NAACCReview

Rachel Lynch
Press and Media Coordinator
Mesothelioma.com

Before the technological revolution and the automation of everything, the world went through an industrialization period. Americans built things with their hands; tradesmen, construction workers, and laborers of all kinds put their blood, sweat, and tears into the creation of buildings, ships, and goods. This time period also aligns with the height of asbestos use. The umbrella term, asbestos, is used to describe six different fibrous minerals and was widely used because of its ability to resist heat, fire, and electricity.

What is Asbestos?

Modern asbestos use in the United States began in the 1930s and peaked during the early 1970s, before federal regulations and alternative options lead to a decline in use. While more than 60 countries around the world have taken actions to prohibit the mineral’s use, the United States has yet to fully implement its own ban. In addition to the United States, the substance is still legal in Russia and Canada. The continued use of the toxic material around the globe is troublesome due to its complications following exposure. Asbestos causes lung cancer, asbestosis, and the rare mesothelioma cancer; in fact the toxin is the only known cause of mesothelioma.

What is Mesothelioma?

Mesothelioma can develop in the lining of the lungs, heart, or abdominal cavity. The most common form is pleural mesothelioma, which affects the lining of the lungs and accounts for 70 to 80 percent of all mesothelioma cases. According to a 2017 report by the Centers for Disease Control, 2,400 to 2,800 people are diagnosed with mesothelioma in the United States each year. The states with the highest number of mesothelioma deaths, from 2001 to 2010, were California, Florida, Pennsylvania, New York, and Texas. Mesothelioma mortality rates are two to four times higher in port cities and parts of “Rust Belt” states.

Mesothelioma and Seniors

Mesothelioma most often affects senior citizens and, unfortunately, there is currently no cure for the disease. Symptoms of the disease can often take decades to develop following initial exposure to the mineral, resulting in a diagnosis much later in life. After such a long period of time has passed, many patients have forgotten about their exposure period and are often uneducated about the potential risks associated with their previous activity.

Unfortunately, while asbestos use has waned in more recent years there has been an increase in the incidence of malignant pleural mesothelioma (MPM) in patients 70 years of age and older. According to the Italian study, patients older than 65 years of age represent 67.4 percent of the registered MPM population, with 26.1 percent of cases diagnosed between 75 and 84-years-old. This population is underserved across the board in the clinical trial realm – geriatric clinical trials are riskier than those for younger patients because they typically have more unrelated health complications. Due to the lack of clinical trials available to identify the best course of treatment for geriatric mesothelioma patients, awareness is the safest way to ensure the best prognosis possible.

With more awareness and education, the hope is that patients will be knowledgeable about their medical history – including any previous asbestos exposure – and initiate conversations with their medical professionals. Starting these conversations early is paramount because catching the disease in its early stages may improve prognosis and treatment options.

How to Prevent Exposure

While much of the exposure occurred years ago when asbestos was not regulated there is still a danger to the public. It has been thirty years since peak asbestos use in the United States, and there are still upwards of 2000 mesothelioma cases diagnosed annually which proves that the US population is still at risk.

Through 2020, the rate of death for malignant mesothelioma in developed countries is expected to increase by 5 to 10 percent annually.

Asbestos can still be found in homes and public buildings built through the 1970s. If your home or office was built during this time period it is in your best interest to have it inspected for asbestos before completing any renovation projects. Insulation, ceiling/floor tiles, cements, caulking, and furnaces are just some examples of the numerous products that once contained asbestos. While current United States federal law requires that newly-manufactured products contain no more than one percent asbestos, products with higher concentrations of the mineral are still lurking in structures across the country. Invest in your future health by ensuring your spaces are free from the carcinogen.

Zach Jump
Director of Epidemiology and Statistics
American Lung Association

Every two and a half minutes someone in the United States will be diagnosed with lung cancer, with an estimated 234,030 new cases in the United States this year. The American Lung Association’s inaugural LUNG FORCE “State of Lung Cancer” 2018 report is the first time that these national and state lung cancer statistics have been analyzed in one report to show how the toll of lung cancer varies across the country and how every state and the nation can do more to protect residents from lung cancer.

“Nationally, the five-year survival rate for lung cancer is 18.1 percent—meaning four out of five people diagnosed will not survive longer than five years,” said American Lung Association National President and CEO Harold P. Wimmer. “More must be done to save lives, and this new report serves as a powerful tool for identifying both needs and opportunities in every state to turn the tide against lung cancer.”

