Asbestos and the diseases it causes

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1 Asbestos and the diseases it causes October 2013 Liz Darlison Mesothelioma UK University Hospitals of Leicester

2 Contents What is asbestos Why is it such an issue in the UK Disease Statistics Asbestos Related Diseases

3 What is asbestos? Fibrous mineral Silicate Highly Resistant to heat and fire Used widely since 19 th century 3 main types Blue (crocidolite) Brown (amosite) White (Chrysotile)

4 Asbestos Use Insulation, heat resistant, non-combustible Ubiquitous in mid 20th Century 6 million tonnes mined in 1977 Ship building, construction industry, mechanics, plumbers, carpenters, electricians, maintenance workers Asbestos use banned in USA in 1986 Chrysotile banned in UK 1999

5 Asbestos and Mesothelioma Doll 1955 asbestos and lung cancer Van der Schoot 1958 mesothelioma in asbestos workers Wagner cases in South Africa, crocidolite miners Keal 1960 East London factory workers

6 Brown Asbestos

7 Blue Asbestos

8 White Asbestos

9

10

11

12

13

14

15 Diseases caused by exposure to asbestos Pleural Plaques Diffuse Pleural Thickening Asbestosis Mesothelioma Lung Cancer 4500 deaths per year

16 HSE data

17 Clinical Diagnosis of Asbestos Related Disease Detailed interview Occupational data Appropriate latency Signs and symptoms Radiological finding Respiratory physiology findings Cytology/histology Experience/professional judgement!

18 Pleural Plaques Circumscribed areas of fibrous thickening, typically of the parietal pleura.

19 Pleural Plaques

20 Diffuse Pleural Thickening Non-circumscribed fibrous thickening affecting both parietal and visceral pleura.

21 Pleural Thickening

22 Asbestosis Diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos dust.

23

24 Asbestosis

25

26

27 Malignant Mesothelioma Malignancy of serosal membrane. Pleural is the most common but can arise from peritoneum, pericardium and tunica vaginalis Universally fatal

28 CT Scan

29 Thoracoscopy

30 Lung Cancer 4 histological types 1 year of heavy or 5-10 year moderate asbestos exposure increases risk of lung cancer 2 fold. Synergistic effect with tobacco smoke.

31 Lung Cancer

32 Benefits Attendance Allowance 65 years + PIP up to 65 years Special Rules War pension Industrial Injuries Disablement Benefit Mesothelioma Diffuse pleural thickening (DFT) (medical) Primary lung cancer with DFT or asbestosis (medical) Post 1948 exposure

33 Pneumoconiosis and Workers Compensation Fund Lump sum payment IIDB pre-requisite Mesothelioma/diffuse pleural thickening/primary lung cancer with DFT or asbestosis No civil case

34 Civil Case If it likely that :- Caused by asbestos Identify an employer Who is legally at fault Can be pursued for Mesothelioma DPT Primary Lung cancer Asbestosis

35 Where to get advice? Local services Citizens advice bureau Macmillan Cancer Support Asbestos Support Groups Legal firm MESOTHELIOMA UK

36 Mesothelioma Key issues Increasing in incidence Patient expectation Fatal Short window of opportunity Highly Symptomatic Rare Complex investigations Medico legal issues No Guidelines Limited treatment options Variation in Practice/Opinion

37 A national nurse led initiative Provide high quality, impartial and up-to-date support and information Develop a national network of trained and experienced nurse specialists. Promote nurse-led research. Work in collaboration with charities, organisations and individuals interested in mesothelioma. Promote the development of mesothelioma support groups.

38

39 Average length of call 17 minutes Mesothelioma UK Help Line Free phone : Open Monday to Friday with answer phone out of hours 1500 calls per year 35% referred to RN 52% Patient and carers

40 Mesothelioma UK Newsletter Circulation = approx Electronically & 1700 postal copies

41 Patient Information

42 Annual Mesothelioma UK Patient and Carer Day 1 st Saturday in October Manchester//Leeds/Newcastle/Londonx4/Leicester delegates Aim share experiences Provide up-to-date, unbiased information Opportunity to raise issues and ask questions Supported by JHMRF, GMAVSG & RMH

43 M-NAT Mesothelioma Nurse Action Team

44

45 Mesothelioma UK and RMH on-line Mesothelioma in practice module 45 completed to date Australian, USA, Japanese and South African Delegates Excellence in Oncology 2011 Award Winner Best Professional Educational Initiative

46 Publications

47 Mesothelioma CNS Posts Leicester Cambridge Cardiff Portsmouth Manchester London??

48

49 Global shift in asbestos use. 70% of global asbestos production originates in 3 Asian countries 10 million lives may be lost before asbestos is banned world wide. 50% of global asbestos consumption occurs in Asian countries (China, Thailand and Indonesia) 3 biggest global consumers are China, Russia, India

50 Thank you Liz Darlison Macmillan Nurse Consultant Mesothelioma UK University Hospitals of Leicester

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