Seeds of death grow to asbestos epidemic

A patient killer has descended on New Zealand men, writes health reporter MARTIN JOHNSTON.

Geoffrey Bennett was mowing the lawn on his bushy Titirangi property when he suspected something was seriously wrong inside his chest.

The retired 74-year-old Aucklander had retained the fitness and strength of working nearly 30 years as a builder. He still maintained his home and garden.

With his wife, Pamela, he was making plans to move to the West Coast of the South Island, an area they love.

But in the middle of last year, Mr Bennett started suffering breathlessness. He gave up tobacco, having smoked a packet of roll-your-owns a week.

Then in January, after pushing the rotary mower up the sloping lawn, "I was leaning over the washing machine gasping for breath. That brought home to me that something was amiss."

In February, his doctors diagnosed malignant mesothelioma, a form of cancer that is constricting his lungs. There is no cure. It is caused almost exclusively by exposure to asbestos, and even minimal exposure can lead to it decades later.

Auckland researchers say an epidemic of asbestos cancer has descended on New Zealand men. Professor Tord Kjellstrom and Dr Pamela Smartt, of the Auckland Medical School, predict that mesothelioma will kill up to 4000 people during the epidemic and that lung cancer attributable to asbestos will take a further 8000.

People who worked as plumbers, fitters, electricians and laggers make up 40 per cent of mesothelioma cases, and carpenters, builders and asbestos cement workers a further 23 per cent. Nine out of 10 are men.

Sixty-five cases were reported in 1997, the latest year figures are available, compared with five in 1977.

Professor Kjellstrom and Dr Smartt calculate that in 1995 there were between 111 and 407 cases of asbestos-related cancer. The uncertainty is because of the suspected severe under-reporting of lung cancer attributable to asbestos - a result of the focus on smoking as the major cause of lung cancer.

Their paper, published in today's Medical Journal, says the pattern of increase in the epidemic mirrors the annual imports of crude asbestos around 30 years earlier, due to the hidden period of infection.

Imports peaked at 12,500 tonnes - 4kg per capita - in 1974. None has been imported in crude form since 1991, although the Occupational Safety and Health service says white asbestos, which is less harmful than the blue and brown fibres, is still used in vehicle brake and clutch linings.

Professor Kjellstrom and Dr Smartt predict the epidemic could peak in the next 10 to 15 years, following the flow of imports, but they warn there will be an ongoing "tail" of cases. They will include demolition workers, home renovators and people who inhale fall-out from fires in buildings containing asbestos.

Mr Bennett says that as a builder from about 1960 until his retirement in 1988, he breathed in plenty of asbestos dust.

Fibrolite asbestos-cement wall boards cut with hand shears produced little dust, but the thicker ones, used for decking and cut with an abrasive-disc machine, threw up a haze. Workers set up the machine according to wind direction to avoid the dust clouds, which they found an irritant without realising they contained the seeds of death for some. They wore no breathing equipment.

Asbestos was used widely as an insulation material. Numerous public buildings, such as the Auckland City Council's headquarters, have had it removed at a cost of millions of dollars. Many people won compensation from their former employers - $2.5 million was the highest payout.

Only claims arising from exposure before ACC was set up in 1974 could go to court, but the Government blocked that avenue in 1993.

At least 13,000 people have reported their exposure to asbestos at work. Since the setting up in 1992 of the OSH asbestos disease register, 923 cases have been notified, although as many cases again may go unreported. Twenty per cent are mesothelioma, 10 per cent lung cancer, 20 asbestosis and 50 pleural disease.

Asbestosis is a scarring of the lungs. Pleural disease (affecting the lining around the lungs) includes pleural plaque, which is a fibrous deposit, and the pleural thickening that can cause breathlessness.

When Mr Bennett was diagnosed in February, a respiratory physician wrote to his GP: "I had a very frank talk with Geoffrey, who has accepted the [mesothelioma] diagnosis stoically. I have explained to him that the average survival is one year from diagnosis to death but with a wide range of anything from three months to three years."

Excess fluid has twice been removed from around Mr Bennett's lungs and a procedure to restrict a fresh build-up has helped. The breathlessness prevents his doing simple tasks like putting out the rubbish; sometimes distress overcomes him.

Mr Bennett says he is not bitter about contracting the disease: "Everyone's life is terminal. You start to die from the day you're born."

What irks him is the battle he had to go through with ACC to win any compensation. The corporation eventually started paying what he considers an insufficient $57 a week "independence" allowance.

He had to wait months for the payments, becoming so frustrated he contacted his MP. The payments started the next day.

Ed Grootegode, of the Asbestos Diseases Association, says the low level of payments and the struggle people have to go through is shocking.

ACC says it has sped up the processing of claims for mesothelioma.

Many asbestos victims are thought to have missed out on their ACC entitlements because their lung cancer has been attributed to smoking. Since 1997, ACC has upheld 83 mesothelioma claims, but only 10 for asbestos-related lung cancer. ACC spokesman Dr John Monigatti says that if a claimant with lung cancer has been exposed to asbestos at his work he is covered.

Former asbestos workers who smoke are 50 times more likely to get lung cancer than non-smokers who have not been exposed to asbestos, but smoking does not seem to increase the risk of developing mesothelioma.

Asbestos-cement products, including Fibrolite board, were produced at James Hardie's Penrose factory in Auckland until the mid-1980s. At peak production in the 1970s the plant employed up to 600 workers. Around 20 have received compensation, understood to be about $150,000 each.

General manager David Worley says the company runs a surveillance programme which offers current and former staff free x-rays and other medical checks for asbestos disease every two years.

Occupational physician Dr Bill Glass found in 1990 that of 87 former workers from Fletcher's Christchurch asbestos products factory, 47 had asbestos-related conditions. Twelve have died.

Green Lane respiratory physician Dr Tim Christmas says there has been little progress in the treatment of mesothelioma. Most chemotherapy regimes have little effect in reducing the tumour, although there are some "slightly promising results" with newer chemotherapy agents.

The Bennetts' dream of shifting to Westport was dashed by the cancer diagnosis. The ever-stoical Mr Bennett does not admit to any burning ambitions he yearns to fulfill in his remaining time. He wants to sort out the here-and-now.

The couple are trying to sell their five-bedroom home of 32 years where they brought up their five children.

"If I'm going to depart sooner than we expected it's going to leave my wife in a tricky position," Mr Bennett says.

"She doesn't want a big house like this to maintain and she doesn't drive.

"We've got to get a smaller house on a bus route."

Mesothelioma - a lurking killer

Mesothelioma is a form of cancer, a malignant tumour. Life expectancy following diagnosis is rarely more than a year.

Cause:


It is caused almost exclusively by asbestos fibres inhaled in asbestos dust. The fibres slowly migrate through lung tissue to get to other areas.

They can also cause asbestosis (scarring of lung tissue).

Where mesothelioma occurs:


It usually occurs in the membrane that covers the lungs and lines the chest cavity (the pleura).

It also occurs in other areas, including the membrane that envelops the heart (pericardium) and the membrane that lines the abdominal cavity (peritoneum).

When it appears:


The median age for the onset of symptoms is 50 to 60 years.

The time between exposure to asbestos and the symptoms appearing varies. The median time is 32 years.

The symptoms:


These are usually vague and include shortness of breath and chest pain. They can be due to the tumour constricting the lung, or a buildup of fluid between the membrane covering the lungs and the chest wall.