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The history of the discovery, diagnosis, treatment, and causes of the cancer we now know as mesothelioma and associate with asbestos exposure, is long and filled with controversy. It has been a tricky type of cancer to figure out and today it remains a difficult type of cancer to diagnose and to treat. The history of mesothelioma includes its discovery as a unique type of cancer, its association with asbestos, and the history of regulating asbestos and making workplaces, schools, buildings, and ships safer for those people who might otherwise be exposed to the dangerous mineral.

Mesothelioma’s Discovery: The Early Years

Joseph Lieutaud, a French pathologic anatomist, is credited with being the first medical professional to refer to a tumor of the chest wall. He studied several thousand autopsies in the 1700s in France and found two cases of what he termed “pleural tumors.” In the 1800s, more cases of such tumors were discovered, but critics of the idea of a cancer of the pleura rejected many of these cases and insisted that the tumors were secondary, that a primary tumor must exist elsewhere in the body.

The first mention of peritoneal mesothelium occurred in 1854.This is the type of mesothelioma that first impacts the lining of the abdominal cavity. The discovery was made by a pathologist, von Rokitansky, who had previously discounted the idea of a cancer of the mesothelium. He called the peritoneal cancer that he discovered, colloid cancer, but later study deemed it likely that he had actually been describing the first known case of peritoneal mesothelioma.

Throughout the late 1800s and early twentieth century, a few more cases of mesothelioma were discovered and described in more detail by pathologists. The first use of the term mesothelioma occurred in 1920 as pathologists described a young man’s tumor as “primary mesothelioma of the pleura.” The name caught on, but other experts continued to fight against the idea that there could be a primary tumor of the pleura.

Mesothelioma and Asbestos

The first possible report of mesothelioma connected to asbestos was made in 1933 when a review of asbestosis cases determined that 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, but in the light of modern evidence it seems that this might be the first described cases of mesothelioma in a patient known to have been exposed to asbestos.

Beginning in the 1940s, more cases were discovered of people with asbestosis developing malignant tumors. In an early study of asbestos workers in Germany, a pathologist reported on the autopsies of 29 individuals, two of whom showed signs of pleural malignancies. Twenty percent of the workers had some type of malignancy. This was one of the first studies to conclude that there was some connection between asbestos and cancer.

Several studies in the following years found more evidence of connections between asbestos, asbestosis, respiratory illness, cancer, and specifically cancer of the pleura. By the 1950s there were also cases that connected asbestos to peritoneal mesothelioma. In one patient, asbestos fibers were actually found within the peritoneal tumor.

Finally, in 1960, a paper now considered seminal was published: “Diffuse Pleural Mesothelioma and Asbestos Exposure in the Northwestern Cape Providence.” This study investigated 33 patients with mesothelioma, all of whom 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, and so the researchers made a definitive conclusion that asbestos was related to mesothelioma of the pleura. The same year, another study was published that described a mesothelioma patient with known, long-term exposure to asbestos. He had asbestos fibers in the biopsy sample of his tumor, which strengthened the connection.

Asbestos and Mesothelioma in the United States

An important study of asbestos and its relationship to mesothelioma was published in the U.S. in 1964. A physician, Dr. Selikoff, reported on the results of studying over 1,000 Union Asbestos & Rubber Company factory workers from Patterson, New Jersey. Among other things, these workers produced asbestos insulation for the U.S. Navy.
Dr. Selikoff concluded that these workers had a mortality rate that was 25 percent higher than the average for similar demographics. The workers died from asbestosis, lung cancer, and other types of cancer. Several other studies and reports followed this one and further cemented the conclusion that asbestos exposure in U.S. workers contributed to cancer and to mesothelioma in particular.

By the early 1970s, the Occupational Safety and Health Administration began to set and update standards for exposure to asbestos in the workplace. In 1971 the Environmental Protection Agency (EPA) declared that asbestos was a hazardous pollutant. Following this the agency instituted several bans of asbestos-containing products, largely in the construction industry. In 1989 the EPA instituted a ban that included nearly all products with asbestos, but this ban was overturned by the Fifth Circuit Court of Appeals in 1991.

A Legal Milestone

In 1969, Borel vs. Fiberboard Paper Products Corporation was the first legal case to recognize that manufacturers of asbestos-containing products have a responsibility to warn workers of the risks of being exposed to asbestos. Borel developed asbestosis after years of working in shipyards with products made by the Fiberboard Paper Products Corporation. Four years later his victory over the company was upheld by the Fifth Circuit Court of Appeals. Over the next ten years, there would be over 16,000 liability and personal injury cases related to asbestos exposure.

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

Treatment History

The treatment strategies used for mesothelioma have developed rapidly over the last 60 years. The surgical treatment of pleural tumors began in the 1940s when doctors began performing pneumonectomies to remove a lung or a part of a lung. In the 1960s, pleurectomies were performed and are still in use today to remove the pleural tissue. By the 1970s some doctors had tried an aggressive and risky type of surgery called extrapleural pneumonectomy, which removes all of a lung, all of the pleura from one side of the chest, part of the diaphragm, and lymph nodes.

Over the years of treating mesothelioma, there have also been developments in chemotherapy, with new drugs and combinations of drugs being discovered. The first uses of radiation to treat mesothelioma began in the 1950s. Today, multimodal treatment is the most common approach. This involves using one or more types of treatment to attack the cancer. Now, researchers are working on using nanoparticles to deliver genetic factors and chemotherapy drugs directly to mesothelioma tumors.

The history of mesothelioma and asbestos goes back several hundred years, but today our understanding of the disease and what causes it is still not perfectly clear. Researchers continue to study the connection between asbestos and cancer and how mesothelioma develops when there is no exposure to asbestos. They also continue to work on newer and better treatments in the fight against this terrible disease.

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