The fact that asbestos exposure can cause malignant mesothelioma and other asbestos-related diseases is well established.  However, despite years of research, the actual mechanisms by which asbestos fibers cause disease on a cellular level remain unclear.  The International Mesothelioma Program (IMP) research team at the Brigham and Women’s Hospital in Boston continues to investigate the role of asbestos in the development of mesothelioma.  They hope these studies will improve mesothelioma patient treatment and recovery leading to the ultimate goal of finding a cure for this deadly tumor.

Focusing on Asbestos Fibers

Researchers such as John Godleski, M.D. at the International Mesothelioma Program want to answer three basic questions about asbestos in the body and its relationship to mesothelioma.  They want to know what kinds of asbestos fiber are present, how much is there and where those fibers are located.  Using various scientific equipment and innovative techniques including confocal microscopy, chemiluminescence on in vivo or live tissue, and scanning electron microscopy, they are able to answer some of these questions.

Confocal microscopy captures images that are cross-sections of tissue samples.  These two-dimensional slices can be combined to create a three-dimensional volume or model which helps researchers visualize the precise locations of the asbestos fibers in the tissue.  Knowing where the asbestos fibers are located is key to understanding the mechanism of translocation, which is the way asbestos fibers deposited in the lungs are transported to the pleura or lining in the lungs and abdomen.

The amount of reactive oxygenation species or ROS present in a tissue sample can be measured using in vivo chemiluminescence techniques.  High levels of ROS can damage DNA and may be linked to the development of cancers such as mesothelioma.  The IMP research team uses chemiluminescence to determine the timing and location of this important process.

Lastly, when asbestos fibers are identified accurately, the amount of asbestos fibers or fiber burden can be estimated with electron microscopes.  The type of fiber may be compared with the patient’s asbestos exposure history to correlate certain fiber types with the development of mesothelioma.

Possible Implications for Mesothelioma Treatment and Prognosis

One approach to prevent the development of mesothelioma is to try to block, disrupt or alter the process of translocation of asbestos fibers from the lungs to the pleura.  As noted earlier, in vivo chemiluminescence can identify susceptible regions like the lymphatic system involved in the translocation process.  This information could be used to slow down the movement or allow removal of the fibers before they are able to develop mesothelioma in the pleura.

The IMP investigators observed that pleural malignant mesothelioma patients with lower asbestos burdens have a higher survival rate than those patients with the highest burdens.  They discovered an association between asbestos fiber burden and degree of tumor suppressor gene silencing.  Higher asbestos burden corresponded to an increase in epigenetic silencing of tumor suppressor genes in mesothelioma.  This may explain why patients with lower asbestos fiber burden are predicted to have better clinical outcomes.

Need for Asbestos Research Remains

The use of asbestos through the 1980s and later in the United States and long latency means that mesothelioma will affect a significant number of exposed individuals for the foreseeable future.  Gary Galiher, a lawyer who has represented mesothelioma patients for more than 30 years, agrees with the International Mesothelioma Program researchers that “additional studies of the role of asbestos in the development of mesothelioma are necessary and will help improve treatment and prognosis of this deadly cancer.”

Mesothelioma patients and their families face many concerns as they seek treatment for this asbestos-related disease.  In addition to the extensive number of tests and procedures that may be needed to diagnose this rare cancer, many patients are concerned about the cost.  Patients worry that they may not be able to pay for the best treatment options offered by their doctors and medical team.

Many mesothelioma patients seek treatment at the International Mesothelioma Program (IMP) at the Brigham and Women’s Hospital (BWH) in Boston, Massachusetts.  This unique program includes doctors from many disciplines, including  pathologists, surgeons, oncologists, and clinicians, all focused on finding the best treatment options and ultimately a cure for mesothelioma.  Dr. David Sugarbaker, the Chief of Thoracic Surgery at Brigham and Women’s Hospital, is the founder and director of the International Mesothelioma Program.

The entire team at the International Mesothelioma Program has dealt with issues related to the cost of medical care for many years and can help guide patients through the process.  Dr. Sugarbaker considers this guidance part of their overall mission to ensure that patients receive all of the support and advice they need at every level.

