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Mesothelioma has long been viewed as an old man’s disease. For many years, the typical patient would be a senior male, with the majority of new cases occurring in those 55 and older. But in more recent years, the health impacts of asbestos have started to become increasingly apparent in younger generations. Secondhand exposure to asbestos, as well as exposure through DIY home projects, have become bigger concerns in the community.
As mesothelioma becomes more common in younger patients, researchers are realizing the differences in how the disease presents and the efficacy of treatments.
Mesothelioma in Younger Patients
In the last few years especially, more studies have come out investigating occurrences of mesothelioma in young adults. Just last month, a story came out about 23-year-old Danielle Smalley from the UK recently being diagnosed with mesothelioma. Smalley wasn’t entirely clear how she was exposed to asbestos, but believes she may have ingested the toxin from an old shed or maybe even a friend’s house.
In interviews, Smalley has said she didn’t even know what asbestos was or anything about its dangers until her diagnosis. The UK banned asbestos in 1999, however the mineral still remains in many old buildings, schools and homes. As long as these old uses remain, citizens like Smalley may easily face exposure to damaged materials containing the deadly fibers. Smalley has since undergone surgery and a heated chemotherapy wash, known as HIPEC, to hopefully kill the cancer cells and improve her life expectancy.
Another report from 2011 investigated the case of pleural mesothelioma in a 26-year-old patient. The male patient had experienced some symptoms, but waited some time before seeking help for what he was experiencing. He suffered chest pain, inflammation and swelling, night sweats and fevers. The young man told his doctors about exposure to asbestos when he was young. His primary school contained the toxin, as do thousands of other school buildings today, and he could have been exposed at any time between the age of 6 and 12.
After several initial tests, his doctors strongly believed the patient was suffering from mesothelioma and performed a thoracoscopy, a type of biopsy, to confirm. Despite his young age, the patient was diagnosed with stage 4 pleural mesothelioma. He began a multimodal chemotherapy regimen in the hopes of stabilizing the disease and improving his quality of life. At such a late stage, options are very limited and patients typically face palliative, rather than curative, treatment.
These are just two recent instances of mesothelioma diagnoses among young adults, but the unfortunate scenario is becoming more frequent and an important area of research.
How Mesothelioma Differs in Younger Patients
Compared to the typical older male patient, mesothelioma in these younger patients has various differences in how the disease presents and progresses. One study from earlier this year examined the differences between genetic characteristics, cell type, cancer growth and overall survival between a group of patients aged 35 or younger and a group of older patients.
Researchers found that younger mesothelioma patients tend to be women, many of whom didn’t report any known asbestos exposure. At the same time, their research showed the BAP1 protein, a mutation that has been identified as a marker for increased mesothelioma risk, was also less prevalent in the younger patients; however, the study didn’t explore other genetic data. The younger group also experienced a higher incidence of cancer in their family history than the older patients.
Researchers didn’t find major histological, or cell type, differences between the age groups either. The only scenario in which researchers saw the younger patients facing a poorer overall survival was in the instance of biphasic or sarcomatoid mesothelioma, and thus a much higher cancer cell growth rate. Overall, the researchers noted the main difference they saw was in the patient's genetics.
In prior studies, researchers have found a correlation between the presence of BAP1 and increased familial history of mesothelioma or other cancers, as well as an improved prognosis compared to those without the mutation. But BAP1 isn’t the only mutation linked to mesothelioma. Another study found a variety of possible gene fusions and mutations that could be signal an increased risk of mesothelioma among younger individuals.
Across all these studies, researchers noted the clear difference in mesothelioma patients’ genetics when developed at a younger age compared to older patients, making this an extremely important area of study.
The Dangers of Secondhand and DIY Exposures
Though genetics has been found to be a major factor in many diagnoses among younger people, other patients are facing the realities of secondhand exposure or exposure as a result of do-it-yourself home renovations. In both older and younger patients, the impact of exposure in these scenarios has led to more mesothelioma diagnoses in recent years.
Since asbestos still lingers in many older homes, any type of home improvement projects families decide to tackle without the help of any professionals can be a huge danger. Any damage done to existing asbestos can lead to the dangerous fibers becoming airborne. As in the case of Smalley ingesting asbestos, any loose asbestos-containing materials may also be a danger for children especially. Any bits of asbestos insulation, for instance, may be easily ingested, just as stories in the past about children eating lead paint chips at home.
Secondhand exposure has always been a concern, as those who work in certain industries using asbestos materials may risk unintentionally bringing fibers home with them on their clothing or equipment. In this way, their families may be exposed by handling their clothes or even just interacting with their loved one after they come home from work. Mesothelioma survivor Heather Von St. James, for instance, was exposed in this way, wearing her father’s work coat that was covered in asbestos dust.
Better awareness to avoid old uses of asbestos can make a huge difference in the incidence rate, as genetics alone are not an underlying cause of mesothelioma. But hopefully with more research, doctors can understand what genetic markers may best predict mesothelioma and use the information for both earlier detection and treatment, like gene therapy. As always, more mesothelioma research and awareness around the disease and its cause are crucial in this fight and helping protect people of all ages.