How Genetics May Affect Mesothelioma Development

The Austalia risk factor for mesothelioma is exposure to asbestos. However, genetic factors also can play a part in determining who develops the disease.
While large numbers of people may have been exposed to asbestos through their jobs or living situation, a significantly smaller number go on to develop mesothelioma. Scientists believe that this susceptibility to mesothelioma is due to mutations of a gene, a specific section of DNA known as BAP1.

The Link Between BAP1 and Mesothelioma

The BAP1 gene is linked not only to mesothelioma, but also other forms of cancer including melanoma, breast cancer, ovarian cancer, pancreatic cancer, and renal (kidney) cancer. This gene first came under scrutiny when researchers noticed individuals with family histories of mesothelioma had mutations on or around the BAP1 region, and researchers have honed in on this gene as a risk factor of this dangerous cancer.
A 2011 National Cancer Institute study evaluated two families with histories of mesothelioma. Upon genetic examination, researchers found that every family member who had either mesothelioma or melanoma had mutations in the BAP1 gene. Furthermore, those who had BAP1 mutations survived longer than those who did not display these mutations. Tumors from 25% of this group also had mutations on this gene. At the time, more research needed to be conducted in order to understand genetic links to cancers.
Four years later, another group of researchers examined BAP1 mutations in participants, who were divided into three groups:
  • Diagnosed with mesothelioma with a family history of cancer
  • Exposed to asbestos with a family history of cancer
  • Exposed to asbestos without a family history of cancer
Out of all the participants, 6% of those with mesothelioma and familial histories of cancer had mutations of the BAP1 gene. These mutations were of two kinds: missense and frameshift mutations.
DNA is made up of smaller nucleotides, which are arranged in a chain formation. A missense mutation is when one nucleotide is incorrect, which then tells the gene to output an incorrect amino acid. Frameshift mutations are caused by the addition or deletion of nucleotides, causing the entire code to shift. Again, this tells the gene to output an incorrect amino acid. These incorrect amino acids wreak havoc on the human body and manifest in malignant ways.
As it turns out, patients with the BAP1 mutations developed mesothelioma earlier in their lives, and also “exhibited improved long-term survival compared to mesothelioma patients without BAP1 mutations.” Patients with mesothelioma and a family history of cancer should then be screened for BAP1 alterations.

Other Familial Connections to Mesothelioma

Another similar study took this association between familial cancers and mesothelioma one step further. In this study, researchers found that mesothelioma was linked to kidney and bladder cancers in siblings. There were no links between spouses, which could be another area for further research.
As mentioned above it is difficult to discern environmental factors from genetic dispositions. While the study makes note that these genetic links are indeed important to look at, the researchers noted that the shared environmental factors between family members cannot be ignored. This may be a confounding factor in the study, as it is difficult to separate genetic and environmental factors in the causes of diseases.
In any event, the fact that multiple studies have shown familial links with respect to the development of mesothelioma provides researchers with direction to pursue additional studies. The associations between the BAP1 gene as well as kidney and bladder cancers should be explored in further research.

Where to Take Mesothelioma Research Next

These recent studies have shed some much needed light on the genetic links of mesothelioma.
One new avenue for early detection and treatment is gene therapy. There are a few ways to apply this therapy to mesothelioma, including replacing or inactivating the malfunctioning gene, or introducing a new gene to help fight mesothelioma. Another way to use gene therapy would be to introduce a virus containing a gene which would instruct the immune system to then attack the mesothelioma cancer cells.
Unfortunately, gene therapy is an extremely risky treatment. As examined above, changing the genetic code of a living being can have dire consequences, with cancer and cancerous tumors arising from a disrupted or edited genetic code. Gene therapy would only be used for as such is diseases with no cures. Currently, gene therapy is a possible treatment, but more research is in order to determine how safe it is for mesothelioma and other cancer treatments.
Multiple studies have shown that BAP1 is a strong risk factor for mesothelioma. As a genetic factor, it is difficult to combat. Currently, individuals will be screened for BAP1 for early detection and treatment. In the future, we can expect to see gene therapy for individuals affected not only with mesothelioma, but with other cancers and diseases with genetic risk factors.
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Late-Stage Mesothelioma Treatment Could Be More Effective with Bevacizumab

Cisplastin and Pemtrexed: The Chemotherapy Gold Standard

Until now, cisplastin and pemetrexed (Almita) have been regarded as the gold standard for first-line chemotherapy treatment. Chemotherapy works by preventing cell divison, interrupting the cell cycle to prevent new cancer cells from forming. Chemotherapy drugs accomplish this by killing off cells that rapidly divide. It is where the treatment is most effective.

