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Mesothelioma and Lung Cancer News - May 2004

Pemetrexed Study Suggests Advances over Docetaxel in Second-Line Non-Small Cell Lung Cancer

INDIANAPOLIS, May 4 /PRNewswire/ -- In a recent study, Lilly's drug pemetrexed showed a similar patient survival rate, but with an improved safety profile, when compared to docetaxel (Taxotere(R)), the current standard of care for second-line non-small cell lung cancer.

The research findings of the largest head-to-head Phase III trial ever reported to date in second-line non-small cell lung cancer were reported in the 1 May issue of the Journal of Clinical Oncology(1), a peer-reviewed journal.

The U.S. Food and Drug Administration (FDA) recently approved pemetrexed, in combination with cisplatin, for use in the treatment of malignant pleural mesothelioma, a cancer often associated with asbestos exposure.

Currently, docetaxel is the only drug approved in both the U.S. and Europe to treat patients with non-small cell lung cancer in the second-line setting. While the drug extends survival when compared to best supportive care, it is associated with several side effects, including hair loss and blood-related toxicities, including neutropenia, a lowering of the white blood cell count that can cause infections and fever, thus requiring hospitalisation.

The new study suggests that pemetrexed, administered in 10 to 15-minute infusions once every three weeks, showed a survival rate comparable to that of docetaxel (median survival was 8.3 months vs. 7.9 months respectively), but with fewer serious side effects.

"Pemetrexed clearly had fewer drug-related hematological side effects, which resulted in fewer hospitalisations," said Nasser Hanna M.D., lead author of the study and assistant professor Indiana University School of Medicine and member of the Indiana University Cancer Center. "So in short, pemetrexed is better tolerated, it's convenient to administer and it's equally as effective as docetaxel." Patients on pemetrexed did show an increased transient elevation in the liver enzyme, Alanine Transaminase (ALT), said Hanna.

Lilly has submitted a New Drug Application to the FDA for the use of pemetrexed in the second-line treatment of non-small cell lung cancer. Lilly anticipates a regulatory decision by the fourth quarter in the U.S. Lilly has also submitted a dual European submission, with the first part for pemetrexed, combined with cisplatin, in the treatment of malignant pleural mesothelioma and the second for pemetrexed as a single-agent in the second-line treatment of non-small cell lung cancer. Lilly anticipates a European regulatory decision in 2005.

"We commend the scientists in this study for their commitment to conducting quality research in an effort to support patients and physicians who are affected by this devastating disease," said Paolo Paoletti, M.D., vice-president, clinical research, oncology products, Eli Lilly and Company. "Importantly, this was a study in which pemetrexed was compared to the standard of care in the treatment of second-line non-small cell lung cancer and the results suggest similar efficacy and less blood-related toxicity for pemetrexed."

Study Design

The Phase III global study involved 571 randomised patients whose non- small cell lung cancer advanced beyond the first chemotherapy regimen. Among the patients enrolled in this study, 283 received docetaxel (75 mg/m2 on day one of a 21-day cycle; one-hour infusion) and 288 received pemetrexed (500 mg/m2 on day one of a 21-day cycle; 10-minute infusion; supplemented with vitamin B12 and folic acid). The primary endpoint was overall survival and secondary endpoints included toxicity, response rate, and progression-free survival.

Key study findings are as follows:

Pemetrexed Docetaxel p-value
(n=265) (n=276)

Median Survival Time 8.3 months 7.9 months NS
(non statistically significant)

Overall Response Rates 9.1 percent 8.8 percent NS
(non statistically significant)

Grade 3 or 4 Neutropenia 5.3 percent 40.2 percent <0.001
(statistically significant)

Hospitalisation for Neutropenia
w/ Fever 1.5 percent 13.4 percent <0.001
(statistically significant)

Alopecia (hair loss) 6.4 percent 37.7 percent < 0.001
(statistically significant)

Grade 3 or 4 Alanine Transaminase
(ALT, a laboratory measurement
of liver function) 1.9 percent 0.0 percent 0.028
(statistically significant)

* This table lists adverse events that occurred during the study that were of a statistically significant variance.

9/11 Attacks Declared NYC's Worst Environmental Disaster

May 4th, 2004
Rescue workers who toiled at Ground Zero in the days following the Sept. 11, 2001, attacks on the World Trade Center are likely to face long-term health problems from what a new federal report calls "the largest acute environmental disease that has ever befallen New York City."

Cases of asthma and severe cough continue to plague firefighters, other rescue workers and nearby residents, according to the report compiled from six research centers, cited by the Associated Press. The findings appear in the May edition of Environmental Health Perspectives, published by a branch of the U.S. National Institutes of Health.

One study of 183 rescue workers found that 33 percent had acquired a severe cough, 18 percent were wheezing, and 24 percent reported increased phlegm production. And asbestos particles detected in the dust from Ground Zero are likely to increase workers' risk of a rare but deadly form of cancer called mesothelioma, the report said.

