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52 amerikaanse wetenschappers hebben verklaard dat chrysotiel asbest in remvoeringen mesothelioom kan veroorzaken. Zij stellen dat ook kortdurende en lage niveaus van asbestblootstelling mesothelioom kunnen veroorzaken. In de wetenschappelijke literatuur komen honderden gevallen van mesothelioom onder automonteurs voor. De verklaring is een reactie op de verdediging die de Amerikaanse auto-industrie voert bij het Hooggerechtshof van Michigan. Men probeert daar aan te tonen dat het aangevoerde bewijs voor mesothelioom door chrysotiel asbest in remvoeringen wetenschappelijk ondeugdelijk is (“junk science”. Bron: Welch, L.S. et al., (2007). Asbestos Exposure Causes Mesothelioma, But Not This Asbestos Exposure: An Amicus Brief to the Michigan Supreme Court. International Journal of Occupational Environmental Health.13:318-327.

Welch, L.S. et al., (2007). Asbestos Exposure Causes Mesothelioma, But Not This Asbestos Exposure: An Amicus Brief to the Michigan Supreme Court. International Journal of Occupational Environmental Health.13:318-327.
Abstract
Manufacturers of asbestos brakes, supported by many manufacturing and insurance industry amicus curie, requested the Michigan Supreme Court to dismiss testimony of an expert regarding the ability of asbestos dust from brakes to cause mesothelioma as “junk science” Scientists are concerned with the sweeping and unequivocal claims that any conclusion that asbestos from brakes caused a signature asbestos-related disease in a particular person must be “junk science.” The manufacturers” sweeping pronouncements are what veer
from accepted, reliable mainstream scientific methods and conclusions. This article outlines the evidence supporting the conclusion that asbestos from brakes can and does cause mesothelioma, and describes the defendants” attempts to fabricate doubt about this conclusion.

Franse huisartsen zien bij rokende longkankerpatiënten nogal eens over het hoofd dat asbestblootstelling een rol kan hebben gespeeld bij het ontstaan van de ziekte. Franse longartsen zijn daar echter wel alert op. Bron: Verger, P. et al. (2007). Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician’s, specialty, workload, and role perception. OEM online, 10 okt 2007, doi:10.1136/oem.2007.035808.

Verger, P. et al. (2007). Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician’s, specialty, workload, and role perception. OEM online, 10 okt 2007, doi:10.1136/oem.2007.035808.
Abstract:
Objectives: To study physician barriers to workers&rsquo. compensation claims for asbestos-related cancers, focusing on smokers&rsquo. stigma and physicians&rsquo. speciality and role perception.
Methods: Cross-sectional telephone study of 486 randomly-selected physicians: general practitioners (GPs) and pulmonologists in southeastern France. Standardised questionnaires explored their behaviour, attitudes and practices in the field of occupational health and their responses to a case-vignette about a lung cancer patient with long-term occupational asbestos exposure. Randomised subgroups of GPs and pulmonologists heard alternative versions
varying only in the worker&rsquo.s smoking status. We studied factors associated with the recommendation that the case-vignette patient file a compensation claim with simple and multiple logistic regressions.
Results: The response rate was 64.4% among GPs and 62.5% among pulmonologists. Recommending the filing of an occupational disease claim was significantly associated in multiple logistic regressions with speciality (OR=4.46. 95%CI=2.38-8.37, for pulmonologists versus GPs), patient&rsquo.s smoking status (OR=3.15. 95%CI=2.11-4.70, for non-smokers versus smokers), physician&rsquo.s workload (OR=1.83. 95%CI= 1.17-2.88, for &le.25 consultations per day versus &gt.25), and role perception (OR=2.00. 95%CI=1.22-3.27, for those who considered completing occupational disease medical certificates to be part of their role versus those who did not).
Conclusions: The results of this French study appear applicable to various countries and contexts. To make physicians and especially GPs more aware of occupational health and smoking stigma, officials and educators must give these topics higher priority during initial training and continuing medical education. Tools and equipment that take time constraints into account.

Biochemicus Peter Duesburg stelt dat schade aan chromosomen de directe oorzaak is van het ontstaan van kanker en niet een bij-effect van de versnelde celdeling. Dat geldt vooral voor kankersoorten die door gevaarlijke stoffen als asbest ontstaan. De menselijke cel bevat 40.000 genen die in 23 verschillende groepen zijn verdeeld, genaamd chromosomen. Bron: The Irish Times, 16 augustus 2007.

