Nieuwsarchief

Franse en Amerikaanse onderzoekers beschrijven in twee overzichtsartikelen de ontwikkelingen in de diagnostiek en behandeling van asbestgerelateerde ziekten, waaronder mesothelioom.

Greillier, L. & Astoul, P. (2008). Mesothelioma and asbestos-related pleural diseases. Respiration. 2008;76(1):1-15. 
ABSTRACT
At present, the use of asbestos is not regulated at a worldwide scale. Moreover, there is a latency period between asbestos exposure and the manifestations of asbestos-related diseases. Consequently, pulmonologists are still dealing with consequences of asbestos exposure, which mainly occur at the pleural surface. The aim of this review is to provide an overview of asbestos-related pleural diseases. We summarized the most relevant data for the diagnosis and the management of benign asbestos pleural effusions, pleural plaques, diffuse pleural thickening and rounded atelectasis. Special attention is dedicated to malignant pleural mesothelioma, given the challenging issues of this disease, the recent advances in its management and the dynamism of research in this area.

Zervos, M.D. et al. (2008). Malignant mesothelioma 2008.Curr Opin Pulm Med. 2008 Jul;14(4):303-9. 
ABSTRACT
PURPOSE OF REVIEW: Mesothelioma is an aggressive malignancy of the pleura with poor survival. There will be approximately 3000 cases of mesothelioma in the United States annually. Multimodality treatment including neoadjuvant chemotherapy in selected individuals followed by extrapleural pneumonectomy and radiation has been studied in recent trials for its effects on disease free and overall survival This review provides a general overview of malignant mesothelioma with a summary of the most significant articles from within the past year as well as from the past. RECENT FINDINGS: Areas of recent interest include the evaluation of osteopontin and mesothelin as new tumor markers for mesothelioma. New phase III trials have been performed to evaluate the use of combined chemotherapy regimens. SUMMARY: Malignant mesothelioma is a very difficult malignancy to treat. Patients with the disease usually have an occupational asbestos exposure, and in some, viral exposure with SV40. There have been many historical treatments including combinations of local control with surgery and radiation as well as attempts to prevent systemic failure with chemotherapy. Novel therapies including intrapleural chemotherapy, photodynamic therapy and hyperthermic perfusion have also been used with some success. Finally there are several attempts at immunomodulating and targeted treatments, which are in phase I/II trials.

Volgens Rivera et al., is er voldoende bewijs om aan te nemen dat het simian 40 virus de ziekte mesothelioom kan veroorzaken: zowel alleen als in combinatie met asbestcontact.
Het bewijs is echter nog onvoldoende om te kunnen bepalen in welke mate het virus oorzaak is van deze ziekte. Het sv40 virus was oorspronkelijk een virus dat alleen bij apen voorkwam, maar bleek per abuis in de jaren 60 van de vorige eeuw ook in het poliovaccin te zitten.
Bron: Rivera, Z. et al. (2008). The relationship between simian virus 40 and mesothelioma. Curr Opin Pulm Med. 2008 Jul;14(4):316-21.
ABSTRACT
PURPOSE OF REVIEW: Simian virus 40 is present in some human malignant mesotheliomas. The evidence in favor and against a pathogenic role of simian virus 40 in malignant mesothelioma is discussed in this review.
RECENT FINDINGS: When simian virus 40 is injected intracardially into hamsters, 60% develop and die of malignant mesothelioma. Moreover, some human malignant mesotheliomas contain and express simian virus 40 DNA and proteins. To date, over 50 laboratories have detected simian virus 40 in malignant mesotheliomas and in other tumors; however, the variability of the percentage of positivity led to a controversy about the role and significance of simian virus 40 in malignant mesotheliomas. Compared with other cell types, human mesothelial cells are unusually susceptible to simian virus 40-induced malignant transformation. The presence of simian virus 40 in malignant mesothelioma has been associated with the activation of specific oncogene pathways. Cocarcinogenesis between simian virus 40 and asbestos in causing malignant mesotheliomas has been demonstrated in three separate research laboratories using different experimental approaches. Epidemiological data possibly linking simian virus 40 and malignant mesothelioma is lacking owing to unattainable identification of infected from noninfected cohorts.
SUMMARY: Available evidence appears sufficient to link simian virus 40 either alone or in conjunction with asbestos in causing malignant mesotheliomas; however, it is still insufficient to speculate about the contribution of simian virus 40 to the overall incidence of malignant mesotheliomas.