Austliya mobile pemetrexed are often chosen because they work very well together. Cisplastin is a cell cycle non-specific alkylating agent – put simply, it keeps cells from rapidly dividing during the resting phase of cell division. Pemetrexed, on the other hand, is a cell cycle specific antimetabolite, meaning that if it is introduced during and active phase of cellular metabolism during an active phase, the cells will not divide.

The cooperation of the two drugs is the primary reason they have been used as the gold standard for treatment. They effectively work together to eliminate cancer cells during both the active and resting phases of mitosis. Using both drugs covers both sides of the mitosis equation, which can lead to remission for many mesothelioma patients.

The Problem with Chemotherapy

However, as with all chemotherapy treatment, the infusion drugs cannot differentiate between cells that are cancerous and those that are normal. It aggressively targets any cell in the body that divides rapidly.
This is why chemotherapy side effects such as nausea, diarrhea, hair loss, mouth sores, and low blood counts are common. Healthy areas of the body such as bone marrow, the lining of the intestines and mouth, and hair follicles produce cells that divide quickly too. Once chemotherapy begins, it is indiscriminate, killing both the cancerous and non-cancerous cells that rapidly divide.

The side effects mentioned above usually stop once treatment is finished. With cancerous cells gone, healthy processes can continue unaffected by chemotherapy – and the body can begin to heal.

Enter Bevacizumab

Research is constantly underway to improve first line chemotherapy treatment in regards to patient care. This is where bevacizumab (Avastin) could play a role.
Classified as an angiogenesis inhibitor, bevacizumab inhibits the growth of new blood vessels. These are blood vessels that could be used to feed certain cancerous cell production cycles, or worse, cancerous tumors.

The promise of bevacizamub lies in its operation. It is very specific and works similarly to a lock and key. Your body constantly creates antibodies to respond to germs that enter the body. These antibodies will attach themselves to the protein found in a germ (called antigens), and “mark” them for destruction by your body's immune system. Cancer researchers have identified certain antigens in cancer cells and developed special antibodies from animal and human proteins to target them. Since they are specific to particular types of cancer cells, the toxicity potential for healthy cells is diminished.

Bevacizamub works by targeting human vascular endothelial growth factor (HVEG). This is a small protein that is responsible for new blood vessel formation when it interacts with certain receptors found in the body. The blood vessels that form could be used to feed the cancerous cell production cycles and tumors mentioned previously.
Currently, bevacizumab is most often used to treat metastatic colon/rectal cancer, certain types of lung cancer, breast cancer, glioblastoma, and renal cell carcinoma.

How Bevacizumab Can Make a Difference

A recent study funded by Intergroupe Francophone de Cancerologie Thoracique holds some findings worth noting. In the study, a Phase 3 trial was conducted using bevacizumab with patients between the ages of 18 and 75. All patients were diagnosed with unresectable malignant pleural mesothelioma, had not received any prior chemotherapy, and had a life expectancy of less than 12 weeks prior to entering treatment.

The results of the study are pretty incredible. After the combined treatment of bevacizumab, cisplatin, and pemetrexed, the average survival rate was 18.8 months – an increase of more than 15 months over the pretrial prognosis! The study also noted some potentially negative effects, including an increase in the chemical creatinine (a byproduct of the process that supplies muscles with energy), increased proteinuria levels (high levels of protein in the urine, a potential sign of kidney problems), and a somewhat higher incidence of hemorrhage. However, the overall increase in survival rate seems to outweigh any of these other problems.

So what does this mean for future first-line chemotherapy treatment for mesothelioma? The horizon appears bright. If survival rates were increased from less than 12 weeks to almost 19 months with individuals in advanced stages of malignant mesothelioma, it is possible that introducing bevacizumab earlier during the treatment process could yield even better results.

