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Asbestos and mesothelioma disease: an interview to learn more about

It is not often that we hear about asbestos and its related diseases. The project “Ancora sotto casa mia”, (which has been discussed in a previous article – to read more click here), has contributed to uncovering this problem around asbestos.

Although the project is praiseworthy and pleasant in its formula, so much so that it is mentioned on the blog International Ban Asbestos Secretariat and Twitter of Laurie Kazan-Allen (one of the most well-known activists in the UK regarding asbestos and its effects), I believe that the scientific side of the project plays a significant role in bringing light to this issue. 

I had the pleasure to interview Doctor Federica Grosso, oncologist and head of SSD Mesothelioma of the Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo in Alessandria. With her, I addressed the medicine part of mesothelioma disease and generally the asbestos effects.

What Asbestos is? Why is it considered dangerous? 

Dr Federica Grosso – Asbestos is a very resistant material composed of fibres present in nature; widely and commonly used in the construction industry and for its thermal insulation, insulate and fireproofing properties in the past. In addition to corrugated roofings are the well-known roofing material produced by the Eternit industry, particularly diffuse in many parts of Italy. 

Although Asbestos usage has been banned in Italy since 1992, its presence is vivid in those areas where it was extracted and processed. Moreover, the release of asbestos fibres in existing structural elements of our buildings in the past still represent a significant problem today, especially in certain geographical areas. 

Not to mention those territories of Casale Monferrato and Alessandria, asbestos is still an unresolved problem because of the presence of the Eternit asbestos-cement factory (closed in 1986, six years before the official announcement). 

For instance, in areas such as Biancavilla, the analogous problem is due to fluorine-edenite quarries, a fibrous mineral composed of thin fibres with a similar structure, albeit different composition to that of asbestos, this type of material was largely used in road constructions. 

The danger of this silent killer lies in its friability. If the material is intact, the risk that fibres are scattered and inhaled remain low. On the contrary, if asbestos is worn, it becomes a serious hazard. In fact, the inhalation of fibres can cause various diseases, including asbestosis, lung cancer and mesothelioma.

From what I understand, therefore, there is a law that bans its use. What about reclamation? How is the situation?

Dr Federica Grosso – Certainly, there exists the law n.257/1992 that bans the extraction, import, export, commercialisation and production of asbestos in the Italian territory. Following the issue of this law, it has begun a significant reclamation work, which is still underway. Unfortunately, we are still far from the definitive eradication of the problem.

Regarding health, you mentioned mesothelioma a little while ago. Could we know what it is?

Dr Federica Grosso – Mesothelioma is a globally rare tumour disease but frequent in territories where the mineral was extracted or processed. 

It is a particularly aggressive tumour that affects the pleura, the thin sheet of cells (called mesothelial) that covers the lungs and allows them to expand during breathing. 

It can also affect other parts of the body, covered by the same mesothelial cells, such as the vaginal tunic that lines the testicles, the peritoneum, which lines the abdominal cavity or the pericardium that lines the outer surface of the heart. 

The initial symptoms of pleural mesothelioma are generally nonspecific and are often ignored or interpreted as signs of other more common diseases. Among the first symptoms are back pain (localized to one side only), shortness of breath, cough, fatigue, loss of appetite. To date, the therapeutic options available are scarce and based mainly on chemotherapy, which does not guarantee recovery.

Has scientific research progressed further on mesothelioma disease?

Dr Federica Grosso – In the last few years, the interest in this disease has undoubtedly increased. Recently, there have been promising results with immunotherapy procedure, as well as numerous trials underway with targeted biological drug therapy.

Since this is a rare tumour, unfortunately, research investments have been insufficient in the past years. Although some signs of progress have been made, results are still too limited. For this reason, scientific/medical research has developed personalised treatment approaches playing significant roles in the fight against this disease.

In Italy, since 2006, guidelines on the diagnosis and treatment of mesothelioma have been implemented by the Italian Association of Medical Oncology (AIOM), which made it possible to standardise the patients’ therapy throughout the national territory.

There are centres in specific geographical areas with a high incidence or historical excursus with asbestos disease, which have a superior specialisation and experience in treating patients affected by mesothelioma. Luckily we work and collaborate closely, and there exists a dedicated network for rare tumours (National Rare Tumours Network). The National Cancer Institute of Milan leads the National Tumours Networks, allowing to share cases electronically and establishing the best pathways for individual patients – even without them leaving their home. 

Our structure within the National Rare Cancer Network is the referral for mesothelioma, in line with the hospital mission to combine clinical care with scientific research. This particular attention to the research shows the presence in our company of the SC Infrastructure Research Training Innovation, directed by Dr Antonio Maconi. A structure entirely dedicated to asbestos and its diseases. 

Mesothelioma and pen in the clinic.

Is there any way to protect yourself from mesothelioma?

Dr Federica Grosso – The best way to prevent mesothelioma today is to minimize or better avoid exposure to asbestos and asbestos-form fibres. For this reason, the reclamation of contaminated places is of primary importance.