We discussed what is pleural mesothelioma with Professor Antonio Giordano, the internationally renowned medical researcher and founder of the "Sbarro Institute for Cancer Research and Molecular Medicine" at Temple University in Philadelphia. Sledet.com reached Professor Antonio Giordano who, despite his numerous professional commitments, found the time to talk about this tumor, which to date still affects too many people.
What is pleural mesothelioma?
Malignant mesothelioma is a highly aggressive tumor originating from cells of the mesothelium, the tissue that covers, like a thin film, most of internal organs and protects them by producing a particular lubricating liquid. The mesothelium has different names depending on the area it covers. It is called pleura in the thorax, peritoneum in the abdomen and pericardium in the space around the heart. The majority of currently detected mesothelioma cases, about 70-80%, are pleural mesothelioma.
Does it occur more often in men or women?
Pleural mesothelioma occurs more often in men than in women, likely due to professional exposure to asbestos mineral fibers and risk increases with age. About two thirds of patients affected by this neoplasm are between 50 and 70 years old.
You may want to mention that there are asbestos-unrelated MM cases in younger patients associated with mutations in tumor suppressors (BAP1)
What is the main symptom?
The main symptom is dyspnea due to pleural effusion and associated with chest pain. The development of this tumor is characterized by a long clinical latency as in fact 30 years can pass from exposure to asbestos fibers to development of the tumor.
Could you explain the main risk factor?
Pleural mesothelioma is one of the few tumor forms for which there is substantial etiopathogenetic certainty, i.e. the cause of onset of this tumor is almost entirely attributable to exposure to asbestos fibres. Until about 30 years ago, this neoplasm was considered an exceptionally rare tumor. Unfortunately, its incidence has increased. Exposure to asbestos fibers in Italy is mostly due to work-related causes and showed high mortality rates in Liguria, Piedmont and Friuli Venezia Giulia, regions rich in shipyards and the asbestos cement industry.
What is asbestos?
The word asbestos and asbestos derive from Greek and mean 'immaculate or incorruptible' and 'perpetual or inextinguishable', names which contain the main characteristics of this mineral. Asbestos fibers are very dense and extremely thin. They are invisible to the human eye, so much so that a single asbestos fiber is thousand times smaller than a hair. Asbestos resists fire and heat, the action of chemical and biological agents, abrasion and thermal and mechanical wear. It is easily worked and can be woven. It also has sound-absorbing as well as heat-insulating properties. It bonds easily with building materials (lime, plaster, cement) and with some polymers (rubber, PVC). These minerals, due to their easy availability and low cost, have been used in a wide range of products and in various industrial activities.
What do asbestos fibers cause?
In regard to asbestos, the mechanisms by which this mineral causes the transformation of mesothelial cells are not fully understood. It is certainly known that asbestos fibers are insoluble and, when inhaled, create physical irritation responsible for scratches and scars which can then lead to development of fibrosis and plaques.
How do we come into contact?
Inhalation.
How is it diagnosed?
Pleural mesothelioma is an insidious neoplasm. Very often it is diagnosed when the disease is already in dvanced stage, both because the clinical symptoms are often underestimated or misunderstood, and because it is difficult to correlate them with exposure to a harmful substances, which could have occurred many years earlier. A chest x-ray alone or other radiological tests may not be sufficient, since different types of tumor may be present in the lungs and it could be not certain that that specific radiological image is a tumor. Therefore, histological investigations are generally necessary for the identification of this neoplasia.
How widespread is pleural mesothelioma today?
Until 1950, pleural mesothelioma was considered a very rare tumor. However, it is currently responsible for approximately 3,000 deaths per year in the United States and over 5,000 deaths in Western Europe.
Has research made progress regarding its treatment?
Yes, but mesothelioma is a difficult tumor even on a molecular level. Thus, further studies, prevention and environmental protection are needed.
In your opinion, what is the most effective action to prevent it?
Most deaths are linked to exposure to carcinogenic mineral fibres. For this reason, many deaths could be prevented. However, the risk of developing this neoplasm has become environmental rather than occupational!
For what reason?
In Western countries asbestos has been banned but it still remains a serious environmental problem, because it has been dispersed in the air for many decades, it has not been completely disposed of, and exists all over the world as natural deposits with which people inevitably comes into contact. Furthermore, to date, there is no test that alone or in combination with others can be used for prevention campaigns that can be applied at a population level.
What should be done in high-risk areas?
In areas at high risk of asbestos-related diseases, it is essential to intervene as quickly as possible. We cannot stall for economic reasons and condemn thousands of people to death.
Sledet.com thanks Professor Antonio Giordano for the interview, and ad maiora!
Professor Antonio Giordano, M.D., Ph.D., is the creator and head of the Sbarro Health Research Organization, located at Temple University's College of Science and Technology in Philadelphia. Stay connected with him through his various social media platforms, including Facebook, LinkedIn, Twitter, and Instagram, to receive the latest updates.
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