Its authors said the long-term effects of the disaster would become more apparent over time and with additional research.

Gene Mutation Linked To Lung Cancer Treatment

Some lung cancer patients may soon benefit from a new discovery that identifies a genetic mutation in some lung tumors that could lead to targeted cancer therapy drugs that produce dramatic effects in treatment.

Genetic screening could assist doctors to identify which lung cancer drug to use in an effort to treat some patients. Two new studies suggest a specific gene mutation in a lung cancer tumor that occurs in approximately 10 percent of people with lung cancer is a key factor in determining if a new drug to treat the cancer should be prescribed.

Lung cancer patients with the mutation were all but cured when treated with the new drug named Iressa, which is made by AstraZeneca Plc . For the remaining 90 percent of lung cancer patients without the mutated gene, Iressa had basically no effect on tumors.

Although there is no simple test currently available to determine if the genetic mutation is present, researchers are in a race to develop one. Researchers hope to have a test available within a year.

Iressa is generically known as gefitinib.

The findings appear in The New England Journal of Medicine.

Devoted Mother dies of Mesothelioma

May 6, 2004
Sheila Revell who has washed her husband's work clothes for years, dies of Mesothelioma. She has inhaled the deadly asbestos fibers or dust into her body during this period. Click here to learn more about Asbestos.

Sheila who is a mother of 3 and 72 years of age used to shake out her husband's clothes freeing them of asbestos particles. She used to do this before washing the clothes.

Sheila contracted Mesothelioma last june and died last month at her residence in Norfolk, UK.

Sheila's husband, Dennis, states that he had worked around asbestos on local air bases. However, he did not know about the dangers of working around asbestos at that time. Dennis is now retired and receiving medical treatment.

Widow wins 152,000 Pounds in Mesothelioma Asbestos Compensation

May 6, 2004
A British Widow from Flintshire has won 152,000 pounds in compensation after her husband died of Mesothelioma in June 1996.

Sylvia's husband, Vernon Barker experienced heavy asbestos exposure between 1960 to 1968 while working for John Summers and Sons Ltd. He worked as a labourer.

According to Lord Justice Kay, Mr. Baker had greatest asbestos exposure over a period of 6 months, when he used to clean up the galvanising section of the firm. He further said "clouds of asbestos" would escape into the air as the workers repaired leaking furnaces. Mr. Baker as part of his job was required to sweep these surfaces after the repairing was done.

Sylvia Barker fought against an attempt to strip her off compensation. The legal successors of the firm, Saint-Gobain Pipelines plc, claimed they were not liable for the exposure and did not have to pay the compensation.

The owner of the firm, Saint-Gobain tried to argue that he worked as a plasterer for 20 years and he himself was exposed to Asbestos. However, the judge declared there was no reason for Saint-Gobain to "escape liability".

Widow launches legal battle for Asbestos Compensation

May 6, 2004
Brian Smith, a 70 year old man, died from the disease Malignant Mesothelioma after working as a bricklayer for Matthews Ltd. in Ingrams Lane, Gorleston.

Brian was exposed to asbestos between the years 1954 to 1978 working as a bricklayer. It is due to this reason that his widow has launched a legal battle for compensation for her husband's death caused by Mesothelioma.

Mrs Joan Smith blames the company for their negligence that cost her husband's life and has issued a claim at the High Court for compensation over 150,000 pounds.

The Evening News has indicated Brian Smith suffered due to the dust of asbestos. The claim filed says Mr. Smith inhaled particles of asbestos dust and fibres when he used to brush roofs using a stiff wire brush.

Mrs. Smith, who was married to her husband for almost 50 years, says Brian did maintenance work on boilers and boiler houses. Asbestos dust was produced after the pipes were lagged with asbestos. This exposed her husband to asbestos.

Brian became unwell in March 2001 and his health worsened until his death in August 6, 2002. It is said that his life was shortened 8 years.

Mrs. Smith therefore claims the company exposed her husband to asbestos negligently failing to provide him with adequate protection and a safe system to work with.

Celebrex Stops Mesothelioma Cells From Growing in a Lab Dish

A drug called Celebrex (also known as Celecoxib) that is usually prescribed for Arthritis, has shown a positive effect for the treatment of malignant mesothelioma. The COX-2 inhibitor has shown to stop mesothelioma cells from growing in experiments done in labs and on animals. This comes from a report in Italy.

The current mesothelioma treatments have been unsuccessful. However, Celebrex has shown a positive sign, comment the authors in the International Journal of Cancer. Dr. Alfonso Catalano and his colleagues at the University of Marche in Ancona have been assessing the effects of Celebrex in experimental Mesothelioma.

Celebrex was tested along with other similar compounds. Celebrex was the most successful because it did not inhibit the growth of a normal mesothelial cell line.

Mesothelioma was embedded into some mice. Celebrex treatment was tested on them and it increased the average survival of the mice from 45 to 62 days!