The investigators of the study concluded the following: "addition of Bevacizumab to Pemetrexed plus Cisplatin significantly improved [overall survival] in malignant pleural mesothelioma at the cost of expected manageable toxic effects; therefore it should be considered as a suitable treatment for the disease."

Only time will bear the findings out in full, but the study seems to suggest that adding bevacizumab to an existing first-line chemotherapy treatment regimen helps. It is one addition that could revolutionize chemotherapy treatment for mesothelioma by both extending life and providing a better quality of life for those who survive.
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Asbestos in Older Homes

Asbestos has been used for thousands of years in textiles and construction, due to its impressive resistance to heat, fire and moisture. Then, in the late 1800s, it became common to use asbestos in housing, as insulation, floor tiles, and other products. These practices continued into the 1980s, and such homes are still standing today. For those considering purchasing or renovating a house built before 1990, there is always the risk of asbestos in various parts of the home. Though usually innocuous if left undisturbed, when doing renovations it is important to know what to look for, and how to safely deal with any asbestos found in the process.

Where Asbestos May Be Located

Because of the numerous products that used asbestos, it can be found almost anywhere in a house, including the attic, basement, kitchen, garage, and even the exterior. It may be impossible to know where, unless the item containing it has been clearly labeled, but knowing what products are used in each area may help to reduce the risk.
In the attic, asbestos was commonly used in insulation, and is especially harmful if the loose-fill insulation was used. Patching compounds used on any ceiling or wall joints may also contain asbestos.
Down in the basement, asbestos was used to insulate oil or coal furnaces, as well as in any paper, millboard, and cement sheets on the walls and floors surrounding a wood-burning stove. Water heaters and the heat reflectors in woodstoves could also contain this product. Manufacturers also coated hot water and steam pipes with asbestos, or covered them with an asbestos blanket or tape. There are also older models of clothes driers that may contain asbestos.
As well as using asbestos insulation in the attic and basement, it was also used throughout the homes in Batt insulation, especially in the exterior walls.
In the kitchen, asbestos has shown up in some unsuspected areas. The walls, ceiling tiles, ceramic or vinyl floor tiles, their backing and adhesives all could contain asbestos. It could even be used in older models of appliances, such as stove-top pads and dishwashers.
Asbestos has even been used in decorative features. Some textured paints, room soundproofing, acoustical tiles, sprayed-on acoustical ceilings, and even the artificial ashes and embers used in gas fireplaces all have been found to contain asbestos.
Outside the home, house exterior could contain numerous asbestos products as well. For example, certain brands of cement siding, roof shingles and felt, undersheeting for siding and decks, and window putty all have been manufactured using asbestos in the past.
Though the garage doesn’t contain as many asbestos building materials as the rest of the house, asbestos has been used to manufacture numerous car parts, including brakes and clutches. If doing any vehicle repairs in this area, be sure to take the same precautions used when handling it anywhere else.

What to Do If You Find Asbestos

Though it is best to leave undamaged asbestos alone, during a renovation it may be necessary to disturb it. If this is the case, it is best to use a few safety precautions.
First, determine whether the asbestos must be removed. If it can remain where it is, there are two options. One option is to enclose it in an airtight, permanent barrier. The other is encapsulation, which is treating the asbestos with a liquid compound that will seal it and prevent the fibers from being released in the future.
If removal is the only option, then be sure to use protective gear. A respirator fitted with cartridges specifically designed to remove asbestos fibers from the air inhaled is the most important item. Wear old clothing, gloves, and goggles to keep the dust out of the eyes.
When ready to begin renovations, be sure to seal off the area, and to turn off any air conditioners and heaters to keep the dust from circulating. Wet down the asbestos with a spray bottle containing water before beginning removal. Keep the pieces of asbestos whole if possible, to reduce the number of fibers released into the air. Seal any pieces into a leak-proof bag, and place the bags into a cardboard box. When the removal is complete, take them to any landfill that permits asbestos disposal.
Do not vacuum or sweep any areas of the home that you are renovating, as doing so can stir up the asbestos fibers. Instead, wash the entire room – including walls and ceiling – with a wet mop, sponges, or cloths. Remove the clothing, discard them if possible in a similar fashion, or wash them immediately. Shower thoroughly to ensure no asbestos dust remains on any area of the body.
Though it is possible for a homeowner to do the removal on their own, it is always safer to have a professional involved, especially when small children live there. A certified inspector can test the home for asbestos, assess any damage, and advise what measures should be taken. An asbestos contractor is certified to repair and remove any asbestos from the home. These individuals are trained to ensure the project is completed safely, decreasing the risks for those in the home.
Any time there is exposure to asbestos, there is the risk of inhaling the dangerous fibers. When doing renovations, there is a higher risk, because of the likelihood of the fibers releasing into the air, where they can be inhaled. Asbestos is the primary cause of mesothelioma, a rare type of cancer found in the lungs, chest, abdomen and heart, as well as other diseases and conditions.
Stay safe when doing renovations. Always take the appropriate precautions when working around asbestos or asbestos-containing products, and contact a professional to assist in the renovation process.
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Back to School Could Mean Back to Asbestos for Many Students

