Statement on malignant mesothelioma in the United Kingdom

Our plain-English summary of Statement on malignant mesothelioma in the United Kingdom, by British Thoracic Society Standards of Care Committee (Thorax, 2001).

The study

• Author: British Thoracic Society Standards of Care Committee
• Journal: Thorax
• Published: 2001;56(4):250-65
• Type of article: Consensus statement, Review
• Cited by: 81 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

The British Thoracic Society (BTS) Standards of Care Committee was asked by the National Health Executive in England to consider how the management of malignant mesothelioma could be improved, given its increasing incidence. A Working Party of clinicians, supplemented by co-opted radiologists, pathologists and oncologists, compiled guidance on pleural and peritoneal mesothelioma in the UK. The guidance was based on literature searches and reviews. The draft was reviewed by BTS members, expert groups, and representatives of patients and the government. The authors stated that it was not strictly evidence based and was offered for guidance.

The statement noted that mesothelioma is almost always caused by inhalation of asbestos fibre many years before presentation. Cases in Britain were expected to rise from about 1300 to more than 3000 a year. All types of asbestos can cause the disease, and one series reported a mean latency of 41 years.

The statement covered:

• presentation and prognosis, with median survival of 8 to 14 months;
• diagnosis, stressing a detailed occupational history and CT scanning;
• pathology and staging;
• radical surgery and management of pleural effusions;
• radiotherapy, chemotherapy and new treatments;
• palliative care and peritoneal mesothelioma.

It recommended specialist care and chemotherapy preferably within clinical trials. It also described UK benefit and compensation routes, including Industrial Injuries Disablement Benefit and common law claims.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is not a research study but a British Thoracic Society guidance statement on pleural and peritoneal mesothelioma in the UK, drawn from literature reviews. The authors stated that asbestos fibres cause most cases, that all types can cause mesothelioma, and that amphiboles (crocidolite, amosite) are more potent. They cited a WHO review finding that chrysotile poses an increased, dose dependent risk. They saw no evidence of a safe threshold dose, though the risk at low exposure is small. Citing the most recent well documented series, they wrote that it suggests about 90% of UK cases have an obtainable occupational exposure history. One series suggested a mean of 41 years (range 15 to 67) from first asbestos exposure to death. Median survival for pleural mesothelioma varied from 8 to 14 months across studies, measured from symptom onset or diagnosis. They recommended CT for undiagnosed pleural exudates. They noted that no randomised trials had established radical surgery's role, and none published compared chemotherapy with best supportive care on survival or symptoms. The authors offered the statement as guidance and acknowledged it was not strictly evidence based.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical guidance statement (consensus document) by a British Thoracic Society Working Party, based on literature searches and reviews by its members; not an original research study
• Who was studied: Patients with pleural and peritoneal malignant mesothelioma in the UK; the statement is written primarily for clinicians caring for them
• Exposure: Asbestos in general, with discussion of amphiboles (crocidolite, amosite) and chrysotile; the statement does not study a specific exposure itself
• Main results:
  • The statement says there is no evidence of a threshold dose of asbestos below which there is no risk, but that the risk at low levels of exposure is small
  • Amphibole fibres (crocidolite and amosite) are described as the more potent causes of mesothelioma
  • Citing a WHO review, the statement reports that chrysotile poses an increased risk of mesothelioma in a dose dependent manner
  • Citing the most recent well documented series (another study), the statement says that series suggests a history of occupational asbestos exposure can be obtained in about 90% of UK cases
  • Citing one recent series (another study), the mean interval between first asbestos exposure and death was 41 years (range 15 to 67)
  • The statement says there is no evidence that mesothelioma can be caused by fibreglass or other building materials, cigarette smoking, or intrapleural talc
  • Pleural plaques indicate asbestos exposure but are absent in many proven cases of mesothelioma
  • Median survival for pleural mesothelioma varied from 8 to 14 months in different (cited) studies
  • The cited survival studies used different starting points: some measured survival from onset of symptoms, others from definite diagnosis
  • The statement recommends CT scanning for all patients with undiagnosed pleural exudates
  • The statement recommends pathological confirmation of the diagnosis unless the patient is frail or has extremely advanced disease
  • No randomised controlled trials have established the role of radical surgery
  • No published randomised trials have compared survival or symptom control between chemotherapy and best supportive care
  • Prophylactic radiotherapy reduces chest wall implantation after invasive procedures
  • Palliative radiotherapy provides pain relief in about half of all patients
  • Peritoneal mesothelioma is described as related to asbestos exposure but less common than pleural mesothelioma
  • For peritoneal mesothelioma, the outlook is described as poor, and no treatment has been shown to alter prognosis
• The authors' conclusion: The authors offered the statement as guidance and stated that it is not an attempt to dictate management dogmatically
• Limitations the authors state:
  • The authors stated the document is not strictly evidence based because they did not attempt a comprehensive review of the epidemiological, pathology and medicolegal literature
  • The authors noted that the rarity of the disease and lack of extensive research leave clinicians without reliable evidence for practice

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Peritoneal Mesothelioma, Mesothelioma, Latency, Prognosis, Median Survival, Occupational History, Pathology.

Related studies

• BTS statement on malignant mesothelioma in the UK, 2007 — British Thoracic Society Standards of Care Committee (2007)
• Risk of cancer from occupational exposure to ionising radiation: retrospective cohort study of workers in France, the United Kingdom, and the United States (INWORKS) — D.B. Richardson, E. Cardis, et al. (2015)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)
• A study of the histological cell types of lung cancer in workers suffering from asbestosis in the United Kingdom — F. Whitwell, M.L. Newhouse, et al. (1974)
• Mortality of employees of the United Kingdom Atomic Energy Authority, 1946-97 — W.D. Atkinson, D.V. Law, et al. (2004)
• Mortality among United Kingdom servicemen who served abroad in the 1950s and 1960s — S.C. Darby, C.R. Muirhead, et al. (1990)

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