Dr. Alfonso and his team had this to say in conclusion, "These results provide the first evidence that celecoxib is effective for the prevention and regression of malignant mesothelioma cells in experimental models ... and strongly support ongoing clinical trials in malignant mesothelioma patients."

UCLA Medical School Proposes a Comprehensive Mesothelioma Research Program

May 10, 2004
Dr. Robert Cameron (Thoracic Surgery Chief at UCLA Medical School) has recommended a comprehensive research and treatment program for Mesothelioma, which will benefit Mesothelioma patients.

This a long overdue program. Several hospitals in USA offer distinct mesothelioma treatment options but very few of them offer a variety of options that gives the patient a reasonable choice.

“From 2000 through last year, the National Cancer Institute spent $8.4 million on mesothelioma research, less than a tenth of one percent of the federal agency's $15.83 billion spent on all cancer research.”

The Wall Street Journal recently reported that mesothelioma research is "woefully underfunded". If this program is implemented, treatments such as radiation, chemotherapy, surgery and pain management will be offered. The UCLA is therefore in need of funding.

More Compensation for South African Asbestos Miners

May 14, 2004
South African Asbestos Miners have received seventh round of payments from Cape plc after a settlement approved by the British high court.

This brings the total to 94% of victims who have been compensated for their asbestos exposure. According to Richard Meeran of UK-based Leigh, Day & Co, the firm representing the victims, the first round of payments were made in September 2003.

About 7500 claimants received a total of 128 million Rand (roughly 185,000 US dollars). Free bank accounts were opened for victims who did not have bank accounts.

Kins of deceased victims were compensated as well but there were problems with the amount of payments that had to be made. Richard quotes, "It was necessary to identify the relative who is legally entitled to receive the money,"

He adds, "A system had to be arranged with local magistrates to formally designate grants of representation to next of kin on behalf of estates of deceased miners."

More victims are being traced and outstanding claims will be fulfilled according to the law firm representing the victims.

Asbestos: Cause of another death

May 21, 2004
Since the age of 16, Alec Woodhead worked around ships and on November 10th 2003, died from Mesothelioma. Alec died at Princess Alexandra Hospital in Harlow, UK, as a retired Ship broker.

According to Coroner Caroline Beasley-Murray, Alec was often aboard ships although he was an officer in the shipping industry. Due to this, his contact with Asbestos was most likely.

Mrs Beasley-Murray quotes, "In those days the dangers of asbestos were not realised and even if he were based in an office he probably, as part of his work, had to go into ships." She added, "On the balance of probabilities he was exposed to asbestos during his occupation."

Mr Woodhead's daughter, Susan Jenssen, gave evidence to the case. The coroner therefore recorded a verdict of death by the industrial disease.

New British Asbestos Duty Introduced

May 24, 2004
In Britain, a new duty has been introduced that requires anyone responsible for the maintenance of commercial, industrial or public properties to ensure safety from asbestos and properly manage the risk.

Before asbestos was banned, about 3500 people died every year from asbestos exposure. The majority of the people dead are building and maintenance workers

According to The Health and Safety Executive, about 5000 lives will be saved if the new duty is effectively applied.

Also, about half a mililion buildings across Britain still contain Asbestos. Click here to learn more about Asbestos.

The British Minister of State for Work, Jane Kennedy quotes, “It must surely make good business sense to find out whether your premises contain asbestos and then make certain that building and maintenance workers are warned in advance.”

Bill Callaghan, Chair of the Health and Safety commission quotes, “Asbestos is not yesterday’s problem. We must now meet the challenge of managing the risk from asbestos, if we are to prevent another generation of workers suffering an early death at its hand.”

May 28, 2004
Carolyn Miller was exposed to Asbestos dust in her father's clothing and died of Mesothelioma in 2000, at the age of 54. Due to this, a southeast Texas Jury awarded her family, a compensation amount of $10 million.

The Brazoria County jury ordered Ford Motor Co. to pay $4.5 million in compensation to Carolyn. It also ordered the company to pay $500,000 to Miller's father, $750,000 to Miller's mother as well as $2.75 million to her husband and $1.5 million to her daughter.

Carolyn was exposed to Asbestos dust when she used to wash her father's clothes. John Roland used to wear these clothes when going to work at Ford's Rouge plant in Dearborn, Michigan.

Roland relined and demolished blast furnaces at Ford's plant in Dearborn, during the period 1953 to 1964. Although Roland is still alive, he has been diagnosed with pleural plaques (scarring on the surface of the lungs).

Ron Eddins, the family's attorney said the Miller family did not want to punish Ford Motor Company. He quotes, "It was solely to compensate the family for their loss."

New drug helping lung cancer patients

Julia Moffitt/Eyewitness News

Indianapolis, April 30 - Doctors will diagnose approximately 173,000 Americans with lung cancer this year.

