The Natural History Of Diffuse Mesothelioma

Our plain-English summary of The Natural History Of Diffuse Mesothelioma, by P.C. Elmes (1973).

The study

• Author: P.C. Elmes
• Published: Biological Effects Of Asbestos (J.C. Wagner, Editor), Lyon: Iarc Scientific Publications, Volume 8, Pp. 267-272 (1973)
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library, J-M no. 002386. The article is still under copyright, so we describe it here rather than post it.

In plain English

This paper described the symptoms, examination findings and course of diffuse mesothelioma of the pleura (chest lining) and peritoneum (abdominal lining). It drew on 63 cases from Northern Ireland, 111 cases from the rest of Great Britain accepted by the London Mesothelioma Panel among deaths from 1960 to 1969, and 118 published cases from other countries. It did not separate cases with and without asbestos exposure. All 63 Northern Ireland cases were men, with a mean age at first symptoms of 62 years. Average age at death was 60.3 years in the other British cases and 54.25 years in the literature cases. The author thought these differences were likely due to selection. In Northern Ireland, pain was the most common first symptom (57%), followed by breathlessness (43%). When first seen, 73% had fluid in the chest (24 bloody, 22 serous). The author estimated that less than 10% of cases start in the peritoneum. The author reported average illness lengths of 13-14 months for pleural cases and six months for peritoneal cases. In the body of the paper, the peritoneal figure is credited to an earlier study.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive clinical review combining the author's own case series, cases accepted by a pathology panel, and cases from the published literature
• Who was studied: 63 cases studied by the author in Northern Ireland (all men, diagnosis agreed by the London Mesothelioma Panel); 111 cases from the rest of Great Britain accepted by the Panel who died between January 1960 and December 1969; 118 cases from other countries in the literature, with British cases excluded
• Exposure: Asbestos exposure was not used to select or divide cases. The paper included cases with and without evidence of asbestos exposure, and no fiber types were specified.
• Main results:
  • All Northern Ireland cases were men; their mean age at onset of symptoms was 62 years
  • Average age at death was 60.3 years for the 111 other British cases and 54.25 years for the 118 cases from other countries. The author said these differences may be statistically significant but are likely due to selection.
  • The author estimated that less than 10% of mesotheliomas start in the peritoneum; peritoneal cases were less frequent than pleural cases in almost all series
  • In the 63 Northern Ireland cases, the first symptom was pain in 57% (32 chest or shoulder, 4 abdomen), breathlessness in 27 (43%), weight loss in 8 (13%), lassitude in 7 and cough in 3 (5%)
  • The average delay between onset of symptoms and seeking expert advice in the Northern Ireland cases was four months
  • At first presentation in the 63 Northern Ireland cases, 73% had a pleural effusion (24 bloody, 22 serous), 18 (29%) had a solid mass, and none had bone involvement
  • In Northern Ireland, 65% of cases showed no pleural or parenchymal chest X-ray changes related to asbestos exposure (39 cases with no changes, 15 with plaques only, 6 with parenchymal changes; no satisfactory film in three cases). About half of the other British cases showed no such changes.
  • The tumour seldom spread early to distant sites, and pain along the intercostal nerves was the main symptom throughout the illness in pleural cases
  • The average duration of illness was 13-14 months for pleural cases and six months for peritoneal cases. In the body of the paper, the peritoneal figure is attributed to Enticknap & Smither (1964).
• The authors' conclusion: The author concluded that the tumour mainly affects men, with a wide age range averaging about 60 years. It usually starts in the pleura, and pain is usually the first symptom. Its course is short despite an insidious onset. The pleural disease can often be diagnosed in life from its characteristic picture, but peritoneal cases are hard to distinguish from other abdominal malignant tumours.
• Limitations the authors state:
  • The author acknowledged having missed or excluded many genuine cases of mesothelioma
  • The natural course was hard to determine because diagnostic and therapeutic measures in most reported cases may have affected it
  • Onset was often hard to determine because cough and breathlessness were common in the elderly population due to chronic bronchitis
  • Age differences between groups were likely due to selection; older cases may be under-recognised, and many early literature reports were set aside because of diagnostic doubt

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Peritoneum, Asbestos Exposure.

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