Because mesothelioma is a relatively rare form of cancer, it is often difficult to diagnose and treat.  Fortunately, researchers all over the country are working hard to improve our understanding of the disease in order to develop better treatments, and ultimately a cure for this terrible disease.

At the Mesothelioma Program at M. D. Anderson Cancer Center at the University of Texas, a team of multidisciplinary scientists and physicians have made significant strides in developing more accurate methods of surgical staging for malignant pleural mesothelioma.  “Staging” is the medical term for the process of determining the extent to which a tumor has spread through the body.

Proper Staging of Mesothelioma Essential to Treatment

M. D. Anderson’s team of more than 30 physicians have worked together to develop an innovative surgical staging process that helps them properly assess and describe the extent of the disease.  This is crucially important, because mesothelioma must be properly staged before a patient begins treatment in order to provide the most effective therapy.  For example, surgical procedures such as extrapleural pneumonectomy (EPP) are can be very effective for a patient in the early stages, but are generally not recommended for patients in the later stages.

Initially, staging is usually done through radiographic imaging, such as a CT scan, an MRI, and/or a PET scan.  Doctors may also use serum mesothelin blood tests to measure certain proteins that are secreted by mesothelioma tumors.  These tests may also be confirmed by biopsy or thoracentesis.

Surgical Staging Also Required Before Surgery

However, these methods are not entirely accurate.  As a result, all patients who undergo surgery at M. D. Anderson also undergo a thorough surgical staging to ensure the mesothelioma has not spread to the lymph glands or abdomen.  This is done through a minimally invasive laparoscopic procedure, usually on an outpatient basis.

According to Dr. Anne Tsao, Director of the Mesothelioma Program, this surgical staging is crucially important to make sure that the patient is a viable candidate for surgery.  Dr. Tsao explained that, “the reason why it’s so hard to treat is often times people have more extensive disease than what we initially realize from the radiographic imaging.  So here at M. D. Anderson before we make the patient undergo a very large surgical procedure, we have to do a smaller surgery that stages the patient to be sure that they’re a correct candidate for that surgery.”

Attorneys Recognize Important Strides Toward Improved Treatment

Attorney Gary Galiher and the law firm Galiher DeRobertis Ono have represented clients with mesothelioma for more than 30 years.  Our attorneys and staff have seen firsthand the devastating effect of this disease on patients and their families.  Gary Galiher says, “We salute the physicians and researchers at M. D. Anderson who are making important strides toward improving the treatments for mesothelioma and giving patients real hope for a cure.”

The International Mesothelioma Program (IMP) at Brigham and Women’s Hospital in Boston has already made significant progress in developing new treatments to extend the lives of mesothelioma patients.  Under the leadership of Dr. David Sugarbaker, the specialists at the IMP have pioneered a number of innovative multimodality therapies.  IMP researchers have also collaborated with other institutions to enhance the scientific understanding of mesothelioma.

Quality of Life Issues Addressed by IMP

Just as importantly, the clinicians and researchers at the IMP are working on ways to enhance the quality of life for mesothelioma patients and their families.  Despite all the improvements in treatment, mesothelioma is still a difficult disease, and the treatments themselves can be grueling.   Even with the best care, the disease can take a heavy toll on mesothelioma patients and their loved ones.  Members of the IMP team are well aware of this fact, and are working to find ways to help patients cope with their disease, and to ease the burden on their caregivers.  Some of the concerns raised by patients include fatigue, feeling anxious or afraid, depression, pain and cognitive problems sometimes called “chemo brain”.  A mesothelioma patient will need to find a new balance or equilibrium to his life.  One’s personal goals and needs will change so that quality of life is redefined by the patient as he journeys through his treatment.

Having represented hundreds of mesothelioma clients over the last 32 years, attorney Gary Galiher commends the IMP for making the mesothelioma patient’s quality of life issues an integral part of their multidisciplinary team approach to patient care.

IMP Study Focuses on Mesothelioma Patients’ Quality of Life

In order to take a more focused look at the quality-of-life needs of mesothelioma patients, the IMP has recently reopened a new study which seeks to identify the factors that make the biggest difference in a mesothelioma patient’s quality of life.  The study is being conducted by Alice Kornblith, a senior research scientist at Dana-Farber Cancer Institute, and is funded by the International Mesothelioma Program. Kornblith hopes to enroll up to 400 IMP patients in this effort to compile a database of information about mesothelioma symptoms and quality of life.

The patients who enroll in the study will be asked to complete special questionnaires every three weeks for a period of 36 weeks.  The questionnaires will collect information about their ongoing symptoms, their pain, their physical functioning, and their emotional and psychological concerns.  This will allow researchers to get a better understanding of the factors that affect a patient’s quality of life, and will help them assess the impact of various different treatment regimens on the patient’s overall sense of well-being.