More than three decades after the U.S. Environmental Protection Agency (EPA) issued a warning about the dangers of asbestos in American schools, the potential harm to students, teachers, and other school employees continues to exist.
That is the finding by Mesothelioma Cancer Alliance based on interviews with environmentalists, school administrators, advocates for victims of asbestos-related diseases and an examination of asbestos-related incidents at schools around the country, as well as government and private studies.
“Asbestos continues to be a problem in schools, leaving students, teachers and staff at risk,” says Linda Reinstein, president of the Asbestos Disease Awareness Organization (ADAO), which represents asbestos victims.
“It’s a significant problem,” says Alex Formuzis of the Environmental Working Group (EWG) in Washington, which has conducted extensive research into asbestos hazards in schools. “Any school built before 1981 is presumed to contain asbestos materials.”
Gina Clayton-Tarvin, president of the Ocean View School District Board in Orange County, Ca., agrees. “It’s (asbestos) in a huge majority of our schools,” she says in an interview. “Our public schools are riddled with it.”

Dealing with Decades of Asbestos

Clayton-Tarvin learned about the problem first-hand two years ago when three of the district’s elementary schools were closed after asbestos was detected in school buildings during a modernization project. A total of 1,600 students had to be bused to other schools across Orange County, and parents pulled an additional 150 others students out of the district’s schools, resulting in loss of state revenue funds. The cost of the asbestos-abatement project combined with the costs of busing students to other schools and the lost state revenue threatened to bankrupt the district – eventually costing it about $15 million.
The continuing hazard from asbestos comes as school children across the nation are poised to return to schools this fall. Though the exact extent of the problem isn’t known, it’s clear that “the hazard is still widespread,” states a report from the EWG Action Fund, which has been researching the problem for years.
“Asbestos in schools is not only a health threat,” the EWG report states. “It is a financial burden that takes resources from education and a charged subject that can spark panic, anger, and mistrust between schools and the communities they serve. The full extent of the problem may be unknown, but it is clearly widespread.”
Almost all U.S. schools built between the 1940s through the 1970s contain asbestos, which was widely used as a fireproofing building material. Indeed, any building constructed before 1981 is presumed to contain asbestos, according to the U.S. Occupational Safety and Health Administration (OSHA).
The presence of asbestos in schools doesn’t necessarily mean there is an immediate danger as long as the asbestos remains undisturbed. However, if the asbestos-containing materials are disturbed during modernization or repair work or becomes friable – that is, easily be crumbled by hand or contact – asbestos fibers can be released into the air and inhaled. Asbestos has long been identified as a carcinogen, and there is no safe level of asbestos exposure.
“Just because a school contains materials made with asbestos should not be reason for parents and caregivers to panic, but they should be understandably concerned,” says EWG’s Formuzis. “Every year, schools around the country are forced to take various levels of action to protect students, teachers and other staff from being exposed to asbestos.”
He adds, “Congress passed a law in 1986 that requires schools to conduct inspections every three years. If those records are not readily accessible, either from the school’s front office or the school district, I’d urge parents to demand they make them available. These records are, in many ways, the best evidence of whether or not their children are in the areas of the school where asbestos is present.”

