BY THE NUMBERS: THE FUTURE OF MESOTHELIOMA IN AMERICA

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1 BY THE NUMBERS: THE FUTURE OF MESOTHELIOMA IN AMERICA 1

2 CUTTING-EDGE ISSUES IN ASBESTOS LITIGATION CONFERENCE Scott Masterson Lewis, Brisbois, Bisgaard & Smith, LLP 1180 Peachtree Street, NE, Suite 2900 Atlanta, GA (404)

3 MESOTHELIOMA IN US 3000 cases of mesothelioma in US each year. Rate of mesotheliomas increasing in world 10-15% for next couple of decades. Incidents of mesothelioma has risen in men since 1950, but not for women. Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypothesis, Journal of Cellular Pathology, 3

4 MESOTHELIOMA IN MEN IN US Prior to cases/million cases/million cases/million Surveillance, Epidemiology and End Results (SEER) Program 4

5 ALL MESOTHELIOMAS Asbestos Exposure No Asbestos Exposure MALE 50-80% 20-50% FEMALE 20-30% 70-80% Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypothesis, Journal of Cellular Pathology, 5

6 MESOTHELIOMA BY TYPE Asbestos Exposure No Asbestos Exposure Pleural 60-70% 30-40% Peritoneal 15-30% 70-85% Includes both men and women. Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypothesis, Journal of Cellular Pathology, 6

7 TYPES OF MESOTHELIOMA - MEN Asbestos Exposure No Asbestos Exposure Pleural 80% 20% Peritoneal 25-30% 70-85% Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypothesis, Journal of Cellular Pathology, 7

8 DR. ROGGLI S FIBER BURDEN DATA FOR MALE MESOTHELIOMA CASES SINCE 2008 Pleural 66% (35/53) Asbestos-related Peritoneal 33% (1/3) Asbestos-related 8

9 MESOTHELIOMA OTHER TYPES Papillary Not associated with asbestos exposure. Women Peritoneum Men Pericardium, Pleura or Tunica vaginalis testis 9

10 MESOTHELIOMA OTHER TYPES Tunica Vaginalis Testis (Testicular) 1-5% of all mesothelioma cases Weak association with asbestos exposure Reports of US cases show only 9-35% of individuals had asbestos exposure Meisenkothen C, Finkelstein MM. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: Case series and review of the literature. OA Case Reports 2013 Feb. Kucukoner, Testis Mesothelioma: A Case Report, World Journal of Urology,

11 OTHER RECOGNIZED CAUSES OF Radiation Genetic/Familial BAP1 Syndrome Erionite MESOTHELIOMA Amphibole contaminated vermiculite/environmental amphibole exposure Idiopathic/spontaneous 11

12 THERAPEUTIC RADIATION & MESOTHELIOMA Epidemiologic studies that support an increased risk factor in survivors of: Testicular cancer (Travis 2005) Non-Hodgkins lymphoma (Tward, et al. 2006; Teta, et al., 2007) Breast cancer (Braun, et al. 2007; Deutsch, et al. 2007) Hodgkin s lymphoma (Hodgson, et al. 2007; DeBruin, et al. 2009) Prostate cancer (Farioli, et al., 2013) 12

13 CARBONE, DODSON 2012 It is estimated that about 50-80% of pleural MM in men and 20-30% in women developed in individuals whose history indicates asbestos exposure(s) above that expected from most background settings. Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypothesis, Journal of Cellular Pathology, 13

14 GIBBS 2014 It is estimated that some 20% to 40% of all diffuse malignant mesotheliomas in the United States are now best regarded as idiopathic. p. 42 Gibbs, AR, Spontaneous/Idiopathic Diffuse Malignant Mesothelioma, Chapter 6 in Advances in Surgical Pathology Mesothelioma, Attanoos, RL and TC Allen (eds.), Lippincott Williams & Wilkins: Philadelphia,

15 CARBONE, DODSON 2012 About 30% of peritoneal MM in men is associated with above background asbestos exposure. The association of peritoneal MM in women to asbestos exposure is epidemiologically weak to undetectable. Thus, factors other than asbestos appear to be the main cause of MM in women. p. 45 Carbone, M, et al., Malignant Mesothelioma: Facts, Myths and Hypotheses, Journal of Cellular Physiology,

16 HUSAIN 2013 Important consensus report on pathologic diagnosis of malignant mesothelioma Authors include Attanoos, Beasley, Churg, Gibbs, Marchevsky, Roggli and Wick Husain, AN, et al., Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2012 Update of the Census Statement from the International Mesothelioma Interest Group, Arch Pathol Lab Med, 133: ,

17 GIBB 2013 Positive relationship between cumulative external radiation dose and mesothelioma. Lack of significantly elevated PMR for lung cancer supports asbestos did not confound the relationship. Gibb, H, et al., Analyses of Radiation and Mesothelioma in the US Transuranium and Uranium Registries, American Journal of Public Health, 103(4): ,

18 VAN GOSEN 2013 Recent concerns raised about potential environmental exposures to erionite in North Dakota and in the western U.S. New mapping underway to identify other natural sources of erionite in the U.S. Van Gosen, BS, et al., Geologic occurrences of erionite in the United States: an emerging national public health concern for respiratory disease, Environ Geochem Health, 35: ,

19 DODSON 2013 The present case study reports on tissue burden of fibrous dust in a person who used a vermiculite material (Zonolite) as an attic insulator some 50 years prior to her death. The findings of Libby amphibole fibers in human tissue can be attributed to exposure to Libby vermiculite. Dodson, RF, et al., Biodurabilikty/Retention of Libby Amphiboles in a Case of Mesothelioma, U.trastructural Pathology, Early Online 1-7,

20 Adgate 2013 Contaminated vermiculite ore from Libby, Montana was processed in northeast Minneapolis from 1936 to 1989 in a densely populated urban residential neighborhood, resulting in non-occupational exposure scenarios from plant stack and fugitive emissions as well as from activity-based scenarios associated with use of the waste rock in the surrounding community. Adgate, JL, et al., Modeling community asbestos exposure near a vermiculite processing facility: Impact of human activities on cumulative exposure, Journal of Exposure Science and Environmental Epidemiology, 21: ,

21 COMMON MESOTHELIOMA PLAINTIFF BEFORE 21

22 NOW Mesothelioma Plaintif f 22

23 OR WORSE 23

24 CONCLUSIONS 24

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