Pleural Cancer Demographics

The Miami Science Museum was closed over the Thanksgiving weekend because workers found asbestos in a room near the planetarium.

Called the mechanical room – the location of the facility’s heating, ventilating, air conditioning (HVAC) and other plant operations – the location is integral to the entire museum, though the asbestos that was found did not enter the air supply to the museum, according to onsite air-quality testing performed by Miami-Dade County environmental regulators.

Reports on the actual closing date vary, from Thanksgiving evening (Thursday, Nov. 24) to Friday evening. The one news item that remains consistent is the fact that asbestos was found, but only in that one area. Comprehensive testing of the rest of the museum did not turn up any other contamination.

The Miami Science Museum was built in 1960 in response to rising local demand. The asbestos found in the mechanical room was apparently isolated on a single wall, and probably dates to construction, according to Frank Steslow, the museum’s COO.

The planetarium was added in 1966, and in the last decade museum staff have expanded operations to include one of the largest summer science camps in the nation, reaching students ages 3 to 14, on a yearly operating budget of $2.5 million.

And even then, the single instance remained largely intact, according to Patrick Wong, division chief of the Miami-Dade Department of Environmental Resources Management. Which is a good sign, since undisturbed or undamaged asbestos is not generally considered a health risk, according to the U.S. Environmental Protection Agency, or EPA.

Once widely used in everything from wall insulation to floor tiles and pipe wrap, asbestos use has been steadily declining in the U.S. In spite of that, imported products from countries that permit asbestos manufacture (China, India and Russia, among others), and mining of the mineral across the border in Canada, means that Americans are still facing legacy costs of an estimated $50 billion per year from asbestos illnesses.

These include asbestosis, a progressive respiratory disease similar to emphysema; small cell and non-small cell lung cancers; and mesothelioma, a cancer of the linings that surround and protect the lungs, heart and abdominal organs.

The latter is particularly disconcerting. As a disease, it tends to lie dormant for up to five decades before exploding into a lethal, fast-moving cancer that generally results (after diagnosis) in a prognosis of about one year to live.

There is no cure, and even aggressive approaches like surgery, chemotherapy and radiation, alone or in combination, are rarely more than palliative therapies designed to improve breathing and reduce the pain associated with mesothelioma.

It is estimated that 10,000 Americans die from asbestos-related diseases yearly, 2,500 of them from mesothelioma. Of the latter, as many as three quarters die from the form of malignant mesothelioma that attacks the lungs (pleural mesothelioma), while only about 20 percent succumb to pericardial mesothelioma, or the form that occurs in the lining around the heart.

Originally, testing at the Miami Science Museum was reportedly triggered by a former employee who complained that insulating material from the ceiling had fallen on him and several of his friends. That material was tested and found not to contain asbestos. Not so for the material on the wall. However, air quality testing by EE&G Environmental Services LLC, after that material was professionally removed, showed no further contamination, either in the room or elsewhere.

Several events had to be cancelled, but the museum reopened Wednesday, Dec. 1. The likelihood that asbestos will again be a concern is slim, since most of the facility was renovated in 1991 using more modern materials that did not contain asbestos, thanks to the EPA’s 1989 ban on the substance in the manufacture of domestic products.

School district officials in Hollister, Missouri, announced that a broken pipe caused severe flooding in the town’s junior high school. As cleanup crews went to work on the soaked classrooms, they discovered that the glue used to hold the tile in place used asbestos as a binding agent. Work crews made the discovery after the classrooms dried and the tile peeled loose from the concrete floors.

The school contacted a local asbestos remediation firm, Horizon Environmental, to remove the asbestos-laced adhesive. After the remediation project has been completed, Horizon will also conduct air and surface tests to determine if the area is asbestos-free. Hollister School District Superintendent Tim Taylor said that the asbestos cleanup work on the school should be finished within two days. Once the school receives the all clear, crews will install and wax new tile in the affected areas.

Mr. Taylor said that the installation process for the new tile could take up to two weeks. He also remarked that the “big concern” for the district is “the safety of the students”, not the project timetable. The project would push back the start of the school year for junior high students. During the tile installation project, the two hundred junior high students would attend classes at the local high school. The high school added eight new classrooms last year, so overcrowding will not be a problem.

Mr. Taylor also mentioned that the original building for the junior high school was constructed in 1984. He said that he expects the school to be asbestos-free when the district reopens the building. He also mentioned that the school’s insurance policy would cover the repairs, estimated to cost up to $200,000.

