Failure to suspect the early asbestosis symptoms of mesothelioma continues to pose problems for those who were exposed to asbestos decades earlier in their working lives. A similar difficulty may also arise when doctors make a diagnosis of a patient’s respiratory ailments and fail to pick up on signs of mesothelioma cancer.

A new survey reports that as many as nearly one in three respiratory physicians are found to be uncertain in their ability to diagnosis a work-related lung disease, such as mesothelioma.

Vital clues may be missed

For the ordinary man or woman, it would be natural to assume that they were coming down with a bout of flu or pneumonia when they start to experience a frequent dry cough, shortness of breath or chest pains. Age, health and a history of smoking can all play their part in preventing mesothelioma being suspected in the early stages.

In many cases, there was a lack of asbestos awareness or health risk information available at the time  – often between the 1950s and 1970s /80s – when a patient was working with or near asbestos in the workplace. It’s not too surprising that a link is unlikely to be made between initial exposure and current respiratory problems.

Doctors can also face difficulties in making a correct diagnosis when presented with the symptoms of mesothelioma. Vital clues may be missed unless a patient’s work history is closely examined and a number of different tests and scans are carried out.

Training was not satisfactory

The results of a new report appear to highlight ‘confidence in diagnosis’ issues confronting medical practitioners. Although the survey was limited to 32 general respiratory physicians in Northern Ireland, the results reveal that nearly 50 per cent felt their medical school training was not satisfactory enough in the field of occupational lung diseases.

More than a third of respondents said they had a “lack of confidence in diagnosis and management” of the various lung and respiratory diseases they most typically encountered.

Doctors should be able to recognise the many types of occupational lung diseases, which include respiratory conditions, such as asbestosis, pleural plaques, occupational asthma and lung cancer.

The concerns raised by the Northern Ireland respiratory doctors are all the more worrying as the survey also found that, of the occupational lung diseases encountered, 90 per cent were pleural plaques, 84 per cent were asbestosis, and 66 per cent were malignant mesothelioma.

Notoriously difficult to identify

Mesothelioma has traditionally been notoriously difficult to identify. Individual cell types can vary considerably and it is not unknown for a doctor to mistakenly diagnose lung cancer even though the two conditions occur in different tissues of the body. Lung cancer affects the lung tissue itself, whereas mesothelioma attacks the pleura, a thin membrane covering both the lungs (and other organs), and the inside of the chest cavity. Symptoms such as pleural effusion, breathing difficulty, chest pain and coughing are also common to both conditions.

Mesothelioma can also be misdiagnosed as a malignant tumour of the lung as the two diseases are often quite difficult to distinguish. In addition, peritoneal (stomach) mesothelioma often causes abdominal symptoms, which may be misdiagnosed as bowel disease or incorrectly diagnosed as ovarian cancer.

Possible prior exposure

A doctor can be helped in making their diagnosis if they are informed by patients of any possible prior exposure to asbestos. This should also include those patients who believe they may have been environmentally exposed when working in a building containing asbestos insulation materials.

A final confirmed diagnosis can be made after a doctor has arranged for a patient with a suspected mesothelioma to undergo the following tests: a thorough physical exam, a detailed work history focused on possible asbestos exposure, CT / MRI imaging scans, blood and lung fluid tests for potential biomarkers, and a biopsy (removal and analysis of a pleural tissue sample).

By these methods, patients may be reassured that doctors and specialists are in a better position to feel more confident in their diagnosis of a historically difficult disease to detect and treat.