Moshammer en Neuberger concluderen dat de verslechtering van de conditie van de longen een betere voorspeller is van de levensverwachting is dan de kennis over de hoeveelheid asbest waaraan iemand is blootgesteld. Volgens Christensen et al. is er een relatie tussen het aantal asbestvezels dat in de longen aangetroffen wordt en de levensverwachting van een mesothelioompatiënt.
Bron: Moshammer, H. & Neuberger, M. (2008). Lung function predicts survival in a cohort of asbestos cement workers. Int Arch Occup Environ Health. 2008 Apr 12. ABSTRACT

PURPOSE: To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death.

METHODS: From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression.

RESULTS: Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5-1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers.

CONCLUSION: Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.

Bron: Christensen, B.C. et. al. (2008). Asbestos burden predicts survival in pleural mesothelioma. Environmental  Health Perspectives, Jun;116(6):723-6.

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of <1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. OBJECTIVE: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods: We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women's Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n=128), and a subset of cases (n=80) with quantitative asbestos fiber burden measures. Results: Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p<0.04), as well as between nonepithelioid tumor histology and reduced survival (p<0.02). Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight)] into groups of low (0-99 asbestos bodies), moderate (100-1,099), and high fiber burden (>1,099), suggested a survival duration association among these groups (p=0.06). After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI), 0.95-9.5; p=0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5-15.0; p<0.01) versus those with moderate exposure. Conclusion: Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.

De Nederlandse staat krijgt de meer dan 5 miljoen kosten voor de sanering van het asbestschip de Otapan mogelijk niet volledig terug. Een schikking met de voormalige Mexicaanse eigenaar van het schip ,,behoort tot de mogelijkheden”, zei milieuminister Jacqueline Cramer op 23 september j.l. in de Tweede Kamer.

Philips reserveert in het derde kwartaal 2008 241 mln euro om te kunnen schikken in een slepende asbestaffaire in de VS.

Het Spaanse hooggerechtshof heeft kanker aan het strottenhoofd (larynxkanker) als beroepsziekte erkend bij een arbeider die als stuwadoor in de haven van Barcelona geregeld asbest had ingeademd.
In 2006 oordeelde het Amerikaanse ‘Institute of Medicine’ dat er voldoende bewijs is om aan te nemen dat er een causaal verband is tussen asbestblootstelling en larynx kanker. Bron: El Pais, 17 september 2008, Europees Vakbondsinstituut Hesa, 8 juni 2006.

Het Gerechtshof Den Bosch oordeelt een aannemer aansprakelijk voor de angstklachten bij een werknemer ten gevolge van blootstelling aan asbest bij het bedrijf.
Volgens het hof staat vast dat ‘de werknemer onbeschermd met asbest in aanraking is gekomen. In het midden kan blijven hoe lang deze blootstelling heeft geduurd. Het was de verantwoordelijkheid van het aannemersbedrijf om erop toe te zien dat de werknemer niet onbeschermd met asbest in aanraking zou komen. Door deze verantwoordelijkheid niet te nemen, is het aannemersbedrijf tekort geschoten in zijn zorgplicht ex art. 7:658 lid 4 BW’. Op grond van een deskundigenrapport acht het hof voldoende aangetoond dat er causaal verband bestaat tussen de klachten van de werknemer en de blootstelling aan asbest. Bron: Gerechtshof ’s Hertogenbosch, 6 mei 2008: HD 103.003.179, LJN BD5666

Mensen die in de omgeving van een Japanse asbestfabriek hebben gewoond hebben een hoger risico op de ziekte mesothelioom. Datzelfde geldt voor vrouwen die in de omgeving woonden van de blauwe asbestmijn in het Australische Wittenoom.