Asbestos was still in common use in carpet and tile cements, but was on the decline as a building material from its height in the 1940s and 1950s. In the earlier part of the last century, asbestos was widely used in insulation and fireproofing materials. In recent years, scientists have discovered a link between asbestos exposure and lung disease. Asbestos fibers, when disturbed, can become an airborne toxin. Workers who do not take the proper protective measures can inhale the microscopic fibers, which embed themselves into the tissue surrounding the lungs. These fibers can affect the cell structure of the tissue and cause a deadly and incurable form of cancer known as pleural mesothelioma.

Debbie Redford, a spokeswoman for the school district, told reporters that students would also be housed in computer centers and the school library during the renovation. She also mentioned that the district had other spaces available if the need arose. Ms. Redford complimented the teamwork demonstrated by faculty and staff members during this unexpected situation, saying that their effort “has been outstanding”.

With seventh- and eighth-graders entering the high school’s facilities, principals and faculty at both schools will make adjustments to the class schedules to avoid overcrowding in the halls and cafeteria. Travis Shaw, the principal at Hollister Junior High, said that, despite the frustrations, “we’ll make it work”.

Sources:
http://www.ky3.com/news/local/Hollister-MO-school-district-shifts-junior-high-to-high-school-temporarily-100422739.html
http://www.news-leader.com/article/20100811/NEWS01/8110428/Flooding-reveals-asbestos-at-Hollister-Junior-High

Congress has authorized a $4.3-billion spending bill to address health care expenses for police officers, firefighters and first responders who became sick from working on the site of former World Trade Center Towers in New York City after the Sept. 11, 2001, terrorist attacks.  Both the US House of Representatives and Senate voted to approve the measure last week.  The bill now sits on President Obama’s desk, awaiting his signature to enact its passage into law.  The president has previously suggested that he would sign the bill.

The destruction of the World Trade Center buildings aired a cloud of dust and debris that carried several varieties of toxic chemicals, including asbestos. Firefighters, paramedics, construction workers, and residents of nearby structures have exhibited symptoms of various lung diseases in addition to mental health problems believed to be associated with exposure to the site of the tragedy.

The measure, which has been promoted by its sponsors since shortly after the attacks, apportions government revenue to supply funds to the World Trade Center Health Program. The program furnishes medical examinations and treatments for people with traumas or illnesses attributable to the attacks and the subsequent environmental effects. The US Department of Health and Human Services will oversee the plan’s administrative functions.

Speaker of the House Nancy Pelosi (D-CA), remarked during the debate on the bill about the first respondersí ìsacrifice and their courageî.  ìHow can we ever repay (them)?î she asked the members of the House.  She said that, "Today we do so, certainly not as enoughî, she called it a ìtoken of our appreciationî for the duties that both workers and volunteers carried out that day.

A few weeks after the attacks, Congress had created a fund to help victims and first responders deal with their illnesses, but closed the program to further claims in 2003.  The new legislation will reopen that fund, as more and more people come forward with illnesses that they developed in the months and years since 9/11.

During the debate, the measure became known as the ìZardroga Billî, named after James Zadroga.  Mr. Zadroga was a detective with the New York City Police Department.  He died in 2006 at the age thirty-four of respiratory failure.  Supporters of the bill claimed that his death was directly attributable to the toxins found in the dust at Ground Zero.

A new study released in the New England Journal of Medicine determined that the 9/11 attacks left thousands of first responders from the New York City Fire Department with respiratory impairment that they endured for the last seven years.  Additional studies have discovered that the growth of asthma occurring among those workers who answered emergency calls to the World Trade Center on September 11 is almost double that found in the population at large.

In the case of asbestos exposure, symptoms often do not appear for decades after the initial exposure period.  The carcinogenic fibers become embedded in the pleural mesothelium, a band of tissue surrounding the lungs, and force the cells to mutate into malignant cancers.  Patients diagnosed with the disease seldom live more than two years.

