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The Deadly Legacy of Asbestos

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‘Even if the Canadian government were to ban all asbestos use tomorrow, this country will be dealing with the legacy of its love affair with the deadly mineral for decades, perhaps centuries, to come.”

This shocking statement is from an article by Michelle Lalonde in the Montreal Gazette. The incubation time for asbestos disease to develop can span five decades, and asbestos is still used in building materials, auto parts, and other products today. That means repercussions of illness, death, and expense might still face Canada, and other countries, on the approach of the 22nd Century.

It is estimated there are 107,000 deaths globally from asbestos exposure each year. There is no safe form of asbestos as it is all comprised of tiny fibers that can implant in the lungs. This can lead to asbestosis, lung cancer, and mesothelioma, the most deadly of the diseases.

There is no safe way for an untrained individual, using common tools and masks, to remove the material. There is also no way to know if there is asbestos present without a trained abatement professional diagnosing the situation. This means Do It Yourself (DIY) projects are risky unless the project is cleared by a professional. Though it’s geared for Canadian citizens, for a more in-depth, concise Q&A review, the Montreal Gazette article is worth reading.

The US has not banned asbestos usage entirely, though it may now be closer since recent passage of the Frank R. Lautenberg Chemical Safety for the 21st Century Act that replaced the outdated Toxic Substances Control Act (TSCA) of 1976.

Asbestos, once hailed as the “miracle mineral”, should be banned globally as this miracle has turned into a legacy of death for far too many people.

New Staging Categories Means More Treatment Options

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When a patient is diagnosed with mesothelioma, a disease stage is also assigned. The stage determines the treatment plan for the patient. These standards for stage evaluation have been updated through a project led by Dr. Valerie Rusch, renowned mesothelioma specialist from Memorial Sloan Kettering Cancer Center in New York. This re-categorization will lead to additional options for some patients diagnosed with stage 3 or stage 4 mesothelioma.

At this time, stage 3 mesothelioma means:

• The cancer is located on one side of the body
• The tumor has spread to other organs
• The tumor has spread to the lymph nodes

A stage 4 mesothelioma diagnosis means:

• The cancer has spread to both sides of the body
• The tumor has spread to multiple different organs
• The cancer has progressed through both the lymph node system and the blood vessels

The new system changes how stage 4 is diagnosed and how stage 3 is categorized. Instead of identifying patients with large tumors as stage 4, they will now be “3b”, opening up more therapeutic and surgical options to them, while also giving more hope.

Generally, staging for mesothelioma is based on the TNM Staging System. The size the spread of the cancer is represented by letters.

• T = size of tumor and its spread to nearby tissues
• N = cancer spread to lymph nodes
• M = cancer spread to other parts of the body

Numbers are attached to these letters which categorizes them further. These go from “0” meaning no cancer found to “4” meaning metastatic cancer.

“For instance, right now, anything that’s stage T4 is considered stage 4 disease, and stage 4 disease for any patient automatically means ‘the end of the road.’ That’s now been moved to stage 3b, and only metastatic disease is stage 4,” Dr. Rusch commented while speaking at the 2016 International Mesothelioma Interest Group conference.

This new categorization begins in 2017. Until that time, many clinicians are using the new system in advance of its formal adoption. This is great news for some patients who are now eligible for treatments that can prolong their lives.

Asbestos in the USA

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For many decades, it has been known that asbestos can cause cancer. A limited ban was placed by the U.S. Environmental Protection Agency on asbestos products and their use in the 1970s. These limitations left room for asbestos to continue to pose a health risk with current products that can affect health for the next 40 years or more.

Where is asbestos found?
Asbestos laden new products that continue the threat include brake linings, window caulk, electrical panels, fire proofing and prevention materials, and plastics –such as electrical cladding, terminal boards and blocks, hard floor tiles, missile casings. In addition to new products, asbestos can still be found in buildings and products from the 1970s and earlier.

What is the risk?
Dr. Jae Y. Kim, chief of thoracic surgery at the City of Hope cancer center in Duate, California, says, “There is no known safe threshold of asbestos exposure. As far as we know, even significant amounts in a short period can cause long-term health problems.”