Asbestos Across the Nation’s Academies

The asbestos problem has impacted schools across the country, according to case studies provided by the EWG’s Formuzis and numerous press reports.
In Chicago, students, faculty and staff in Chicago schools were put at risk of exposure to deadly asbestos fibers in 184 public elementary, middle and high schools throughout the city, according to a 2016 EWG report. The report said that school inspection records show that in 2013, inspectors found friable asbestos that was damaged or showed the potential for damage in areas readily accessible to students and others, including school corridors, restrooms, teachers’ lounges, and auditoriums. Friable asbestos can easily be crumbled by hand or contact, and if damaged could become airborne and inhaled. The inspectors recommended that the asbestos be removed or repaired, but almost all of it had remained in place, the EWG report said.
In January 2015, the U.S. Department of Labor filed a whistleblower lawsuit against the Idaho Falls School District charging that the district had fired its environmental health engineer in retaliation for her raising concerns about asbestos removal from boiler pipes at a junior high school. Federal law prohibits firing or discriminating against employees who call attention to asbestos problems.
In March 2015, a photo from an Akron, Ohio, high school that showed an asbestos-abatement worker in a protective suit inside a classroom near a DANGER sign caused an uproar when it was posted on Twitter. Said one parent: “We don’t know what’s going on in there. We haven’t been told [the facts] by anybody; all we are hearing is from the kids.”
That same month, a church-run preschool in Arlington, Va., was shut down after volunteers cleaning the building ripped up flooring, releasing asbestos dust into the air. An unidentified tipster told a local news outlet: “Chaos ensued when folks figured out what had happened … and now 100-plus kids don’t have a daycare to go to. Who knows if the church has the money to remediate asbestos.”
In February 2011, officials temporarily shut down a high school and junior high in St. Louis Park, Minnesota after finding asbestos dust from floor tiles.
For at least five months in 2010, children who attended Washington Elementary School in Berkeley, California might have been exposed to asbestos.
Here in southern California, the Ocean View district’s problems received widespread attention. Clayton-Tarvin, the school board president, says the board was initially unaware that asbestos-abatement was occurring in the schools. She says she became concerned when she learned that asbestos-abatement was occurring while the buildings were occupied.
“My main concern was the safety of the children,” Clayton-Tarvin tells Mesothelioma Cancer Alliance. “The lesson I learned is that when (a school district) is about to embark on a construction project, you need to investigate what’s behind the walls, what’s behind the ceiling, and what are we going to be exposing when you open up the walls.”
The Ocean View experience was far from an isolated example in southern California. A recent Orange County grand jury report noted that all but one of the county’s 28 school districts have asbestos present in at least one of their schools or administrative buildings. The report noted that the mere presence of encapsulated asbestos at a school site doesn’t not present any immediate danger, but it urged care during modernization and repair projects.
“The presence of encapsulated asbestos does call for continued awareness of where the asbestos is located, for extreme care not to disturb encapsulated asbestos during modifications or repairs of a facility, and for continued monitoring for wear and tear of asbestos-containing materials,” the grand jury report said. “Districts must know how to inspect for, contract for, schedule and manage removal (abatement) of asbestos and other hazardous materials prior to and during construction work.”
The report noted that 21 Orange County districts were embarking on modernization and repair projects, the time of greatest risk of asbestos exposure from encapsulated asbestos.

Pushing for a Better Asbestos Policy

All of this has continued to occur decades after the EPA first warned about the problem of asbestos in schools. In 1980, the agency issued a sobering study stating: “The agency has determined that exposure to asbestos in school buildings poses a significant hazard to public health.,” the EPA said in the study, titled Asbestos-Containing Materials in Schools: Health Effects and Magnitude of Exposure.
Four years later, in 1984, the EPA conducted a survey of 2,600 public school districts and private schools to try to determine the extent of the problem. Based on the survey, EPA estimated that 15 million students and 1.4 million teachers, administrators and other employees were at risk of exposure to asbestos. That three-decades-old survey was the last time the federal government took an extensive look at the dangers of asbestos in American schools.
In 1986, Congress passed the 1986 Asbestos Hazard Emergency Response Act (AHERA) in an effort to protect students, teachers and other school workers. But last year, U.S. Sens. Edward Markey, D-Mass. and Barbara Boxer, D-Cal, wrote to the governors of all 50 states asking for detailed information on asbestos in each state’ schools. They received responses from only 20 of the states.
In a December 2015 report titled Failing the Grade: Asbestos in America’s Schools, the Senators concluded that the scope of asbestos hazards in schools in the United States is likely widespread but remains difficult to ascertain; that states do not appear to be systematically monitoring, investigating, or address asbestos hazards in schools, and that states do not report conducting regular inspections of local education agencies to detect asbestos and enforce compliance. They also said that oversight of the 1986 law was “insufficient.”
“The simplest questions, including how many schools continue to harbor asbestos-containing materials, remain unanswered by many states,” the report says, recommending that the Asbestos Hazard Emergency Response Act be strengthened to require EPA to evaluate each state’s compliance every 10 years and increase funds for enforcement.
Formuzis of the Environmental Working Group agrees that reforms are long overdue.“It’s time for Congress to step up and figure out a way to better protect our students and teachers from this known human carcinogen,” he says.
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Cancer Moonshot Infographic: How the Moonshot Helps Mesothelioma Patients