Finse onderzoekers constateerden dat aan asbest blootgestelde bouwvakkers die in herfst of winter geboren zijn relatief vaker fibrose aan de longen hebben dan degenen die in lente of zomer geboren zijn. Een mogelijke verklaring is dat herfst- en winterkinderen vlak na de geboorte vaker infecties aan de luchtwegen hebben die hen gevoeliger maken voor de effecten van asbestvezels later in hun leven. Bron: Hannu, T. et al., (2007). Season of birth and lung fibrosis among workers exposed to asbestos. Chronobiology Intenational 24(3):539-552.
Hannu, T. et al., (2007). Season of birth and lung fibrosis among workers exposed to asbestos. Chronobiology Intenational 24(3):539-552.
The season of birth has been suggested to influence the development of some diseases, but its role in lung fibrosis seems to not have been studied previously. The aim of this study was to investigate the relation between the season of birth and fibrotic abnormalities as detected radiologically in high-resolution computed tomography (HRCT) among workers exposed to asbestos. The HRCT examination was performed on 528 study subjects. Multiple ordinal regression analysis adjusting for covariates was used to study the relations between birth month or season and radiological fibrosis signs. Subjects born in autumn or winter had more extensive fibrotic changes than those born in spring or summer. This applied to all fibrotic changes, apart from subpleural nodules, but only the overall fibrosis score, septal lines, and honeycombing showed statistically significantly higher values in comparison to spring births. The highest scores were detected among those born in autumn and winter months (September-February). These results suggest that there are differences in fibrotic radiological abnormalities according to the season of birth in adults exposed to asbestos. Several hypotheses could explain the observed findings, including the effects of early respiratory infections, cold temperature, and differences in air pollution levels, as well as some metabolic and hormonal effects.

Een artikel in het Britse blad Nursing Standard beschrijft de specifieke uitdagingen voor verpleegkundigen bij de zorg van mesothelioompatiënten, een groep waarmee zij steeds meer in aanraking komen omdat het aantal patiënten nog steeds toeneemt. Maligne mesothelioom vereist een speciale aanpak omdat de ziekte zowel medische als juridische gevolgen heeft. In het Verenigd Koninkrijk moet de ziekte bijvoorbeeld gemeld worden bij de politie. Er bestaan geen nationale richtlijnen voor de behandeling. Nursing Standard, 21, nr. 42, juni 2007, pag. 24-25.

Slechts de helft van de Australische asbestslachtoffers met mesothelioom krijgt behandeling met het medicijn Alimta vergoed. Het hangt af van het gebied waarin men woont. Bron: The Advertiser, 29 augustus 2007

In een Italiaans onderzoek werden bij 32 van 169 mesothelioompatiënten (19%) andere primaire tumoren gevonden. Bij al deze pati&euml.nten was asbestblootstelling aanwijsbaar. De onderzoekers adviseren nader onderzoek naar gemeenschappelijke oorzaken van maligne mesothelioom en bepaalde andere tumoren. Bron: Bianchi, C & T. , (2007). Malignant mesothelioma of the pleura and other malignancies in the same patient. Tumori, 93, 19-22.

Bianchi, C &amp. T. , (2007). Malignant mesothelioma of the pleura and other malignancies in the same patient. Tumori, 93, 19-22.

Aims and background: The co-existence of mesothelioma, mostly asbestos-related, and other primary malignancies has repeatedly been reported. The present study evaluated the frequency of such an occurrence. Methods: In the period October 1979-June 2002, 215 cases of malignant pleural mesothelioma were diagnosed at the Hospital of Monfalcone, Italy. All the cases of the above series, examined at necropsy (169), were included in the study. Occupational histories had been obtained from the patients or from their relatives by personal or telephone interviews. In 132 cases, asbestos bodies were isolated after chemical digestion of lung samples. The thoracic cavities were examined for pleural plaques. Results: Additional malignancies were observed in 32 cases (18.9%). Multiple tumors were synchronous in 22 cases, metachronous in 8 cases, and synchronous and metachronous in 2. Four different tumors were found in 2 cases, 3 malignancies were detected in 6 patients, and 2 malignancies in the remaining 24. The most frequent additional malignancies were prostate adenocarcinoma (7 cases), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5 cases), bladder carcinoma (4 cases), kidney carcinoma (4 cases), large bowel carcinoma (4 cases), and liver cell carcinoma (4 cases). All the patients had histories of exposure to asbestos, mostly in shipbuilding. Lung asbestos body burdens ranged between 60 and 230,000 per gram of dried tissue. Pleural plaques were found in 26 cases. Conclusions: In contrast with other series of the literature, in the present cases the co-existence of mesothelioma and other malignancies appeared as a relatively frequent event. The lack of a control group does not allow definite conclusions about the meaning of the occurrence. However, the co-existence of certain tumors with asbestos-related mesothelioma suggests that mesothelioma and associated malignancies might share some etiologic factors (asbestos and others)

De Britse gezondheidsautoriteit NICE is teruggekomen op een eerdere uitspraak dat het medicijn Alimta niet door de National Health Service (NHS) vergoed zou moeten worden. Een jaar geleden oordeelde NICE dat er niet genoeg bewijs was dat behandeling met dit medicijn beter werkt dan voordeliger behandelingen. Artsen, patiëntengroepen en farmaceut Ei Lily gingen tegen deze uitspraak in beroep. Nu wordt in een richtlijn vermeld dat chemotherapeutische behandeling met een combinatie van Alimta en Cisplatine aanbevolen is en door de NHS moet worden vergoed. Bron: The Times, 9 juli 2007.