Who is at risk?
Homeowners remodeling their homes, if built in the 1970s or earlier, should have their homes checked for asbestos materials before starting any remodeling projects. If found, only abatement professionals should remove the materials to avoid spreading fibers throughout the house. Mechanics doing brake work on cars, planes, busses, and trains can be exposed via the dust created. Even workers who clean industrial areas that might contain asbestos are susceptible to breathing the fibers.

Inform your doctor of exposures
If you have been exposed to asbestos fibers, let your doctor know so you can be monitored for any signs of an asbestos-related disease over time. Exposure can cause asbestosis, which scars lungs and increases cancer risk, lung cancer, or mesothelioma – a fatal form of cancer caused almost exclusively by asbestos exposure. It may take 50 years from exposure to diagnosis, so be aware of any exposure risks and take precautions now. What may seem harmless now may be deadly later.

VA Lessens Need to Choose Between Hospice and Cancer Treatment

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Too often, cancer patients and their families must choose between traditional hospice limited to palliative care and active treatment of their disease. Fortunately, the Veterans Health Administration (VA) has taken a lead in offering both hospice/palliative care and cancer therapy concurrently in the United States (US). This is a major step in what has been demonstrated in clinical trials to improve quality of life for cancer patients, and, potentially a longer life as well.

Traditionally, when entering hospice, a patient transitioned to a new paradigm – new medical goals, new medical team, perhaps new surroundings. The intent was to provide comfort, symptom relief, and mental relief, both psychologically and spiritually. The US medical establishment has lagged behind the United Kingdom (UK) for the past two decades in merging palliative care into the full range of cancer care.

Palliative care in the US was recognized for its financial benefits initially. Through this model, resources were used more effectively and there were fewer readmissions – both highly prized in the Diagnosis Related Groups reimbursement model, which sets payments and penalizes hospitals for readmissions. But creating a system where patients must choose either hospice or treatment has significant drawbacks. People on the palliative care of hospice no longer had access to treatments that could possibly give them better quality of life, or even extend their lives. Those patients who chose treatments, but not hospice, were denied the extra support and management of symptoms that palliative care offers.

In the 2015 Quality of Death Index, the US came in 9th place behind the UK, the Netherlands, Germany, Taiwan, Belgium, Ireland, New Zealand, and Australia. However, the Centers for Medicate and Medicaid Services (CMS) is currently piloting a new program for Medicare beneficiaries that could change that standing. Patients in the program can receive both palliative and anticancer therapies through any of 140 Medicare-certified hospices enrolled for a period of five years. Patients must fit certain criteria to participate.

Hurdles remain before the US can move up the ladder to providing the best care in the world to its citizens, but with the VA leading the way, and the CMS providing a pilot program for comprehensive care, the US can move up a needed rung on that ladder.

Asbestos Cement Water Pipes – A Lurking Danger

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Recently Hillary Clinton announced a plan to remediate lead pipes from our nation’s infrastructure. A necessary plan to be sure, however there is another dangerous pipe throughout the United States – asbestos cement (AC) pipe, also called Transite. This pipe was primarily manufactured and sold from the 1950s through the early 1990s, though it was used as early as 1931 – especially in the western US. This pipe is comprised of a mixture of Portland cement and asbestos fibers. It was, and is, used for a variety of applications, including drainage systems, water works systems, sewage drains, and gas lines.

Originally the pipe lifespan was considered 70 years, meaning many miles of it is now deteriorating from age and, in some cases, from environmental factors. Many cities have already replaced the pipe and in the next few years strategic replacement planning will need to be implemented for those that have not replaced it.

As it breaks down, pipe used in water systems can leach asbestos fibers into water leading to potentially serious health hazards. Ingesting water from pipes with loose asbestos fibers can cause occurrences of peritoneal mesothelioma. Those who worked in manufacturing the pipe, in repairing it, or in removing it are subject to inhaling the asbestos dust. This can lead to the development of asbestos-related injuries. It is of the utmost importance to have safety measures in place to prevent airborne fibers and to provide protective equipment for workers.

Asbestos, the “miracle” mineral of the last century – strong, fireproof, flexible, with so many uses – has become a deadly legacy for many.