Asbestos exposure FAQ - What is the cause of Mesothelioma
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And I wanted to ask how long or how often does a person need to be in contact with asbestos to have a high risk of developing mesothelioma?

Right, so that's a very question. So there's two factors there. One is the amount of exposure, right? So if in a room like this close and it's white, pale, white with asbestos and sometimes we hear that from patients, " I was working in the Navy and they put me down in a submarine or whatever it was and we couldn't see each other 'cause it was white, like snowing in there." And you know the exposure's really high. And he says, "But I was there for two weeks." Well it doesn't really matter. Now, the second is time. So here we go. Now we have something called the epic genetics, which is something that jumps over, like a saddle on a horse. So the horse is the [inaudible 00:01:02] the cell is something that you put on the horse to drive it around.
So, the epic genetics is something that comes onto the horse and changes the direction that horse is going. So, asbestos exposure, the more you have onto the horse, more chances that horse will change it's direction other words more chance the cell will change it's direction into cancer. That's one. The amount of asbestos.
And the other is prolonged time. For example, someone says, "Well really I wasn't sure because my dad was working in it, would bring clothes with asbestos, I would clean every weekend or so whatever it maybe. But for fifteen years." So then you have that little epic genetic factor, jump onto the cell even though a small amount throughout a long period of time until a certain amount of time the cell changes it's cycle and goes into cancer cycle. So both exposure and time are important factors. Which one's more important? In our experience, it's exposure.
So I say this because we saw a patient once said, "I think I worked in the summer time in the camp in Australia and the bags were full of asbestos but at seventeen I need some cash and I did that for three weeks." But this is forty years ago, fifty years ago, yeah but there was enough that left in there and made those cells change in the different direction. And that's the fascinating part of it is you're almost like a detective. You have to go back and find the reason for that.

So Dr. Desilva, is there a ratio of people who are exposed to asbestos versus who come down with mesothelioma and who don't?

Yes. The majority of patients don't. And that is the conflicting, but if you look into lung cancer. Sixty percent, sixty, six zero depending where you read, sixty percent of patients who have lung cancer never smoked, don't even know what cigarette is. Forty percent smoked, but if you go around and say of the patients who have lung cancer, present lung cancer, what percent of them smoked? Ninety percent. So there we go. Say well what's up with mesothelioma? If you go around and say what percent of patients are exposed to asbestos that have mesothelioma, the incidence is gonna be lower, but if you go back to the patient who have mesothelioma and say, "Were you exposed to asbestos?" Yes. The majority of them will be exposed to asbestos. So it crossed over. I don't know if it made sense to you what I just said.
So, in other words, if you've got a hundred patients been exposed to asbestos, about two percent of patients will have mesothelioma. But if you say, well forget about that, let's see all the patients that have mesothelioma around the world, what percentage of them were exposed to asbestos? Ninety percent. Why is that important? 'Cause that tells you that asbestos, nothing else, all other components involved with it, but asbestos was the predominant factor who changed the cell direction.

So are you seeing people from all over the world, 'cause it seems like are they coming or will they come?

So right now they're coming from Boston. Which to me is the other part of the world. No we've got people from Canada coming down here. We have Illinois, Michigan, Wisconsin, they have what they call unions for pipe feeders and plumbers. They call locals, LOCL, LOCLs so we sent fifty one information sent to those places and trying to get places to come here 'cause a lot of people don't know there's a program up and running Chicago.
We do get the idea that people, someone from Brazil was gonna come and see me and they decided to go for a trial first which is perfectly fine and so yes we're open for business.

And so people from the LOCLs whether they're symptomatic or not come and see you?

No, only when they're symptomatic or someone saw it, so what I'm trying to say I sent to the LOCLs because when the patients, when pipe feeders or plumbers get sick, they have to report their sick to the LOCLs.

Right.

Then the LOCLs, they don't know where to send the patients. They said, "well we'll go to Boston, go to Maryland, go to someplace else. Go to Pittsburgh, or Philadelphia." Now I'm telling them you don't have to send them out I'm in Chicago, can send them to us.

You brought up a good point at the beginning about patients navigating the system that's mesothelioma is a unique disease 'cause I think a lot of people hear about it from all the ads and all that's on the TV, but they don't really know what to do about it. So, you speaking kind of gives it a face more than anything, but can you speak a little bit about patients navigating the system? 'Cause I don't think a lot of people know how to get in contact with you or you know what I mean?

Right. So we've been working. I mean I've been here since September and if you take September out because it was one of those months just move in and then December was kind of another kind of down month. I've been here for about six months now. And I have put a lot emphasis in contacting different LOCL agencies, Web Connection, Cure for Meso, IMG, the study group for mesothelioma and let them know that we exist. There's gonna be a publication I think one of the sites for mesothelioma and we're trying to get support from the media here in Chicago to have either TV or newspaper advertise with patients telling that they had a good experience in our program. So I think when patients go out and try to navigate, there's a lot of misinformation. So I think for the sites that you don't have the input of both nurses and doctors highly involved in treatment and care of mesothelioma we should exclude them.
The other option is go to sites where people have the most hits and ask the question, what are the places that I can go? One of the sites actually lists universities by location where you can go and get comprehensive mesothelioma care. So that's a good site, but they don't know it so they have to select which one's best.

Yeah. I think it must be very confusing for them.

Correct.

Yeah. Do you think the United States, is it the United States and Britain? Well I don't know how progressive Britain is, but are the United States are they leading in aggressiveness?

Yes. So is England. England's beginning, oh I should say the UK, beginning to change a little. Not much, but a little and that's mainly because there's a new generation of thoracis surgeons coming up like myself and we have this very selective group that we exchange information across the pond and get more aggressive including in France and Belgium and Switzerland is beginning to do more so...

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