According to Wimmer, in its inaugural year the “State of Lung Cancer” will serve as a baseline for tracking of efforts to defeat lung cancer, and unveil new opportunities to enact change.

“While we have seen some advancements in lung cancer treatment options and a new method of early detection, the burden of lung cancer is not the same everywhere,” said Wimmer. “The ‘State of Lung Cancer’ report makes it clear that as a nation we need to do a better job. Every state needs to make prevention a priority with proven effective policies, and to also ensure screening facilities are available for those eligible for screening, regardless of where you live. This is how we’ll save lives.”

The LUNG FORCE “State of Lung Cancer” 2018 report finds that lung cancer diagnoses and survival rates vary state by state. By better understanding the impact of lung cancer across the nation, efforts and policies can be focused where the needs are greatest. This report ranks each state on the following:

• Incidence: More than 234,000 people will be diagnosed with lung cancer this year, and the rate of new cases varies greatly by state. The report finds that Utah has the nation’s lowest lung cancer rates while Kentucky has the highest. There are a variety of risk factors associated with lung cancer, including smoking, exposure to radon gas, air pollution and secondhand smoke. Radon testing and mitigation, healthy air protections, and reducing the smoking rate through tobacco tax increases, smokefree air laws and access to comprehensive quit smoking services are all ways to help prevent new lung cancer cases.
• Survival Rate: Lung cancer is often not caught at an early stage, when it is more likely to be curable. The five-year lung cancer survival rate ranges from 24 percent in New York to 15.9 percent in Louisiana. Only 31 states track this important metric, which should be implemented by all states to enhance monitoring of lung cancer, and help identify how to improve lung cancer survival.
• Early or Late Diagnosis: People diagnosed at an early stage of lung cancer are five times more likely to survive, but only 18.9 percent of lung cancer cases are diagnosed at an early stage. The percent of cases diagnosed at an early stage—when it is most likely to be curable—was highest for Wyoming at 23.3 percent and lowest for Hawaii and Oregon at 15.0 percent.
• Screening Centers: The “State of Lung Cancer” finds that those living in states with greater availability of accredited lung cancer screening sites generally have greater early diagnosis and survival of lung cancer. Delaware had the most screening centers per million people at 21.1, while Utah had the fewest centers per million people at 0.7. Raising awareness of screening facilities that perform low-dose CT scans for those eligible can improve patient outcomes.
• Surgical Treatment: Lung cancer is more likely to be curable if the tumor can be surgically removed, and surgery is more likely to be an option if the diagnosis is made at an early stage before the cancer has spread. Nationally, 21 percent of cases underwent surgery as part of the first course of treatment, ranging from 30.1 percent in Massachusetts to 14.3 percent in Oklahoma.

As the American Lung Association works toward defeating lung cancer, it is the goal of the LUNG FORCE “State of Lung Cancer” report to empower the public with the knowledge and information to appeal to state governors and raise awareness of this deadly disease. The report takes a look at key lung cancer measures to highlight the burden and examine opportunities to better address lung cancer at the state level. The report found that in addition to incidence, early diagnosis, and surgical treatment, it is imperative for states to track survival rate and to identify opportunities to enact lung cancer interventions like decreasing exposure to radon and secondhand smoke, and eliminating tobacco use. This report is both a one-stop resource and rallying cry for state officials, policymakers, researchers and those affected by lung cancer and to emphasize the need for resources and action to decrease the toll of lung cancer across the country.

Click here to view the 2018 State of Lung Cancer Report

Jon Patrick, Ph.D
CEO
Health Language Analytics Global

The California legislature has enacted a regulation for all cancer service providers to provide electronic reporting to the Cancer Registry. This is expected to significantly increase the number of organisations supplying reports causing a concomitant enlarged volume of reports received annually. Furthermore across the USA there is an ageing CTR workforce without sufficient attraction of younger staff to sustain workforce numbers. This is further compounded by the ageing population who will also add to the increase of the total volume of cancer cases reported annually.