According to Potsdam Village Administrator Michael D. Weil, the abatement – involving about 16 feet of asbestos insulation on boiler piping – will be performed by fully certified and licensed LVI Environmental Services of Massena.
The asbestos was reportedly discovered during the installation of new HVAC (heating, ventilating and air conditioning) equipment in the Civic Center.
The asbestos remediation is not the first at the Center. In November of 2009, according to Weil, Potsdam officials approved spending $50,000 to remove asbestos from other areas in the Center in order to create a community resource center in the basement.
These areas included not only the basement, but parts of the upstairs village courtroom and an administrative office near the front entrance.
The resource center is the brainchild of the Potsdam Public Library board, and the work – expected to take place during the week of August 9 – will take place after normal working hours to insure the safety of Center workers and members of the public who use the facility.
In spite of previous and repeated efforts to remove all the asbestos, some dating back to the early 1980s, Weil admits that the Center might still contain some asbestos, largely because of its extreme age.
The Potsdam Civic Center is housed in the historic Potsdam Water Works building at 11 Raymond Street. The building was first erected in 1871 at a cost of about $50,000 and added to in 1890.
Still, Weil asserts, the building has been repeatedly tested by both state officials, from the New York State Department of Labor, and private building hazard and contamination assessors, and so far all the air quality tests conducted have come back negative for asbestos fibers.
This includes 100 samples taken in November and subjected to electron microscopy testing – an all-encompassing survey that followed on the heels of the deaths of two Potsdam city employees, Sharon M. LaDuke and Linda M. Power, both within weeks of one another.
LaDuke died in May of pleural mesothelioma, and Power died in June of ovarian cancer. The first, mesothelioma, is only caused by asbestos fibers, according to scientists who have researched the illness. Asbestos is also responsible for small and non-small cell lung cancers, asbestosis, diffuse pleural thickening, and fibrosis.
Of them all, mesothelioma is the only disease with an extended latency (sometimes up to 50 years), after which tumors become highly aggressive and spread rapidly to involve considerable vital tissue and organs.
There is currently no cure for mesothelioma, and aggressive therapies like surgery, radiation and chemotherapy – while offering relief of pain and improved breathing – do not extend lifetimes by more than a few months, whether used individually or in combination. In fact, most patients diagnosed with the disease die within a year.
The best hope for mesothelioma, in fact, may be new tests which sample pleural fluid for protein markers associated with mesothelioma and provide a positive diagnosis long before the tumors are visible on scans or evident from specific symptoms.
At the Potsdam Civic Center, where asbestos contamination has been identified in the mastic used to affix ceiling tiles in the courtroom, continued surveillance of the premises will help ensure others do not contract mesothelioma or any of the other diseases associated with the hazardous material.

Mesothelioma can be described as a dangerous neoplasm originating from the mesothelial surfaces of the pleural and peritoneal cavities, the pericardium or the tunica vaginalis. Around 80% of all diagnosed cases are pleural in nature. Exposure to asbestos has been identified as the primary cause of malignant mesothelioma and around 70% cases of pleural mesothelioma have been linked with documented exposure to asbestos. In this article, the epidemiology and pathology of mesothelioma will be discussed. Treatment options, and other topics such as clinical presentation, evaluation, and staging of malignant mesothelioma have been discussed separately.

Cancer statistics are only estimates and cannot be calculated with absolute certainty because they are based on large populations and factors can vary within each individual case.
It is important for patients to keep in mind that cancer statistics are only possible outcomes. The data may significantly vary on incidence, prevalence, and mortality for various age groups, time periods, and cancer stages, so the most relevant cancer statistics are those that most closely match a patient’s individual case. The stage of cancer that a patient is in at time of the diagnosis largely determines largely what the outcome of the disease will be.

The quality of life can get severely affected due to pleural mesothelioma. A variety of approaches are available to drain out the effusion and prevent its reaccumulation.

• Treatment is not required for asymptomatic patients with malignant pleural effusions. An initial therapeutic thoracentesis is recommended for patients who experience symptoms resulting from a malignant pleural effusion. The reaccumulation rate of the pleural effusion and the patient’s symptomatic response should be determined.

Management of patients who have undergone initial thoracentesis and require treatment for recurring symptomatic effusions includes:

• Repeat outpatient therapeutic thoracentesis should be given preference over pleurodesis or an indwelling catheter in case of patients with shorter life expectancy (less than 3 months) who experience slower reaccumulation of malignant pleural effusion (for instance, more than a month).
• For majority of patients whose reaccumulation rate of malignant pleural effusion is fast enough to create problems with multiple repeat thoracentesis (for instance, less than a month), fluid removal via an indwelling pleural catheter or chemical pleurodesis via catheter or thoracoscopy is recommended instead of repeat therapeutic thoracentesis.

