Results from two pioneering studies led by researchers from Duke University Medical Center offer hope to patients with glioblastoma multiforme (GBM), one of the more common and deadliest types of brain tumors.
Both studies involve the use of vaccines in conjunction with chemotherapy to try to boost the body’s immune response against the cancers. Preliminary results were presented over the weekend at the American Society of Clinical Oncology's Annual Meeting in Chicago.
In the first study, the researchers tested a vaccine that targets epithelial growth factor receptor variant III (EGFRvIII), a protein that's found in about half of all GBM tumors. The vaccine was given to 23 patients along with temozolomide (TMZ), the standard chemotherapy treatment for patients with GBM. On average, the combination more than doubled the time it usually takes for these cancers to begin growing again, and seemed to help them live longer as well. Patients treated with standard therapy typically live an average of 14.3 months; the average time for the study participants was 33.1 months.
"We're more than doubling survival time in this group, and we have some patients who are 4, 5, or 6 years out from diagnosis, which is virtually unheard of in these people," said lead researcher John Sampson, MD, PhD, a neurosurgeon at Duke. "The possibility of doubling expected survival—with few if any side effects—would represent a big step and a lot of hope for this group of patients."
The vaccine is thought to work by enhancing the body's immune response to EGFRvIII, prompting the body to kill off and prevent the growth of cells that have the protein -- the GBM tumor cells. The treatment is administered every 2 weeks for the first 3 doses and every month thereafter. Patients have reported minimal side effects, except for swelling at the injection site and fatigue common with chemotherapy treatment regimens.
"While the body is recovering from chemotherapy, immune response is actually stronger as the immune system overcompensates in order to right itself," said Sampson. "It's actually the perfect time to introduce a vaccine."
In order to qualify for the study, patients had to meet several criteria. Their tumors must have been mostly removed through surgery, and they must have already completed standard radiation treatment for GBM. And in order to continue the treatment, they must stay disease-free.
Patients who have had good results with the regimen continue to travel to Duke every month. Cameron Mitchell, of Grand Rapids, Michigan, has been making the trip for the last 4 years.
"You're wiped out for a couple days after the treatment, but it's a small price to pay," said Mitchell. "I'll keep going as long as it keeps working."
Based on the encouraging results from this trial, a larger phase II/III study is now open at more than 20 sites in the US and in Canada.
The second study focused on a vaccine targeting cytomegalovirus (CMV), a type of herpes virus often seen in the blood of people with GBM.
"Previous work has demonstrated the activation of this virus in patients with GBMs, so we took it one step further and tested a vaccine, in a small group of patients, that seems to show some efficacy in stalling the recurrence of these deadly tumors," said Duane Mitchell, MD, PhD, lead researcher of the study at Duke. "We knew there was a connection between this virus and the brain cancer, and we were hoping to take advantage of that connection to treat one by treating the other."
Twenty-one GBM patients were given the vaccine in combination with TMZ after undergoing standard treatment. Mitchell and his colleagues found that the regimen appeared to double the expected disease-free survival time and extend overall survival time from about 14 months with standard treatment to more than 20 months.
Additional studies of this vaccine are also planned.
Monday, July 28, 2008
Classification of Adult Sarcomas
Scientists have demonstrated that genetic "fingerprinting" can help classify subtypes of soft-tissue sarcomas that otherwise look virtually identical. Soft-tissue sarcomas begin in tissues such as fat, muscles, nerves, tendons, and blood vessels. There are more than 50 known subtypes of soft-tissue sarcomas.
For decades, many pathologists have lumped difficult-to-diagnose sarcomas into a "catch-all" category called malignant fibrous histiocytomas (MFH). With current treatments, about 50% of patients with MFH sarcoma survive long-term.
Doctors have long debated whether MFH is one distinct subtype of sarcoma. In this study, researchers used a gene technology called oligonucleotide array analysis to analyze the pattern of activity of 12,500 genes from 52 subtypes of adult soft-tissue sarcoma on a single slide, or "chip." This provides a genetic fingerprint unique to each subtype of sarcoma.
The analysis could easily distinguish between sarcomas with specific genetic alterations. But the technology also differentiated between certain MFH sarcomas and found that some of them formed a distinct subtype. Genes characteristic of each sarcoma subtype were identified. (Abstract # 1611)
What does this mean for patients?
This discovery opens the door to better diagnosis of sarcoma, and may lead to new, more targeted treatments that attack sarcomas based on their genetic differences.
"Genetic fingerprinting of adult sarcomas will likely be useful when pathologists disagree about a diagnosis or when the appearance of tumor cells does not conclusively link them to a particular subtype," said lead investigator Robert Maki, MD, a medical oncologist at Memorial Sloan-Kettering Cancer Center.
Genetic fingerprinting technology may also help scientists evaluate how genes in cancer cells are turned on or off in response to therapy. That will help to determine if a particular sarcoma subtype will eventually become resistant to a given treatment, said Dr. Maki.
Breast Cancer: ASCO Recommendations on Aromatase Inhibitors
Aromatase inhibitors are a class of hormone treatments designed to reduce the amount of estrogen in a womanÆs body and slow or stop the growth of breast cancers that are estrogen "receptor-positive" (tumors that grow faster on estrogen). Aromatase inhibitors are newer treatments, and show some promise in preventing recurrence in women with early stage breast cancer.
Tamoxifen is another hormone treatment for breast cancer. It blocks the effects of estrogen on tumor growth, and has proven to prevent recurrence in women with early stage breast cancer. It has been studied for 30 years and the benefits and side effects are well known.
To see if aromatase inhibitors are more effective than tamoxifen, researchers have started a five-year clinical trial called the ATAC trial (Arimidex (anastrozole), Tamoxifen Alone or in Combination). In 2001, researchers released some early results of the trial, which show that anastrozole is effective in reducing risk for recurrence, maybe more than tamoxifen.
After the results were released, ASCO formed a panel of breast cancer experts to assess aromatase inhibitors. This is the first independent assessment of aromatase inhibitors for the prevention of breast cancer recurrence following surgery. The panel finds that the early results are promising but does not support routine use outside of clinical trials.
ASCO examined the ATAC trial, published medical literature, and unpublished data from drug companies on planned and ongoing studies. Their report is one of ASCOÆs Technology Assessments, designed to recommend if new procedures, tests, or devices are appropriate for broad use.
ATAC Trial Findings
The ATAC study is designed to compare anastrozole and tamoxifen for five years. It includes over 9,000 women with early stage breast cancer. All women in the study had received primary surgery and were candidates to receive adjuvant (added) hormonal therapy.
After a median of 33 months, 317 of the 3,125 women taking anastrozole had a relapse of breast cancer or died, compared to 379 of the 3,116 women on tamoxifen. This is a 17% reduction in the risk of recurrence with anastrozole compared to tamoxifen.
The impact of anastrozole on patient survival has not yet been formally studied.
Findings of ASCOÆs Expert Panel
The reduction in breast cancer recurrence seen in the ATAC trial is promising. However, the panel found that it is premature to recommend anastrozole for routine use. Because tamoxifen provides its greatest benefit when taken for five years, the two drugs cannot be properly compared until anastrozole has been tested for five years also.
While there were few serious side effects in the ATAC trial for both anastrozole and tamoxifen, the long-term side effects of anastrozole are still unknown. Since there is extensive, long-term data on tamoxifen and a clearer understanding of its risks, the panel recommends that tamoxifen remain the standard of care.
The expert panel found no evidence to suggest that women who have started a standard course of tamoxifen should switch to anastrozole or other aromatase inhibitors.
For women who cannot take tamoxifen for specific reasons or severe side effects, anastrozole may be an option. Healthcare providers and women should make decisions with careful consideration of all the available data.
ASCO Assessment of Tamoxifen and Raloxifene
ASCO has also updated its recommendations on the use of hormonal therapies for reducing breast cancer risk in pre-menopausal women at elevated risk. The results of a new technology assessment recommend that women age 35 and over with a five-year projected breast cancer risk of greater than 1.66 should be considered candidates for tamoxifen. The updated assessment confirms ASCOÆs recommendations from 1999.
The assessment also found there is not enough evidence to suggest that raloxifene or aromatase inhibitors be used for breast cancer risk reduction.
To see the original assessment, or ASCOÆs other guidelines, visit www.asco.org or call 703-299-0150.
What does this mean for patients?
These findings represent no change in the current recommendations for women with early breast cancer.
"Patients and physicians can rest assured that tamoxifen remains the best option for use outside of clinical trials, and that it reduces the risk of recurrence and improves overall survival with manageable side effects for most women," said Eric Winer, MD, Director of the Breast Oncology Center at the Dana-Farber Cancer Institute and chair of the panel. "While recent findings on the use of aromatase inhibitors for the prevention of breast cancer recurrence are encouraging, data on long-term use of the drugs are needed before a change in the standard of care is justified."
Women interested in a clinical trial of anastrozole should talk with their doctor.
For decades, many pathologists have lumped difficult-to-diagnose sarcomas into a "catch-all" category called malignant fibrous histiocytomas (MFH). With current treatments, about 50% of patients with MFH sarcoma survive long-term.
Doctors have long debated whether MFH is one distinct subtype of sarcoma. In this study, researchers used a gene technology called oligonucleotide array analysis to analyze the pattern of activity of 12,500 genes from 52 subtypes of adult soft-tissue sarcoma on a single slide, or "chip." This provides a genetic fingerprint unique to each subtype of sarcoma.
The analysis could easily distinguish between sarcomas with specific genetic alterations. But the technology also differentiated between certain MFH sarcomas and found that some of them formed a distinct subtype. Genes characteristic of each sarcoma subtype were identified. (Abstract # 1611)
What does this mean for patients?
This discovery opens the door to better diagnosis of sarcoma, and may lead to new, more targeted treatments that attack sarcomas based on their genetic differences.
"Genetic fingerprinting of adult sarcomas will likely be useful when pathologists disagree about a diagnosis or when the appearance of tumor cells does not conclusively link them to a particular subtype," said lead investigator Robert Maki, MD, a medical oncologist at Memorial Sloan-Kettering Cancer Center.
Genetic fingerprinting technology may also help scientists evaluate how genes in cancer cells are turned on or off in response to therapy. That will help to determine if a particular sarcoma subtype will eventually become resistant to a given treatment, said Dr. Maki.
Breast Cancer: ASCO Recommendations on Aromatase Inhibitors
Aromatase inhibitors are a class of hormone treatments designed to reduce the amount of estrogen in a womanÆs body and slow or stop the growth of breast cancers that are estrogen "receptor-positive" (tumors that grow faster on estrogen). Aromatase inhibitors are newer treatments, and show some promise in preventing recurrence in women with early stage breast cancer.
Tamoxifen is another hormone treatment for breast cancer. It blocks the effects of estrogen on tumor growth, and has proven to prevent recurrence in women with early stage breast cancer. It has been studied for 30 years and the benefits and side effects are well known.
To see if aromatase inhibitors are more effective than tamoxifen, researchers have started a five-year clinical trial called the ATAC trial (Arimidex (anastrozole), Tamoxifen Alone or in Combination). In 2001, researchers released some early results of the trial, which show that anastrozole is effective in reducing risk for recurrence, maybe more than tamoxifen.
After the results were released, ASCO formed a panel of breast cancer experts to assess aromatase inhibitors. This is the first independent assessment of aromatase inhibitors for the prevention of breast cancer recurrence following surgery. The panel finds that the early results are promising but does not support routine use outside of clinical trials.
ASCO examined the ATAC trial, published medical literature, and unpublished data from drug companies on planned and ongoing studies. Their report is one of ASCOÆs Technology Assessments, designed to recommend if new procedures, tests, or devices are appropriate for broad use.
ATAC Trial Findings
The ATAC study is designed to compare anastrozole and tamoxifen for five years. It includes over 9,000 women with early stage breast cancer. All women in the study had received primary surgery and were candidates to receive adjuvant (added) hormonal therapy.
After a median of 33 months, 317 of the 3,125 women taking anastrozole had a relapse of breast cancer or died, compared to 379 of the 3,116 women on tamoxifen. This is a 17% reduction in the risk of recurrence with anastrozole compared to tamoxifen.
The impact of anastrozole on patient survival has not yet been formally studied.
Findings of ASCOÆs Expert Panel
The reduction in breast cancer recurrence seen in the ATAC trial is promising. However, the panel found that it is premature to recommend anastrozole for routine use. Because tamoxifen provides its greatest benefit when taken for five years, the two drugs cannot be properly compared until anastrozole has been tested for five years also.
While there were few serious side effects in the ATAC trial for both anastrozole and tamoxifen, the long-term side effects of anastrozole are still unknown. Since there is extensive, long-term data on tamoxifen and a clearer understanding of its risks, the panel recommends that tamoxifen remain the standard of care.
The expert panel found no evidence to suggest that women who have started a standard course of tamoxifen should switch to anastrozole or other aromatase inhibitors.
For women who cannot take tamoxifen for specific reasons or severe side effects, anastrozole may be an option. Healthcare providers and women should make decisions with careful consideration of all the available data.
ASCO Assessment of Tamoxifen and Raloxifene
ASCO has also updated its recommendations on the use of hormonal therapies for reducing breast cancer risk in pre-menopausal women at elevated risk. The results of a new technology assessment recommend that women age 35 and over with a five-year projected breast cancer risk of greater than 1.66 should be considered candidates for tamoxifen. The updated assessment confirms ASCOÆs recommendations from 1999.
The assessment also found there is not enough evidence to suggest that raloxifene or aromatase inhibitors be used for breast cancer risk reduction.
To see the original assessment, or ASCOÆs other guidelines, visit www.asco.org or call 703-299-0150.
What does this mean for patients?
These findings represent no change in the current recommendations for women with early breast cancer.
"Patients and physicians can rest assured that tamoxifen remains the best option for use outside of clinical trials, and that it reduces the risk of recurrence and improves overall survival with manageable side effects for most women," said Eric Winer, MD, Director of the Breast Oncology Center at the Dana-Farber Cancer Institute and chair of the panel. "While recent findings on the use of aromatase inhibitors for the prevention of breast cancer recurrence are encouraging, data on long-term use of the drugs are needed before a change in the standard of care is justified."
Women interested in a clinical trial of anastrozole should talk with their doctor.
Surgery to Prevent Breast and Ovarian Cancer
Researchers have shown for the first time that women with mutations in BRCA1 and BRCA2 genes can reduce their risk of breast and ovarian cancers if they have surgery to remove their ovaries and fallopian tubes.
The study involved 173 women whose genetic tests showed mutations in the BRCA1 and BRCA2 genes. These mutations place women at higher risk for developing breast and ovarian cancer. The women received genetic counseling regarding their options, and chose a course of action. Of the group, 101 chose surgery to remove their ovaries and fallopian tubes (a procedure called salpingo-oophorectomy). The other 72 chose in-tensive screening: transvaginal ultrasound and a CA-125 blood test twice a year.
Compared to screening, surgery to remove the ovaries and fallopian tubes reduced the risk of breast and ovarian cancers by 75%.
After two years, three breast cancers and one peritoneal cancer were diagnosed in women who had preventive surgery. In the group of women who chose intensive screening, there were eight breast cancers, four ovarian cancers, and one peritoneal cancer.
Among the women who chose preventive surgery, doctors detected three unsuspected early-stage ovarian tumors during the operation. "This highlights the limitations of current screening tests for ovarian cancer," said Richard Barakat, MD, Chief of Gynecologic Oncology at MSKCC, and a co-author of the study.
Removing the ovaries may also reduce breast cancer risk by decreasing estrogen and halting or slowing breast cancers that depend on estrogen to grow.
The researchers will continue to follow the women in the study to evaluate the long-term effects of preventive surgery on cancer rates, on other health risks, and on overall survival. (Abstract #3)
What does this mean for patients?
Every woman with BRCA1 and BRCA2 mutations makes a highly individual decision with help from family, her doctors, and genetic counselors. These results are short-term, but suggest that women with these mutations may now have another option when making decisions.
"We now have prospective evidence to present to patients so that they can make informed decisions about their care," said lead investigator Kenneth Offit, MD, Chief of the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center. Women at high risk for breast and ovarian cancer should talk with their doctor.
The study involved 173 women whose genetic tests showed mutations in the BRCA1 and BRCA2 genes. These mutations place women at higher risk for developing breast and ovarian cancer. The women received genetic counseling regarding their options, and chose a course of action. Of the group, 101 chose surgery to remove their ovaries and fallopian tubes (a procedure called salpingo-oophorectomy). The other 72 chose in-tensive screening: transvaginal ultrasound and a CA-125 blood test twice a year.
Compared to screening, surgery to remove the ovaries and fallopian tubes reduced the risk of breast and ovarian cancers by 75%.
After two years, three breast cancers and one peritoneal cancer were diagnosed in women who had preventive surgery. In the group of women who chose intensive screening, there were eight breast cancers, four ovarian cancers, and one peritoneal cancer.
Among the women who chose preventive surgery, doctors detected three unsuspected early-stage ovarian tumors during the operation. "This highlights the limitations of current screening tests for ovarian cancer," said Richard Barakat, MD, Chief of Gynecologic Oncology at MSKCC, and a co-author of the study.
Removing the ovaries may also reduce breast cancer risk by decreasing estrogen and halting or slowing breast cancers that depend on estrogen to grow.
The researchers will continue to follow the women in the study to evaluate the long-term effects of preventive surgery on cancer rates, on other health risks, and on overall survival. (Abstract #3)
What does this mean for patients?
Every woman with BRCA1 and BRCA2 mutations makes a highly individual decision with help from family, her doctors, and genetic counselors. These results are short-term, but suggest that women with these mutations may now have another option when making decisions.
"We now have prospective evidence to present to patients so that they can make informed decisions about their care," said lead investigator Kenneth Offit, MD, Chief of the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center. Women at high risk for breast and ovarian cancer should talk with their doctor.