The Cancer Moonshot Initiative is continuing to move along, and it’s gaining more and more attention from those outside of the community. In fact, one of the presidential candidates even mentioned it in a stump speech, acknowledging the importance of the program while promising to keep it going.
In a statement released by her campaign, Hillary Clinton expressed her support for the Cancer Moonshot Initiative, saying, “We know more than we ever have about the biology of cancer, how to prevent it, and how to treat it. We need to do more to build on these developments, advance our understanding, and develop more effective treatments.”
Clinton continued by challenging Congress to fund the moonshot’s efforts, asking for bipartisan support in tackling the difficult task of finding a cure for cancer. “Cancer does not discriminate,” Clinton said, “and I believe leaders of both parties can come together to tackle this disease as part of a comprehensive effort to improve medical research.”

How Does the Moonshot Affect Mesothelioma?

There are a lot of different problems and concerns being addressed as part of the Cancer Moonshot. This includes better cooperation between researchers, doctors, patients, and advocates, such as by sharing the data and results of research, making it easier to find clinical trials, and generally improving communications and collaborations between these different groups.
One of the big ways in which mesothelioma will be helped is through the research and development of experimental treatments, such as immunotherapy. Embodied in drugs like Keytruda – which is seeing increasing success in treating mesothelioma patients, as well as individuals with other forms of cancer – immunotherapy is a way of helping to boost or kickstart the body’s natural immune system to help it fight the deadly cancer cells.
While improvements in detection, treatment, and other areas of cancer research will help everyone, there is a good chance that those who suffer from rare forms of cancer will benefit even more. Traditionally, rare cancers (such as mesothelioma) receive less attention … and funding … making it less likely that a cure will be discovered.

View and Share Our Cancer Moonshot Infographic

In order to help you visualize the impact of the Cancer Moonshot on mesothelioma research, the Mesothelioma Cancer Alliance has created a new infographic, explaining the relationship between immunotherapy, research efforts, and the benefits to rare forms of cancer. Please check out the new graphic below (click for a larger version) and share it with family, friends, and others who may be curious about how the Cancer Moonshot is progressing.
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New HMGB1 Blood Test Could Detect Mesothelioma Early

A promising recent study published in the journal Clinical Cancer Research has shown that a blood test that can speed the diagnosis of mesothelioma. Diagnosis is often delayed and usually requires surgery to obtain a tissue sample for examination, and early identification of mesothelioma has been shown to be one of the best ways to improve the effectiveness of treatment. As such, researchers have been working to develop new blood tests to diagnose mesothelioma, and this study shows that a blood protein commonly referred to as HMGB1 can be used with near 100% accuracy.
The abstract of the study concludes:
Our results are significant and clinically relevant as they provide the first biomarker of asbestos exposure and indicate that hyperacetylated HMGB1 is an accurate biomarker to differentiate malignant mesothelioma patients from individuals occupationally exposed to asbestos and unexposed controls.

