“Te tumour forms a bulk around the


lining of the lungs and constricts the ability to expand and contract, so that the patient progressively becomes more breathless.” Radiotherapy has nothing to offer and


although there is a new drug on trial – pemetrexed – Dr Clark says patients are oſten reluctant to enter trials at the risk of blighting their last few months with side- effects, with limited benefit. Treatment then is “best supportive care” – in effect painkillers like morphine, which also eases breathlessness but affects consciousness levels.


Other conditions Among other asbestos-related conditions encountered by clinicians are asbestosis, pleural plaques and thickening, and asbestos-related lung cancer. “In my experience there are not nearly as


many cases of asbestosis as there used to be,” says Professor Britton. “It needs a high dose of exposure and the latency period is not so long, so these cases are diminishing in number. I have seen one new case in the past month.” Pleural plaques, he says, will indicate


that a patient has been exposed to asbestos but they present no greater risk of developing mesothelioma than someone exposed to asbestos not displaying plaques. Te key advice for GPs is to ensure that any patients with pleural plaques who become breathless should be sent for chest X-ray. An estimated mortality rate of 2,000 per


year puts asbestos-related lung cancer on a par with mesothelioma. Certainly cigarette


smoking and asbestos can form a deadly combination. “Smokers are staggered when you tell them that asbestos exposure increases their risk of lung cancer eight- fold,” says Dr Clark.


Sleeping dogs Today typical patients suffering with asbestos-related conditions are no longer the older laggers and shipyard workers, and the people who manufactured asbestos products, but maintenance workers such as carpenters, electricians, plumbers, heating and telephone engineers. “Now it can be secondary exposure –


“The cost is going to be in human rather than financial terms”


handling and working with asbestos products – and that can happen anywhere,” says Professor Britton, who sits on the Industrial Injury Advisory Council. In public buildings and office blocks


where asbestos has been used, a policy of “let sleeping dogs lie” has oſten been followed. Asbestos products are still around in buildings and still being handled, sawn and drilled. Even when the material appears to be in a stable situation, accidental damage can introduce risk. Not even teachers and office workers


have been immune nor, presumably, GPs, dentists and their staff and patients in older buildings. It is worth noting that every commercial building is now required to have an asbestos register in place and available for inspection by employees or trades people working on site. Te HSE tells us: “If you're responsible


for maintenance of non-domestic premises, you have a duty to manage the asbestos in them, to protect anyone using or working in the premises from the risks to health that exposure to asbestos causes.” Failure to comply can result in fines,


imprisonment, refusal of employers’ and public liability insurance, and refusal by public utilities to conduct repairs to essential services (see www.tinyurl.com/smnsasb). So the message for doctors is be aware –


asbestos-related disease is by no means a thing of the past.


nAlan MacDermid is a freelance writer and former health correspondent with Te Herald


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