NYC-WTC_000195068

NYC 9/11 Public Portal Document

* ASBESTOS MEDITEXT ® - Medical Management Page 10 of 15

reporting of mesothelioma as an occupational disease. 2. CLINICAL PRESENTATIONS include the following - a. A large unilateral pleural effusion is the most frequent presenting manifestation of malignant mesothelioma (Gefter & Conant, 1988). Uncommonly, mesothelioma may present as a solitary pleural mass. b. A characteristic aching, nonpleuritic chest pain may precede development of any radiographic findings (Gefter & Conant, 1988; Miller, 1990). c. A small percentage of patients may present with repeated episodes of benign pleurisy with resolving effusions (Gefter & Conant, 1988). d. Abdominal pain, a palpable mass, or increased abdominal girth are the usual presenting symptoms of peritoneal mesothelioma (Talcott & Antman, 1988). e. Pericardial effusion and tamponade, brachial plexopathy, Homer's syndrome, dysphagia, and the superior vena cava syndrome are less common presentations (Talcott & Antman, 1988). 3. CLINICAL COURSE - The 1-year survival rate of mesothelioma patients is less than 30 percent; no efficacious treatment has been identified, although intensive multimodality therapy has been shown to prolong the disease-free interval (ATSDR, 1990; Newhouse, 1983; Talcott & Antman, 1988). 4. DOSE-RESPONSE RELATIONSHIP - Although there is a correlation between asbestosis and risk of mesothelioma, pleural and peritoneal tumors may occur with exposures of less than a year (ATSDR, 1990; Newhouse, 1983). A multiplicative relative risk of 1.9 was estimated for each fiber-year/mL of exposure (Albin et al, 1990). 5. SMOKING - Unlike asbestos-related bronchogenic carcinoma, mesothelioma risk does not appear to be influenced by smoking (ATSDR, 1995; Berry et al, 1985; Muscat & Wynder, 1991). 6. FAMILIAL MESOTHELIOMA - Reports of mesothelioma among family members with no direct occupational exposure to asbestos have been reported and attributed to "bystander" exposure to other family members who have direct asbestos exposure (Huncharek et al, 1989; Li et al, 1989; Giarelli et al, 1997; Schneider et al, 1996; Maltoni et al, 1995; Dodoli et al, 1992; ATSDR, 1995). Others have suggested the role of genetic factors (Hammar et al, 1989). a. Two genotypes have been identified with increased risk of mesothelioma: GSTM null, and NAT2 (slow-acetylator). Each confers a 2-fold increased risk, and individuals with both genotypes have a 4-fold higher risk; when combined with asbestos exposure, this risk increases to 7-fold, compared to those with "beneficial" genotypes GSTMl and NAT2 (fast-acetylator) (Hirvonen et al, 1995). 7. COMMUNITY ACQUIRED EXPOSURE - Numerous reports and case series have been published which document an increased risk of mesothelioma in non-asbestos workers in various locations where local asbestos industries exists (Berry, 1987; Magnani et al, 1997; Rogers & Nevill, 1995). Local asbestos bearing deposits also appear to increase risk (Selcuk et al, 1992). In some cases, local asbestos containing minerals are used to produce whitewash (Sakellariou et al, 1996; Constantopoulos et al, 1991). 8. FIBER TYPE effects include the following - a. In a retrospective study of 94 asbestos related mesotheliomas, Roggli et al (1993) found amosite asbestos in 81 percent of the cases which accounted for 58 percent of all fibers 5 mcm of greater in length. Tremolite/actinolite/anthophyllite were found in 55 percent of all cases; chrysotile was found in 21 percent of all cases; crocidolite was found in 16 percent of all cases. This suggests that crocidolite asbestos may not be responsible for most mesotheliomas in the USA. E. PULMONARY CARCINOMA

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NYC-WTC_000195078