Bone drug has benefits in cancer patients
NEW YORK (Reference Thanks to Reuters Health) - The bone-strengthening drug zoledronic acid not only reduces fracture risk in patients with cancer that has spread to the bones, it also improves overall survival, according to the results of a retrospective analysis of three large studies.
Bones are common sites for the spread, or metastasis, of cancer. Zoledronic acid decreases bone turnover and reduces bone fractures in patients with the bone-thinning disease osteoporosis.
Dr. Allan Lipton of Milton S. Hershey Medical Center at Pennsylvania State University and colleagues took a look back at 578 patients with bone metastases from breast cancer, 472 patients with hormone-refractory prostate cancer and 291 patients with non-small cell lung cancer and other solid tumors, who were given either zoledronic acid or control therapy.
Control therapy was the bone drug pamidronate in breast cancer patients and placebo in prostate and lung cancer patients. Treatment was given for up to 2 years.
They found that most patients with initially normal levels NTx -- a marker of bone loss that is secreted in urine -- maintained normal levels while taking zoledronic acid. Most patients with elevated NTx levels at the outset, suggesting increased bone loss, saw their NTx levels normalize with zoledronic acid.
Normalization of NTx levels occurred with zoledronic acid in 81 percent of breast cancer patients, in 70 percent of prostate cancer patients and in 81 percent of lung cancer patients with initially high NTx levels.
NTx levels normalized with pamidronate "control" therapy in 65 percent of breast cancer patients, while 8 percent and 17 percent of the prostate and lung cancer patients, respectively, saw their NTx levels normalize on placebo.
Of note, the study showed improved overall survival in patients got their NTx levels into the normal range compared to those with persistently elevated NTx levels, Lipton and colleagues report.
Bones are common sites for the spread, or metastasis, of cancer. Zoledronic acid decreases bone turnover and reduces bone fractures in patients with the bone-thinning disease osteoporosis.
Dr. Allan Lipton of Milton S. Hershey Medical Center at Pennsylvania State University and colleagues took a look back at 578 patients with bone metastases from breast cancer, 472 patients with hormone-refractory prostate cancer and 291 patients with non-small cell lung cancer and other solid tumors, who were given either zoledronic acid or control therapy.
Control therapy was the bone drug pamidronate in breast cancer patients and placebo in prostate and lung cancer patients. Treatment was given for up to 2 years.
They found that most patients with initially normal levels NTx -- a marker of bone loss that is secreted in urine -- maintained normal levels while taking zoledronic acid. Most patients with elevated NTx levels at the outset, suggesting increased bone loss, saw their NTx levels normalize with zoledronic acid.
Normalization of NTx levels occurred with zoledronic acid in 81 percent of breast cancer patients, in 70 percent of prostate cancer patients and in 81 percent of lung cancer patients with initially high NTx levels.
NTx levels normalized with pamidronate "control" therapy in 65 percent of breast cancer patients, while 8 percent and 17 percent of the prostate and lung cancer patients, respectively, saw their NTx levels normalize on placebo.
Of note, the study showed improved overall survival in patients got their NTx levels into the normal range compared to those with persistently elevated NTx levels, Lipton and colleagues report.
PSA Test
This study suggested that annual PSA screening tests for prostate cancer might not be necessary for many men. Men whose initial tests show very low PSA levels may safely choose less frequent screening, once every five years in some cases. Some organizations currently recommend that a PSA test be offered annually to men age 50 and older. The test detects blood levels of prostate-specific antigen. Higher than normal levels may indicate pros-tate cancer.
This study is part of the National Cancer InstituteÆs nationwide PLCO (pros-tate, lung, colorectal, ovarian) cancer screening trial. The PLCO trial is still ongoing. In this particular analysis, researchers followed 27,863 men ages 55-74 for five years. Of those men, 90% had initial PSA levels that were considered normal (less than 4 ng/ml). Based on the results, they predicted how many men would have PSA levels rising above normal in five years.
The researchers found that most men (98.6%) with extremely low initial PSA levels (under 1 ng/ml) would continue to have normal PSA tests over the next four years. Most men (98.8%) with PSA levels of 1-2 ng/ml would also have a normal PSA test the following year.
One question of the PLCO trial is if PSA screening improves survival in men with prostate cancer, and that question has not been answered yet. These are interim results and do not yet indicate if PSA screening itself improves survival. (Abstract #4)
What does this mean for patients?
The researchers estimate that if men with a PSA below 1 ng/ml are screened once every five years and those with PSA levels of 1-2 ng/ml are screened every two years, only 2.6% of men would miss an earlier potentially positive test.
The researchers recommend that men with PSA levels of 2-4 ng/ml, should be followed more closely. They predict that 24% of this groupÆs PSA levels will become elevated within one year, and 83% rise within four years.
"We found that the vast majority of men whose initial PSA levels are very low do not need to worry that they would skyrocket within one year," said E. David Crawford, MD, Senior Associate Director at the University of ColoradoÆs Health Sciences Center.
This study is part of the National Cancer InstituteÆs nationwide PLCO (pros-tate, lung, colorectal, ovarian) cancer screening trial. The PLCO trial is still ongoing. In this particular analysis, researchers followed 27,863 men ages 55-74 for five years. Of those men, 90% had initial PSA levels that were considered normal (less than 4 ng/ml). Based on the results, they predicted how many men would have PSA levels rising above normal in five years.
The researchers found that most men (98.6%) with extremely low initial PSA levels (under 1 ng/ml) would continue to have normal PSA tests over the next four years. Most men (98.8%) with PSA levels of 1-2 ng/ml would also have a normal PSA test the following year.
One question of the PLCO trial is if PSA screening improves survival in men with prostate cancer, and that question has not been answered yet. These are interim results and do not yet indicate if PSA screening itself improves survival. (Abstract #4)
What does this mean for patients?
The researchers estimate that if men with a PSA below 1 ng/ml are screened once every five years and those with PSA levels of 1-2 ng/ml are screened every two years, only 2.6% of men would miss an earlier potentially positive test.
The researchers recommend that men with PSA levels of 2-4 ng/ml, should be followed more closely. They predict that 24% of this groupÆs PSA levels will become elevated within one year, and 83% rise within four years.
"We found that the vast majority of men whose initial PSA levels are very low do not need to worry that they would skyrocket within one year," said E. David Crawford, MD, Senior Associate Director at the University of ColoradoÆs Health Sciences Center.
New Drug for Pleural Mesothelioma
In this study, people with pleural mesothelioma (cancer of the lining of the lung) lived longer and had less pain and shortness of breath if they received the new chemotherapy drug pemetrexed. The phase III randomized study is the largest meso-thelioma trial ever conducted, involving 456 patients. Patients were chosen at random to receive pemetrexed plus cisplatin (a common chemotherapy drug) or cisplatin alone.
Mesothelioma patients treated with pemetrexed plus cisplatin lived about a year after their diagnosis, nearly three months longer than patients who received only cisplatin.
The two-drug combination caused the cancer to shrink in 41% of patients, compared to 17% of patients who received only cisplatin. The drug combination was also more effective at reducing pain and shortness of breath, symptoms commonly experienced by mesothelioma patients.
Shortly after the study began, many patients began having low levels of folic acid and vitamin B12. These patients who re-ceived pemetrexed were more likely to experience severe side effects (very low white blood cell counts, severe diarrhea, and severe mouth ulcers) than patients who received only cisplatin.
Following the observation, all patients in the study began receiving folic acid and vitamin B12. This reduced the side effects associated with pemetrexed, and more patients benefited from the drug.
Mesothelioma is most commonly caused by exposure to asbestos. Peme-trexed is a cousin of an early chemotherapy drug, methotrexate, used to treat other types of cancer. Methotrexate blocks one enzyme necessary for cell division and tumor growth, and pemetrexed blocks three such enzymes. (Abstract #5)
What does this mean for patients?
Pemetrexed is the first drug shown to prolong the lives of people with mesothelioma. "The results are very encouraging and significant because mesothelioma patients and their families now have proof that this new chemotherapy drug offers real and tangible benefits," said Nicholas J. Vogel-zang, MD. Dr. Vogelzang is the Fred C. Buffett Professor and Director of the University of Chicago Cancer Research Center.
Mesothelioma patients treated with pemetrexed plus cisplatin lived about a year after their diagnosis, nearly three months longer than patients who received only cisplatin.
The two-drug combination caused the cancer to shrink in 41% of patients, compared to 17% of patients who received only cisplatin. The drug combination was also more effective at reducing pain and shortness of breath, symptoms commonly experienced by mesothelioma patients.
Shortly after the study began, many patients began having low levels of folic acid and vitamin B12. These patients who re-ceived pemetrexed were more likely to experience severe side effects (very low white blood cell counts, severe diarrhea, and severe mouth ulcers) than patients who received only cisplatin.
Following the observation, all patients in the study began receiving folic acid and vitamin B12. This reduced the side effects associated with pemetrexed, and more patients benefited from the drug.
Mesothelioma is most commonly caused by exposure to asbestos. Peme-trexed is a cousin of an early chemotherapy drug, methotrexate, used to treat other types of cancer. Methotrexate blocks one enzyme necessary for cell division and tumor growth, and pemetrexed blocks three such enzymes. (Abstract #5)
What does this mean for patients?
Pemetrexed is the first drug shown to prolong the lives of people with mesothelioma. "The results are very encouraging and significant because mesothelioma patients and their families now have proof that this new chemotherapy drug offers real and tangible benefits," said Nicholas J. Vogel-zang, MD. Dr. Vogelzang is the Fred C. Buffett Professor and Director of the University of Chicago Cancer Research Center.
Thursday, July 24, 2008
Union Workers at Risk - Asbestos
Unions
Because asbestos was so widely used for centuries, including the first three-quarters of the 20th century, literally millions of workers have been and remain at risk for developing asbestos-related diseases. In the majority of cases, these workers never knew that they were putting their lives on the line by working with this "miracle" mineral, which served as an insulator and fire proofing agent for thousands of products manufactured and used worldwide.
The material was ever present in the factories of America prior to 1980 and the use of asbestos was indeed looked upon as essential for many decades. Advocates of asbestos use promoted the fact that it was "protecting" workers, not harming them, even though many company executives already knew of the dangers of the toxic material but did little or nothing to protect workers.
Some industries and occupations were more affected than others and it has been the trade unions for these industries and workers that have rallied together to support those who were unknowingly exposed to asbestos. If your Union is not on our list please send us an email. Those occupations most affected include:
Auto Mechanics
For many years, brakes and clutches used in automobiles contained asbestos. The material was included in these auto parts in order to avoid fires. Mechanics who changed or repaired these parts often breathed in asbestos dust.
Boilermakers & Shipbuilders
Boilermakers and Shipbuilders were involved with the manufacture, installation and repair of boilers. Because of their heat-producing capacity, boilers were usually insulated with asbestos, therefore exposing workers on a regular basis.
Bricklayers, Painters, Masons and Allied Craftworkers
Workers in these trades were often exposed to a variety of asbestos-containing paints, compounds and adhesives.
Building and Construction Workers
Myriad workers in the construction industry were exposed to asbestos in the building of homes, factories, office buildings, and schools.
Carpenters
Many of the products that carpenters used contained asbestos including wallboard, gypsum, floor tiles, shingles, paint, paper and cement.
Electricians
Those who worked as electricians in any number of industries – including shipyards, power plants, and steel mills – were exposed to the asbestos traditionally used as an insulator for wires.
Elevator Constructors
Asbestos was used to provide insulation from the friction created in the operation of elevators putting elevator installation and repair workers at risk.
Engineers
Engineers, particularly those working in shipyards, on ship, submarines and in boiler rooms were often exposed to airborne asbestos.
Firefighters
Being exposed to asbestos while fighting fires in old buildings, both in cities and small towns, can be a definite hazard for the nation’s firefighters.
Food and Commercial Workers
These union workers were exposed to asbestos containing products that were used to provide insulation from intense heat generated by the equipment in these work settings.
Heat and Frost Insulators and Asbestos Workers
Because asbestos has historically been used as an insulator, those whose job it was to insulate pipes, electrical lines, etc. were constantly exposed to the dangerous mineral.
Iron Workers
Iron workers were susceptible to frequent direct exposure to asbestos products. Day in and day out they would work with slate board made from asbestos as well as insulation products.
Laborers
Laborers worked in a variety of settings where the use of asbestos-containing products was prevalent.
Longshoremen, Boatmen & Maritime Workers
Working in and around ships and submarines subjected many of these union workers to hazardous asbestos exposure in highly concentrated quantities due to the tight quarters that they were confined to.
Mine Workers
Those who toiled in asbestos, vermiculite, or talc mines may have been exposed to large amounts of asbestos dust on a daily basis. The rate of mesothelioma among mine workers is quite high.
Plumbers, Pipefitters & Steamfitters
Plumbers, Pipefitters and Steamfitters, the individuals who lay out, assemble, maintain and repair piping systems, worked in a number of different industries where they were exposed to asbestos. They were particularly busy in the shipyards of America prior to, during, and after World War II.
Roofers
Asbestos was one of the strongest and most durable materials available for use in roofing applications and construction projects putting roofers at risk for asbestos exposure.
Sheet Metal Workers
Sheet metal workers were very likely to have come into contact with asbestos-containing products in the course of their work in the sheet metal trade.
Steel Workers
Due to the high levels of heat found in steel plants, asbestos was used regularly. Decades ago, steel workers even wore protective clothing made from asbestos, including aprons, gloves, and even face masks.
Transportation Workers
Trains, buses, cars and planes all contained asbestos based materials that served to provide protection from intense heat due to friction. Union workers in this industry were needlessly exposed to airborne asbestos fibers as a result.
Utility Workers
Utility workers were exposed to asbestos containing insulation materials used to protect against extreme heat.
Because asbestos was so widely used for centuries, including the first three-quarters of the 20th century, literally millions of workers have been and remain at risk for developing asbestos-related diseases. In the majority of cases, these workers never knew that they were putting their lives on the line by working with this "miracle" mineral, which served as an insulator and fire proofing agent for thousands of products manufactured and used worldwide.
The material was ever present in the factories of America prior to 1980 and the use of asbestos was indeed looked upon as essential for many decades. Advocates of asbestos use promoted the fact that it was "protecting" workers, not harming them, even though many company executives already knew of the dangers of the toxic material but did little or nothing to protect workers.
Some industries and occupations were more affected than others and it has been the trade unions for these industries and workers that have rallied together to support those who were unknowingly exposed to asbestos. If your Union is not on our list please send us an email. Those occupations most affected include:
Auto Mechanics
For many years, brakes and clutches used in automobiles contained asbestos. The material was included in these auto parts in order to avoid fires. Mechanics who changed or repaired these parts often breathed in asbestos dust.
Boilermakers & Shipbuilders
Boilermakers and Shipbuilders were involved with the manufacture, installation and repair of boilers. Because of their heat-producing capacity, boilers were usually insulated with asbestos, therefore exposing workers on a regular basis.
Bricklayers, Painters, Masons and Allied Craftworkers
Workers in these trades were often exposed to a variety of asbestos-containing paints, compounds and adhesives.
Building and Construction Workers
Myriad workers in the construction industry were exposed to asbestos in the building of homes, factories, office buildings, and schools.
Carpenters
Many of the products that carpenters used contained asbestos including wallboard, gypsum, floor tiles, shingles, paint, paper and cement.
Electricians
Those who worked as electricians in any number of industries – including shipyards, power plants, and steel mills – were exposed to the asbestos traditionally used as an insulator for wires.
Elevator Constructors
Asbestos was used to provide insulation from the friction created in the operation of elevators putting elevator installation and repair workers at risk.
Engineers
Engineers, particularly those working in shipyards, on ship, submarines and in boiler rooms were often exposed to airborne asbestos.
Firefighters
Being exposed to asbestos while fighting fires in old buildings, both in cities and small towns, can be a definite hazard for the nation’s firefighters.
Food and Commercial Workers
These union workers were exposed to asbestos containing products that were used to provide insulation from intense heat generated by the equipment in these work settings.
Heat and Frost Insulators and Asbestos Workers
Because asbestos has historically been used as an insulator, those whose job it was to insulate pipes, electrical lines, etc. were constantly exposed to the dangerous mineral.
Iron Workers
Iron workers were susceptible to frequent direct exposure to asbestos products. Day in and day out they would work with slate board made from asbestos as well as insulation products.
Laborers
Laborers worked in a variety of settings where the use of asbestos-containing products was prevalent.
Longshoremen, Boatmen & Maritime Workers
Working in and around ships and submarines subjected many of these union workers to hazardous asbestos exposure in highly concentrated quantities due to the tight quarters that they were confined to.
Mine Workers
Those who toiled in asbestos, vermiculite, or talc mines may have been exposed to large amounts of asbestos dust on a daily basis. The rate of mesothelioma among mine workers is quite high.
Plumbers, Pipefitters & Steamfitters
Plumbers, Pipefitters and Steamfitters, the individuals who lay out, assemble, maintain and repair piping systems, worked in a number of different industries where they were exposed to asbestos. They were particularly busy in the shipyards of America prior to, during, and after World War II.
Roofers
Asbestos was one of the strongest and most durable materials available for use in roofing applications and construction projects putting roofers at risk for asbestos exposure.
Sheet Metal Workers
Sheet metal workers were very likely to have come into contact with asbestos-containing products in the course of their work in the sheet metal trade.
Steel Workers
Due to the high levels of heat found in steel plants, asbestos was used regularly. Decades ago, steel workers even wore protective clothing made from asbestos, including aprons, gloves, and even face masks.
Transportation Workers
Trains, buses, cars and planes all contained asbestos based materials that served to provide protection from intense heat due to friction. Union workers in this industry were needlessly exposed to airborne asbestos fibers as a result.
Utility Workers
Utility workers were exposed to asbestos containing insulation materials used to protect against extreme heat.
