Asbestos exposure is also a concern in older buildings. If building materials that contain asbestos (like older insulation and ceiling and floor tiles) begin to decompose over time, asbestos fibers can be found in indoor air and may pose a health threat. There is no health risk if the asbestos is bonded into intact finished products, such as walls and tiles. As long as the material is not damaged or disturbed (for example, by drilling or remodeling), the fibers are not released into the air. Maintenance workers who sweep up and dispose of the asbestos dust or handle damaged asbestos-containing materials are often exposed to higher levels than other people in these buildings. Removing asbestos from homes and other buildings can also cause some exposure, although modern asbestos abatement workers are trained to use proper protective equipment to minimize exposure.
Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job, through the environment, or at home via a family contact should inform their doctor about their exposure history and whether or not they experience any symptoms. The symptoms of asbestos-related diseases may not become apparent for many decades after the exposure. It is particularly important to check with a doctor if any of the following symptoms develop: Shortness of breath, wheezing, or hoarseness A persistent cough that gets worse over time Blood in the sputum (fluid) coughed up from the lungs Pain or tightening in the chest Difficulty swallowing Swelling of the neck or face Loss of appetite Weight loss Fatigue or anemia A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. The chest x-ray is currently the most common tool used to detect asbestos-related diseases. Although chest x-rays cannot detect asbestos fibers in the lungs, they can help identify any early signs of lung disease resulting from asbestos exposure . A lung biopsy, which detects microscopic asbestos fibers in pieces of lung tissue removed by surgery, is the most reliable test to confirm exposure to asbestos . A bronchoscopy is a less invasive test than a biopsy and detects asbestos fibers in material that is rinsed out of the lungs . It is important to note that these procedures cannot determine how much asbestos an individual may have been exposed to or whether disease will develop. Asbestos fibers can also be detected in urine, mucus, and feces, but these tests are not reliable for determining how much asbestos may be in an individual’s lungs .
Keytruda (pembrolizumab) and Opdivo (nivolumab) are among several immunotherapy drugs that have already been FDA approved for the treatment of certain kinds of asbestos-related lung cancer, including all types of non-small cell lung carcinoma (NSCLC). Though no immunotherapy drugs are FDA-approved for mesothelioma yet, the National Comprehensive Cancer Network (NCCN) revised the standard chemotherapy treatment recommendation of alimta and cisplatin to also include Avastin (bevacizumab), another type of immunotherapy drug.
Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium). The most common area affected is the lining of the lungs and chest wall. Less commonly the lining of the abdomen and rarely the sac surrounding the heart, or the sac surrounding the testis may be affected. Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss. These symptoms typically come on slowly.
Friable asbestos-containing materials are dangerous because the asbestos fibres can easily get into the air and may be inhaled by people living or working nearby. Bonded materials usually contain a smaller proportion of asbestos (usually less than 15%). If bonded materials are in good condition, they do not normally release any fibres. However if bonded asbestos materials are damaged, badly weathered or disturbed (e.g. using power tools to drill into them) they can become friable and easily release fibres.
Other key elements in treating patients with asbestosis are smoking cessation, early detection of worsening disease or cancer, and avoidance of further exposure to asbestos. Supplemental oxygen during exercise or at rest (depending on the need) may be provided to improve daily function.
Karen Selby joined Asbestos.com in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators. Contact Karen
IARC Monographs Volume 100C Asbestos (Chrysotile, Amosite, Crocidolite, Tremolite, Actinolite and Anthophyllite) Supplementary Web Tables, Section 2, Cancer in Humans These web tables formed part of the original submission and have been peer reviewed. They are posted as supplied by the Working Group. Readers are requested to report any errors to: edit-vol100C@iarc.fr. Table 2.1 Case-control studies of asbestos exposure and lung cancer Table 2.2 Cohort studies of asbestos exposed populations and lung cancer and mesothelioma Table 2.3 Summary of asbestos cohort study design characteristics Table 2.4 Summary of design and findings from mesothelioma case-control studies Table 2.5 Cohort studies of asbestos and cancer of the pharynx and larynx Table 2.6 Cohort studies of asbestos and cancer of the oesophagus and stomach Table 2.7 Cohort studies of asbestos and colorectal cancer Table 2.8 Epidemiologic studies of asbestos exposure and ovarian cancer References
Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008), or with one of the latter. A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed. In localized pericardial mesothelioma, pericardectomy can be curative; when the tumor has metastasized, pericardectomy is a palliative care option. The entire tumor is not often able to be removed.