinions also differ on the benefits of this type of treatment and trials are still underway to gain more of an understanding as to how to treat this asbestos related disease.