Susie Moore of Franklin, who's also a breast cancer survivor, learned of her lung cancer in March. "It was a shock when he called and said they found cloudiness in the chest X-ray."

Susie's doctors found her cancer early, and chemotherapy, the traditional way to treat lung cancer, is working for her.

But for ten to 15 percent of the patients that chemotherapy doesn't work for, a new generation of cancer medications is now offering some patients hope.

Studies show a drug called Tarceva significantly improves survival for certain lung cancer patients who fail standard chemotherapy.

Doctor Sumeet Bhatia, medical oncologist with Community Regional Cancer Care says the drug is a positive step forward for this, so far, incurable disease. "For the first time, you have a drug that's been demonstrated to show that people with advanced lung cancer live longer, so non-chemo drug that makes people live longer, it's a big deal."

The drug is the first of its kind to show in a big study that the approach can extend survival of patients with non-small cell lung cancer, the most common form.

Non-small cell lung cancer accounts for almost 80 percent of all lung cancer, a disease that kills 1.1 million people a year.

Doctors are giving Susie an 80 percent chance of survival. She says if her chemotherapy didn't work, she's grateful there is an option out there. "I wouldn't be hesitant, I think (it's) wonderful what they can achieve and available for patients."

The findings of this study came as a surprise. Tarceva, in earlier studies, failed to prolong survival in patients with metastic lung cancer when patients had not yet had any treatment.

Analysts say they expect Roche, the drug's maker, to launch Tarceva late next year or early in 2006.

INDIANAPOLIS, May 4 /PRNewswire/ -- In a recent study, Lilly's drug pemetrexed showed a similar patient survival rate, but with an improved safety profile, when compared to docetaxel (Taxotere(R)), the current standard of care for second-line non-small cell lung cancer.

The research findings of the largest head-to-head Phase III trial ever reported to date in second-line non-small cell lung cancer were reported in the 1 May issue of the Journal of Clinical Oncology(1), a peer-reviewed journal.

The U.S. Food and Drug Administration (FDA) recently approved pemetrexed, in combination with cisplatin, for use in the treatment of malignant pleural mesothelioma, a cancer often associated with asbestos exposure.

Currently, docetaxel is the only drug approved in both the U.S. and Europe to treat patients with non-small cell lung cancer in the second-line setting. While the drug extends survival when compared to best supportive care, it is associated with several side effects, including hair loss and blood-related toxicities, including neutropenia, a lowering of the white blood cell count that can cause infections and fever, thus requiring hospitalisation.

The new study suggests that pemetrexed, administered in 10 to 15-minute infusions once every three weeks, showed a survival rate comparable to that of docetaxel (median survival was 8.3 months vs. 7.9 months respectively), but with fewer serious side effects.

"Pemetrexed clearly had fewer drug-related hematological side effects, which resulted in fewer hospitalisations," said Nasser Hanna M.D., lead author of the study and assistant professor Indiana University School of Medicine and member of the Indiana University Cancer Center. "So in short, pemetrexed is better tolerated, it's convenient to administer and it's equally as effective as docetaxel." Patients on pemetrexed did show an increased transient elevation in the liver enzyme, Alanine Transaminase (ALT), said Hanna.

Lilly has submitted a New Drug Application to the FDA for the use of pemetrexed in the second-line treatment of non-small cell lung cancer. Lilly anticipates a regulatory decision by the fourth quarter in the U.S. Lilly has also submitted a dual European submission, with the first part for pemetrexed, combined with cisplatin, in the treatment of malignant pleural mesothelioma and the second for pemetrexed as a single-agent in the second-line treatment of non-small cell lung cancer. Lilly anticipates a European regulatory decision in 2005.

"We commend the scientists in this study for their commitment to conducting quality research in an effort to support patients and physicians who are affected by this devastating disease," said Paolo Paoletti, M.D., vice-president, clinical research, oncology products, Eli Lilly and Company. "Importantly, this was a study in which pemetrexed was compared to the standard of care in the treatment of second-line non-small cell lung cancer and the results suggest similar efficacy and less blood-related toxicity for pemetrexed."

Study Design

The Phase III global study involved 571 randomised patients whose non- small cell lung cancer advanced beyond the first chemotherapy regimen. Among the patients enrolled in this study, 283 received docetaxel (75 mg/m2 on day one of a 21-day cycle; one-hour infusion) and 288 received pemetrexed (500 mg/m2 on day one of a 21-day cycle; 10-minute infusion; supplemented with vitamin B12 and folic acid). The primary endpoint was overall survival and secondary endpoints included toxicity, response rate, and progression-free survival.