One sub-set of the study will focus on mesothelioma survivors who are cancer-free for one year or more after completing treatment.   According to Kornblith, “Little is known about this group of patients, but as therapy improves and more patients survive longer, it is important to understand how survivors adjust to their disease, how their quality of life is affected, and what supports might be beneficial for them.”

This research will be used at the IMP and other mesothelioma treatment facilities to better address the quality-of-life needs of mesothelioma patients.  Clinicians will be able to use the study’s data to identify the greatest needs of mesothelioma patients, and create new treatment protocols and support services to enhance patients’ health and well-being.

The Canadian asbestos industry has stirred up serious controversy in the province of Quebec in recent weeks, as Canadian health experts and opposition party members call for a re-examination of Canada’s export of asbestos to the developing world.  So far, the Quebec government has rejected these calls.  Indeed, the majority Liberal party recently refused to even create a parliamentary committee to study the health effects of exporting the nearly 175,000 tons of asbestos that are mined in Quebec and shipped all over the world.

The controversy began with Premier Jean Charest’s trade mission to India in early February.  Before this visit, Charest received a letter from a coalition of over 100 scientists from 28 countries, calling upon the premier to speak out about the hazards of India’s growing asbestos industry.  The scientists asked Charest to recognize the international consensus that all forms of asbestos cause asbestosis, lung cancer, and mesothelioma, and present a serious threat to human health.  Accordingly, the letter asked Charest to stop promoting the use of asbestos in India and other developing countries.

Chrysotile Asbestos

Unfortunately, rather than speaking out about the hazards of asbestos on his trade mission, Premier Charest insisted that: “Chrysotile can be used in a safe manner; this is what WHO reports say.  It is not a banned substance.  It is up to the government of India to put the necessary laws in place.”

In fact, the World Health Organization (WHO) says no such thing about the safety of chrysotile asbestos.  According to Maria Neria, the director of public health at WHO, the organization’s “position is very, very clear” that “all types of asbestos are carcinogenic.”  As noted in a recent article in The Lancet magazine, WHO guidelines state that “increased cancer risks have been observed in populations exposed to very low levels.”  The WHO has further stated that “the most effective way to eliminate asbestos-related disease is to stop using all types of asbestos.”

Despite the strong international consensus that all forms of asbestos cause lung cancer and mesothelioma, the Quebec government has so far refused to stop exporting deadly and carcinogenic asbestos to India and other poor countries.  On the contrary, the  government continues to support the Chrysotile Institute, which lobbies internationally to minimize the health hazards of asbestos and prevent international organizations from banning the material.

So far, the voice of Canada’s $100 million a year asbestos industry has outweighed the voices of scientists and worker advocates.  However, public health experts are extremely concerned about the high rates of mesothelioma, asbestosis, and lung cancer that are likely to emerge in the developing world as a result of Canada’s ongoing exports of this toxic substance.

According The Lancet, asbestos disease already claims the lives of 90,000 people a year worldwide.  Asbestos which is mined in Canada today will continue this deadly legacy for another generation.

The law firm of Galiher DeRobertis Ono has represented clients with asbestos-related diseases, including mesothelioma, for over 30 years.  We have seen first hand how this toxic and carcinogenic substance has harmed workers and their families.   Our firm urges the Quebec government to halt the export of Canadian asbestos, so that the dire public health consequences can be avoided.  It is time to stop this deadly industry.

Pearl Harbor Naval Shipyard

Two of Hawaii’s historic military bases will be merged this year as part of an effort to make the military more efficient by combining 26 installations nationwide.  On February 1, 2010, military officials removed the chain-link fence separating Pearl Harbor Naval Station from Hickam Air Force Base, beginning a process of integration at the new Joint Base Pearl Harbor-Hickam (JBPHH).

The missions of the two neighboring bases will remain separate, as the joint base will continue to service two distinct branches of the Armed Forces.  However, installation management and support services will be combined.  This merger comes as a result of a 2005 report by an independent panel on military bases, which recommended the merger of a number of bases around the country in order to save money on administrative and personnel costs.  These savings will be put to work funding the military operations in Iraq, Afghanistan and elsewhere.

Joint Base Will Encompass Many Historic Sites

Most people are well aware of Pearl Harbor’s historic role in World War II.  More than 1000 sailors lost their lives during the infamous aerial attack on December 7, 1941, which launched the United States’ involvement in the War against the Axis powers.

In addition, Pearl Harbor Naval Shipyard became the hub of maintenance and repair for Navy vessels in the Pacific theater.  Thousands of Navy personnel and civilian shipyard workers toiled bravely to keep our country’s battleships, destroyers, carriers, submarines, and other vessels in fighting shape.  The sacrifices of these brave men and women are memorialized at the USS Arizona Memorial, the Battleship Missouri Memorial, and the USS Bowfin Submarine Museum and Park.