How HMGB1 Detects Asbestos and Mesothelioma

Mesothelioma is a cancer that affects the mesothelium, a tissue lining that covers the chest and abdominal cavities. Since asbestos fibers typically enter the body by being breathed in through the air, about 80% of mesothelioma cases primarily affect the lungs when the disease develops. It is also a rare disease that takes from 20 to 50 years or more from when exposure to asbestos occurs until mesothelioma develops. The initial symptoms such as pain, shortness of breath or fluid around the lungs can be caused by other more common illnesses such as COPD, pneumonia or bronchial infections.
Three different blood tests have been used to measure substances (known as “biomarkers”) that are elevated when mesothelioma is suspected. However, the biomarker tests developed thus far have not been accurate enough to confirm the diagnosis of mesothelioma without also doing a surgical biopsy.
High mobility group box protein 1 (HMGB1) is a new biomarker that has shown in clinical trials to be an accurate predictor of past exposure to asbestos. Using evidence from previous studies, the authors believe that HMGB1 plays a role in the development of mesothelioma in two ways. Foremost, HMGB1 is released by cells damaged by the chronic presence of asbestos fibers. Furthermore, they believe that once the damage from asbestos turned into mesothelioma, the cells continue to release HMGB1 while undergoing a process called “acetylation,” which differentiates mere asbestos exposure from cancerous growths. The HMGB1 that has been “acetylated” by mesothelioma cells is referred to as “hyperacetylated HMGB1”.
The study used different groups of people to test both if HMGB1 could predict past exposure to asbestos and if a person had mesothelioma:
  • Healthy people who had never been exposed to asbestos. The study found low levels of any form of HMGB1.
  • Healthy people who were known to have been exposed to asbestos in the past. The study found high levels of HMGB1, but low levels of the hyperacetylated type.
  • People with respiratory (pleural) mesothelioma. The study found the very high levels of both types of HMGB1.
Mesothelioma that affects the lungs often causes a buildup of fluid – known as pleural effusion – between the lungs and the chest wall, often causing shortness of breath, pain, or weakness. The study tested patients with pleural effusion fluid caused both by mesothelioma and by other illnesses. Once again, the study found that testing the different HMGB1 levels was very good at identifying mesothelioma, since the biomarker did not appear with other conditions.

Comparing HMGB1 to Other Biomarker Tests

The study also compared HMGB1 to the other three blood tests that are currently being used to help test for asbestos exposure and mesothelioma. Essentially, the study found that HMGB1 testing was much better than all of the other tests in detecting asbestos exposure. It also found that HMGB1 testing was better than two of the existing blood tests for diagnosing mesothelioma. If combined with the third blood test called fibulin-3, the two were better together in diagnosing mesothelioma in patients with fluid in the chest than either one alone.
Previous studies have shown a link between HMGB1 levels and non-small cell lung cancer (NSCLC). A meta-review of fifteen studies found a link was found between HMGB1 levels and NSCLC, and that different levels could even be used to determine what stage the cancer was at. Non-small cell lung cancer and mesothelioma are different, but since they both affect the lungs, challenges in proper diagnosis and treatment are often very similar.
Further research about HMGB1 testing and mesothelioma are needed to help doctors with early diagnosis and better treatment. Over 30% of mesothelioma cases are in military veterans who were exposed to asbestos during their service time. Given this situation, the Department of Defense has provided over $3 million to the University of Hawaii for further research in several different areas:
  • Confirming that HMGB1 levels can be used to detect past exposure to asbestos and early diagnosis of mesothelioma.
  • Using HMGB1 research to help find genes that are related to increased risk of developing mesothelioma.
  • Developing a vaccine against developing mesothelioma in people who were exposed to asbestos.
Mesothelioma is typically not diagnosed until it has reached an advanced stage. At that point, treatment is less effective. The ongoing search for better ways to detect and treat mesothelioma earlier continues to break new ground. This will help in developing better treatment and prognosis for patients and ultimately save lives.
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Parents’ Guide to Protecting Children from Asbestos in Schools

Millions of children who attend schools in the United States built before the 1980s are at risk of being exposed to harmful asbestos – yet there are important steps parents can take to protect their children.
Those steps include:
  • Understanding the risk of asbestos exposure;
  • Knowing their school’s responsibility under federal laws intended to protect students, teachers and other school employees;
  • Inspecting their school’s asbestos management plan;
  • Being persistent in demanding to see public records and asking questions of school administrators;
  • Seeking guidance from the U.S. Environmental Protection Agency (EPA) if danger is suspected.
“Just because a school contains materials made with asbestos should not be reason for parents and caregivers to panic, but they should be understandably concerned,” says Alex Formuzis of the Environmental Working Group (EWG) in Washington, D.C., which has done extensive research into the hazards of asbestos in American schools.
Linda Reinstein, president of the Asbestos Disease Awareness Organization (ADAO), agrees. She urges parents to be “vigilant” in making sure federal laws and regulations intended to protect students, teachers and other school employees in schools are enforced. “As a mesothelioma widow and mom, I’ve learned the hard way – asbestos kills,” she says.
Nearly all U.S. schools built between the 1940s through the 1970s contain asbestos, which was widely used as a fireproofing building material. In fact, any building constructed before 1981 is presumed to contain asbestos, according to the U.S. Occupational Safety and Health Administration (OSHA).