Een Schotse gezondheidsdienst heeft verzuimd een mesothelioompatiënt te informeren over de mogelijkheden van schadevergoeding en aan welke voorwaarden daarvoor moet worden voldaan. Het slachtoffer overleed drie maanden na diagnose zonder dat aan de voorwaarde van een biopsie ter herbeoordeling van de diagnose was voldaan. Pas na zijn dood hoorde zijn vrouw over de mogelijkheden om in aanmerking te komen voor een schadevergoeding. De Schotse ombudsman Publieke Diensten oordeelt dat de Gezondheidsdienst excuses moet aanbieden aan de weduwe. Bron: The Herald, 21 juni 2007.

Biomerkers als Soluble mesothelin-related peptide (SMRP), osteopontine en megakaryocyte potentiating factor (MPF) zijn nog niet voldoende accuraat om cytohistologie als gouden standaard voor de diagnose van maligne mesothelioom te vervangen. Aldus een overzichtsartikel en een onderzoeksverslag. Biomerkers zijn eiwitten in het bloed die iets kunnen zeggen over de aanwezigheid of verloop van sommige ziektes. Bron: Scherpereel, A. &amp. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339. Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35-343.
Scherpereel, A. &amp. Lee, G. (2007). Biomarkers for mesothelioma. Current Opinion in Pulmonary Medicine 2007, 13:339-343.

Purpose of review

Mesothelioma is an incurable cancer and its global incidence continues to increase. There has been strong interest in the search for a biomarker that would be of value for the diagnosis, prognosis and disease monitoring of mesothelioma. Large series evaluating the use of novel candidate markers have recently been published.

Recent findings

To date, global gene profiling studies have failed to find a molecule that reliably captures all subtypes of mesothelioma, and differentiates it from benign pathologies and metastatic carcinomas. Soluble mesothelin-related peptide (SMRP), osteopontin and megakaryocyte potentiating factor have been assessed as markers. SMRP testing is clinically available and provides reasonable diagnostic sensitivity and specificity when applied to serum or pleural fluid. Elevated SMRP levels can occur in metastatic, especially ovarian and pancreatic, adenocarcinomas. False negatives are common with sarcomatoid mesothelioma. SMRP levels may reflect tumor load and disease progression. The role of SMRP in predicting mesothelioma development in subjects exposed to asbestos has raised interest. Osteopontin lacks specificity as a diagnostic marker for mesothelioma but may have value in disease monitoring.

Summary

The proposed markers have insufficient accuracy to replace cytohistology as the gold standard for diagnosis for mesothelioma. Elevated SMRP levels raise suspicion of mesothelioma although negative values do not exclude disease. Its role in disease monitoring in patients and in predicting disease development in at-risk individuals warrant further study.



Grigoriu, B.D. et al., (2007). Utility of Osteopontin and SerumMesothelin in Malignant Pleural Mesothelioma Diagnosis and Prognosis Assessment. Clin Cancer Res 13 (10), may 15, p 2928-35

Abstract

Purpose: Malignant mesothelioma is a highly aggressive tumor and is often diagnosed too late for a curative treatment.We compared diagnostic and prognostic values ofmesothelin and osteopontin in172 patients suspected ofmalignant pleuralmesothelioma (MPM) and in a control group

of 112 asymptomatic asbestos-exposed subjects.

Experimental Design: Osteopontin and mesothelin were assayed with commercial ELISA kits in a series of 43 patients with pleural metastases of various carcinomas, 33 patients with benign pleural lesions associated with asbestos exposure, 96 patients with MPMs, and 112 asbestos-exposed healthy subjects. Results were correlated with patient’s diagnosis and survival.

Results: Serumosteopontin level was higher in MPMpatients compared with healthy asbestos exposed subjects and had a good capability to distinguish between these two populations. However, osteopontin was unable to distinguish between MPM and pleural metastatic carcinoma or benign pleural lesions associated with asbestos exposure. Neither plasma nor pleural fluid osteopontin were more powerful in this respect. Serum mesothelin had a good ability for diagnosing MPM but was unable to identify patients with nonepithelioid mesothelioma subtypes. Survival analysis identified tumor histologic subtype along with serum osteopontin and serum mesothelin as independent prognostic factors in mesothelioma patients.

Conclusions: Osteopontin has a lower diagnostic accuracy than mesothelin in patients suspected of MPM. Insufficient specificity limits osteopontin utility as diagnosticmarker. Bothmolecules have a potential value as prognostic markers.