Hickam Air Force Base also played a key role in World War II.  The air station was another major target on December 7, 1941, as the Japanese strafed and bombed the U.S. aircraft there.  The attackers killed 189 people at Hickam, and wounded 303 others.  One of the Hickam barracks still bears the bullet holes from the Japanese machine guns.

Galiher DeRobertis Ono has represented numerous shipyard workers and Navy veterans who were exposed to asbestos on Navy vessels at Pearl Harbor Naval Shipyard.  We have also represented Air Force mechanics and civilian employees at Hickam, who were exposed to asbestos in the buildings or in the aircraft components.  Tragically, these veterans and workers remain at an elevated risk for mesothelioma, lung cancer, and other asbestos-related diseases.

Map of Rajasthan, India

Most people in the United States today are aware that asbestos is a dangerous and potentially deadly substance.  Asbestos is no longer commercially mined for domestic use in the U.S., and asbestos-containing products have largely been banned.  There are a host of federal agencies such as the Environmental Protection Agency (EPA) and National Institute for Occupational Safety and Health (NIOSH) that work to protect workers and consumers from the hazards of asbestos.  As a result, American workers are not usually exposed to raw asbestos without respiratory protection.  In developing countries like India, however, the picture for workers is vastly different.

The Growth of the Indian Asbestos Industry

Despite the overwhelming scientific evidence that asbestos causes mesothelioma, lung cancer, and asbestosis, the Indian asbestos industry is alive and well.  India is a leading importer of raw asbestos, purchasing hundreds of thousands of tons of chrysotile asbestos from Canada, Russia, Brazil, and Zimbabwe.  Asbestos is also mined commercially in the Indian state of Rajasthan.

Most of this asbestos is manufactured into asbestos cement, which is widely used as a construction material in impoverished villages and shantytowns throughout India.  The Indian asbestos industry has had great success in promoting asbestos cement roofing, pipes, and siding to India’s poor.  According to the Indian business daily Business Standard, the asbestos cement industry in India produces almost 4.5 million tons of asbestos products annually, and is growing at a “healthy” 10-12 percent a year.

Unfortunately, it is becoming increasingly clear that Indian workers and consumers are paying a heavy price for this “healthy” growth in the asbestos industry.  This large-scale industrial use of asbestos is leading to high rates of occupational exposure, household exposure, and environmental exposure.  As a result, India is likely to face an epidemic of asbestosis, lung cancer, and mesothelioma.

Indian Workers at Risk

Asbestos disease is already a major problem in the mining region of Rajasthan.  Many of the asbestos mines there are operated illegally.  According to the asbestos mine workers who attended a recent workshop by the Occupational and Environmental Health Network of India, the working conditions in the mines are horrendous.  Not surprisingly, this has led to a high rate of asbestos disease among the miners.  The India Times recently reported that three former mining workers from a single mining district have died of asbestosis in the last six months alone.

Working conditions in India’s asbestos processing plants are also extremely hazardous.  A recent study of the small-scale asbestos mills of Rajasthan showed that many workers in these units are diagnosed with asbestosis after only five years of exposure, far less than the usual 20 year latency period.  Researchers also reported extremely high concentrations of airborne asbestos fibers in these plants, up to 18-22 fibers per cubic foot of air.  By contrast, the permissible exposure limit in the U.S. is 0.1 fiber/cc.

In addition to this heavy occupational exposure in the asbestos mines and processing plants, there is also a high risk of secondary exposure among users of asbestos products.  Construction workers and pipefitters often cut asbestos cement pipes and roofing as they are installed, generating large amounts of asbestos dust that settle over the nearby streets and houses.  This puts both the workers and the nearby residents at risk for mesothelioma and other asbestos diseases.

The Asbestos Industry’s Pattern of Denial

Indian labor unions, environmental groups, and public health experts are working hard to educate the Indian people about the hazards of asbestos, and have repeatedly asked the Indian government to ban the mining and manufacture of asbestos products in India.  Unfortunately, the Indian asbestos industry has been largely successful in whitewashing the hazards of asbestos, thereby insulating themselves from any real accountability for the harm caused by their toxic product.

Rather than warning workers and consumers about the deadly properties of asbestos, Indian asbestos industry officials continue to insist that their product is safe, and even environmentally friendly.  In an interview with the Toronto Star, an executive at Visaka Industries insisted that the company’s asbestos cement products were not at all hazardous to workers or consumers, and were “not creating carcinogenicity in any way.”  Indeed, he went so far as to state that asbestos “is such an environmentally friendly product actually.”  Likewise, in a recent Business Standard story, industry officials described the production of asbestos cement as “environmentally benign,” and insisted that their products were perfectly safe.

Tragically, this approach seems to be working.  Rather than banning asbestos, the Indian government is currently considering an expansion of asbestos mining in Rajasthan to promote economic development in this very poor region.  Unless the situation changes dramatically, it appears that India will be facing an epidemic of mesothelioma and other asbestos diseases for many decades to come.