Symptoms of Mesothelioma
Combine the characteristics of mesothelioma with its long latency period and its symptoms of being non-specific, there is a great risk of delay in diagnosis. Person exposed to asbestos will only start experiencing the symptoms after 30 to 50 years. On top of that, the symptoms are very similar to that of viral pneumonia and other less serious illnesses resulting to a misdiagnosis. Symptoms appear about 2 to 3 months before the cancer is found. Some patients do not show any symptoms at all. Often, the patient finds out about the seriousness of his illness too late. Here following are common symptoms of mesothelioma, which can be mistaken as an indication of the person suffering from a less serious illness:
Blood in the sputum
*
A cough or change in cough pattern
*
Difficulty in swallowing
*
Hoarseness
*
Shortness of breath
*
Pain in the chest or abdomen
*
Weight loss
*
Immune deficiency related illnesses such as colds
More symptoms are also noted, and they become confusing for they vary depending on the organ the cancer has affected. Pleural mesothelioma is the most common type of mesothelioma since asbestos particles when airborne is inhaled by the person. It account for 75% of all mesothelioma cases. This kind of mesothelioma affects the chest cavity and sometimes including the lungs. There is build-up of fluid or pleural effusion when one has pleural mesothelioma. Pleural effusion is the most common symptom of this type and it is characterized by the accumulation of fluid in the chest wall and lungs. In normal conditions the amount of fluid is enough to act as lubricant between the chest wall and the lung. The excess fluid is absorbed by blood and lymph vessels to maintain the balance. When too much of this fluid is formed it causes effusion. Pleural effusion is either confined to the right (60%) or left (40%) lung. Effusion is accompanied by other symptoms like trouble in breathing, cough, weight loss and fever. More symptoms are indicated below:
*
Chest pain and pain in the lower back
*
Muscle weakness and sensory loss
*
Swelling of the face and arms
*
Hoarseness
*
Coughing up of blood
At the onset of the illness the shortness of breath may be experienced only when the patient exercises but as lung function drops breathlessness can be experienced even he or she is resting. Metastases occurs when the cancer spreads from the lungs to the chest wall and ribs. This can be extremely painful. Survival time of pleural mesothelioma cancer patients is approximately 17 months. Peritoneal mesothelioma affects the abdominal cavity and organs including the liver, spleen and bowels. This type of mesothelioma accounts for about 10% of all cases. Most patients complain of pain making it the most common symptom of this kind of mesothelioma. Furthermore, the abdomen would seem enlarged due to the accumulation of fluid in that area. Other symptoms of peritoneal mesothelioma:
*
Nausea and vomiting
*
Swelling of the feet
*
Fever
*
Impaired bowel function
*
Breathing problems
*
Chest pain
*
Loss of appetite
*
Anemia
*
Sometimes blood clotting abnormalities
The tumor can cause increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. It is presses upward it can impair one’s breathing capacity. As nerve fibers are affected and bowel distends, the amount of pain can increase. Survival time of this form of cancer is less that that of pleural mesothelioma averaging at 10 months from the onset of symptoms. Mesothelioma Cancer affecting the thin lining of tissue that surrounds the heart or the pericardium is known as pericardial mesothelioma. This is the rarest form of cancer among the three. Symptoms include chest pain, cough, dyspnea and palpitations.
If you suspect that you or your loved one could be suffering from this rare form of cancer, immediately seek your physician’s attention and apprise him of any exposure to asbestos you or your loved one have had. The patient should also disclose his or her medical history and more importantly his work history for it could hasten the physician’s diagnosis once he is informed regarding possible exposure to asbestos. It is important also to indicate duration of exposure. Those living near areas or factories that handle asbestos could also be at risk. Even family members of workers handling asbestos are at risk as well. It is essential that the patient gets a complete physical examination like a chest x-ray, lung function tests and blood tests. Tests in the urine, feces, mucus and material rinsed out of the lungs can also aid in the correct diagnosis of mesothelioma for it could pinpoint any abnormalities in the body organs.
Diagnosing mesothelioma can be obtained through imaging techniques and tissue sampling. Imagine techniques include x-rays, computed tomography or CT scans, magnetic resonance imaging or MRI and positron emission tomography or PET.
Once mesothelioma is suspected through imaging tests, confirming is done through pathological examinations. This is characterized by the removal of tissue and placed under the microscope allowing a pathologist to make a definitive diagnosis. Further examinations can be done to make a complete verification of the illness. A thorascope is used in thorascopy tests for pleural mesothelioma patients where the physician cuts through the chest wall and inserts the instrument between the two ribs. A thoracentesis is done by collecting excess fluid from the affected organ. Perioneoscopy is done on peritoneal mesothelioma patients. A peritonescope is put into an opening made in the abdomen. Paracentesis is done by collecting excess fluid from the abdomen.
When there is abnormal tissue in the organ, the physician will obtain a biopsy by cutting out a small piece of the tissue and examine it under a microscope. This is the final determining factor that could lead to a correct diagnosis of mesothelioma. A pathologist is tasked to determine whether the cancer is benign or malignant based on the sample tissue obtained from the patient. Although pathologists have a general expertise of various diseases, only a small number have acquired training in the study of mesothelioma.
Blood in the sputum
*
A cough or change in cough pattern
*
Difficulty in swallowing
*
Hoarseness
*
Shortness of breath
*
Pain in the chest or abdomen
*
Weight loss
*
Immune deficiency related illnesses such as colds
More symptoms are also noted, and they become confusing for they vary depending on the organ the cancer has affected. Pleural mesothelioma is the most common type of mesothelioma since asbestos particles when airborne is inhaled by the person. It account for 75% of all mesothelioma cases. This kind of mesothelioma affects the chest cavity and sometimes including the lungs. There is build-up of fluid or pleural effusion when one has pleural mesothelioma. Pleural effusion is the most common symptom of this type and it is characterized by the accumulation of fluid in the chest wall and lungs. In normal conditions the amount of fluid is enough to act as lubricant between the chest wall and the lung. The excess fluid is absorbed by blood and lymph vessels to maintain the balance. When too much of this fluid is formed it causes effusion. Pleural effusion is either confined to the right (60%) or left (40%) lung. Effusion is accompanied by other symptoms like trouble in breathing, cough, weight loss and fever. More symptoms are indicated below:
*
Chest pain and pain in the lower back
*
Muscle weakness and sensory loss
*
Swelling of the face and arms
*
Hoarseness
*
Coughing up of blood
At the onset of the illness the shortness of breath may be experienced only when the patient exercises but as lung function drops breathlessness can be experienced even he or she is resting. Metastases occurs when the cancer spreads from the lungs to the chest wall and ribs. This can be extremely painful. Survival time of pleural mesothelioma cancer patients is approximately 17 months. Peritoneal mesothelioma affects the abdominal cavity and organs including the liver, spleen and bowels. This type of mesothelioma accounts for about 10% of all cases. Most patients complain of pain making it the most common symptom of this kind of mesothelioma. Furthermore, the abdomen would seem enlarged due to the accumulation of fluid in that area. Other symptoms of peritoneal mesothelioma:
*
Nausea and vomiting
*
Swelling of the feet
*
Fever
*
Impaired bowel function
*
Breathing problems
*
Chest pain
*
Loss of appetite
*
Anemia
*
Sometimes blood clotting abnormalities
The tumor can cause increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. It is presses upward it can impair one’s breathing capacity. As nerve fibers are affected and bowel distends, the amount of pain can increase. Survival time of this form of cancer is less that that of pleural mesothelioma averaging at 10 months from the onset of symptoms. Mesothelioma Cancer affecting the thin lining of tissue that surrounds the heart or the pericardium is known as pericardial mesothelioma. This is the rarest form of cancer among the three. Symptoms include chest pain, cough, dyspnea and palpitations.
If you suspect that you or your loved one could be suffering from this rare form of cancer, immediately seek your physician’s attention and apprise him of any exposure to asbestos you or your loved one have had. The patient should also disclose his or her medical history and more importantly his work history for it could hasten the physician’s diagnosis once he is informed regarding possible exposure to asbestos. It is important also to indicate duration of exposure. Those living near areas or factories that handle asbestos could also be at risk. Even family members of workers handling asbestos are at risk as well. It is essential that the patient gets a complete physical examination like a chest x-ray, lung function tests and blood tests. Tests in the urine, feces, mucus and material rinsed out of the lungs can also aid in the correct diagnosis of mesothelioma for it could pinpoint any abnormalities in the body organs.
Diagnosing mesothelioma can be obtained through imaging techniques and tissue sampling. Imagine techniques include x-rays, computed tomography or CT scans, magnetic resonance imaging or MRI and positron emission tomography or PET.
Once mesothelioma is suspected through imaging tests, confirming is done through pathological examinations. This is characterized by the removal of tissue and placed under the microscope allowing a pathologist to make a definitive diagnosis. Further examinations can be done to make a complete verification of the illness. A thorascope is used in thorascopy tests for pleural mesothelioma patients where the physician cuts through the chest wall and inserts the instrument between the two ribs. A thoracentesis is done by collecting excess fluid from the affected organ. Perioneoscopy is done on peritoneal mesothelioma patients. A peritonescope is put into an opening made in the abdomen. Paracentesis is done by collecting excess fluid from the abdomen.
When there is abnormal tissue in the organ, the physician will obtain a biopsy by cutting out a small piece of the tissue and examine it under a microscope. This is the final determining factor that could lead to a correct diagnosis of mesothelioma. A pathologist is tasked to determine whether the cancer is benign or malignant based on the sample tissue obtained from the patient. Although pathologists have a general expertise of various diseases, only a small number have acquired training in the study of mesothelioma.
Medical Experts
Medical Experts
Medical experts are often necessary to help prove a plaintiff's claims in a Mesothelioma case and thus establish his or her right to compensation. Possible experts include the physician who diagnosed the plaintiff's Mesothelioma, those who have treated the disease, and others who can establish the link between asbestos exposure and Mesothelioma. Although the plaintiff's treating physician may have a wonderful bedside manner, he or she may not make the best expert witness. Experienced asbestos-litigation attorneys can secure the services of the best-qualified medical experts who are comfortable with the trial process and can serve as part of the plaintiff's legal team.
The Role of Medical Experts in a Mesothelioma Case
The role that experts play in any lawsuit varies from case to case. Sometimes an expert will serve solely as a consultant to the plaintiff's lawyer and will remain in the background. Other experts may be used only in the pre-trial stages, and yet others may serve as expert witnesses at trial.
Some of the principal functions that medical experts serve in Mesothelioma cases include:
* Evaluate the case. Medical experts are often used by lawyers to evaluate a Mesothelioma case and help determine whether a claim has merit. In other cases, experts are used to evaluate the nature and extent of the damages sustained, such as the loss of earning capacity and income a claimant has experienced, for use in settlement negotiations.
* Identify other expert witnesses. Medical experts are sometimes used to locate and recruit other experts who will testify at trial. If, for instance, the expert who is in the best position to educate the plaintiff's attorney is not a suitable trial witness due to unavailability, lack of impressive credentials, or some other factor, he or she may be in the best position to help find another expert who would make a more credible or impressive witness.
* Provide sworn statements. A medical expert may be called upon to prepare a report of his or her findings to be used in settlement negotiations or in connection with pre-trial court proceedings.
* Provide expert-witness testimony in a deposition or at trial. Medical expert testimony is often presented to provide proof of a critical element in the plaintiff's case, either in a pre-trial deposition as part of the discovery process, or at the trial itself if the case does not settle out of court.
Qualifications of a Medical Expert
There is no specific list of requirements for experts in Mesothelioma cases, but certain considerations are generally applied when selecting a medical expert.
* Presentation. If a medical expert is expected to testify at trial, he or she should be well spoken, easy to understand, and credible to the average person as well as the judge.
* Education and experience. Medical experts from more prestigious medical schools and residency programs may be more persuasive to jurors and less vulnerable to criticism by opposing counsel.
* Specialized expertise. A medical expert in a Mesothelioma case should have specialized knowledge with regard to this disease in order to have the credibility required to win over the judge, arbitrator, or jurors.
* Relevant experience. A Mesothelioma expert should have several years of actual practical experience working with Mesothelioma patients or in Mesothelioma research.
* Publications and teaching. A medical expert's credentials with regard to Mesothelioma are strengthened if he or she has written, taught, or lectured on the subject.
* Appearance of neutrality or objectivity. An expert who testifies for both plaintiffs and defendants in lawsuits can be viewed as a "paid spokesperson" and thus lack credibility.
How Medical Experts' Fees Are Paid
It is important to note that medical experts are not paid for the testimony per se, since so doing would certainly compromise the objectivity and thus the credibility of their testimony. Rather, they are compensated for their time based on hourly rates. Some medical experts charge a minimum fee. Expenses for travel and lodging, if incurred, are also reimbursed. Generally, plaintiffs do not have to come up with these fees until the case settles or the jury renders a verdict (costs are deducted from any recovery).
Although the best experts may charge the highest rates, it is important to keep the charges in line with what is standard. If defense counsel inquires into the payment made to a particular medical expert in the presence of the jury, an exorbitant payment could raise a few eyebrows and compromise the believability of the testimony-in fact, the plaintiff's case itself could be compromised if the jury believes that he or she had to "bribe" someone to testify on their behalf.
Conclusion
An experienced asbestos-litigation attorney is in the best position to evaluate and work with medical experts who will be strong advocates for the plaintiff in a Mesothelioma case. Contact one today.
Copyright ©2007 FindLaw, a Thomson Business
DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.
Medical experts are often necessary to help prove a plaintiff's claims in a Mesothelioma case and thus establish his or her right to compensation. Possible experts include the physician who diagnosed the plaintiff's Mesothelioma, those who have treated the disease, and others who can establish the link between asbestos exposure and Mesothelioma. Although the plaintiff's treating physician may have a wonderful bedside manner, he or she may not make the best expert witness. Experienced asbestos-litigation attorneys can secure the services of the best-qualified medical experts who are comfortable with the trial process and can serve as part of the plaintiff's legal team.
The Role of Medical Experts in a Mesothelioma Case
The role that experts play in any lawsuit varies from case to case. Sometimes an expert will serve solely as a consultant to the plaintiff's lawyer and will remain in the background. Other experts may be used only in the pre-trial stages, and yet others may serve as expert witnesses at trial.
Some of the principal functions that medical experts serve in Mesothelioma cases include:
* Evaluate the case. Medical experts are often used by lawyers to evaluate a Mesothelioma case and help determine whether a claim has merit. In other cases, experts are used to evaluate the nature and extent of the damages sustained, such as the loss of earning capacity and income a claimant has experienced, for use in settlement negotiations.
* Identify other expert witnesses. Medical experts are sometimes used to locate and recruit other experts who will testify at trial. If, for instance, the expert who is in the best position to educate the plaintiff's attorney is not a suitable trial witness due to unavailability, lack of impressive credentials, or some other factor, he or she may be in the best position to help find another expert who would make a more credible or impressive witness.
* Provide sworn statements. A medical expert may be called upon to prepare a report of his or her findings to be used in settlement negotiations or in connection with pre-trial court proceedings.
* Provide expert-witness testimony in a deposition or at trial. Medical expert testimony is often presented to provide proof of a critical element in the plaintiff's case, either in a pre-trial deposition as part of the discovery process, or at the trial itself if the case does not settle out of court.
Qualifications of a Medical Expert
There is no specific list of requirements for experts in Mesothelioma cases, but certain considerations are generally applied when selecting a medical expert.
* Presentation. If a medical expert is expected to testify at trial, he or she should be well spoken, easy to understand, and credible to the average person as well as the judge.
* Education and experience. Medical experts from more prestigious medical schools and residency programs may be more persuasive to jurors and less vulnerable to criticism by opposing counsel.
* Specialized expertise. A medical expert in a Mesothelioma case should have specialized knowledge with regard to this disease in order to have the credibility required to win over the judge, arbitrator, or jurors.
* Relevant experience. A Mesothelioma expert should have several years of actual practical experience working with Mesothelioma patients or in Mesothelioma research.
* Publications and teaching. A medical expert's credentials with regard to Mesothelioma are strengthened if he or she has written, taught, or lectured on the subject.
* Appearance of neutrality or objectivity. An expert who testifies for both plaintiffs and defendants in lawsuits can be viewed as a "paid spokesperson" and thus lack credibility.
How Medical Experts' Fees Are Paid
It is important to note that medical experts are not paid for the testimony per se, since so doing would certainly compromise the objectivity and thus the credibility of their testimony. Rather, they are compensated for their time based on hourly rates. Some medical experts charge a minimum fee. Expenses for travel and lodging, if incurred, are also reimbursed. Generally, plaintiffs do not have to come up with these fees until the case settles or the jury renders a verdict (costs are deducted from any recovery).
Although the best experts may charge the highest rates, it is important to keep the charges in line with what is standard. If defense counsel inquires into the payment made to a particular medical expert in the presence of the jury, an exorbitant payment could raise a few eyebrows and compromise the believability of the testimony-in fact, the plaintiff's case itself could be compromised if the jury believes that he or she had to "bribe" someone to testify on their behalf.
Conclusion
An experienced asbestos-litigation attorney is in the best position to evaluate and work with medical experts who will be strong advocates for the plaintiff in a Mesothelioma case. Contact one today.
Copyright ©2007 FindLaw, a Thomson Business
DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.
Malignant Mesothelioma
The Mesothelioma-Net website was created to provide mesothelioma patients, their familes and friends with up-to-date information about mesothelioma. We have consolidated the latest information on mesothelioma, its symptoms, causes, diagnosis, and treatment. We have also gathered vital information on coping with the personal and financial effects of a mesothelioma diagnosis, which can be devastating without the proper preparation.
Malignant mesothelioma is a rare form of cancer. Mesothelioma is the term used to describe a cancerous tumor which involves the mesothelial cells of an organ, usually the lungs, heart or abdominal organs. Pleural mesothelioma or cancer of the lung lining is the most common form of mesothelioma. Peritoneum mesothelioma is cancer of the stomach and is the next most common form.
