Published On: Wed, Sep 13th, 2017

Why Mesothelioma Deaths Continue to Rise Despite Preventive Measures

Mesothelioma mortality rates in the United States have continued to rise over the last two decades despite increased public awareness and better treatment methods, according to a recent CDC report. Deaths from malignant mesothelioma increased 5 percent each year from 1999 to 2015, rising from 2,479 to 2,597. Over this interval, 45,200 victims died from mesothelioma or from mesothelioma as a contributing cause. The data is consistent with other studies that predict mesothelioma deaths will continue rising until 2020.

Why are mesothelioma deaths continuing to rise even though preventive efforts have increased and public awareness has grown over the last several decades? A review of some historical background will provide context to help shed light on why mesothelioma continues to be a problem in America.

photo/Peggy und Marco Lachmann-Anke

The Discovery of Mesothelioma

Tumors in the lining of the lungs, known as pleura, were first recorded by French pathologic anatomy pioneer Joseph Lieutaud in 1767. By 1819, stethoscope inventor René-Théophile-Hyacinthe Laennec had proposed that malignancy could arise from pleura. However, in 1843, Austrian pathologic anatomist Karl Freiherr von Rokitansky challenged this theory, contending that pleural cancer was always symptomatic of cancer elsewhere in the body. Despite lack of evidence, this remained the dominant theory for the following decades. Gradually, however, the medical community came to accept that cancer could originate in the pleura.

In 1909, British pathologist J.G. Adami gave the name “mesothelioma” to forms of cancer originating in the lining of the lungs, abdominal cavity and heart. In 1931, American pathologists Paul Klemperer and C.B. Rabin proposed a framework for diagnosing mesothelioma and analyzing its pathology.

The Asbestos Link

Klemperer and Rabin’s work inspired other pathologists to begin exploring the causes of mesothelioma. In 1935, British pathologist Steven Gloyne suggested a link to occupational asbestos exposure. This was confirmed in 1943 when German researcher H.W. Wedler reviewed autopsy records for asbestos workers and discovered a pattern of lung and pleural malignancies. The German academic community accepted Wedler’s findings, but due to the political climate of World War II, they were initially ignored elsewhere.

Consequently, it took several more decades for researchers outside Germany to confirm the link between asbestos and mesothelioma. Between the 1940s and the 1960s, studies in South Africa, America and Great Britain gradually advanced the case for a link between asbestos exposure and mesothelioma. By 1968, this link had been generally accepted.

The Battle Against Mesothelioma Begins

As understanding advanced in the postwar years, researchers developed techniques for treating mesothelioma. Surgical treatment methods started in the 1940s as pneumonectomy and pleurectomy techniques developed. The 1960s saw the introduction of pleurectomy/decorticationa, which remains in use today. In the 1970s, pneumonectomy was added as another surgical treatment method. Mortality rates for this surgery were 31 percent at that time, but today they have fallen to 4 percent among the best cancer centers.

Radiation therapies began emerging in the 1950s. By 2001, these had advanced to the point that a clinical trial found just a 13-percent local recurrence rate. Multimodal therapies combining different methods have also developed.

Meanwhile, regulatory authorities began pursuing preventive measures. While the asbestos industry and other industries had begun to suspect asbestos-related health risks in the early 20th century, the U.S. federal government did not intervene until 1971, when the Occupational Safety and Health Administration was created. OSHA began regulating exposure limits at that time, and as scientific understanding improved, exposure limits were gradually lowered throughout the 1970s, and again in the 1980s and 1990s.

Lawsuits gave increased impetus to safety improvements and mesothelioma settlements. Mesothelioma claims have increased as public awareness and injury levels have grown.

The Struggle Continues

Despite medical and regulatory advances, mesothelioma levels continue to rise for a number of reasons identified by the CDC. Mesothelioma symptoms can take twenty to fifty years to begin to appear, and some cases showing up now reflect exposures decades ago when weaker regulatory measures were in effect. Accordingly, mesothelioma rates have been rising among those 85 years and older, while they have fallen for those aged 35 to 64.

However, mesothelioma cases continue to occur among those under 55, indicating other factors at work. Here occupational hazards are the main suspected culprit. In 96 percent of cases where the victim’s industry and occupation was known, the person worked in either the shipyard or the construction industry. Employers and workers in these industries need to remain especially vigilant to prevent mesothelioma.

Author: Carol Trehearn

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