Do general pulmonologists have the training they need to diagnose an illness as rare and challenging as mesothelioma? There is evidence that, at least in Northern Ireland, they do not.
A survey conducted of general respiratory physicians in Northern Ireland found that just over a third of the 32 respondents indicated a “lack of confidence in diagnosis and management” of occupational lung diseases like mesothelioma. Almost half said they were “dissatisfied” with their medical school training in occupational lung diseases.
Occupational lung diseases include not only mesothelioma, but also other respiratory conditions such as asbestosis, pleural plagues, hypersensitivity pneumonitis, lung cancer, and occupational asthma. Many are related to asbestos exposure in jobs like electrical work, plumbing, construction, shipbuilding, and chrysotile mining.
According to the survey, 90 percent of the occupational lung diseases encountered by the Northern Ireland respiratory doctors were pleural plaques, 84 percent were asbestosis, and 66 percent were cases of deadly malignant mesothelioma, a rare cancer whose only known causes is asbestos exposure. In the US, only about 1,500 cases of mesothelioma are diagnosed each year.
The authors of the new survey, which was published in Occupational Medicine, say the responses from these frustrated respiratory doctors highlight the need for better training to help these and other physicians more easily recognize and diagnose occupational lung diseases like mesothelioma.
Mesothelioma is not only rare but also notoriously difficult to diagnose. Patients suspected of having the disease typically undergo not only a thorough physical exam, but also a detailed work history with a focus on possible asbestos exposure, imaging studies such as CT, blood and lung fluid tests for potential biomarkers, and a biopsy of pleural tissue.
If you suspect you or a loved one may have mesothelioma, click here for a list of doctors who treat mesothelioma patients.
McKeagney, TFP, et al, “Occupational lung disease survey of respiratory physicians in Northern Ireland”, August 14, 2015, Occupational Medicine, Epub ahead of print