The onset of mesothelioma is usually very slow, and the most commonly noted symptoms are chest pain and pain in the lower back. Sometimes the pain is accompanied by difficulty breathing, coughing, weight loss and fever.
As the disease progresses rapidly it is very important that one seeks medical treatment as soon as possible. The Treatment Options section lists mesothelioma doctors and hospitals across the country. In our Coping Strategy section we outline what to do and how to obtain financial assistance. Our Articles & News section has a variety of mesothelioma news and medical articles about treatments options and new medications.
Malignant mesothelioma is a rare form of cancer. Mesothelioma is the term used to describe a cancerous tumor which involves the mesothelial cells of an organ, usually the lungs, heart or abdominal organs. Pleural mesothelioma or cancer of the lung lining is the most common form of mesothelioma. Peritoneum mesothelioma is cancer of the stomach and is the next most common form.
The onset of mesothelioma is usually very slow, and the most commonly noted symptoms are chest pain and pain in the lower back. Sometimes the pain is accompanied by difficulty breathing, coughing, weight loss and fever.
As the disease progresses rapidly it is very important that one seeks medical treatment as soon as possible. The Treatment Options section lists mesothelioma doctors and hospitals across the country. In our Coping Strategy section we outline what to do and how to obtain financial assistance. Our Articles & News section has a variety of mesothelioma news and medical articles about treatments options and new medications.
Mesothelioma Research Foundation Teams with Yale Cancer Medical Center
Mesothelioma patients throughout the United States, overwhelmed with decisions that need to be made regarding their health, call the Mesothelioma Research Foundation of America (MESORFA). Some of these cancer patients have already been treated with chemotherapy, surgery, and even radiation and are left feeling as though there is nowhere else to turn; others have been recently diagnosed and are now searching for some hope.
In the past, the MESORFA referred these patients to Dr. Parkash Gill at USC Norris Comprehensive Cancer Center. However, patients who are on the east coast are unable to make the trek across the U.S. to see Dr. Parkash Gill. In an endeavor to meet the needs of the patients we are now working with a team of doctors on the East Coast at the Yale Cancer Medical Center. Dr. Scott Gettinger, a medical oncologist in the Thoracic Oncology Program (TOP) at Yale is working on a Phase 1 clinical trial of an orally administered histone deacetylase inhibitor called PXD101 that the Curagen pharmaceutical company is sponsoring. Prior studies with a similar agent have reported responses in patients with metastatic mesothelioma.
Acceptance for this clinical trial depends upon the patient?s condition and health history. Although not the same for every patient the most common side effects of PXD101 include being tired and/or fatigued, along with low-grade nausea, which can be treated with medications. These side effects have proven to be minimal and less severe than the effects of chemotherapy or radiation. This trial is appealing in cases where all other standard line therapies have failed and no other treatment options are available.
The Mesothelioma Research Foundation of America looks forward to working closely with the Yale Cancer Center along with other hospitals throughout the United States in treating patients with mesothelioma and finding a cure for this horrible disease.
In the past, the MESORFA referred these patients to Dr. Parkash Gill at USC Norris Comprehensive Cancer Center. However, patients who are on the east coast are unable to make the trek across the U.S. to see Dr. Parkash Gill. In an endeavor to meet the needs of the patients we are now working with a team of doctors on the East Coast at the Yale Cancer Medical Center. Dr. Scott Gettinger, a medical oncologist in the Thoracic Oncology Program (TOP) at Yale is working on a Phase 1 clinical trial of an orally administered histone deacetylase inhibitor called PXD101 that the Curagen pharmaceutical company is sponsoring. Prior studies with a similar agent have reported responses in patients with metastatic mesothelioma.
Acceptance for this clinical trial depends upon the patient?s condition and health history. Although not the same for every patient the most common side effects of PXD101 include being tired and/or fatigued, along with low-grade nausea, which can be treated with medications. These side effects have proven to be minimal and less severe than the effects of chemotherapy or radiation. This trial is appealing in cases where all other standard line therapies have failed and no other treatment options are available.
The Mesothelioma Research Foundation of America looks forward to working closely with the Yale Cancer Center along with other hospitals throughout the United States in treating patients with mesothelioma and finding a cure for this horrible disease.
What Caused Mesothelioma - Asbestos Exposure
Where was I Exposed to Asbestos?
The primary factor for mesothelioma risk is asbestos exposure. The use of this material has been banned in the United States since around 1975, but there are about 8 million Americans that may already have been exposed through various jobs, such as miners, ship builders, factory workers, railroad workers, mechanics and construction workers (particularly those responsible for installing brakes in automobiles and insulation in buildings). Many men and women who served in the Navy have been exposed to significant amounts of asbestos on their ships.
The material asbestos is not only found on the job or in the workplace. It may also be found in 10-15% of public schools (about 110,000) throughout America. Asbestos fibers and dust have also been known to be picked up through clothing or other articles. After exposure to the airborne fibers or dust, the risk of lung cancer is 7 times greater than that of the general population (smokers who are exposed to asbestos have a risk that is 50-90 times greater still).
And not all of the workers that have been exposed to asbestos will develop diseases related to their exposure. In fact, many workers will experience no ill effects or symptoms.
The asbestos that is bonded into many finished products such as walls, tiles, and pipes poses no risk to our health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When the asbestos particles are set free and inhaled, however, exposed individuals are at risk of developing one or many of the asbestos-related diseases. Once these fibers work their way into body tissues, they may stay there indefinitely.
The health risk of developing asbestos-related diseases varies with the type of industry in which the asbestos exposure occurred and with the extent of the worker's asbestos exposure. In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that workplace exposure to amphibole forms of asbestos are more likely than exposure to chrysotile asbestos form to cause lung cancer, asbestosis, and, in particular, mesothelioma. Even so, no asbestos fiber type can be considered harmless, and proper safety precautions should always be taken by people that work under threat of asbestos exposure.
The primary factor for mesothelioma risk is asbestos exposure. The use of this material has been banned in the United States since around 1975, but there are about 8 million Americans that may already have been exposed through various jobs, such as miners, ship builders, factory workers, railroad workers, mechanics and construction workers (particularly those responsible for installing brakes in automobiles and insulation in buildings). Many men and women who served in the Navy have been exposed to significant amounts of asbestos on their ships.
The material asbestos is not only found on the job or in the workplace. It may also be found in 10-15% of public schools (about 110,000) throughout America. Asbestos fibers and dust have also been known to be picked up through clothing or other articles. After exposure to the airborne fibers or dust, the risk of lung cancer is 7 times greater than that of the general population (smokers who are exposed to asbestos have a risk that is 50-90 times greater still).
And not all of the workers that have been exposed to asbestos will develop diseases related to their exposure. In fact, many workers will experience no ill effects or symptoms.
The asbestos that is bonded into many finished products such as walls, tiles, and pipes poses no risk to our health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When the asbestos particles are set free and inhaled, however, exposed individuals are at risk of developing one or many of the asbestos-related diseases. Once these fibers work their way into body tissues, they may stay there indefinitely.
The health risk of developing asbestos-related diseases varies with the type of industry in which the asbestos exposure occurred and with the extent of the worker's asbestos exposure. In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that workplace exposure to amphibole forms of asbestos are more likely than exposure to chrysotile asbestos form to cause lung cancer, asbestosis, and, in particular, mesothelioma. Even so, no asbestos fiber type can be considered harmless, and proper safety precautions should always be taken by people that work under threat of asbestos exposure.
Thursday, July 10, 2008
Affect Our Health - Asbestos
Asbestos mainly affects the lungs and the membrane that surrounds the lungs. Breathing high levels of asbestos fibers for a long time may result in scar-like tissue in the lungs and in the pleural membrane (lining) that surrounds the lung. This disease is called asbestosis and is usually found in workers exposed to asbestos, but not in the general public. People with asbestosis have difficulty breathing, often a cough, and in severe cases heart enlargement. Asbestosis is a serious disease and can eventually lead to disability and death.
Breathing lower levels of asbestos may result in changes called plaques in the pleural membranes. Pleural plaques can occur in workers and sometimes in people living in areas with high environmental levels of asbestos. Effects on breathing from pleural plaques alone are not usually serious, but higher exposure can lead to a thickening of the pleural membrane that may restrict breathing.
Breathing lower levels of asbestos may result in changes called plaques in the pleural membranes. Pleural plaques can occur in workers and sometimes in people living in areas with high environmental levels of asbestos. Effects on breathing from pleural plaques alone are not usually serious, but higher exposure can lead to a thickening of the pleural membrane that may restrict breathing.
Asbestos At Your Home
What Is Asbestos?
Asbestos is a mineral fiber. It can be positively identified only with a special type of microscope. There are several types of asbestos fibers. In the past, asbestos was added to a variety of products to strengthen them and to provide heat insulation and fire resistance.
How Can Asbestos Affect My Health?
From studies of people who were exposed to asbestos in factories and shipyards, we know that breathing high levels of asbestos fibers can lead to an increased risk of:
*
lung cancer:
-- mesothelioma, a cancer of the lining of the chest and the abdominal cavity
-- asbestosis, in which the lungs become scarred with fibrous tissue.
The risk of lung cancer and mesothelioma increases with the number of fibers inhaled. The risk of lung cancer from inhaling asbestos fibers is also greater if you smoke. People who get asbestosis have usually been exposed to high levels of asbestos for a long time. The symptoms of these diseases do not usually appear until about 20 to 30 years after the first exposure to asbestos.
Most people exposed to small amounts of asbestos, as we all are in our daily lives, do not develop these health problems. However, if disturbed, asbestos material may release asbestos fibers, which can be inhaled into the lungs. The fibers can remain there for a long time, increasing the risk of disease. Asbestos material that would crumble easily if handled, or that has been sawed, scraped, or sanded into a powder, is more likely to create a health hazard.
Where Can I Find Asbestos And When Can It Be A Problem?
Most products made today do not contain asbestos. Those few products made which still contain asbestos that could be inhaled are required to be labeled as such. However, until the 1970s, many types of building products and insulation materials used in homes contained asbestos. Common products that might have contained asbestos in the past, and conditions which may release fibers, include:
*
Steam pipes, boilers and furnace ducts insulated with an asbestos blanket or asbestos paper tape. These materials may release asbestos fibers if damaged, repaired, or removed improperly.
*
Resilient floor tiles (vinyl asbestos, asphalt, and rubber), the backing on vinyl sheet flooring, and adhesives used for installing floor tile. Sanding tiles can release fibers. So may scraping or sanding the backing of sheet flooring during removal.
*
Cement sheet, millboard, and paper used as insulation around furnaces and woodburning stoves. Repairing or removing appliances may release asbestos fibers. So may cutting, tearing, sanding, drilling, or sawing insulation.
*
Door gaskets in furnaces, wood stoves, and coal stoves. Worn seals can release asbestos fibers during use.
*
Soundproofing or decorative material sprayed on walls and ceilings. Loose, crumbly, or water-damaged material may release fibers. So will sanding, drilling, or scraping the material.
*
Patching and joint compounds for walls and ceilings, and textured paints. Sanding, scraping, or drilling these surfaces may release asbestos.
*
Asbestos cement roofing, shingles, and siding. These products are not likely to release asbestos fibers unless sawed, dilled, or cut.
*
Artificial ashes and embers sold for use in gas-fired fireplaces. Also, other older household products such as fireproof gloves, stove-top pads, ironing board covers, and certain hairdryers.
*
Automobile brake pads and linings, clutch facing, and gaskets.
Where Asbestos Hazards May Be Found In The Home
* Some roofing and siding shingles are made of asbestos cement.
* Houses built between 1930 and 1950 may have asbestos as insulation.
* Asbestos may be present in textured paint and in patching compounds used on wall and ceiling joints. Their use was banned in 1977.
* Artificial ashes and embers sold for use in gas-fired fireplaces may contain asbestos.
* Older products such as stove-top pads may have some asbestos compounds.
* Walls and floors around woodburning stoves may be protected with asbestos paper, millboard, or cement sheets.
* Asbestos is found in some vinyl floor tiles and the backing on vinyl sheet flooring and adhesives.
* Hot water and steam pipes in older houses may be coated with an asbestos material or covered with an asbestos blanket or tape.
* Oil and coal furnaces and door gaskets may have asbestos insulation.
What Should Be Done About Asbestos In The Home?
If you think asbestos may be in your home, don't panic, usually the best thing is to leave asbestos material that is in good condition alone. Generally, material in good condition will not release asbestos fibers. There is no danger unless fibers are released and inhaled into the lungs. Check material regularly if you suspect it may contain asbestos. Don't touch it, but look for signs of wear or damage such as tears, abrasions, or water damage. Damaged material may release asbestos fibers. This is particularly true if you often disturb it by hitting, rubbing, or handling it, or if it is exposed to extreme vibration or air flow. Sometimes, the best way to deal with slightly damaged material is to limit access to the area and not touch or disturb it. Discard damaged or worn asbestos gloves, stove-top pads, or ironing board covers. Check with local health, environmental, or other appropriate officials to find out proper handling and disposal procedures. If asbestos material is more than slightly damaged, or if you are going to make changes in your home that might disturb it, repair or removal by a professional is needed. Before you have your house remodeled, find out whether asbestos materials are present.
How To Identify Materials That Contain Asbestos
You can't tell whether a material contains asbestos simply by looking at it, unless it is labeled. If in doubt, treat the material as if it contains asbestos or have it sampled and analyzed by a qualified professional. A professional should take samples for analysis, since a professional knows what to look for, and because there may be an increased health risk if fibers are released. In fact, if done incorrectly, sampling can be more hazardous than leaving the material alone. Taking samples yourself is not recommended. If you nevertheless choose to take the samples yourself, take care not to release asbestos fibers into the air or onto yourself. Material that is in good condition and will not be disturbed (by remodeling, for example) should be left alone. Only material that is damaged or will be disturbed should be sampled. Anyone who samples asbestos-containing materials should have as much information as possible on the handling of asbestos before sampling, and at a minimum, should observe the following procedures:
*
Make sure no one else is in the room when sampling is done.
*
Wear disposable gloves or wash hands after sampling.
*
Shut down any heating or cooling systems to minimize the spread of any released fibers.
*
Do not disturb the material any more than is needed to take a small sample.
*
Place a plastic sheet on the floor below the area to be sampled.
*
Wet the material using a fine mist of water containing a few drops of detergent before taking the sample. The water/detergent mist will reduce the release of asbestos fibers.
*
Carefully cut a piece from the entire depth of the material using, for example, a small knife, corer, or other sharp object. Place the small piece into a clean container (for example, a 35 mm film canister, small glass or plastic vial, or high quality resealable plastic bag).
*
Tightly seal the container after the sample is in it.
*
Carefully dispose of the plastic sheet. Use a damp paper towel to clean up any material on the outside of the container or around the area sampled. Dispose of asbestos materials according to state and local procedures.
*
Label the container with an identification number and clearly state when and where the sample was taken.
*
Patch the sampled area with the smallest possible piece of duct tape to prevent fiber release.
*
Send the sample to an asbestos analysis laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) at the National Institute of Standards and Technology (NIST). Your state or local health department may also be able to help.
How To Manage An Asbestos Problem
If the asbestos material is in good shape and will not be disturbed, do nothing! If it is a problem, there are two types of corrections: repair and removal. Repair usually involves either sealing or covering asbestos material. Sealing (encapsulation) involves treating the material with a sealant that either binds the asbestos fibers together or coats the material so fibers are not released. Pipe, furnace, and boiler insulation can sometimes be repaired this way. This should be done only by a professional trained to handle asbestos safely. Covering (enclosure) involves placing something over or around the material that contains asbestos to prevent release of fibers. Exposed insulated piping may be covered with a protective wrap or jacket. With any type of repair the asbestos remains in place. Repair is usually cheaper than removal, but it may make later removal of asbestos, if necessary, more difficult and costly. Repairs can either be major or minor. Major repairs must be done only by a professional trained in methods for safely handling asbestos. Minor repairs should also be done by professionals since there is always a risk of exposure to fibers when asbestos is disturbed.
Repairs
Doing minor repairs yourself is not recommended since improper handling of asbestos materials can create a hazard where none existed. If you nevertheless choose to do minor repairs, you should have as much information as possible on the handling of asbestos before doing anything. Contact your state or local health department or regional EPA office for information about asbestos training programs in your area. Your local school district may also have information about asbestos professionals and training programs for school buildings. Even if you have completed a training program, do not try anything more than minor repairs. Before undertaking minor repairs, carefully examine the area around the damage to make sure it is stable. As a general matter, any damaged area which is bigger than the size of your hand is not a minor repair.
Before undertaking minor repairs, be sure to follow all the precautions described earlier for sampling asbestos material. Always wet the asbestos material using a fine mist of water containing a few drops of detergent. Commercial products designed to fill holes and seal damaged areas are available. Small areas of material such as pipe insulation can be covered by wrapping a special fabric, such as rewettable glass cloth, around it. These products are available from stores (listed in the telephone directory under Safety Equipment and Clothing") which specialize in asbestos materials and safety items.
Removal is usually the most expensive method and, unless required by state or local regulations, should be the last option considered in most situations. This is because removal poses the greatest risk of fiber release. However, removal may be required when remodeling or making major changes to your home that will disturb asbestos material. Also, removal may be called for if asbestos material is damaged extensively and cannot be otherwise repaired. Removal is complex and must be done only by a contractor with special training. Improper removal may actually increase the health risks to you and your family.
Asbestos Professionals: Who Are They And What Can They Do?
Asbestos professionals are trained in handling asbestos material. The type of professional will depend on the type of product and what needs to be done to correct the problem. You may hire a general asbestos contractor or, in some cases, a professional trained to handle specific products containing asbestos.
Asbestos professionals can conduct home inspections, take samples of suspected material, assess its condition, and advise about what corrections are needed and who is qualified to make these corrections. Once again, material in good condition need not be sampled unless it is likely to be disturbed. Professional correction or abatement contractors repair or remove asbestos materials.
