About mesothelioma treatment options - mesothelioma_treatment_options
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"After Helsinki: A multidisciplinary review of the relationship between asbestos exposure and lung cancer, with emphasis on studies published during 1997–2004".
"Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaïve patients with malignant pleural mesothelioma: results of the International Expanded Access Program".
"Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma".
"Prognostic factors for malignant mesothelioma in 142 patients: validation of CALGB and EORTC prognostic scoring systems".
"Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients".
"We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr.
815 (1999) had individual liability from a single corporation and its insurance carriers of nearly $2 billion.
A biopsy may be done in different ways, depending on where the abnormal area is located.
A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985.
A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed.
A thoracoscopy (inserting a tube with a camera into the chest) can be used to acquire biopsy material, and allows the introduction of substances such as talc to obliterate the pleural space (a procedure called pleurodesis), preventing more fluid from accumulating and pressing on the lung.
Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.
After a long period of untreated illness and pain, Zevon was diagnosed with inoperable mesothelioma in the fall of 2002.
After his diagnosis, Gould wrote "The Median Isn't the Message" for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny.
Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors.
As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.
Australian Prime Minister Kevin Rudd mentioned Banton's extended struggle in his acceptance speech after winning the 2007 Australian federal election.
Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease.
Compensation via asbestos funds or class action lawsuits is an important issue in law practices regarding mesothelioma (see asbestos and the law).
Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years.
Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques.
Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes.
Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.
Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism.
For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery.
For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır.
For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer).
For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs.
For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial effusion with pericardiocentesis.
From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women.
Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
Gould lived for another 20 years, eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma.
He claimed James Hardie knew of the dangers of asbestos before he began work with the substance making insulation for power stations.
He continues to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide" in which he presented his philosophy about healing and the decision making that led him to use integrative medicine.
He died of a heart attack on November 7, 1980, in Juárez, Mexico, following cancer surgery.
He had previously survived against slim odds stranded near the summit of Mount Everest with altitude sickness in 2006.
He was given a prognosis of less than a year to live and used a variety of complementary modalities.
However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople.
However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved.
However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity.
However, to date, the US Congress has not stepped in and there are no federal laws governing asbestos compensation.
If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe.
If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma.
In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine.
In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept.
In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma.
In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs.
Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.
Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.
Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia.
It has also been suggested that washing clothes of a family member who worked with asbestos increases their risk for developing mesothelioma.
It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma.
James Hardie made an undisclosed settlement with Banton only when his mesothelioma had reached its final stages and he was expected to have no more than 48 hours to live.
Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).
Marines as a young adult—asbestos was then commonly used to insulate ships' piping—or from its use as an insulating material in automobile racing suits (McQueen was an avid racing driver and fan).
Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects.
Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum.
One notable case was that of June Hancock, who contracted the disease in 1993 and died in 1997.
Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.
Prior to the use of advanced microscopy techniques, malignant mesothelioma was often diagnosed as a variant form of lung cancer.
Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma.
Recently, however, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.
Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver.
Refusing treatments that he believed might incapacitate him, Zevon focused his energies on recording his final album The Wind, including the song "Keep Me in Your Heart," which speaks of his failing breath.
Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients.
Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.
Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the links between asbestos, asbestosis, and mesothelioma became known (some reports seem to place this as early as 1898).
Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group.
Some studies suggested that simian virus 40 (SV40) might have acted as a cofactor in the development of mesothelioma, but these studies have not been corroborated by later research.
The Bruce Vento Hopebuilder award is given yearly by his wife at the MARF Symposium to persons or organizations who have done the most to support mesothelioma research and advocacy.
The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma.
The diagnosis may be suspected with chest X-ray and CT scan, but must be confirmed pathologically, either with serous effusion cytology or with a biopsy (removing a sample of the suspicious tissue) and microscopic examination.
The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year.
The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.
The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.
The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars.
The mesothelioma is indicated by yellow arrows, the central pleural effusion (fluid collection) is marked with a yellow star.
The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph).
The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group.
The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases.
The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system.
These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.
These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs.
This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities.
This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.
This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats.
This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.
To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity.
To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
Using conventional cytology diagnosis of malignant mesothelioma is difficult, but immunocytochemistry has greatly enhanced the accuracy of cytology.
Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation.
While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.
booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information.
regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.
"The Option", an alternate name for the South Tyrol Option Agreement, a resettlement program of German speakers living in Italy initiated by Adolf Hitler and Benito Mussolini
, the risk of mesothelioma appears to increase to the third or fourth power from first exposure.
3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.
Adenomyoma · Pleomorphic adenoma · Mixed Müllerian tumor · Mesoblastic nephroma · Wilms' tumor · Rhabdoid tumour · Clear-cell sarcoma of the kidney · Hepatoblastoma · Pancreatoblastoma · Carcinosarcoma
All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer.
Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome.
Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma.
Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century.
Bernie Banton, an Australian workers' rights activist, fought a long battle for compensation from James Hardie after he contracted mesothelioma after working for that company.
Bob Miner, one of the founders of Software Development Labs, the forerunner of Oracle Corporation, died of mesothelioma in 1994.
By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims.
CT scan of a patient with mesothelioma, coronal section (the section follows the plane that divides the body in a front and a back half).
Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials.
Christie Hennessy, the influential Irish singer-songwriter, died of mesothelioma in 2007, and had stridently refused to accept the prognosis in the weeks before his death.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication.
Despite proof that the dust associated with asbestos mining and milling causes asbestos-related disease, mining began at Wittenoom in 1943 and continued until 1966.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion.
Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century.
Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.
Fibroma/fibromatosis: Aggressive infantile fibromatosis · Aponeurotic fibroma · Collagenous fibroma · Diffuse infantile fibromatosis · Familial myxovascular fibromas · Fibroma of tendon sheath · Fibromatosis colli · Infantile digital fibromatosis · Juvenile hyaline fibromatosis · Plantar fibromatosis · Pleomorphic fibroma · Oral submucous fibrosis
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment.
Harold Hopkins, Australian actor who appeared in films such as The Club, Don's Party, Gallipoli,and the TV mini series Sara Dane died from mesothelioma on December 11, 2011 in a Sydney hospital.
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Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
In Leeds, England the Armley asbestos disaster involved several court cases against Turner & Newall where local residents who contracted mesothelioma claimed compensation because of the asbestos pollution from the company's factory.
In the card game bridge, a treatment is the meaning associated with a natural bid as distinct from a conventional bid
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos.
John William MacDougall, Scottish Labour MP, died of mesothelioma on August 13, 2008, after fighting the disease for two years.
Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma.
Leiomyoma · Angioleiomyoma · Angiolipoleiomyoma · Genital leiomyoma · Leiomyosarcoma · Multiple cutaneous and uterine leiomyomatosis syndrome · Multiple cutaneous leiomyoma · Neural fibrolipoma · Solitary cutaneous leiomyoma · STUMP
Malcolm McLaren, former manager of New York Dolls and Sex Pistols, died on 8 April 2010.
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos.
Merlin Olsen, Pro Football Hall of Famer and television actor, died on March 10, 2010, from mesothelioma that had been diagnosed in 2009.
Mesothelioma (or, more precisely, malignant mesothelioma) is a rare form of cancer that develops from transformed cells originating in the mesothelium, the protective lining that covers many of the internal organs of the body.
Most people who develop mesothelioma have worked in jobs where they inhaled asbestos, or were exposed to asbestos dust and fibers in other ways.
OPTION unit, a fictional weapons platform for the Vic Viper in the Gradius series of video games
Option (filmmaking), a contractual agreement between a film producer and a writer, in which the producer obtains the right to buy a screenplay from the writer before a certain date.
Option (finance), an instrument that conveys the right, but not the obligation, to engage in a future transaction (for example, on some underlying security or on a parcel of real property), or in a futures contract
Option (オプション, opushun?), a catch-all term for similar satellite weapon units which orbit some sort of main unit, appearing in various Japanese video games
Paul Gleason, American film and television actor perhaps best known for his portrayal of Principal Richard Vernon in the 1985 film The Breakfast Club, died in 2006.
Signs and symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and constitutional signs such as unexplained weight loss.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity).
Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos.
Terrence McCann, Olympic gold medalist and longtime Executive Director of Toastmasters, died of mesothelioma on June 7, 2006, at his home in Dana Point, California.
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities.
The most common anatomical site for the development of mesothelioma is the pleura (the outer lining of the lungs and internal chest wall), but it can also arise in the peritoneum (the lining of the abdominal cavity), and the pericardium (the sac that surrounds the heart), or the tunica vaginalis (a sac that surrounds the testis).
The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments.
There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed).
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage.
 Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified.
 People who work with asbestos wear personal protective equipment to lower their risk of exposure.
 The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.
 This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers.
 Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.
 However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008).
 Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare.
 This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.
 The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen.
 However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.
 Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.
 Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium.
 For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000.
 Unlike lung cancer, there seems to be no association between mesothelioma and tobacco smoking, but smoking greatly increases the risk of other asbestos-induced cancers.
 It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004.
 Hennessy's mesothelioma has been attributed to his younger years spent working on building sites in London.
 Some people who were exposed to asbestos have collected damages for asbestos-related disease, including mesothelioma.
 The amounts and method of allocating compensation have been the source of many court cases, reaching up to the United States Supreme Court, and government attempts at resolution of existing and future cases.
 The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa.
 In 1962 McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker.
 The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950.
 In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably" associated with the development of mesothelioma.
 Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.
 However, there is now evidence that smaller particles may be more dangerous than the larger fibers.
 The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.
^ a b c d e Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT (2002).