Treatment is the First Priority

The International Mesothelioma Program works with the patient’s health insurance provider to ensure that a lack of personal financial resources does not interfere with the patient’s mesothelioma treatment – whether it is surgery, chemotherapy, radiation therapy, or a combination of therapies.  There may be differences in allowable benefits among health insurance providers, including private insurers such as Blue Cross/Blue Shield PPO plans and HMOs like Kaiser Permanente, federal Medicare and state Medicaid programs, Veterans Affairs’ beneficiaries and dependents, and active duty military personnel covered by Tricare.  However, each insurer has an obligation to honor the terms and conditions of the patient’s insurance policy or plan benefits.

A Patient’s Role and Obligations

When a mesothelioma patient contacts the International Mesothelioma Program for a consultation or evaluation, the administrators at Brigham and Women’s Hospital work with the health insurance carriers or plan administrators to verify eligibility and obtain payment approvals.  To accomplish this, current insurance information from the patient as well as a referral from the primary care physician or treating doctor is needed.  In some cases, additional documentation such as a statement of a lack of necessary and recommended care at the patient’s local hospital or medical clinic is required before treatment at the International Mesothelioma Program may begin.  While the staff at the International Mesothelioma Program often deals with the insurance carrier directly, they may ask for the patient’s help to expedite matters by obtaining certain required documents or contacting the primary care physician.

Recent Patients’ Experiences

Some of the mesothelioma patients seeking treatment at the International Mesothelioma Program are represented by Gary Galiher, an attorney with over 30 years experience handling thousands of asbestos-related personal injury claims.  Over the years, some of his clients have had surgery performed by Dr. Sugarbaker to remove the mesothelioma cancer.  Attorney Galiher is mindful of the importance of ensuring their health insurers work hand in hand with the IMP staff:

“We are all aware of the high costs associated with medical care and treatment, especially when surgery and hospital care are required.  The treatment which Dr. Sugarbaker and his team at the International Mesothelioma Program provides includes surgery to remove the visible mesothelioma tumor, followed by a treatment of chemotherapy drugs.  This surgery is typically followed by a few days of recovery in the Intensive Care Unit and another week or 10 days of hospitalization.  Because of the associated costs, it is important that a patient’s health insurance company and the IMP staff coordinate closely with each other.”

One such patient had private insurance while another received health care benefits through Veterans Affairs because of his military service.  Both of these patients received prior approval from the insurance company and Veterans Affairs respectively before their operations.  With all that a mesothelioma patient is dealing with, seeking pre-approval from the medical insurance carrier may seem stressful and overwhelming.  The team at the IMP has vast experience in working with the various medical insurance carriers and will lend a supportive hand so a patient’s treatment can be scheduled expeditiously, and financial concerns about insurance coverage will not be a stumbling block to proceeding.

USS Laffey DD-724

The historic U.S. Navy destroyer USS Laffey DD-724 is one step closer to returning to her berth at Patriots Point Naval and Maritime Museum in South Carolina after major repairs to her hull were completed in February 2010.  The Laffey is the last floating Sumner Class destroyer, one of a large class of ships that utilized hundreds of tons of asbestos insulation on board.

Recently, she faced her greatest threat of sinking since enduring ferocious kamikaze attacks during the invasion of Okinawa near the end of the War in the Pacific in 1945.  A 2008 inspection report by the staff at the Patriots Point Museum discovered several significant leaks that caused thousands of gallons of seawater to enter the lower sections of the ship.  Emergency repairs to these hull breaches were made, the water was pumped out and steps for longer term solutions were developed.

A Call to Action

Just as they did before, many Navy veterans and other supporters rallied to save the Laffey.  They donated time and money, lobbied local, state and federal agencies for funds, and volunteered to work on the ship.  Since the museum relies on donations, memberships and visitor revenue to maintain and operate its collection of historic ships, government loans were needed to pay the multi-million dollar cost to repair the hull.  The USS Laffey Association, Tin Can Sailors and other groups organized and publicized this most recent Laffey rescue.