Kurumatani N, Kumagai S. (2008). Mapping the risk of mesothelioma due to neighborhood asbestos exposure. Am J Respir Crit Care Med. 2008 Sep 15;178(6):624-9.
ABSTRACT
RATIONALE: Little is known about neighborhood exposure to asbestos and mesothelioma risk among residents around an industrial source of asbestos. OBJECTIVES: To investigate the magnitude of the risk among residents by asbestos exposure levels and to determine the range of the area affected by asbestos. METHODS: We calculated standardized mortality ratios of mesothelioma from 1995 to 2006 among the estimated population at risk that lived around a former large asbestos cement pipe plant in Amagasaki City, Japan, between 1957 and 1975, the time when the plant had used crocidolite and chrysotile. The distance between the plant and homes and relative asbestos concentrations obtained by diffusion equations involving meteorological conditions were used to determine asbestos exposure levels among residents. MEASUREMENTS AND MAIN RESULTS: We identified 73 mesothelioma deaths of 35 men and 38 women who had no occupational exposure to asbestos. Among persons who had lived within a 300-m radius of the plant, the standardized mortality ratio of mesothelioma was 13.9 (95% confidence interval, 5.6-28.7) for men and 41.1 (95% confidence interval, 15.2-90.1) for women. When the study area was divided into five regions by relative asbestos concentration, standardized mortality ratios of mesothelioma declined, for both sexes, in a linear dose-dependent manner with concentration. The regions with a significantly elevated standardized mortality ratio reached 2,200 m from the plant in the same direction in which the wind predominantly blew. CONCLUSIONS: Neighborhood exposure to asbestos can pose a serious risk to residents across a wide area.

Bron: Reid, A. et al. (2008). Cancer incidence among women and girls environmentally and occupationally exposed to blue asbestos at Wittenoom, Western Australia. Int J Cancer. 2008 May 15;122(10):2337-44.
ABSTRACT
The impact of crocidolite exposure on the health of former Wittenoom miners and millers (largely male) has been well documented. Less is known about the health outcomes of the 2,968 women and girls who lived (N = 2,552) and worked (N = 416) in the blue asbestos milling and mining town of Wittenoom between 1943 and 1992. Quantitative exposure measurements were derived from dust studies undertaken over the lifetime of the mine and mill and the township. Incident cancers were obtained from the Western Australian (WA) Cancer Registry and the National Cancer Clearing House. Standardized incidence ratios (SIRS) compared Wittenoom females with the WA female population. Exposure-response relationships were examined using a matched case-control study design. There were (47) mesothelioma and (55) lung cancer cases among the 437 cancers in the Wittenoom females over the period 1960-2005. When compared to the WA female population, Wittenoom women and girls had higher rates of mesothelioma and possibly lung cancer. Mesothelioma incidence rates are increasing with the incidence rate of 193 per 100,000 in the period 2000-2005 being more than double that for the period 1995-1999 at 84 per 100,000. A significant exposure-response relationship was present for mesothelioma, but not for lung cancer. Forty years after the asbestos mine and mill at Wittenoom were closed, there is a high toll from cancer among the former female residents of the town and company workers.

Een Britse ondernemer heeft 36.000 pond (ca. 46.000 euro) boete gekregen nadat zijn firma zonder vergunning asbest uit een winkel had verwijderd. Bron: safetymedia.co.uk, 30 september 2008.

Alle Britse mesothelioomslachtoffers komen sinds 1 oktober j.l. in aanmerking voor een vergoeding van gemiddeld 10.000 pond (bijna 13.000 euro) via het Mesothelioma Scheme 2008.