Some firms offer combinations of testing, assessment, and correction. A professional hired to assess the need for corrective action should not be connected with an asbestos-correction firm. It is better to use two different firms so there is no conflict of interest. Services vary from one area to another around the country.
The federal government has training courses for asbestos professionals around the country. Some state and local governments also have or require training or certification courses. Ask asbestos professionals to document their completion of federal or state-approved training. Each person performing work in your home should provide proof of training and licensing in asbestos work, such as completion of EPA-approved training. State and local health departments or EPA regional offices may have listings of licensed professionals in your area.
If you have a problem that requires the services of asbestos professionals, check their credentials carefully. Hire professionals who are trained, experienced, reputable, and accredited - especially if accreditation is required by state or local laws. Before hiring a professional, ask for references from previous clients. Find out if they were satisfied. Ask whether the professional has handled similar situations. Get cost estimates from several professionals, as the charges for these services can vary.
Though private homes are usually not covered by the asbestos regulations that apply to schools and public buildings, professionals should still use procedures described during federal or state-approved training. Homeowners should be alert to the chance of misleading claims by asbestos consultants and contractors. There have been reports of firms incorrectly claiming that asbestos materials in homes must be replaced. In other cases, firms have encouraged unnecessary removals or performed them improperly. Unnecessary removals are a waste of money. Improper removals may actually increase the health risks to you and your family. To guard against this, know what services are available and what procedures and precautions are needed to do the job properly.
In addition to general asbestos contractors, you may select a roofing, flooring, or plumbing contractor trained to handle asbestos when it is necessary to remove and replace roofing, flooring, siding, or asbestos-cement pipe that is part of a water system. Normally, roofing and flooring contractors are exempt from state and local licensing requirements because they do not perform any other asbestos-correction work. Call 1-800-USA-ROOF for names of qualified roofing contractors in your area. (Illinois residents call 708-318-6722.) For information on asbestos in floors, read "Recommended Work Procedures for Resilient Floor Covers." You can write for a copy from the Resilient Floor Covering Institute, 966 Hungerford Drive, Suite 12-B, Rockville, MD 20850. Enclose a stamped, business-size, self-addressed envelope.
Asbestos-containing automobile brake pads and linings, clutch facings, and gaskets should be repaired and replaced only by a professional using special protective equipment. Many of these products are now available without asbestos. For more information, read "Guidance for Preventing Asbestos Disease Among Auto Mechanics," available from regional EPA offices.
If You Hire A Professional Asbestos Inspector
*
Make sure that the inspection will include a complete visual examination and the careful collection and lab analysis of samples. If asbestos is present, the inspector should provide a written evaluation describing its location and extent of damage, and give recommendations for correction or prevention.
*
Make sure an inspecting firm makes frequent site visits if it is hired to assure that a contractor follows proper procedures and requirements. The inspector may recommend and perform checks after the correction to assure the area has been properly cleaned.
If You Hire A Corrective-Action Contractor
*
Check with your local air pollution control board, the local agency responsible for worker safety, and the Better Business Bureau. Ask if the firm has had any safety violations. Find out if there are legal actions filed against it.
*
Insist that the contractor use the proper equipment to do the job. The workers must wear approved respirators, gloves, and other protective clothing.
*
Before work begins, get a written contract specifying the work plan, cleanup, and the applicable federal, state, and local regulations which the contractor must follow (such as notification requirements and asbestos disposal procedures). Contact your state and local health departments, EPA's regional office, and the Occupational Safety and Health Administration's regional office to find out what the regulations are. Be sure the contractor follows local asbestos removal and disposal laws. At the end of the job, get written assurance from the contractor that all procedures have been followed.
*
Assure that the contractor avoids spreading or tracking asbestos dust into other areas of your home. They should seal the work area from the rest of the house using plastic sheeting and duct tape, and also turn off the heating and air conditioning system. For some repairs, such as pipe insulation removal, plastic glove bags may be adequate. They must be sealed with tape and properly disposed of when the job is complete.
*
Make sure the work site is clearly marked as a hazard area. Do not allow household members and pets into the area until work is completed.
*
Insist that the contractor apply a wetting agent to the asbestos material with a hand sprayer that creates a fine mist before removal. Wet fibers do not float in the air as easily as dry fibers and will be easier to clean up.
*
Make sure the contractor does not break removed material into small pieces. This could release asbestos fibers into the air. Pipe insulation was usually installed in preformed blocks and should be removed in complete pieces.
*
Upon completion, assure that the contractor cleans the area well with wet mops, wet rags, sponges, or HEPA (high efficiency particulate air) vacuum cleaners. A regular vacuum cleaner must never be used. Wetting helps reduce the chance of spreading asbestos fibers in the air. All asbestos materials and disposable equipment and clothing used in the job must be placed in sealed, leakproof, and labeled plastic bags. The work site should be visually free of dust and debris. Air monitoring (to make sure there is no increase of asbestos fibers in the air) may be necessary to assure that the contractor's job is done properly. This should be done by someone not connected with the contractor.
Caution!
Do not dust, sweep, or vacuum debris that may contain asbestos. These steps will disturb tiny asbestos fibers and may release them into the air. Remove dust by wet mopping or with a special HEPA vacuum cleaner used by trained asbestos contractors.
Asbestos is a mineral fiber. It can be positively identified only with a special type of microscope. There are several types of asbestos fibers. In the past, asbestos was added to a variety of products to strengthen them and to provide heat insulation and fire resistance.
How Can Asbestos Affect My Health?
From studies of people who were exposed to asbestos in factories and shipyards, we know that breathing high levels of asbestos fibers can lead to an increased risk of:
*
lung cancer:
-- mesothelioma, a cancer of the lining of the chest and the abdominal cavity
-- asbestosis, in which the lungs become scarred with fibrous tissue.
The risk of lung cancer and mesothelioma increases with the number of fibers inhaled. The risk of lung cancer from inhaling asbestos fibers is also greater if you smoke. People who get asbestosis have usually been exposed to high levels of asbestos for a long time. The symptoms of these diseases do not usually appear until about 20 to 30 years after the first exposure to asbestos.
Most people exposed to small amounts of asbestos, as we all are in our daily lives, do not develop these health problems. However, if disturbed, asbestos material may release asbestos fibers, which can be inhaled into the lungs. The fibers can remain there for a long time, increasing the risk of disease. Asbestos material that would crumble easily if handled, or that has been sawed, scraped, or sanded into a powder, is more likely to create a health hazard.
Where Can I Find Asbestos And When Can It Be A Problem?
Most products made today do not contain asbestos. Those few products made which still contain asbestos that could be inhaled are required to be labeled as such. However, until the 1970s, many types of building products and insulation materials used in homes contained asbestos. Common products that might have contained asbestos in the past, and conditions which may release fibers, include:
*
Steam pipes, boilers and furnace ducts insulated with an asbestos blanket or asbestos paper tape. These materials may release asbestos fibers if damaged, repaired, or removed improperly.
*
Resilient floor tiles (vinyl asbestos, asphalt, and rubber), the backing on vinyl sheet flooring, and adhesives used for installing floor tile. Sanding tiles can release fibers. So may scraping or sanding the backing of sheet flooring during removal.
*
Cement sheet, millboard, and paper used as insulation around furnaces and woodburning stoves. Repairing or removing appliances may release asbestos fibers. So may cutting, tearing, sanding, drilling, or sawing insulation.
*
Door gaskets in furnaces, wood stoves, and coal stoves. Worn seals can release asbestos fibers during use.
*
Soundproofing or decorative material sprayed on walls and ceilings. Loose, crumbly, or water-damaged material may release fibers. So will sanding, drilling, or scraping the material.
*
Patching and joint compounds for walls and ceilings, and textured paints. Sanding, scraping, or drilling these surfaces may release asbestos.
*
Asbestos cement roofing, shingles, and siding. These products are not likely to release asbestos fibers unless sawed, dilled, or cut.
*
Artificial ashes and embers sold for use in gas-fired fireplaces. Also, other older household products such as fireproof gloves, stove-top pads, ironing board covers, and certain hairdryers.
*
Automobile brake pads and linings, clutch facing, and gaskets.
Where Asbestos Hazards May Be Found In The Home
* Some roofing and siding shingles are made of asbestos cement.
* Houses built between 1930 and 1950 may have asbestos as insulation.
* Asbestos may be present in textured paint and in patching compounds used on wall and ceiling joints. Their use was banned in 1977.
* Artificial ashes and embers sold for use in gas-fired fireplaces may contain asbestos.
* Older products such as stove-top pads may have some asbestos compounds.
* Walls and floors around woodburning stoves may be protected with asbestos paper, millboard, or cement sheets.
* Asbestos is found in some vinyl floor tiles and the backing on vinyl sheet flooring and adhesives.
* Hot water and steam pipes in older houses may be coated with an asbestos material or covered with an asbestos blanket or tape.
* Oil and coal furnaces and door gaskets may have asbestos insulation.
What Should Be Done About Asbestos In The Home?
If you think asbestos may be in your home, don't panic, usually the best thing is to leave asbestos material that is in good condition alone. Generally, material in good condition will not release asbestos fibers. There is no danger unless fibers are released and inhaled into the lungs. Check material regularly if you suspect it may contain asbestos. Don't touch it, but look for signs of wear or damage such as tears, abrasions, or water damage. Damaged material may release asbestos fibers. This is particularly true if you often disturb it by hitting, rubbing, or handling it, or if it is exposed to extreme vibration or air flow. Sometimes, the best way to deal with slightly damaged material is to limit access to the area and not touch or disturb it. Discard damaged or worn asbestos gloves, stove-top pads, or ironing board covers. Check with local health, environmental, or other appropriate officials to find out proper handling and disposal procedures. If asbestos material is more than slightly damaged, or if you are going to make changes in your home that might disturb it, repair or removal by a professional is needed. Before you have your house remodeled, find out whether asbestos materials are present.
How To Identify Materials That Contain Asbestos
You can't tell whether a material contains asbestos simply by looking at it, unless it is labeled. If in doubt, treat the material as if it contains asbestos or have it sampled and analyzed by a qualified professional. A professional should take samples for analysis, since a professional knows what to look for, and because there may be an increased health risk if fibers are released. In fact, if done incorrectly, sampling can be more hazardous than leaving the material alone. Taking samples yourself is not recommended. If you nevertheless choose to take the samples yourself, take care not to release asbestos fibers into the air or onto yourself. Material that is in good condition and will not be disturbed (by remodeling, for example) should be left alone. Only material that is damaged or will be disturbed should be sampled. Anyone who samples asbestos-containing materials should have as much information as possible on the handling of asbestos before sampling, and at a minimum, should observe the following procedures:
*
Make sure no one else is in the room when sampling is done.
*
Wear disposable gloves or wash hands after sampling.
*
Shut down any heating or cooling systems to minimize the spread of any released fibers.
*
Do not disturb the material any more than is needed to take a small sample.
*
Place a plastic sheet on the floor below the area to be sampled.
*
Wet the material using a fine mist of water containing a few drops of detergent before taking the sample. The water/detergent mist will reduce the release of asbestos fibers.
*
Carefully cut a piece from the entire depth of the material using, for example, a small knife, corer, or other sharp object. Place the small piece into a clean container (for example, a 35 mm film canister, small glass or plastic vial, or high quality resealable plastic bag).
*
Tightly seal the container after the sample is in it.
*
Carefully dispose of the plastic sheet. Use a damp paper towel to clean up any material on the outside of the container or around the area sampled. Dispose of asbestos materials according to state and local procedures.
*
Label the container with an identification number and clearly state when and where the sample was taken.
*
Patch the sampled area with the smallest possible piece of duct tape to prevent fiber release.
*
Send the sample to an asbestos analysis laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) at the National Institute of Standards and Technology (NIST). Your state or local health department may also be able to help.
How To Manage An Asbestos Problem
If the asbestos material is in good shape and will not be disturbed, do nothing! If it is a problem, there are two types of corrections: repair and removal. Repair usually involves either sealing or covering asbestos material. Sealing (encapsulation) involves treating the material with a sealant that either binds the asbestos fibers together or coats the material so fibers are not released. Pipe, furnace, and boiler insulation can sometimes be repaired this way. This should be done only by a professional trained to handle asbestos safely. Covering (enclosure) involves placing something over or around the material that contains asbestos to prevent release of fibers. Exposed insulated piping may be covered with a protective wrap or jacket. With any type of repair the asbestos remains in place. Repair is usually cheaper than removal, but it may make later removal of asbestos, if necessary, more difficult and costly. Repairs can either be major or minor. Major repairs must be done only by a professional trained in methods for safely handling asbestos. Minor repairs should also be done by professionals since there is always a risk of exposure to fibers when asbestos is disturbed.
Repairs
Doing minor repairs yourself is not recommended since improper handling of asbestos materials can create a hazard where none existed. If you nevertheless choose to do minor repairs, you should have as much information as possible on the handling of asbestos before doing anything. Contact your state or local health department or regional EPA office for information about asbestos training programs in your area. Your local school district may also have information about asbestos professionals and training programs for school buildings. Even if you have completed a training program, do not try anything more than minor repairs. Before undertaking minor repairs, carefully examine the area around the damage to make sure it is stable. As a general matter, any damaged area which is bigger than the size of your hand is not a minor repair.
Before undertaking minor repairs, be sure to follow all the precautions described earlier for sampling asbestos material. Always wet the asbestos material using a fine mist of water containing a few drops of detergent. Commercial products designed to fill holes and seal damaged areas are available. Small areas of material such as pipe insulation can be covered by wrapping a special fabric, such as rewettable glass cloth, around it. These products are available from stores (listed in the telephone directory under Safety Equipment and Clothing") which specialize in asbestos materials and safety items.
Removal is usually the most expensive method and, unless required by state or local regulations, should be the last option considered in most situations. This is because removal poses the greatest risk of fiber release. However, removal may be required when remodeling or making major changes to your home that will disturb asbestos material. Also, removal may be called for if asbestos material is damaged extensively and cannot be otherwise repaired. Removal is complex and must be done only by a contractor with special training. Improper removal may actually increase the health risks to you and your family.
Asbestos Professionals: Who Are They And What Can They Do?
Asbestos professionals are trained in handling asbestos material. The type of professional will depend on the type of product and what needs to be done to correct the problem. You may hire a general asbestos contractor or, in some cases, a professional trained to handle specific products containing asbestos.
Asbestos professionals can conduct home inspections, take samples of suspected material, assess its condition, and advise about what corrections are needed and who is qualified to make these corrections. Once again, material in good condition need not be sampled unless it is likely to be disturbed. Professional correction or abatement contractors repair or remove asbestos materials.
Some firms offer combinations of testing, assessment, and correction. A professional hired to assess the need for corrective action should not be connected with an asbestos-correction firm. It is better to use two different firms so there is no conflict of interest. Services vary from one area to another around the country.
The federal government has training courses for asbestos professionals around the country. Some state and local governments also have or require training or certification courses. Ask asbestos professionals to document their completion of federal or state-approved training. Each person performing work in your home should provide proof of training and licensing in asbestos work, such as completion of EPA-approved training. State and local health departments or EPA regional offices may have listings of licensed professionals in your area.
If you have a problem that requires the services of asbestos professionals, check their credentials carefully. Hire professionals who are trained, experienced, reputable, and accredited - especially if accreditation is required by state or local laws. Before hiring a professional, ask for references from previous clients. Find out if they were satisfied. Ask whether the professional has handled similar situations. Get cost estimates from several professionals, as the charges for these services can vary.
Though private homes are usually not covered by the asbestos regulations that apply to schools and public buildings, professionals should still use procedures described during federal or state-approved training. Homeowners should be alert to the chance of misleading claims by asbestos consultants and contractors. There have been reports of firms incorrectly claiming that asbestos materials in homes must be replaced. In other cases, firms have encouraged unnecessary removals or performed them improperly. Unnecessary removals are a waste of money. Improper removals may actually increase the health risks to you and your family. To guard against this, know what services are available and what procedures and precautions are needed to do the job properly.
In addition to general asbestos contractors, you may select a roofing, flooring, or plumbing contractor trained to handle asbestos when it is necessary to remove and replace roofing, flooring, siding, or asbestos-cement pipe that is part of a water system. Normally, roofing and flooring contractors are exempt from state and local licensing requirements because they do not perform any other asbestos-correction work. Call 1-800-USA-ROOF for names of qualified roofing contractors in your area. (Illinois residents call 708-318-6722.) For information on asbestos in floors, read "Recommended Work Procedures for Resilient Floor Covers." You can write for a copy from the Resilient Floor Covering Institute, 966 Hungerford Drive, Suite 12-B, Rockville, MD 20850. Enclose a stamped, business-size, self-addressed envelope.
Asbestos-containing automobile brake pads and linings, clutch facings, and gaskets should be repaired and replaced only by a professional using special protective equipment. Many of these products are now available without asbestos. For more information, read "Guidance for Preventing Asbestos Disease Among Auto Mechanics," available from regional EPA offices.
If You Hire A Professional Asbestos Inspector
*
Make sure that the inspection will include a complete visual examination and the careful collection and lab analysis of samples. If asbestos is present, the inspector should provide a written evaluation describing its location and extent of damage, and give recommendations for correction or prevention.
*
Make sure an inspecting firm makes frequent site visits if it is hired to assure that a contractor follows proper procedures and requirements. The inspector may recommend and perform checks after the correction to assure the area has been properly cleaned.
If You Hire A Corrective-Action Contractor
*
Check with your local air pollution control board, the local agency responsible for worker safety, and the Better Business Bureau. Ask if the firm has had any safety violations. Find out if there are legal actions filed against it.
*
Insist that the contractor use the proper equipment to do the job. The workers must wear approved respirators, gloves, and other protective clothing.