• For patients who experience rapid reaccumulation of pleural effusion, several different factors (for instance, the patient’s preferences and characteristics, agent availability and clinical experience) help ascertain the most appropriate management approach.

• Radiotherapy and/or systemic chemotherapy when administered to the underlying cancer can help control the effusion in specific malignancies (for instance, lymphoma, breast, prostate, ovarian, thyroid). However, these therapies are often not sufficient to control symptoms resulting from other types of malignant pleural effusions.

Your decision to shoulder the responsibility of a caregiver most probably implies that you share a close bond with the mesothelioma patient. This relationship, in turn, would give you a better understanding of the physiological, emotional and spiritual needs of the patient. You will also be responsible for the proper implementation of care and treatment directives issued by health care professionals. To perform this duty effectively, you will have to gather information from the patient and make it available to the appropriate person from the medical team. You may also have to develop a detailed plan for dealing with day to day issues concerning the patient.

Patient Communications

The nature of the disease is such that most patients and their family members are taken aback by the news of the sudden, and often late, diagnosis. Only a few manage to recover quickly from the initial shock and are able to take timely decisions regarding their care and treatment. However, most patients react negatively and very often go into a state of denial. Your role, as a caregiver, would require you to understand the patient’s fears and concerns and provide reassurance that you will always be there to provide the required help. Allow the patient to have these conversations on their own time, thereby giving them a sense of control over the situation, especially at a time when most decisions regarding their life and medical condition are being made by others.

Working with Health Care Professionals

When accompanying the patient for medical checkups, you need to be ready with a list of questions or queries that you or the patient may have regarding the illness or the treatment plan. It’s essential that you do not overlook symptoms, no matter how small or insignificant they might appear. Be ready with all the information that the health care team members might require and ensure that you always carry a pen and paper when communicating with health care professionals. Write down everything and make a file so that you can access the required information, as and when needed.

Taking Help from Family and Friends

If you wish to provide the best possible care to the patient, it’s always advisable to seek help from other family members and close friends. You can allocate specific tasks or responsibilities to them based on their individual strengths or define specific roles that they can manage easily. Avoid being judgmental of how others contribute to the cause of providing care to the patient. The key to success in this effort is working as a team.

Anyone who was exposed to asbestos for more than a couple of months between 20 and 50 years ago is at the greatest risk for mesothelioma. Mesothelioma is a cancer of the lining around the lungs, and it’s aggressive, fast-growing, and deadly. Most people don’t realize that they have it until they start experiencing symptoms like chest pain and shortness of breath. At that point they see their doctor, thinking that they’re having a problem with their heart. When they’re told that they have mesothelioma, they wonder how they could’ve gotten something like that. They’ve often forgotten about their asbestos exposure, or they don’t realize that they were ever exposed to it because they didn’t actively work with it on a daily basis.

People who were close to an asbestos worker – like his spouse and children – could also be in the risk category for mesothelioma. Asbestos workers brought home fibers of the substance on their skin, hair, and clothing, and those fibers became airborne in their homes, where they were inhaled by other people. There are also risk factors for people who lived and worked for long periods of time in houses and buildings that had asbestos insulation, and for people who worked on Naval vessels, where asbestos insulation was also used. If you fall into one of the at-risk categories, see your doctor even if you feel fine. Mesothelioma is much more treatable when caught early.

If you don’t understand your risk for a disease, it can be difficult for you to seek proper preventative care and treatment. However, a lot of people avoid learning about their risk for something because they don’t want to be frightened, or spend their time worrying over something that might not happen. That’s perfectly understandable and often works out in most cases, but mesothelioma is something you really need to know your risk factors for. If you’ve been exposed to asbestos in the past for longer than a month or two, you should see your doctor and discuss testing options with him. People who’ve been exposed to asbestos can develop mesothelioma 20 to 50 years after exposure, and they won’t show symptoms until the disease is already advanced.

With that in mind, don’t wait until you’re experiencing chest pain and shortness of breath before you visit your doctor to talk about your asbestos exposure. Be your own advocate and talk with your doctor about the exposure that you had, how long it lasted, and how long it’s been since it took place. From that information, your doctor can recommend any tests that you’ll want to have in order to make sure that you aren’t developing mesothelioma. A clean bill of health is always a good thing, and if you are showing signs of mesothelioma you’ll be able to get it treated more easily when it’s caught early.