Key study findings are as follows:

Pemetrexed Docetaxel p-value
(n=265) (n=276)

Median Survival Time 8.3 months 7.9 months NS
(non
statistically
significant)

Overall Response Rates 9.1 percent 8.8 percent NS
(non
statistically
significant)

Grade 3 or 4 Neutropenia 5.3 percent 40.2 percent <0.001
(statistically
significant)

Hospitalisation for Neutropenia
w/ Fever 1.5 percent 13.4 percent <0.001
(statistically
significant)

Alopecia (hair loss) 6.4 percent 37.7 percent < 0.001
(statistically
significant)

Grade 3 or 4 Alanine Transaminase
(ALT, a laboratory measurement
of liver function) 1.9 percent 0.0 percent 0.028
(statistically
significant)

* This table lists adverse events that occurred during the study that were
of a statistically significant variance.

About Eli Lilly and Company
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organisations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs.

Taxotere(R) (docetaxel, Aventis)
pemetrexed (proposed tradename Alimta(R))

(1) Hanna N, Shepherd FA, Fossella FV, et al. Randomised Phase III Trial of Pemetrexed Versus Docetaxel in Patients with Non-Small Cell Lung Cancer Previously Treated with Chemotherapy. Journal Clinical Oncology, Vol. 22, pp. 1589-1597; May 1, 2004.

9-11 study: New Yorkers poisoned by WTC plume

Newsday

NEW YORK -- The World Trade Center disaster caused the largest acute environmental disaster ever to affect New York City, generating an "intensely toxic atmospheric plume," a new study concludes. Dust from the fire-fueled collapses of the Twin Towers contained a perilous blend: pulverized cement; glass shards from shattered windows; asbestos; lead; PCBs, a chemical in electrical equipment and florescent lights; chemicals found in roofing tar and oil; and hydrochloric acid, the study states.

Cement dust and glass fibers, which were large enough to be caught in the upper airways, caused the chronic cough and irritation reported by many people. Phillip Landrigan, the lead author of the study, said the dust was "extremely caustic," similar to lye or drain cleaner. He said researchers are still finding tiny shards of glass in the lungs of some workers. In addition to causing a higher rate of respiratory ailments, such as persistent cough and wheezing, an increased risk of asthma was found.

There was also an increased risk of mesothelioma, a type of lung cancer, among workers exposed to asbestos. Researchers also found a higher incidence of smaller-size babies born of women who were pregnant and in the area Sept. 11, 2001. The condition was similar to babies born to mothers who smoke during pregnancy, or who live in highly polluted cities, Landrigan said.

The study confirms what other private researchers have said, that health risks stemming from the disaster were more serious than government officials initially disclosed. "It's fair to say that the toxicity of the dust caught the people in the agencies by surprise," Landrigan said.

A consortium of research institutions was involved in the study, including Mount Sinai School of Medicine, New York University School of Medicine and the Mailman School of Public Health at Columbia University.

Lung Cancer
Office of Women's Health
Take Time To Care
www.fda.gov/womens

Lung cancer is the leading cause of cancer deaths among both men and women. More women die each year of lung cancer than of breast cancer.

How is lung cancer found?

Lung cancer is hard to find in its early stages. Sometimes the disease spreads very quickly. And symptoms often do not appear until the disease is advanced.
Most lung cancers are not found until the cancer has spread beyond the lungs. Only about 15 percent are found before the cells have spread to lymph nodes or distant organs.

What FDA-approved methods are used to find (diagnose) lung cancer?

Chest x-ray or CT scan to check for spots on the lungs
Studying phlegm cells under a microscope. (Phlegm is a thick liquid that can collect in your throat. It is pronounced "flem.")
Bronchoscopy. This method uses lighted tubes, which carry air to the lungs, to see if there are tumors or other tissue blocking the airway.

There are two types of lung cancer:

Small Cell Lung Cancer
Non-Small Cell Lung Cancer
About 25 percent of lung cancer cases are small cell lung cancer. The other 75 percent of cases are non-small cell lung cancer.

Stages of lung cancer:

Small Cell

Limited stage --The tumor is usually in only one lung and in the lymph nodes on the same side of the chest.
Extensive stage --The cancer has spread to the other lung and to lymph nodes on the other side of the chest. Or it has spread to distant organs.

Non-Small Cell

Occult Stage: Cancer is found in saliva, but tumors cannot be found in the lungs.
Stage 0: There is cancer in only a few layers of cells.
Stage 1: The tumor is only in the lung.
Stage II: Cancer has spread to nearby lymph nodes.
Stage III: Cancer has spread to one of these areas:
the chest wall or diaphragm near the lung
the lymph nodes between the two lungs
the lymph nodes on the other side of the chest or in the neck.
Stage IV: Cancer has spread to other parts of the body.
Recurrent cancer: is cancer that returns after treatment. It can be either small cell or non-small cell cancer.

What lung cancer treatments are approved by the FDA?

Surgery --taking out the cancer in an operation
Chemotherapy --using medicine to kill cancer cells
Radiation --using high-dose x-rays to kill cancer cells
Treatment may combine two or more of these therapies.

The risks of smoking:

Smoking causes 90 percent of lung cancers in men and more than 70 percent in women.
The more you smoke and the longer you smoke, the more likely you are to develop lung cancer.

