Mesothelioma and Asbestos History

Mesothelioma and its association with asbestos exposure has a long and controversial history. Because it is so rare and aggressive, this cancer is difficult to treat and diagnose. The history of mesothelioma includes its discovery, its association with asbestos, and the regulation of its use in workplaces, schools, buildings, and ships. These government regulations made life safer for those people who might otherwise be exposed to this dangerous mineral.

Mesothelioma’s Discovery: The Early Years

Joseph Lieutaud, a French pathologic anatomist, was the first medical professional to refer to a tumor of the chest wall. In the 1700s, Lieutaud studied several thousand French autopsies and found two cases of what he termed “pleural tumors.” Although more tumors were discovered in the 1800s, critics of pleural cancer rejected many of these cases, insisting the tumors were secondary. These critics insisted a primary tumor existed elsewhere in the body.

Peritoneal mesothelioma was first mentioned in 1854. This rare cancer affects the lining of the abdominal cavity and was first discovered by a pathologist named von Rokitansky. Although von Rokitansky had previously discounted the idea of a cancer of the mesothelium, he called it colloid cancer Later study revealed he had described the first known case of peritoneal mesothelioma.

During the late nineteenth and early twentieth century, pathologists discovered and described several more cases of mesothelioma. The word mesothelioma was first used in 1920 as pathologists described a young man’s tumor as “primary mesothelioma of the pleura.”  The name gained popularity, even as experts disagreed about the possibility of a primary tumor in the pleura.

Mesothelioma and Asbestos

In 1933, mesothelioma and asbestos were linked when a review of asbestosis cases determined there were complications that included tumors. The reviewer, S. Roodhouse Gloyne, concluded that cancer in the pleura of one patient was not related to asbestosis. Modern evidence suggests this might be the first described case of mesothelioma in a patient known to have been exposed to asbestos.

In the 1940s, more people with asbestosis were found to have malignant tumors. In an early study of 29 German asbestos workers, a pathologist found two with signs of pleural malignancies while 20 percent had some form of malignancy. This was one of the first studies connecting asbestos and cancer.

Later studies revealed further evidence of connections between asbestos, asbestosis, respiratory illness, cancer, and specifically cancer of the pleura. By the 1950s, some cases specifically connected asbestos to peritoneal mesothelioma. In one patient, asbestos fibers were actually found within the peritoneal tumor.

Finally, in 1960, a seminal paper was published. This paper was titled, “Diffuse Pleural Mesothelioma and Asbestos Exposure in the Northwestern Cape Providence.” It described an investigation of 33 patients with mesothelioma. All of these patients had been exposed to a certain type of asbestos mined in part of South Africa. Mesothelioma was rarely seen in any other part of the country so the researchers concluded that asbestos was related to mesothelioma of the pleura. That same year, another study described a mesothelioma patient with known, long-term exposure to asbestos. The biopsy sample from this patient’s tumor contained actual asbestos fibers, strengthening the connection between the two.

Asbestos and Mesothelioma in the United States

An important study of the relationship between asbestos and mesothelioma was published in the United States in 1964. A physician named Dr. Selikoff, reported on 1,000 Union Asbestos & Rubber Company workers from Patterson, New Jersey. These factory workers manufactured asbestos insulation for the United States Navy and had a mortality rate 25 percent higher than the average person. These workers all died from asbestosis, lung cancer, and other cancers. Further studies confirmed the connection between asbestos exposure among U.S. workers and the development of cancer, particularly mesothelioma.

By the early 1970s, the Occupational Safety and Health Administration set standards for workplace exposure to asbestos. In 1971, the Environmental Protection Agency (EPA) declared asbestos a hazardous pollutant and banned many asbestos-containing products, largely in the construction industry. In 1989, the EPA banned nearly all products with asbestos. However, the Fifth Circuit Court of Appeals overturned that ban in 1991.

A Legal Milestone

In 1969, Borel vs. Fiberboard Paper Products Corporation was the first legal victory requiring manufacturers to warn workers of asbestos risks. After years working in shipyards with products made by Fiberboard Paper Products Corporation, Borel developed asbestosis. Four years later, Borel’s victory was upheld by the Fifth Circuit Court of Appeals. Over the next decade, there would be over 16,000 liability and personal injury cases related to asbestos exposure.

In 1982, two major manufacturers of asbestos-containing products, the Union Asbestos & Rubber Company and Johns Manville, both declared bankruptcy. These companies faced numerous lawsuits over asbestos exposure and asbestos-related illnesses. Over the next several years, nearly 50 other companies would go bankrupt for the same reason.

Treatment History

Teatment strategies for mesothelioma have developed rapidly over the past 60 years. In the 1940s, doctors began performing pneumonectomies, surgical procedures that removed a lung or part of a lung. In the 1960s, pleurectomies were added to the surgical arsenal against mesothelioma. By the 1970s, some doctors had tried an aggressive surgery called extrapleural pneumonectomy. This high-risk surgery removes an entire lung, all of the pleura from one side of the chest, part of the diaphragm, and nearby lymph nodes.

Chemotherapy has also advanced over the years, adding new drugs and drug combinations. Radiation was first used to treat mesothelioma in the 1950s. Today, a multi-modal treatment approach, using one or more treatments to attack the cancer, is common. Researchers are even working on nanoparticles to deliver genetic factors and chemotherapy drugs directly to mesothelioma tumors.

Even after several hundred years of research and study, our understanding of mesothelioma and its causes is not perfect. Researchers continue to study the connection between asbestos and cancer, as well as how mesothelioma develops when there is no asbestos exposure. They also continue to develop more effective treatments in the fight against this devastating disease.