Months of Hard Work Ensures a Solid Future

On August 19, 2009, the USS Laffey was transported to Deyten’s Shipyard in North Charleston, South Carolina and placed in drydock for a comprehensive repair of her hull and damaged compartments.  The restoration effort took nearly five months with crews working around the clock to remove and replace rusted or corroded steel plates and frame members.  She was refloated recently and the museum hopes that the Laffey can return to Patriots Point sometime next year.

USS Laffey Not Alone

Other vessels at the Patriots Point Naval and Maritime Museum including the aircraft carrier USS Yorktown CV-10, Balao Class submarine USS Clamagore SS-343, and Coast Guard cutter USCGC Ingham WHEC-35 have substantial maintenance and repair costs.  Ship museums across the country have similar issues.  The USS Missouri Memorial Association recently completed 18 million dollars worth of restoration to the USS Missouri BB-63 at Pearl Harbor Naval Shipyard.

Preserving a Legacy of Sacrifice

The Navy veterans who served aboard the USS Laffey and other ships as well as the shipyard workers who kept these vessels operating and ready for action deserve to have their contributions and sacrifices honored.  Unfortunately, their legacy includes exposure to asbestos as well as combat duty.  Attorney Gary Galiher, who has represented many Navy veterans and shipyard workers with mesothelioma and other asbestos-related diseases such as lung cancer and asbestosis, has visited the Laffey and other museum ships and submarines to support his clients’ cases.  Gary Galiher says, “These museums are important resources which help bring the realities of being and working aboard ships to life.  People can appreciate better the living and working conditions that may be lacking in a ship plan or blueprint.”

On January 28-29, 2010, the ASTM (American Society for Testing and Materials) Committee D22 on Air Quality sponsored the Michael E. Beard Asbestos Conference 2010:  Laboratory Issues.  This year’s conference, held in San Antonio, Texas was named in honor of Michael E. Beard (1940-2008) who served as Chair of ASTM International Subcommittee on Sampling and Analysis of Asbestos for many years.  This committee is responsible for developing methods for monitoring asbestos  in different materials and has hosted six conferences on these issues at Johnson State College and the University of Vermont, beginning in 1986.  Mr. Beard was a long-time supporter and organizer of the ASTM International Johnson Conferences on asbestos.

Presentations at this conference focused on asbestos issues as they relate to people working in laboratories, users of analytical data, as well as those who interpret the results of laboratory investigations.  The conference showcased some of the most recent investigations and included discussions of new ideas and interpretation of the data.

Conference Highlights

The conference agenda highlighted four areas of interest for scientists and laboratories studying asbestos exposure, including:

1. Analysis of soil and other media
2. Quality assurance, training, and inter-laboratory studies
3. Definitions of asbestos, cleavage fragments and NOA (naturally occurring asbestos) considerations
4. Issues of laboratory interactions with NVLAP (National Voluntary Laboratory Accreditation Program), assessors and government agencies

These issues are relevant not only to people diagnosed with asbestos-related diseases such as mesothelioma, lung cancer and asbestosis and the medical teams treating them, but to commercial interests and government regulators too.  Researchers from the Environmental Protection Agency (EPA), National Institute of Occupational Health and Safety (NIOSH), and New York State Department of Health were among the scheduled speakers.

Test for Detecting Asbestos in Vermiculite

A presentation on a possible new method for detecting asbestos in Vermiculite attic insulation could help homeowners who may have this material in their houses.  This asbestos-containing product was mined at W.R. Grace’s mines in Libby, Montana and distributed nationally.  Another presentation explains a technique to distinguish sepiolite from chrysotile used in industrial gasket materials.  Lastly, there was a presentation on a new ASTM draft method for fibers in floor tiles.

Three Presentations by James Millette, Ph.D.

One of the symposium’s co-chairs, James Millette, Ph.D., made three presentations.  The first topic covered the analysis of soil and other media, the second was an overview of a method to analyze talc for asbestos, and the third discussed the practical aspects of cleavage fragment and asbestos determination.  The law firm of Galiher DeRobertis Ono has worked with Dr. Millette and many other distinguished experts to investigate claims of people injured by exposure to asbestos and asbestos-containing products.