The warning signs of lung cancer:

A cough that hangs on and on
Chest pain
Weight loss and/ or loss of appetite
Bloody phlegm
Shortness of breath
Hoarseness
A fever for an unknown reason
Recurring infections, such as bronchitis and pneumonia
To Learn More:

Food and Drug Administration
www.fda.gov
FDA's Office of Women's Health
www.fda.gov/womens/

The American Cancer Society
Phone: 1-800-227-2345 (1-800-ACS-2345)
www.cancer.org

American Lung Association
Phone 1-800-586-4872 (1-800-LUNG-USA)
www.lungusa.org

October 2003

A PAINFUL LESSON

School maintenance workers may be at increased risk for developing diseases related to prolonged exposure to asbestos

By Jennifer Autrey
Star-Telegram Staff Writer
May. 02, 2004

The telltale white patches covered his left lung.

As Randall Blevins was recovering from surgery, doctors told his wife that the patches indicated exposure to significant amounts of asbestos. Presumably, they said, the right lung was the same.

That was May 2002, 25 years after Blevins began working as a heating and air-conditioning technician for the Fort Worth school district. He fixed boilers and repaired pipes -- products often encased in asbestos.

Blevins, 50, believes that his lung disease stemmed from his work for the district because he knows of no other contact with asbestos dust.

From 1977, when he was hired, until about 1982, when the district stepped up its precautions, he handled asbestos without thinking. Blevins said he and the district's other boiler-room workers hit it with their wrenches and ripped it off pipes with their bare hands while crawling under buildings. Each time, the white shards cascaded into their hair, eyes, noses and mouths.

"We would handle asbestos like it was nothing," said Blevins, who lives in Southlake. "Might have on only paper masks."

Blevins said he appears to be the only one in his maintenance team who has been diagnosed with asbestos-related symptoms. But asbestos illnesses typically don't show up until decades later, and Blevins' illness gives some of his co-workers pause.

"I look at him and think, 'That could be me,' " said Arthur Cox, the district's heating and air-conditioning foreman.

Longtime school custodians and maintenance workers are among the groups quietly paying the price for the nation's slow reaction to the dangers of asbestos, a heat-resistant insulation used for decades before it was linked to high incidences of cancer.

Before the mid-1980s, maintenance workers commonly handled asbestos without protection, said Herman Earwood, former director of central services for the Fort Worth school district and now mayor of River Oaks.

"Everybody in the country was doing it because they didn't know any better," said Earwood, who supervised asbestos containment at the district.

Several medical studies have documented lung abnormalities in such employees, many of whom had no known exposure to asbestos outside their school duties.

Blevins' situation is dire. He has lost his school district insurance. He has been unable to find a doctor who will take workers compensation insurance and provide the long-term monitoring that he needs.

On April 21, Blevins filed a lawsuit in state district court against a long list of asbestos-product manufacturers in a last-ditch effort to find some way to pay his escalating medical bills.

Blevins' body and spirit are broken. Once a 250-pound man who could perform one-arm pushups, he can no longer lift his 17-pound grandson.

The mineral that has caused so many of Blevins' problems was once hailed as a modern miracle. When woven together, asbestos fibers produce a reliable substance for fireproofing and thermal insulation.

They have also proved to be reliable killers.

Not everyone who worked with asbestos products ends up with cancer. But the risk for mesothelioma -- a cancer in which tumors grow in the protective lining of the lungs -- is hundreds of times higher for them than for the general population, said W. Roy Smythe, a thoracic surgeon who is head of the surgery department at Texas A&M University's College of Medicine.

Medical records indicate that Blevins showed evidence of asbestos-related damage in 2000, when a CT scan found thickened areas called pleural plaques on his left lung. The plaques aren't cancerous, but they can be painful.

Blevins believes that they were the cause of his excruciating pain, which prompted doctors to prescribe numerous medications for pain and anxiety.

"He was hurting so bad at night that he was on his knees in the bed, crying," said his wife, Cheryl.

By April 2002, another CT scan found more abnormalities: a 3-centimeter pleural mass, adjacent to the diaphragm; numerous pleural plaques, some of which had calcified; and possible mesothelioma.

"Findings are compatible with asbestos exposure," the report said.

A month later, Blevins was in surgery. The doctors warned him that cancer was likely, but after months of waiting for the test results, he was told that the cells were benign. Good news.

But doctors say he must continue to be monitored.

"He's truly at risk of malignant mesothelioma," said David Carter, the cardiothoracic surgeon who performed Blevins' surgery.

Blevins remains in extreme discomfort. He has had a heart attack. He shows signs of "post-thoracotomy syndrome," a common lingering pain from lung surgery, Carter said. He has diabetes, and an inability to control the disease has contributed to a weight gain.

Blevins believes that the school district should have warned him earlier about the dangers of asbestos.