*
Before work begins, get a written contract specifying the work plan, cleanup, and the applicable federal, state, and local regulations which the contractor must follow (such as notification requirements and asbestos disposal procedures). Contact your state and local health departments, EPA's regional office, and the Occupational Safety and Health Administration's regional office to find out what the regulations are. Be sure the contractor follows local asbestos removal and disposal laws. At the end of the job, get written assurance from the contractor that all procedures have been followed.
*
Assure that the contractor avoids spreading or tracking asbestos dust into other areas of your home. They should seal the work area from the rest of the house using plastic sheeting and duct tape, and also turn off the heating and air conditioning system. For some repairs, such as pipe insulation removal, plastic glove bags may be adequate. They must be sealed with tape and properly disposed of when the job is complete.
*
Make sure the work site is clearly marked as a hazard area. Do not allow household members and pets into the area until work is completed.
*
Insist that the contractor apply a wetting agent to the asbestos material with a hand sprayer that creates a fine mist before removal. Wet fibers do not float in the air as easily as dry fibers and will be easier to clean up.
*
Make sure the contractor does not break removed material into small pieces. This could release asbestos fibers into the air. Pipe insulation was usually installed in preformed blocks and should be removed in complete pieces.
*
Upon completion, assure that the contractor cleans the area well with wet mops, wet rags, sponges, or HEPA (high efficiency particulate air) vacuum cleaners. A regular vacuum cleaner must never be used. Wetting helps reduce the chance of spreading asbestos fibers in the air. All asbestos materials and disposable equipment and clothing used in the job must be placed in sealed, leakproof, and labeled plastic bags. The work site should be visually free of dust and debris. Air monitoring (to make sure there is no increase of asbestos fibers in the air) may be necessary to assure that the contractor's job is done properly. This should be done by someone not connected with the contractor.
Caution!
Do not dust, sweep, or vacuum debris that may contain asbestos. These steps will disturb tiny asbestos fibers and may release them into the air. Remove dust by wet mopping or with a special HEPA vacuum cleaner used by trained asbestos contractors.
Asbestos Fibres
A common public perception about asbestos-containing buildings is that occupants will be subject to respiratory ailments; i.e., emphysema, lung cancer, etc. The belief that the threat is possible affects perception of risk even if the risk is minimal because the fibers are not exposed. Public fear of asbestos in the United States has had an impact on the amount of nationwide regulations associated with it. This fact sheet will examine the public's fear of asbestos and present current scientific evidence about this material.
The negative reputation of asbestos comes from the high death rate among asbestos workers exposed, without protective attire, to extremely high levels of asbestos dust. Because asbestos is only a generic name for fibrous aggregates of minerals, specific types need to be identified to understand their variations. Within the scientific community, views have polarized on the potential health hazards of asbestos due to the structure of the specific fibers and the time of exposure to given amounts. Some asbestos researchers, known as revisionists, insist that different types of asbestos should be regulated differently. Opposing arguments state that all fiber types should be strictly regulated. Two common asbestos types are amphiboles (or brown and blue) and chrysolites (also known as white). In the U.S., about 95% of asbestos used are of the white variety.
Fiber Size
Studies of the fiber sizes of asbestos have shown that lengths above eight micrometers and widths less than 0.25 micrometers were linked with respiratory ailments. Fibers in these target ranges are the ones most easily inhaled through the respiratory tract into the lungs. Once in the lungs, a fiber must be durable with respect to the lung fluids to stay intact and cause damage. One study found that the average lifetime or biodurability of a chrysotile fiber one micrometer in diameter is approximately nine months due to the dissolution rate. This result is compared to a silica fiber of the same size that can take up to 438 years to dissolve. Amphibole asbestos fibers have width measurements from 0.073 to 0.243 micrometers yet biodurability tests have not been conducted on amphiboles. The rate of lung cancer in asbestos miners further explains why miners and millers working with this fiber type have elevated incidents.
Testing concentrations of airborne asbestos fibers in buildings is a means of determining exposure levels. The unit of measure is fibers per centimeter cubed over an 8 hour time weight average. The federal standard is 0.1 fibers per cubic cm.. To illustrate, a 12-story office building in Minnesota was sampled to ensure compliance with the maximum standard. Nine test sites with obvious damage to asbestos-containing surface material were chosen throughout the building. Variables included areas with or without suspended ceilings and areas with or without current construction. Other test sites were near the air intake on the roof and in the garage. Of the asbestos levels detectable, the highest was 0.008 fibers per cubic cm.. This level was detected in an area without a suspended ceiling undergoing current construction. This study was consistent with similar sampling methods; one conclusion that some researchers make is general building occupants are not at significant risk for concentrated asbestos exposure. Workers involved with renovation, however, are at an increased risk and are mandated to observe extra safety precautions.
Hazards of Asbestos
The clarity of true hazard of asbestos is not known -- there are many aspects of asbestos removal vs. maintenance, such as economics, that make the issue more confusing. An anonymous survey was conducted to get reactions from those with an economic interest in asbestos abatement. The survey focused on the issue of asbestos abatement being a health and safety concern or a means of economic advancement. Six groups of twelve people each received the survey, including politicians, industrial hygienists, building managers, contractors, suppliers and lawyers. Of those who responded, 78.33% agreed that they would have an economic loss if asbestos were declared harmless. When asked if it were safer to leave asbestos in place, the majority replied that it was worth the short-term risk to increase the airborne fibers in renovation for the permanent removal benefits. These beliefs are in contradiction to a symposium held at Harvard University, which revealed that actual risks are much lower than once thought. Without definite standards from the medical community, danger of asbestos exposure to humans is uncertain.
It's still not clear whether heavy exposure to white asbestos caused lung cancer in miners throughout North America as cancer rates were highest in the workers who were also smokers. Conflicting research on the hazards of asbestos is all that is available to the public until differing scientific communities can communicate in the same arena. While beliefs about the hazard of asbestos are polarized, researchers do concur that there is a health risk. The intensity of the risk is the focus of the debate. One belief is that workers exposed to various asbestos fiber types contract lung diseases at similar rates. At the other end of the continuum, researchers state that the health risk posed by the roughly 30 million tons of asbestos in buildings is small, far less than most other environmental health hazards, such as tobacco smoke and radon. Asbestos management does include a range of variables, therefore careful evaluation and scientific analysis are necessary on a case-by-case basis.
The negative reputation of asbestos comes from the high death rate among asbestos workers exposed, without protective attire, to extremely high levels of asbestos dust. Because asbestos is only a generic name for fibrous aggregates of minerals, specific types need to be identified to understand their variations. Within the scientific community, views have polarized on the potential health hazards of asbestos due to the structure of the specific fibers and the time of exposure to given amounts. Some asbestos researchers, known as revisionists, insist that different types of asbestos should be regulated differently. Opposing arguments state that all fiber types should be strictly regulated. Two common asbestos types are amphiboles (or brown and blue) and chrysolites (also known as white). In the U.S., about 95% of asbestos used are of the white variety.
Fiber Size
Studies of the fiber sizes of asbestos have shown that lengths above eight micrometers and widths less than 0.25 micrometers were linked with respiratory ailments. Fibers in these target ranges are the ones most easily inhaled through the respiratory tract into the lungs. Once in the lungs, a fiber must be durable with respect to the lung fluids to stay intact and cause damage. One study found that the average lifetime or biodurability of a chrysotile fiber one micrometer in diameter is approximately nine months due to the dissolution rate. This result is compared to a silica fiber of the same size that can take up to 438 years to dissolve. Amphibole asbestos fibers have width measurements from 0.073 to 0.243 micrometers yet biodurability tests have not been conducted on amphiboles. The rate of lung cancer in asbestos miners further explains why miners and millers working with this fiber type have elevated incidents.
Testing concentrations of airborne asbestos fibers in buildings is a means of determining exposure levels. The unit of measure is fibers per centimeter cubed over an 8 hour time weight average. The federal standard is 0.1 fibers per cubic cm.. To illustrate, a 12-story office building in Minnesota was sampled to ensure compliance with the maximum standard. Nine test sites with obvious damage to asbestos-containing surface material were chosen throughout the building. Variables included areas with or without suspended ceilings and areas with or without current construction. Other test sites were near the air intake on the roof and in the garage. Of the asbestos levels detectable, the highest was 0.008 fibers per cubic cm.. This level was detected in an area without a suspended ceiling undergoing current construction. This study was consistent with similar sampling methods; one conclusion that some researchers make is general building occupants are not at significant risk for concentrated asbestos exposure. Workers involved with renovation, however, are at an increased risk and are mandated to observe extra safety precautions.
Hazards of Asbestos
The clarity of true hazard of asbestos is not known -- there are many aspects of asbestos removal vs. maintenance, such as economics, that make the issue more confusing. An anonymous survey was conducted to get reactions from those with an economic interest in asbestos abatement. The survey focused on the issue of asbestos abatement being a health and safety concern or a means of economic advancement. Six groups of twelve people each received the survey, including politicians, industrial hygienists, building managers, contractors, suppliers and lawyers. Of those who responded, 78.33% agreed that they would have an economic loss if asbestos were declared harmless. When asked if it were safer to leave asbestos in place, the majority replied that it was worth the short-term risk to increase the airborne fibers in renovation for the permanent removal benefits. These beliefs are in contradiction to a symposium held at Harvard University, which revealed that actual risks are much lower than once thought. Without definite standards from the medical community, danger of asbestos exposure to humans is uncertain.
It's still not clear whether heavy exposure to white asbestos caused lung cancer in miners throughout North America as cancer rates were highest in the workers who were also smokers. Conflicting research on the hazards of asbestos is all that is available to the public until differing scientific communities can communicate in the same arena. While beliefs about the hazard of asbestos are polarized, researchers do concur that there is a health risk. The intensity of the risk is the focus of the debate. One belief is that workers exposed to various asbestos fiber types contract lung diseases at similar rates. At the other end of the continuum, researchers state that the health risk posed by the roughly 30 million tons of asbestos in buildings is small, far less than most other environmental health hazards, such as tobacco smoke and radon. Asbestos management does include a range of variables, therefore careful evaluation and scientific analysis are necessary on a case-by-case basis.
Monday, July 7, 2008
Mesothelioma Treatment Overview
How malignant mesothelioma is treated
There are treatments for all patients with malignant mesothelioma. Three kinds of treatment are used:
*
Surgery (taking out the cancer).
*
Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
*
Chemotherapy (using drugs to fight the cancer).
Surgery is a common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, the doctor may drain the fluid out of the body by putting a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. The doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).
Intraoperative photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.
Mesothelioma Treatment by stage
Treatment depends on where the cancer is, how far it has spread, and the patient's age and general health.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for many patients with malignant mesothelioma.
Advanced Malignant Mesothelioma (Stages II, III, and IV)
Treatment may be one of the following:
1.
Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
2.
Surgery to relieve symptoms.
3.
Radiation therapy to relieve symptoms.
4.
Chemotherapy.
5.
A clinical trial of surgery, radiation therapy, and chemotherapy.
6.
Chemotherapy given in the chest or abdomen.
Localized Malignant Mesothelioma (Stage I)
The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung. If the cancer is only in one place in the chest or abdomen, treatment will probably be surgery to remove part of the pleura and some of the tissue around it. If the cancer is found in a larger part of the pleura, treatment may be one of the following:
1.
Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
2.
Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
3.
External beam radiation therapy to relieve symptoms.
4.
A clinical trial of surgery followed by chemotherapy given inside the chest.
5.
A clinical trial of surgery, radiation therapy, and/or chemotherapy.
Pleural mesothelioma
Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)
Benign mesothelioma can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesothelioma, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.
The remainder of this section is about diffuse malignant pleural mesothelioma.
Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.
Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.
The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.
The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.
Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.
The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.
The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.
Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as well as promote its growth; the tumor does not depend on any other processes for its development.
There is as yet no known cure for malignant mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment. KMESA has represented many clients who lived for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months; the average survival time is about a year.
The treatment options for people with mesothelioma have improved significantly, especially for those whose cancer is diagnosed early and treated vigorously. Many people are treated with a combination of therapies, sometimes known as multimodal therapy.
Specific types of treatment include:
*
Chemotherapy and other drug-based therapies
*
Radiation therapy
*
Surgery and
*
Intra-operative photodynamic therapy.
There are also experimental treatments like gene therapy and immunotherapy, angiogenesis inhibitors, and clinical trials for various new treatments and combinations of treatments.
Treatments that reduce pain and improve lung function, are becoming more successful (although they cannot cure mesothelioma.) Pain control medications have become easier to administer. Debulking is a surgical process of removing a substantial part of the tumor and reducing the pleural thickening; this can provide significant relief. X-ray therapy has also been successfully used to control the tumor and the pain associated with it for a while.
Peritoneal mesothelioma
Many of the organs in the abdomen are enveloped by a thin membrane of mesothelial cells, known as the peritoneum.
Peritoneal mesothelioma is a tumor of this membrane. Its only known cause in the U.S. is previous exposure to asbestos, but it can be many years after exposure before the disease appears. Peritoneal mesotheliomas account for about one-fifth of all mesotheliomas.
Like pleural mesothelioma, peritoneal mesothelioma can be either benign or malignant. This discussion is only about malignant peritoneal mesothelioma.
Mesothelioma is sometimes diagnosed by coincidence, before any symptoms have appeared. For example, the tumor is sometimes seen on a routine abdominal x-ray for a check-up or before surgery.
When the symptoms of peritoneal mesothelioma appear, they typically include abdominal pains, weakness, weight loss, loss of appetite, nausea, and abdominal swelling. Fluid often accumulates in the peritoneal space, a condition known as ascites. Over time the wasting symptoms can become more and more severe.
The growing tumor can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. If the tumor presses upward, it can impair breathing capacity. If the tumor pushes against areas with many nerve fibers, and the bowel distends, the amount of pain can increase.
X-rays and CT scans are, typically, the first step towards detecting peritoneal mesothelioma. The actual diagnosis is typically achieved by obtaining a piece of tissue. The medical procedure of looking at the peritoneum is known as a peritoneoscopy. It is a hospital procedure and requires anesthesia. If an abnormality is seen, the doctor will attempt to obtain a tissue sample - this is known as a biopsy. The tissue sample will be examined by a pathologist who makes a diagnosis using microscopic analysis of specialized stains.
There are at least two explanations for how asbestos fibers can get into the peritoneum. The first is that fibers caught by the mucus of the trachea and bronchi end up being swallowed. Some of them lodge in the intestinal tract and from there they can move through the intestinal wall into the peritoneum. The second explanation is that fibers that lodge in the lungs can move into the lymphatic system and be transported to the peritoneum.
Medical science does not know exactly how or why, at a cellular level, a carcinogen like asbestos causes a cell to become malignant (cancerous.) Thus it is not known whether only one fiber can cause a tumor to develop or whether it takes many fibers, or what the exact conditions and predispositions are for this change to happen.
At this time there are treatments, but no known cure, for peritoneal mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, its extent, the cell type, and whether or not the tumor responds to treatment.
Benign Mesothelioma:
A rare form of mesothelioma is the cycstic mesothelioma of the peritoneum. Its prognosis is benign. Its occurrence has been described primarily in young women. However the diagnosis presents difficulties, requiring extensive electron miscroscopy and immunohistochemical studies.
Rare Sites:
Mesothelioma of the pericardium, is a very seldom seen cardiac cancer. The mass is usually detected at a late stage by echocardiography, the prognosis is very poor , with or without therapy. Mesothelioma of the ovaries and the scrotum have also been reported in the literature. The management differs based on the stage of the disease, the prognosis is also very poor. The etiology of the few cases of mesothelioma described in children remains unclear and is not believed to be asbestos-related, the therapy and prognosis differ on an individual basis.
There are treatments for all patients with malignant mesothelioma. Three kinds of treatment are used:
*
Surgery (taking out the cancer).
*
Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
*
Chemotherapy (using drugs to fight the cancer).
Surgery is a common treatment of malignant mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. Depending on how far the cancer has spread, a lung also may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy).
If fluid has collected in the chest or abdomen, the doctor may drain the fluid out of the body by putting a needle into the chest or abdomen and using gentle suction to remove the fluid. If fluid is removed from the chest, this is called thoracentesis. If fluid is removed from the abdomen, this is called paracentesis. The doctor may also put drugs through a tube into the chest to prevent more fluid from accumulating.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. In mesothelioma, chemotherapy may be put directly into the chest (intrapleural chemotherapy).
Intraoperative photodynamic therapy is a new type of treatment that uses special drugs and light to kill cancer cells during surgery. A drug that makes cancer cells more sensitive to light is injected into a vein several days before surgery. During surgery to remove as much of the cancer as possible, a special light is used to shine on the pleura. This treatment is being studied for early stages of mesothelioma in the chest.
Mesothelioma Treatment by stage
Treatment depends on where the cancer is, how far it has spread, and the patient's age and general health.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for many patients with malignant mesothelioma.
Advanced Malignant Mesothelioma (Stages II, III, and IV)
Treatment may be one of the following:
1.
Draining of fluid in the chest or abdomen (thoracentesis or paracentesis) to reduce discomfort. Drugs also may be put into the chest or abdomen to prevent further collection of fluid.
2.
Surgery to relieve symptoms.
3.
Radiation therapy to relieve symptoms.
4.
Chemotherapy.
5.
A clinical trial of surgery, radiation therapy, and chemotherapy.
6.
Chemotherapy given in the chest or abdomen.
Localized Malignant Mesothelioma (Stage I)
The cancer is found in the lining of the chest cavity near the lung and heart or in the diaphragm or the lung. If the cancer is only in one place in the chest or abdomen, treatment will probably be surgery to remove part of the pleura and some of the tissue around it. If the cancer is found in a larger part of the pleura, treatment may be one of the following:
1.
Surgery to remove the pleura and the tissue near it to relieve symptoms, with or without radiation therapy after surgery.
2.
Surgery to remove sections of the pleura, the lung, part of the diaphragm, and part of the lining around the heart.