The California Cancer Registry opted to investigate the use of advance Artificial Intelligence methods to automate the identification of cancer reports and coding of the 5 core cancer attributes required from a report of: Site, Histology, Grade, Behaviour and Laterality. The CCR invited Health Language Analytics Global (HLA-G) to demonstrate the application of their technology to this problem in a project running for 15 months over 2016-17. In November 2017 the CCR decided the trials produced sufficiently accurate results to justify going live with the HORIZON system, fixing a date of 26th January 2018. The installed system has automated 100% of Reportability determinations and codifies 70% of reports, with investigations underway to improve this figure.

The success of this technology enables the CCR to investigate the automatic extraction of other content that could increase its contribution to the wider clinical community. The CCR has now requested HLA-G to provide a version that is updated for the 2018 NAACCR reporting specifications. This will be provided in March 2018.

Click here to view the full release

Sarah Wallace, Health Advocate,
Mesothelioma + Asbestos Awareness Center

September 26th is Mesothelioma Awareness Day – a day dedicated to spread information on the rarity of the disease, as well as its cause, asbestos. Asbestos exposure counts for nearly 80% of all cases of mesothelioma. While legality varies throughout the world on asbestos, its lasting health impact has been well-known and documented throughout the medical community.

Although legislations throughout the world have regulated or outright banned asbestos, the lasting effects of the former wonder mineral still plague society on a global scale. 55 countries globally have outlawed the usage and importation of the deadly substance; however, many large international players, including the United States, still do not have a ban on asbestos. The biggest threat asbestos poses is the manifestation of mesothelioma, a hyper-aggressive cancer that affects the lining of the organs. With only 10,000 annual cases diagnosed globally, mesothelioma remains a rare killer.

Incidence in North America

Due to the heavy usage of asbestos during periods of industrialization, wartime and building, laborers, veterans and tradesmen have, historically, been the most affected demographic for asbestos-related illness. While male diagnoses still account for the vast majority of mesothelioma cases, female incidence rates have been climbing steadily since the early 1990s. Between 2000-2014, there were 12,045 male diagnoses and only 3,808 female diagnoses – these figures include all races. However, when races are divided, white males account for 11,222 – around 93% of all male cases. White females accounted for 3,476 cases, or 91% of all North American incidences of mesothelioma. While Canada is set on a total ban of asbestos by 2018, both import and usage, the United States and the Environmental Protection Agency are still in the process of evaluating its effects and risk on public health.

International Mesothelioma Rates 

While the majority of Europe has banned asbestos outright, new cases do emerge every year. Great Britain remains the epicenter of mesothelioma incidence in Europe, as the country accounts for highest age-adjusted mortality rate in the world, at 18.36 per million people. Australia ranks as the second highest worldwide, with an incidence rate of of 16.7 per million people. While both nations have made it illegal to import or use asbestos, incidences of mesothelioma still climb. Asia accounts for the most rampant current asbestos usage in the world, with China leading the way at 570,000 tons used per year. Although Asian countries such as China, Indonesia, India and Vietnam utilize the material, statistics related to mesothelioma and asbestos-related illness are not readily available. In some preliminary studies, however, China’s incidence rate for malignant mesothelioma is 1.5 per million – substantially low for its usage for industrial purposes.

The Effects of Asbestos Bans

The move to federally ban asbestos is a relatively recent development, with the Scandinavian countries starting the trend in the early 1980s. Thus, conclusive data regarding the decline of mesothelioma in banned countries is not universally known. However, there have been several studies suggesting rates of asbestos-related cancer seem to be in decline in countries that have outlawed the substance. A collaborative study at Umeå University resulted in the conclusion that workers starting their careers in Sweden, either during or after the ban, have a decreased risk of mesothelioma. Furthermore, the study has shown that the ban has resulted in roughly 12 avoided mesothelioma cases per year. Although the study is restricted only to findings in Sweden, similar results are expected to occur in countries after the ban of asbestos.

What’s the Risk?

Mesothelioma, traditionally, was a disease that affected working males – laborers who worked with asbestos on a day-to-day bases. However, more cases are being diagnosed in a multitude of demographics; men and women of all racial backgrounds are susceptible. In America, homes and buildings constructed prior to 1980 run the risk of housing the deadly material, as it was used extensively in insulation, piping and other home applications. If you suspect your home may contain asbestos, seek out a licensed professional for abatement and removal strategy. OSHA has declared that there is no safe level of asbestos exposure, and awareness of potential hazards to health is paramount.