In 1982, the district provided boiler-room workers with training and equipment for asbestos removal, Blevins said. A few years later, they were told not to touch the stuff at all, he said.

"If I had been told that this would do this to my life, I wouldn't have been as naive," Blevins said. "I was not really told it was as harmful as it is. Then the '80s came about and I got to thinking, 'This could affect me.' "

In 1972, the Occupational Safety and Health Administration began regulating asbestos exposure and required certain procedures for reducing asbestos dust.

But Earwood said the district didn't know about the dangers Blevins and other maintenance workers faced until Earwood was sent for training in the mid-1980s.

"We were working without protection, but without knowledge," he said.

A 1991 study of 120 Boston public school custodians found that 33 percent had pleural plaques. The study by Dr. Christine Oliver, an assistant professor at Harvard Medical School, was published in the American Journal of Industrial Medicine.

Lung abnormalities in Wisconsin school custodial and maintenance workers increased the longer they worked for their districts, according to a study published in a 1992 environmental journal. About 2 percent of those who had worked in schools less than 10 years had the abnormalities; 37 percent of those who worked more than 30 years in schools had them.

Mike Lee, who is in charge of asbestos cleanup at the Fort Worth school district, said the district's training has been exemplary at least since 1999, when he was hired.

"I didn't see them doing anything that was not 100 percent aboveboard," said Lee, a former investigator for the Texas Department of Health.

Bertha Whatley, the school district's attorney, said administrators would not comment on asbestos training because of the potential for lawsuits.

But Blevins can't sue the district, legal experts said. Texas law precludes an employee from suing his employer for injuries suffered on the job if the company has workers compensation insurance.

His only recourse is to sue the manufacturers in hopes of getting a settlement that will help pay for long-term treatment.

"You know what I want? I want my husband back," Cheryl Blevins said. "I just want us to grow old and enjoy our grandkids. I want him back the way he was before he got sick. But I don't see that happening."

Asbestos information

Asbestos is a mineral that was used in building construction, including insulation, and as a fire-retardant. It has been linked to lung diseases and chest and abdominal cancers.

Sources of asbestos are insulation that is deteriorating, damaged or disturbed; fireproofing; acoustical materials; and floor tiles.

Elevated asbestos levels can occur in older houses where materials containing asbestos are damaged or disturbed.

To reduce exposure:

• Leave undamaged asbestos materials alone if they are not likely to be disturbed.

• Use trained and qualified contractors for control measures that may disturb asbestos and for cleanup.

• Follow proper procedures in replacing wood stove door gaskets that may contain asbestos.

For more information, go to www.epa.gov/iaq/asbestos.html.

SOURCE: U.S. Environmental Protection Agency

'Significant Adverse Effects'

Recent reports show that the dust from the World Trade Center attacks is more toxic than researchers initially realized—and so is the range of health problems in those exposed to it

By Jennifer Barrett
Newsweek
May 19, 2004 - John Graham used to joke that his doctor would go bankrupt if he relied on him for income. The longtime carpenter, who was also trained as an emergency medical technician (EMT), was so seldom sick that he can’t recall taking anything stronger than an occasional aspirin for a headache. But that was before the September 11 attacks.

Now Graham carries a bag full of medications around with him each day. He takes 17 different drugs for ailments ranging from asthma to chronic infections, and sees his doctor so often that he’s had to ask the receptionist to call and remind him of upcoming appointments so he can keep track.

Graham, whose office was blocks from the World Trade Center, was able to get down to the Twin Towers so quickly after the first plane struck that he was standing across the street from the North Tower when the second plane hit. Because of his unusual combination of medical and carpentry skills, Graham ended up staying at the site for more than nine months helping out, despite his own mounting health problems. His first sought treatment three weeks after the attacks. The initial diagnosis: respiratory problems including asthma, and chemical burns on his esophagus and throat.

Doctors and researchers now believe that Graham is one of tens of thousands who suffer debilitating health problems stemming from their exposure to contaminants in the air around the World Trade Center site—and it’s not just rescue and recovery workers who are affected. A report published this month in the journal Environmental Health Perspectives found that pregnant women who were inside the Twin Towers or within a 10-block radius at the time of the attacks showed a twofold increase in the incidence of smaller than average infants compared to pregnant women in a demographically similar population who weren’t in Manhattan on September 11.

The findings are part of a comprehensive report believed to be the first to combine extensive environmental and medical data on the effects of the World Trade Center attacks; it draws a direct link between the contaminated air at and near the World Trade Center site and “significant adverse effects on [the] health” of those who were in the area.

As the 9/11 Commission holds hearings this week in New York to examine the coordination and communication between response units on September 11, the recently published health report sheds new light on the environmental dangers that those first responders and rescuers, as well as construction workers, were exposed to that day and for several weeks afterward.