Why Asbestos Vigilance Is Important

As the Mesothelioma Cancer Alliance reported last week, more than three decades after the EPA issued a warning about the dangers of asbestos in American schools, the potential harm to students, teachers, and other school employees continues to exist. In Orange County, Ca., three elementary schools in the Ocean View School District were closed in 2014 after asbestos was discovered in school buildings during a modernization project. In Chicago, inspectors found friable asbestos that was damaged or showed the potential for damage in school corridors, restrooms, teachers’ lounges and auditoriums at 184 public schools, putting students, faculty and staff at risk.
“Across the United States, too many students and teachers continue to be at risk of inhaling harmful asbestos fibers in their schools’ classrooms, cafeterias and hallways,” states Megan Boyle, writing in Healthy Child, Healthy World, a website aimed at empowering parents to take action and protect children from harmful chemicals. Earlier this year, the site published Boyle’s excellent blog post titled “How to Talk to Your Child’s School about Asbestos.”
As children go back to school this year, here are some steps that parents should take:

Understand the risk of asbestos exposure

If you child’s school was built before 1980, it almost certainly contains asbestos materials. The mere presence of asbestos in schools doesn’t necessarily mean there is an immediate danger as long as asbestos remains undisturbed. But if asbestos-containing materials are disturbed during repairs or modernization projects or becomes friable – that is, easily crumbled by hand or contact – asbestos fibers can be released into the air and inhaled.
Asbestos has long been identified as a carcinogen, and there is no safe level of asbestos exposure.
Bottom line: You should be especially vigilant if your school is undertaking a modernization or repair project, as many older schools are.

Understand the law and regulations aimed at protecting students and teachers

The Asbestos Hazard Emergency Response Act (AHERA) of 1986 requires public, private and charter schools to inspect their buildings for asbestos-containing materials and prepare management plans and to take action to prevent or reduce asbestos hazards. The inspections must be conducted every three years, according to the EPA.
Under the law, schools are specifically required to do all of the following:
  1. 1. Perform an original inspection to determine whether asbestos-containing materials are present and then re-inspect asbestos-containing material in each school every three years.
  2. 2. Develop, maintain an asbestos management plan and keep a copy at the school available for public inspection. The management plan contains important information, including the date of the last inspection, whether asbestos was discovered and any remedial actions are being taken.
  3. 3. Provide yearly notification to parent, teacher and employee organizations on the availability of the school’s asbestos management plan and any asbestos-related actions taken or planned at the school.
  4. 4. Designate a contact person to ensure the responsibilities of school are properly carried out. The contact person is required to be available to answer questions from parents and the public.

Understand your rights to inspect inspection reports and a school’s management plan – and be relentless in demanding access to them

Inspection reports and the asbestos management plan are public documents. The school is required to keep a copy available to parents and others for public inspection. So parents should be persistent in seeking access to those records.
“If those records are not readily accessible from the school’s front office or the school district, I’d urge parents to demand they make they available,” says the EWG’s Formuzis. “Those records are, in many ways, the best evidence of whether or not their children are in the areas of the school where asbestos is present.”

If you suspect danger, seek answers and guidance from the U.S. Environmental Protection Agency.

That advice comes from ADAO’s Reinstein. In fact, the EPA provides helpful information on its web site, including a posting dealing Asbestos Laws and Regulations and another on School Buildings. The information is available in both English and Spanish-language versions.
In urging vigilance, Reinstein says that nothing is more important than protecting students and teachers.
“Students, teachers and staff should be protected from asbestos,” she says. “The fear of the unknown is unimaginable when a child has been exposed at school. With each cough, a parent waits in anguish, wondering if their child will one day be diagnosed with an asbestos-caused disease. There is no safe level of asbestos exposure, as prevention remains the only cure.”
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