Feature
Two Australians diagnosed with mesothelioma each day: AIHW
While symptoms of the deadly disease can take decades to present, GPs need to be aware of full occupational history, an expert says.
Often diagnosed at advanced stages because early symptoms can go unnoticed, between 700–800 Australians are diagnosed with mesothelioma each year.
Two men, aged 77 years old, each day.
That is the average diagnosis of mesothelioma in Australia, according to the latest Australian Institute of Health and Welfare (AIHW) figures, in a country with one of the world’s highest rates of the deadly disease.
But with a ‘long and highly varied latency’, the AIHW emphasises that mesothelioma can take decades to develop – between 20 and 60 years – post-exposure to asbestos.
This means that the occupational lung disease can be difficult to diagnose, as symptoms can develop immediately, or months or years after exposure. Symptoms of mesothelioma can also be similar to other conditions, with the cells looking similar to those of other cancers.
So how can GPs be best prepared for diagnosing and managing these patients?
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP that ‘good clinical practice’ for all patients includes taking a comprehensive occupational and environmental history.
‘GPs have a critical role in identifying patients at risk of any of the occupational lung diseases, which include mesothelioma, silicosis, and many others, since the majority of patients usually first present to GPs with their symptoms,’ she said.
‘These are usually respiratory in nature and may include cough, breathlessness, fatigue.
‘Given the latency period of occupational lung diseases, this should include a full employment history, inclusive of both current and past employment.’
The AIHW report presents the latest available statistics from the Australian Mesothelioma Registry (AMR) and details notified cases of mesothelioma received by the AMR between 1 January – 31 December 2021, with 722 cases diagnosed during that year.
Supplemented by data from the National Mortality and Australian Cancer databases, it reveals that between 700–800 people are diagnosed with mesothelioma each year, with men more likely to be diagnosed than women across all age groups.
The number of cases diagnosed each year for both men and women has steadily increased over the past 40 years. For example, between 1982 and 2021, cases increased from 135 to 577 for men, and from 22 to 145 for women.
Unsurprisingly, the most common job-specific occupational exposure is among trades. As part of its research, the AIHW tracked common trades’ exposure to asbestos across 2010–21, showing ‘possible or probable’ exposure for:
- 96% of the 82 people in electrical trade jobs
- 90% of the 245 people in building trade jobs
- 90% of the 58 people in metal production and fabrication jobs
- 85% of the 52 people in plumber/gasfitter jobs
- 78% of the 94 people in metal fitter/turner and toolmaker jobs.
In addition to a comprehensive general health and occupational history, Dr Hancock recommends GPs follow
up-to-date guidance on investigating symptoms of lung disease.
‘Timely investigations and subsequent timely referrals are important,’ she said.
‘[As is] not ignoring symptoms, such as the new or changed cough lasting more than three weeks, haemoptysis – no matter how slight – chest and/or shoulder pain, shortness of breath and not putting it down to age or the patient being a smoker without further investigation.
‘Even presentations of fatigue and DVT [should be investigated], let alone the more obvious sinister symptoms and signs such as finger clubbing or recurrent chest infections or abnormal chest signs that might indicate a pleural effusion.’
When GPs have a ‘high clinical suspicion’ of lung cancer/mesothelioma, the recommendation is to urgently refer for a chest CT, Dr Hancock says, and discuss with the local radiology team the appropriate type of CT, and concurrently – within two weeks – refer to a
specialist linked to a lung cancer multidisciplinary team.
The use of asbestos has been banned in Australia since 2003, and the rise of another occupational lung disease, silicosis – dubbed
‘the asbestos of the 2020s’ – has led for
calls to also fast-track the ban of silica products.
In 2020, 701 people died from mesothelioma – a mortality rate of 2.1 deaths per 100,000 population, according to the AIHW. With a ‘very low’ survival rate compared to other cancers, the AIHW also notes that many factors can affect a person’s chances of survival, including overall health status, age at diagnosis, and the level and duration of exposure to asbestos.
Dr Hancock says increased awareness of occupational cancers in general practice is crucial, given there is currently no cures for either mesothelioma or silicosis, and cases are
expected to rise for
both diseases.
She recommends a number of resources for GPs and their patients:
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