Air sampling, the report found, showed dust in the plume above the towers had high alkaline levels (about 10 pH—the same as ammonia or detergent) and contained contaminants like asbestos, lead and polychlorinated biphenyls (or PCBs)—in addition to pulverized cement and glass fibers. Among workers involved in the cleanup and recovery, many of whom—like Graham—spent several months in and around the disaster site inhaling that air, almost one third experienced a chronic cough that began shortly after employment at the site, 24 percent reported new onset of phlegm production and 18 percent reported new onset of wheezing. About half of all workers reported at least one new symptom after they began working at the site. Residents in the area reported similar health problems. Of 10,116 firefighters evaluated, 332 suffered from a persistent cough and other respiratory symptoms so severe as to require at least four weeks leave of absence. Other rescue and construction workers were treated for a host of ailments ranging from asthma and alkaline burns to rashes and respiratory infections.

“One problem is that no one was insisting that workers wear respirators,” says Dr. Philip J. Landrigan, chair of the Department of Community and Preventive Medicine and director of Environmental and Occupational Medicine at Mt. Sinai School of Medicine in New York, and principal author of the recently published study. “I wouldn’t fault anyone in the first 48 hours during the immediate response,” he adds, “but for months afterward most workers at Ground Zero were still not wearing respirators and, in my mind, that is a terrible failure in regulation and it’s going to result in a lot of diseases that could have been prevented.”

Graham did not use a respirator when he started work at the site, though he wore a mask later. Still, he says, he believed the air was safe after the Environmental Protection Agency Administrator Christie Whitman declared it so a week after the attacks (a statement she has since been widely criticized for making). “The government lied to us,” he says. “They said the air was clean.”

Graham continued to work after his initial diagnosis. But his symptoms only worsened. When he left Ground Zero in May 2002, he could no longer work as a carpenter—the combination of dust and exertion provoked asthma attacks so bad he had to be rushed to the emergency room once when he was working with an apprentice. So he took a cut in pay and a job as a health and safety instructor for the New York District Council of Carpenters. Even that is a struggle at times; last winter he suffered a severe attack in class and was unable to talk until a student brought him medication.

“This was a life-changing event medically for people who were caught in the dust cloud—and probably tens of thousands were caught in that cloud,” says Dr. Michael D Weiden, a medical officer for the Fire Department of New York who has treated hundreds of firefighters—many of whom suffer permanent disabilities. “There are hundreds who are no longer able to work,” he says.

Weiden, Landrigan and other doctors who have treated or studied those who spent time at Ground Zero are urging continued long-term follow-up of the health impact of exposure to the contaminants as well as long-term treatment for those affected, some of whom risk developing more serious ailments like mesothelioma, a relatively rare form of cancer (with no cure) associated with asbestos exposure.

Making sure that long-term treatment is covered is a particular challenge to those representing the residents and rescue and construction workers who were in the area, as there’s no way to predict what symptoms may yet emerge.

“The real concern is that we do not yet know the long term effects of 9/11, and the period of manifestation differs from person to person,” says Michael Palodino, the president-elect of the Detectives' Endowment Association, which represents about 15,000 active and retired police detectives. “But despite the possible fiscal costs, you can’t turn your back on these people.”

Lawyer Michael Barasch, who has helped file hundreds of injury claims with the Victim Compensation Fund, says all but a handful of those he has represented have had their claims approved. But the fund has turned down some claims for lack of medical proof or because the victim’s symptoms improved. “It’s so ironic that so many of these guys who were rescue workers are now in need of being rescued themselves,” he adds.

There are bills under consideration at the state and federal level that would help cover the costs of long-term medical care and follow-up for a wider range of those affected by the attacks. Nationally, the Remember 9/11 Health Act, sponsored by New York Congresswoman Carolyn Maloney in March, would expand those eligible for coverage for health problems related to the attacks; it has been referred to a House subcommittee. Proposed state legislation would shift the burden of proof from the rescue workers to the compensation board in determining whether health problems were a direct result of exposure at the World Trade Center site.

“There are those who are active[-duty] today but suffering from some symptoms and may get sick down the road when the answers come out, but there is no mechanism now to bring them back then and get them what they deserve—unless we get this bill passed,” says Palodino. He adds that about 5 percent of active detectives have been treated for symptoms, from rashes to respiratory problems. “And I am positive that there are plenty more who are running around that are not reporting them.”

It’s not clear how many of those who were exposed to the contaminated air around Ground Zero have yet to come forward for treatment, but there is widespread agreement within the medical community that the number who are suffering lingering health problems from the September 11 attacks is greater than initially anticipated. Weiden, who treats the New York firefighters, says there’s still "a large unmet need" and warns: "Some—or many—of those caught in the cloud will be in crisis if they don’t understand what’s going on.".

"It's much more serious than we initially realized," says Landrigan, the principal author of the study. “It took awhile to realize just how toxic this dust was.”

It could take even longer still—Landrigan says the first related cancer cases may not appear for at least a decade—to realize just how serious the consequences will be for the thousands like Graham who were exposed to the dust.