3.
External beam radiation therapy to relieve symptoms.
4.
A clinical trial of surgery followed by chemotherapy given inside the chest.
5.
A clinical trial of surgery, radiation therapy, and/or chemotherapy.
Pleural mesothelioma
Pleural mesothelioma is of two kinds: (1) diffuse and malignant (cancerous), and (2) localized and benign (non-cancerous.)
Benign mesothelioma can often be removed surgically, are generally not life-threatening, and are not usually related to asbestos exposure. Malignant mesothelioma, however, are very serious. Fortunately, they are rare - about two thousand people are diagnosed with mesothelioma in the U.S. each year.
The remainder of this section is about diffuse malignant pleural mesothelioma.
Pleural mesothelioma is a cancer of the cells that make up the pleura or lining around the outside of the lungs and inside of the ribs. Its only known cause in the U.S. is previous exposure to asbestos fibers, including chrysotile, amosite or crocidolite. This exposure is likely to have happened twenty or more years before the disease becomes evident, since it takes many years for the disease to "incubate." It is the most common type of mesothelioma, accounting for about 75% of all cases.
Mesothelioma is sometimes diagnosed by coincidence, before there are any symptoms. For instance, tumors have been discovered through routine chest x-rays. However, when symptoms occur, they may include shortness of breath, weakness, weight loss, loss of appetite, chest pains, lower back pains, persistent coughing, difficulty in swallowing, alone or in combination. An initial medical examination often shows a pleural effusion, which means an accumulation of fluid in the pleural space - the area between the lungs and the chest wall.
The first step in detecting pleural mesothelioma is, typically, a chest x-ray or CT scan. This is often followed by a bronchoscopy, using a viewing scope to look inside the lungs.
The actual diagnosis usually requires obtaining a piece of tissue through a biopsy. This could be a needle biopsy, an open biopsy, or through a tube with a camera (thoracoscopy or chest scope.) If an abnormality is seen through the camera then a tissue sample can be taken at the same time, using the same tube. This is a hospital procedure that requires anesthesia, but is not usually painful. The tissue sample is tested by a pathologist.
Fluid build-up from the pleural effusion can generally be seen on a chest x-ray and heard during a physical examination, but a firm diagnosis of mesothelioma can only be made through a biopsy and pathological testing. This is important because there are also benign pleural effusions and other tumors that have a similar appearance to mesothelioma. Diagnosing mesothelioma can be quite difficult; it requires special lab stains, and much experience in understanding them.
The spread of the tumor over the pleura causes pleural thickening. This can reduce the flexibility of the pleura and encase the lungs in an increasingly restrictive girdle. With the lungs restricted, they get smaller and less functional, and breathing becomes more difficult. At first a person with mesothelioma may be breathless only when he or she exercises, but as lung function drops, he or she can become short of breath even while resting.
The tumor spreads by direct invasion of surrounding tissue. As it spreads inward it can compress the lungs. As the tumor spreads outward it can invade the chest wall and ribs, and this can be extremely painful.
Current medical science does not know exactly how and why, at a cellular level, asbestos fibers cause mesothelial cells to become abnormal (malignant or cancerous.) Thus it is not known whether only one fiber causes the tumor or whether it takes many fibers. It seems that asbestos fibers in the pleura can start a tumor as well as promote its growth; the tumor does not depend on any other processes for its development.
There is as yet no known cure for malignant mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, the extent of the tumor, the cell type, and whether or not the tumor responds to treatment. KMESA has represented many clients who lived for five to ten years after diagnosis, most of them in good health for a majority of those years. Some mesothelioma victims succumb within a few months; the average survival time is about a year.
The treatment options for people with mesothelioma have improved significantly, especially for those whose cancer is diagnosed early and treated vigorously. Many people are treated with a combination of therapies, sometimes known as multimodal therapy.
Specific types of treatment include:
*
Chemotherapy and other drug-based therapies
*
Radiation therapy
*
Surgery and
*
Intra-operative photodynamic therapy.
There are also experimental treatments like gene therapy and immunotherapy, angiogenesis inhibitors, and clinical trials for various new treatments and combinations of treatments.
Treatments that reduce pain and improve lung function, are becoming more successful (although they cannot cure mesothelioma.) Pain control medications have become easier to administer. Debulking is a surgical process of removing a substantial part of the tumor and reducing the pleural thickening; this can provide significant relief. X-ray therapy has also been successfully used to control the tumor and the pain associated with it for a while.
Peritoneal mesothelioma
Many of the organs in the abdomen are enveloped by a thin membrane of mesothelial cells, known as the peritoneum.
Peritoneal mesothelioma is a tumor of this membrane. Its only known cause in the U.S. is previous exposure to asbestos, but it can be many years after exposure before the disease appears. Peritoneal mesotheliomas account for about one-fifth of all mesotheliomas.
Like pleural mesothelioma, peritoneal mesothelioma can be either benign or malignant. This discussion is only about malignant peritoneal mesothelioma.
Mesothelioma is sometimes diagnosed by coincidence, before any symptoms have appeared. For example, the tumor is sometimes seen on a routine abdominal x-ray for a check-up or before surgery.
When the symptoms of peritoneal mesothelioma appear, they typically include abdominal pains, weakness, weight loss, loss of appetite, nausea, and abdominal swelling. Fluid often accumulates in the peritoneal space, a condition known as ascites. Over time the wasting symptoms can become more and more severe.
The growing tumor can exert increasing pressure on the organs in the abdomen, leading to bowel obstruction and distention. If the tumor presses upward, it can impair breathing capacity. If the tumor pushes against areas with many nerve fibers, and the bowel distends, the amount of pain can increase.
X-rays and CT scans are, typically, the first step towards detecting peritoneal mesothelioma. The actual diagnosis is typically achieved by obtaining a piece of tissue. The medical procedure of looking at the peritoneum is known as a peritoneoscopy. It is a hospital procedure and requires anesthesia. If an abnormality is seen, the doctor will attempt to obtain a tissue sample - this is known as a biopsy. The tissue sample will be examined by a pathologist who makes a diagnosis using microscopic analysis of specialized stains.
There are at least two explanations for how asbestos fibers can get into the peritoneum. The first is that fibers caught by the mucus of the trachea and bronchi end up being swallowed. Some of them lodge in the intestinal tract and from there they can move through the intestinal wall into the peritoneum. The second explanation is that fibers that lodge in the lungs can move into the lymphatic system and be transported to the peritoneum.
Medical science does not know exactly how or why, at a cellular level, a carcinogen like asbestos causes a cell to become malignant (cancerous.) Thus it is not known whether only one fiber can cause a tumor to develop or whether it takes many fibers, or what the exact conditions and predispositions are for this change to happen.
At this time there are treatments, but no known cure, for peritoneal mesothelioma. The prognosis depends on various factors, including the size and stage of the tumor, its extent, the cell type, and whether or not the tumor responds to treatment.
Benign Mesothelioma:
A rare form of mesothelioma is the cycstic mesothelioma of the peritoneum. Its prognosis is benign. Its occurrence has been described primarily in young women. However the diagnosis presents difficulties, requiring extensive electron miscroscopy and immunohistochemical studies.
Rare Sites:
Mesothelioma of the pericardium, is a very seldom seen cardiac cancer. The mass is usually detected at a late stage by echocardiography, the prognosis is very poor , with or without therapy. Mesothelioma of the ovaries and the scrotum have also been reported in the literature. The management differs based on the stage of the disease, the prognosis is also very poor. The etiology of the few cases of mesothelioma described in children remains unclear and is not believed to be asbestos-related, the therapy and prognosis differ on an individual basis.
Alfacell Updates Status of ONCONASE(R) Phase III Clinical Program
Alfacell Corporation today announced that it has confirmed that 316 evaluable events (patient deaths) have occurred in the confirmatory Phase IIIb clinical trial of its lead compound, ONCONASE (ranpirnase), for the treatment of patients with unresectable malignant mesothelioma (UMM). In accordance with the statistical plan for the trial, the company has begun the process necessary to conduct the formal statistical analyses required to complete the final sections of the ONCONASE rolling New Drug Application (NDA).
The trial was designed to show a statistically significant improvement in overall survival for UMM patients who were treated with a combination of ONCONASE and doxorubicin as compared to UMM patients who were treated with doxorubicin as a single agent. Enrollment in the ONCONASE Phase IIIb clinical trial closed on Sept. 30, 2007. A total of 428 patients were enrolled in the trial.
Alfacell has licensed the U.S. commercial rights for ONCONASE to Strativa, the branded product division of Par Pharmaceuticals, Inc. Strategic marketing and distribution agreements for ONCONASE have been secured with BL&H Co. Ltd. for Korea, Taiwan and Hong Kong, USP Pharma Spolka Z.O.O., an affiliate of US Pharmacia, for Eastern Europe, and GENESIS Pharma, S.A. for Southeastern Europe.
ONCONASE has been granted fast track status and orphan-drug designation for the treatment of malignant mesothelioma by the U.S. Food and Drug Administration (FDA). Additionally, ONCONASE has been granted orphan-drug designation in the European Union and Australia.
About ONCONASE(R)
ONCONASE is a first-in-class product candidate based on Alfacell’s proprietary ribonuclease (RNase) technology. A natural protein isolated from the leopard frog, ONCONASE has been shown in the laboratory and clinic to target cancer cells while sparing normal cells. ONCONASE triggers apoptosis, the natural death of cells, via multiple molecular mechanisms of action.
About Alfacell Corporation
Alfacell Corporation is the first company to advance a biopharmaceutical product candidate that works in a manner similar to RNA interference (RNAi) through late-stage clinical trials. The product candidate, ONCONASE, is an RNase that overcomes the challenges of targeting RNA for therapeutic purposes while enabling the development of a new class of targeted therapies for cancer and other life-threatening diseases. In addition to the Phase IIIb study in malignant mesothelioma, Alfacell is conducting a Phase I/II trial of ONCONASE in non-small cell lung cancer (NSCLC) and other solid tumors. For more information, visit http://www.alfacell.com/
The trial was designed to show a statistically significant improvement in overall survival for UMM patients who were treated with a combination of ONCONASE and doxorubicin as compared to UMM patients who were treated with doxorubicin as a single agent. Enrollment in the ONCONASE Phase IIIb clinical trial closed on Sept. 30, 2007. A total of 428 patients were enrolled in the trial.
Alfacell has licensed the U.S. commercial rights for ONCONASE to Strativa, the branded product division of Par Pharmaceuticals, Inc. Strategic marketing and distribution agreements for ONCONASE have been secured with BL&H Co. Ltd. for Korea, Taiwan and Hong Kong, USP Pharma Spolka Z.O.O., an affiliate of US Pharmacia, for Eastern Europe, and GENESIS Pharma, S.A. for Southeastern Europe.
ONCONASE has been granted fast track status and orphan-drug designation for the treatment of malignant mesothelioma by the U.S. Food and Drug Administration (FDA). Additionally, ONCONASE has been granted orphan-drug designation in the European Union and Australia.
About ONCONASE(R)
ONCONASE is a first-in-class product candidate based on Alfacell’s proprietary ribonuclease (RNase) technology. A natural protein isolated from the leopard frog, ONCONASE has been shown in the laboratory and clinic to target cancer cells while sparing normal cells. ONCONASE triggers apoptosis, the natural death of cells, via multiple molecular mechanisms of action.
About Alfacell Corporation
Alfacell Corporation is the first company to advance a biopharmaceutical product candidate that works in a manner similar to RNA interference (RNAi) through late-stage clinical trials. The product candidate, ONCONASE, is an RNase that overcomes the challenges of targeting RNA for therapeutic purposes while enabling the development of a new class of targeted therapies for cancer and other life-threatening diseases. In addition to the Phase IIIb study in malignant mesothelioma, Alfacell is conducting a Phase I/II trial of ONCONASE in non-small cell lung cancer (NSCLC) and other solid tumors. For more information, visit http://www.alfacell.com/
ASBESTOS Q & A
ASBESTOS Q & A
1. What is asbestos?
"Asbestos" is the name given to a group of minerals that occur naturally as bundles of fibers which can be separated into thin threads. These fibers are not affected by heat or chemicals and do not conduct electricity. For these reasons, asbestos has been widely used in many industries. Four types of asbestos have been used commercially:
* Chrysotile, or white asbestos;
* Crocidolite, or blue asbestos;
* Amosite, which usually has brown fibers; and
* Anthophyllite, which usually has gray fibers.
Chrysotile asbestos, with its curly fibers, is in the serpentine family of minerals. The other types of asbestos, which all have rod-like fibers, are known as amphiboles.
Asbestos fiber masses tend to break easily into a dust composed of tiny particles that can float in the air and stick to clothes. The fibers may be easily inhaled or swallowed and can cause serious health problems.
Comment: Mesothelioma can be caused by exposure to all types of asbestos.
2. How is asbestos used?
Asbestos was mined and used commercially in North America beginning in the late 1800s. Its use increased greatly during World War II. Since then, it has been used in many industries. For example, the building and construction industry has used it for strengthening cement and plastics as well as for insulation, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steampipes, and hot water pipes. The automotive industry uses asbestos in vehicle brakeshoes and clutch pads. More than 5,000 products contain or have contained asbestos. Some of them are listed below:
* Asbestos cement sheet and pipe products used for water supply and sewage piping, roofing and siding, casings for electrical wires, fire protection material, electrical switchboards and components, and residential and industrial building materials;
* Friction products, such as clutch facings, brake linings for automobiles, gaskets, and industrial friction materials;
* Products containing asbestos paper, such as table pads and heat-protective mats, heat and electrical wire insulation, industrial filters for beverages, and underlying material for sheet flooring;
* Asbestos textile products, such as packing components, roofing materials, and heat- and fire-resistant fabrics (including blankets and curtains); and
* Other products, including ceiling and floor tile; gaskets and packings; paints, coatings, and adhesives; caulking and patching tape; artificial ashes and embers for use in gas-fired fireplaces; plastics; vermiculite-containing consumer garden products; and some talc-containing crayons.
In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. Additionally, asbestos was voluntarily withdrawn by manufacturers of electric hair dryers. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; uses established prior to 1989 are still allowed.
The EPA has established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure to occupants by removing the asbestos or encasing it. In June 2000, the CPSC concluded that the risk of children's exposure to asbestos fibers in crayons was extremely low. However, the U.S. manufacturers of these crayons agreed to reformulate their products within a year. In August 2000, the EPA recommended that consumers reduce possible asbestos exposure from vermiculite-containing garden products by limiting the amount of dust produced during use. The EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite use into the home on clothing; and use premixed potting soil, which is less likely to generate dust.
The regulations described above and other actions, coupled with widespread public concern about the hazards of asbestos, have resulted in a significant annual decline in U.S. use of asbestos: Domestic consumption of asbestos amounted to about 719,000 metric tons in 1973, but it had dropped to about 9,000 metric tons by 2002. Asbestos is currently used most frequently in gaskets and in roofing and friction products.
3. What are the health hazards of exposure to asbestos?
Exposure to asbestos may increase the risk of several serious diseases:
* Asbestosis-a chronic lung ailment that can produce shortness of breath, coughing, and permanent lung damage;
* Lung cancer;
* Mesothelioma-a relatively rare cancer of the thin membranes that line the chest and abdomen; and
* Other cancers, such as those of the larynx, oropharynx, gastrointestinal tract, and kidney.
4. Who is at risk?
Nearly everyone is exposed to asbestos at some time during their life. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.
Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, brake repair, and a variety of other trades. Demolition workers, drywall removers, and firefighters also may be exposed to asbestos fibers. As a result of Government regulations and improved work practices, today's workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past.
Although it is known that the risk to workers increases with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years for symptoms of an asbestos-related condition to appear.
There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma. This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. This type of exposure is called paraoccupational exposure. To decrease these exposures, people exposed to asbestos at work are required to shower and change their clothing before leaving the workplace.
5. How great is the risk?
Not all workers exposed to asbestos will develop diseases related to their exposure. The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. Asbestos that is bonded into finished products such as walls and tiles poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.
6. How does smoking affect risk?
Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer. However, smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma.
There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers. People who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke. If they smoke, they should stop.
7. Who needs to be examined?
Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job or at home via a family contact should inform their physician of their exposure history and any symptoms. Asbestos fibers can be measured in urine, feces, mucus, or material rinsed out of the lungs. A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. It is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any lung changes resulting from asbestos exposure. Interpretation of the chest x-ray may require the help of a specialist who is experienced in reading x-rays for asbestos-related diseases. Other tests also may be necessary.
As noted earlier, the symptoms of asbestos-related diseases may not become apparent for many decades after exposure. If any of the following symptoms develop, a physical examination should be scheduled without delay:
* Shortness of breath;
* A cough or a change in cough pattern;
* Blood in the sputum (fluid) coughed up from the lungs;
* Pain in the chest or abdomen;
* Difficulty in swallowing or prolonged hoarseness; and/or
* Significant weight loss.
8. How can workers protect themselves?
Employers are required to follow regulations dealing with asbestos exposure on the job that have been issued by the Occupational Safety and Health Administration (OSHA), the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. The Mine Safety and Health Administration (MSHA) enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended work practices and safety procedures. For example, National Institute of Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.
Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the "United States Government" section of telephone directories' blue pages (under "Department of Labor"). Regional offices can also be located at http://www.osha-slc.gov/html/RAmap.html on the Internet, or by contacting OSHA's national office at:
Organization: Office of Public Affairs
Occupational Safety and Health Administration
U.S. Department of Labor
Address: Room N-3647
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone: 202-693-1999
1-800-321-6742 (1-800-321-OSHA)
TTY (for deaf or hard of hearing callers): 1-877-889-5627
Internet Web site:
http://www.osha.gov/as/opa/worker/index.html(Worker's Page)
Mine workers may contact:
Organization: Office of Information and Public Affairs Mine Safety and Health Administration (MSHA)
U.S. Department of Labor
Address: 23rd Floor
1100 Wilson Boulevard
Arlington, VA 22209-3939
Telephone: 202-693-9400
Internet Web site:
The National Institute for Occupational Safety and Health (NIOSH) is another Federal agency that is concerned with asbestos exposure in the workplace. The Institute conducts asbestos-related research, evaluates work sites for possible health hazards, and makes exposure control recommendations. In addition, NIOSH distributes publications on the health effects of asbestos exposure and can suggest additional sources of information. NIOSH can be contacted at:
Organization: Information Resources Branch
National Institute for Occupational Safety and Health (NIOSH)
Address: Robert A. Taft Laboratories
Mailstop C-18
4676 Columbia Parkway
Cincinnati, OH 45226-1998
Telephone: 1-800-356-4674 (1-800-35-NIOSH)
E-mail: pubstaft@cdc.gov
Internet Web site:
http://www.cdc.gov/niosh
9. Will the Government provide examinations and treatment for asbestos-related conditions? What about insurance coverage?
Medical services related to asbestos exposure are available through the Government for certain groups of eligible individuals. In general, individuals must pay for their own medical services unless they are covered by private or Government health insurance. Some people with symptoms of asbestos-related illness may be eligible for Medicare coverage. Information about benefits is available from the Medicare office serving each state. For the telephone number of the nearest office, call toll-free 1-800-633-4227 (1-800-MEDICARE) or visit http://www.medicare.gov on the Internet.
People with asbestos-related diseases also may qualify for financial help, including medical payments, under state workers' compensation laws. Because eligibility requirements vary from state to state, workers should contact the workers' compensation program in their state. Contact information for the workers' compensation program in each state may be found in the blue pages of a local telephone directory or at http://www.dol.gov/esa/regs/compliance/owcp/wc.htm on the Internet.
If exposure occurred during employment with a Federal agency (military or civilian), medical expenses and other compensation may be covered by the Federal Employees' Compensation Program. Workers who are or were employed in a shipyard by a private employer may be covered under the Longshoremen and Harbor Workers' Compensation Act. Information about eligibility and how to file a claim is available from:
Organization: Office of Worker's Compensation Programs
Employment Standards Administration
U.S. Department of Labor
Address: Room S-3229
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone: 202-693-0040
E-mail: OWCP-Mail@dol-esa.gov
Internet Web site:
http://www.dol.gov/esa/owcp_org.htm
Workers also may wish to contact their international union for information on other sources of medical help and insurance matters.
Eligible veterans and their dependents may receive health care at a Department of Veterans Affairs (VA) Medical Center. Treatment for service-connected and nonservice-connected conditions is provided. If the VA cannot provide the necessary medical care, they will arrange for enrolled veterans to receive care in their community. Information about eligibility and benefits is available from the VA Health Benefits Service Center at 1-877-222-8387 (1-877-222-VETS) or on the VA Web site at http://www.va.gov/health_benefits on the Internet.
10. Is there a danger of nonoccupational exposure from the environment and products contaminated with asbestos fibers?
Asbestos is so widely used that the entire population has been exposed to some degree. Air, drinking water, and a variety of consumer products all may contain small amounts of asbestos. In addition, asbestos fibers are released into the environment from natural deposits in the earth and as a result of wear and deterioration of asbestos products. Disease is unlikely to result from a single, high-level exposure, or from a short period of exposure to lower levels of asbestos.
11. What other organizations offer information related to asbestos exposure?
The organizations listed below can provide more information about asbestos exposure.
The Agency for Toxic Substances and Disease Registry (ATSDR) is responsible for preventing exposure, adverse human health effects, and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. The ATSDR provides information about asbestos and where to find occupational and environmental health clinics. The ATSDR Information Center can be reached at:
Organization: Agency for Toxic Substances and Disease Registry Division of Toxicology
Address: Mailstop E-29
1600 Clifton Road, NE.
Atlanta, GA 30333
Telephone: 404-498-0160
1-888-422-8737 (1-888-42-ATSDR)
E-mail: ATSDRIC@cdc.gov
Internet Web site:
http://www.atsdr.cdc.gov
The U.S. Environmental Protection Agency (EPA) regulates the general public's exposure to asbestos in buildings, drinking water, and the environment. The EPA's Toxic Substances Control Act (TSCA) Assistance Information Service, or TSCA Hotline, can answer questions about toxic substances, including asbestos. Printed material is available on a number of topics, particularly on controlling asbestos exposure in schools and other buildings. The EPA's Asbestos and Vermiculite Home Page has suggestions for homeowners who suspect asbestos in their homes, lists laws and regulations applicable to asbestos, and links to the Agency's findings on asbestos exposure at the World Trade Center and the Pentagon. Questions may be directed to:
Organization: TSCA Assistance Information Service
U.S. Environmental Protection Agency
Address: Mailcode 74080
401 M Street, SW.
Washington, DC 20460
Telephone: 202-554-1404
TDD: 202-554-0551
E-mail: tsca-hotline@epa.gov
Internet Web site:
http://www.epa.gov/asbestos/
The U.S. Consumer Product Safety Commission (CPSC) is responsible for the regulation of asbestos in consumer products. The CPSC maintains a toll-free information line on the potential hazards of commercial products; the telephone number is 1-800-638-2772. In addition, CPSC provides information about laboratories for asbestos testing, guidelines for repairing and removing asbestos, and general information about asbestos in the home. Publications are available from:
Organization: Office of Information and Public Affairs
U.S. Consumer Product Safety Commission
Address: 4330 East-West Highway
Bethesda, MD 20814-4408
Telephone: 1-800-638-2772
TTY (for deaf or hard of hearing callers): 1-800-638-8270
E-mail: info@cpsc.gov
Internet Web site:
http://www.cpsc.gov
Information about asbestos is also available from the U.S. Department of Health and Human Services Web site at http://www.hhs.gov/news/press/2001pres/20010916a.html on the Internet. In addition, people can contact their local community or state health or environmental quality department with questions or concerns about asbestos.
Materials about cancer and how to quit smoking are available by calling the Cancer Information Service (CIS) (see below).
1. What is asbestos?
"Asbestos" is the name given to a group of minerals that occur naturally as bundles of fibers which can be separated into thin threads. These fibers are not affected by heat or chemicals and do not conduct electricity. For these reasons, asbestos has been widely used in many industries. Four types of asbestos have been used commercially:
* Chrysotile, or white asbestos;
* Crocidolite, or blue asbestos;
* Amosite, which usually has brown fibers; and
* Anthophyllite, which usually has gray fibers.
Chrysotile asbestos, with its curly fibers, is in the serpentine family of minerals. The other types of asbestos, which all have rod-like fibers, are known as amphiboles.
Asbestos fiber masses tend to break easily into a dust composed of tiny particles that can float in the air and stick to clothes. The fibers may be easily inhaled or swallowed and can cause serious health problems.
Comment: Mesothelioma can be caused by exposure to all types of asbestos.
2. How is asbestos used?
Asbestos was mined and used commercially in North America beginning in the late 1800s. Its use increased greatly during World War II. Since then, it has been used in many industries. For example, the building and construction industry has used it for strengthening cement and plastics as well as for insulation, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steampipes, and hot water pipes. The automotive industry uses asbestos in vehicle brakeshoes and clutch pads. More than 5,000 products contain or have contained asbestos. Some of them are listed below:
* Asbestos cement sheet and pipe products used for water supply and sewage piping, roofing and siding, casings for electrical wires, fire protection material, electrical switchboards and components, and residential and industrial building materials;
* Friction products, such as clutch facings, brake linings for automobiles, gaskets, and industrial friction materials;
* Products containing asbestos paper, such as table pads and heat-protective mats, heat and electrical wire insulation, industrial filters for beverages, and underlying material for sheet flooring;
* Asbestos textile products, such as packing components, roofing materials, and heat- and fire-resistant fabrics (including blankets and curtains); and
* Other products, including ceiling and floor tile; gaskets and packings; paints, coatings, and adhesives; caulking and patching tape; artificial ashes and embers for use in gas-fired fireplaces; plastics; vermiculite-containing consumer garden products; and some talc-containing crayons.
In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. Additionally, asbestos was voluntarily withdrawn by manufacturers of electric hair dryers. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; uses established prior to 1989 are still allowed.
The EPA has established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure to occupants by removing the asbestos or encasing it. In June 2000, the CPSC concluded that the risk of children's exposure to asbestos fibers in crayons was extremely low. However, the U.S. manufacturers of these crayons agreed to reformulate their products within a year. In August 2000, the EPA recommended that consumers reduce possible asbestos exposure from vermiculite-containing garden products by limiting the amount of dust produced during use. The EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite use into the home on clothing; and use premixed potting soil, which is less likely to generate dust.
The regulations described above and other actions, coupled with widespread public concern about the hazards of asbestos, have resulted in a significant annual decline in U.S. use of asbestos: Domestic consumption of asbestos amounted to about 719,000 metric tons in 1973, but it had dropped to about 9,000 metric tons by 2002. Asbestos is currently used most frequently in gaskets and in roofing and friction products.
3. What are the health hazards of exposure to asbestos?
Exposure to asbestos may increase the risk of several serious diseases:
* Asbestosis-a chronic lung ailment that can produce shortness of breath, coughing, and permanent lung damage;
* Lung cancer;
* Mesothelioma-a relatively rare cancer of the thin membranes that line the chest and abdomen; and
* Other cancers, such as those of the larynx, oropharynx, gastrointestinal tract, and kidney.
4. Who is at risk?
Nearly everyone is exposed to asbestos at some time during their life. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.
Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, brake repair, and a variety of other trades. Demolition workers, drywall removers, and firefighters also may be exposed to asbestos fibers. As a result of Government regulations and improved work practices, today's workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past.
Although it is known that the risk to workers increases with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years for symptoms of an asbestos-related condition to appear.
There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma. This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. This type of exposure is called paraoccupational exposure. To decrease these exposures, people exposed to asbestos at work are required to shower and change their clothing before leaving the workplace.
5. How great is the risk?
Not all workers exposed to asbestos will develop diseases related to their exposure. The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. Asbestos that is bonded into finished products such as walls and tiles poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.
6. How does smoking affect risk?
Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer. However, smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma.
There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers. People who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke. If they smoke, they should stop.
7. Who needs to be examined?
Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job or at home via a family contact should inform their physician of their exposure history and any symptoms. Asbestos fibers can be measured in urine, feces, mucus, or material rinsed out of the lungs. A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. It is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any lung changes resulting from asbestos exposure. Interpretation of the chest x-ray may require the help of a specialist who is experienced in reading x-rays for asbestos-related diseases. Other tests also may be necessary.
As noted earlier, the symptoms of asbestos-related diseases may not become apparent for many decades after exposure. If any of the following symptoms develop, a physical examination should be scheduled without delay:
* Shortness of breath;
* A cough or a change in cough pattern;
* Blood in the sputum (fluid) coughed up from the lungs;
* Pain in the chest or abdomen;
* Difficulty in swallowing or prolonged hoarseness; and/or
* Significant weight loss.
8. How can workers protect themselves?
Employers are required to follow regulations dealing with asbestos exposure on the job that have been issued by the Occupational Safety and Health Administration (OSHA), the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. The Mine Safety and Health Administration (MSHA) enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended work practices and safety procedures. For example, National Institute of Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.
Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the "United States Government" section of telephone directories' blue pages (under "Department of Labor"). Regional offices can also be located at http://www.osha-slc.gov/html/RAmap.html on the Internet, or by contacting OSHA's national office at:
Organization: Office of Public Affairs
Occupational Safety and Health Administration
U.S. Department of Labor
Address: Room N-3647
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone: 202-693-1999
1-800-321-6742 (1-800-321-OSHA)
TTY (for deaf or hard of hearing callers): 1-877-889-5627
Internet Web site:
http://www.osha.gov/as/opa/worker/index.html(Worker's Page)
Mine workers may contact:
Organization: Office of Information and Public Affairs Mine Safety and Health Administration (MSHA)
U.S. Department of Labor
Address: 23rd Floor
1100 Wilson Boulevard
Arlington, VA 22209-3939
Telephone: 202-693-9400
Internet Web site:
The National Institute for Occupational Safety and Health (NIOSH) is another Federal agency that is concerned with asbestos exposure in the workplace. The Institute conducts asbestos-related research, evaluates work sites for possible health hazards, and makes exposure control recommendations. In addition, NIOSH distributes publications on the health effects of asbestos exposure and can suggest additional sources of information. NIOSH can be contacted at:
Organization: Information Resources Branch
National Institute for Occupational Safety and Health (NIOSH)
Address: Robert A. Taft Laboratories
Mailstop C-18
4676 Columbia Parkway
Cincinnati, OH 45226-1998
Telephone: 1-800-356-4674 (1-800-35-NIOSH)
E-mail: pubstaft@cdc.gov
Internet Web site:
http://www.cdc.gov/niosh
9. Will the Government provide examinations and treatment for asbestos-related conditions? What about insurance coverage?
Medical services related to asbestos exposure are available through the Government for certain groups of eligible individuals. In general, individuals must pay for their own medical services unless they are covered by private or Government health insurance. Some people with symptoms of asbestos-related illness may be eligible for Medicare coverage. Information about benefits is available from the Medicare office serving each state. For the telephone number of the nearest office, call toll-free 1-800-633-4227 (1-800-MEDICARE) or visit http://www.medicare.gov on the Internet.
People with asbestos-related diseases also may qualify for financial help, including medical payments, under state workers' compensation laws. Because eligibility requirements vary from state to state, workers should contact the workers' compensation program in their state. Contact information for the workers' compensation program in each state may be found in the blue pages of a local telephone directory or at http://www.dol.gov/esa/regs/compliance/owcp/wc.htm on the Internet.
If exposure occurred during employment with a Federal agency (military or civilian), medical expenses and other compensation may be covered by the Federal Employees' Compensation Program. Workers who are or were employed in a shipyard by a private employer may be covered under the Longshoremen and Harbor Workers' Compensation Act. Information about eligibility and how to file a claim is available from:
Organization: Office of Worker's Compensation Programs
Employment Standards Administration
U.S. Department of Labor
Address: Room S-3229
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone: 202-693-0040
E-mail: OWCP-Mail@dol-esa.gov
Internet Web site:
http://www.dol.gov/esa/owcp_org.htm
Workers also may wish to contact their international union for information on other sources of medical help and insurance matters.
Eligible veterans and their dependents may receive health care at a Department of Veterans Affairs (VA) Medical Center. Treatment for service-connected and nonservice-connected conditions is provided. If the VA cannot provide the necessary medical care, they will arrange for enrolled veterans to receive care in their community. Information about eligibility and benefits is available from the VA Health Benefits Service Center at 1-877-222-8387 (1-877-222-VETS) or on the VA Web site at http://www.va.gov/health_benefits on the Internet.
10. Is there a danger of nonoccupational exposure from the environment and products contaminated with asbestos fibers?
Asbestos is so widely used that the entire population has been exposed to some degree. Air, drinking water, and a variety of consumer products all may contain small amounts of asbestos. In addition, asbestos fibers are released into the environment from natural deposits in the earth and as a result of wear and deterioration of asbestos products. Disease is unlikely to result from a single, high-level exposure, or from a short period of exposure to lower levels of asbestos.
11. What other organizations offer information related to asbestos exposure?
The organizations listed below can provide more information about asbestos exposure.
The Agency for Toxic Substances and Disease Registry (ATSDR) is responsible for preventing exposure, adverse human health effects, and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. The ATSDR provides information about asbestos and where to find occupational and environmental health clinics. The ATSDR Information Center can be reached at:
Organization: Agency for Toxic Substances and Disease Registry Division of Toxicology
Address: Mailstop E-29
1600 Clifton Road, NE.
Atlanta, GA 30333
Telephone: 404-498-0160
1-888-422-8737 (1-888-42-ATSDR)
E-mail: ATSDRIC@cdc.gov
Internet Web site:
http://www.atsdr.cdc.gov
The U.S. Environmental Protection Agency (EPA) regulates the general public's exposure to asbestos in buildings, drinking water, and the environment. The EPA's Toxic Substances Control Act (TSCA) Assistance Information Service, or TSCA Hotline, can answer questions about toxic substances, including asbestos. Printed material is available on a number of topics, particularly on controlling asbestos exposure in schools and other buildings. The EPA's Asbestos and Vermiculite Home Page has suggestions for homeowners who suspect asbestos in their homes, lists laws and regulations applicable to asbestos, and links to the Agency's findings on asbestos exposure at the World Trade Center and the Pentagon. Questions may be directed to:
Organization: TSCA Assistance Information Service
U.S. Environmental Protection Agency
Address: Mailcode 74080
401 M Street, SW.
Washington, DC 20460
Telephone: 202-554-1404
TDD: 202-554-0551
E-mail: tsca-hotline@epa.gov
Internet Web site:
http://www.epa.gov/asbestos/
The U.S. Consumer Product Safety Commission (CPSC) is responsible for the regulation of asbestos in consumer products. The CPSC maintains a toll-free information line on the potential hazards of commercial products; the telephone number is 1-800-638-2772. In addition, CPSC provides information about laboratories for asbestos testing, guidelines for repairing and removing asbestos, and general information about asbestos in the home. Publications are available from:
Organization: Office of Information and Public Affairs
U.S. Consumer Product Safety Commission
Address: 4330 East-West Highway
Bethesda, MD 20814-4408
Telephone: 1-800-638-2772
TTY (for deaf or hard of hearing callers): 1-800-638-8270
E-mail: info@cpsc.gov
Internet Web site:
http://www.cpsc.gov
Information about asbestos is also available from the U.S. Department of Health and Human Services Web site at http://www.hhs.gov/news/press/2001pres/20010916a.html on the Internet. In addition, people can contact their local community or state health or environmental quality department with questions or concerns about asbestos.
Materials about cancer and how to quit smoking are available by calling the Cancer Information Service (CIS) (see below).
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