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Mesothelioma in the UK

Links to information and advice from trusted websites for mesothelioma in the UK

By Niall Evans

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I’ve pulled together links to trusted sites to give you access to the best information about mesothelioma in the UK.  Many of the links lead you to further information and advice.

I don’t claim this is a comprehensive set of links, so if you can suggest other authoritive, non-commercial sites, please let me know.

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Facts about the disease of mesothelioma

Note.  You will sometimes see mesothelioma referred to as malignant pleural mesothelioma or malignant diffuse pleural mesothelioma.   These are scientifically correct for mesothelioma of the chest.  However, a minority of cases are mesothelioma of the abdomen (the peritoneum).

Definition.  A short and simple statement about mesothelioma from NHS Direct.

Detail.  A more detailed explanation from the British Lung Foundation.

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Asbestos and mesothelioma in the UK

FAQs.  Read my Asbestos FAQs.

Asbestos awareness.  The group of workers most at risk of mesothelioma today are tradesmen who work on the maintenance, repair or refurbishment of buildings.  It is essential that these workers get asbestos awareness training.  See HSE’s Hidden Killer Campaign.

Managing asbestos.  A vital ingredient to preventing the exposure to asbestos in buildings is the regulation requiring asbestos management plans.  Read my asbestos management FAQs.   Download HSE’s short guide to managing asbestos in premises.  Or download the full ACoP (L127) on management of asbestos in non-domestic premises.

Industrial Diseases Advisory Council.   The IIAC advises government on industrial injuries, including meosthelioma.  Find out about IIAC.  In 2005 the DWP issued an IIAC report on Asbestos-related Diseases

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Statistics and epidemiology for mesothelioma in the UK

Deaths from mesothelioma.  The latest HSE statistics for mesothelioma in the UK, for the year 2009, show 2321 deaths.  83% of these are men.  About two thirds of the female deaths are thought to be due to exposure outside the workplace.  The latest prediction is that the number of deaths will continue to rise until the year 2016.  See the simple graph of annual mesothelioma deaths or download the mesothelioma mortality report.

Trends.  THOR is The Health and Occupational Research network.  It collects data on ill-health from doctors and is one of the important sources of statistics.  This 2011 government report discussed trends in ill-health – including mesothelioma.

Epidemiology.  This 2010 paper from the Annals of Occupational hygiene reviews studies from the 1974-1994.  Epidemiology of Malignant Mesothelioma—An Outline

Quantifying risk.  The landmark 2000 paper, again in the Annals, from John Hodgson and Andrew Darnton quatifying the risk of both mesothelioma and lung cancer from asbestos.  The Quantitative Risks of Mesothelioma and Lung Cancer in Relation to Asbestos Exposure

Historical.  Tracing the discovery of the link between asbestos exposure and mesothelioma, this paper by JC and AD McDonald is readable and informative. The epidemiology of mesothelioma in historical context

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Medical information about mesothelioma

Methothelioma is a fatal cancer of the lining of the chest or abdominal cavity.  Unfortunately, mesothelioma is usually diagnosed too late for life-saving treatment. However, treatment to prolong life is available and may be effective.

Symptoms and treatment.  As always, those wonderful people at McMillan provide concise and accurate information.  They have full information about mesothelioma, but for medical information you may want to start with the symptoms of mesothelioma and the treatment of mesothelioma.

Tests for mesothelioma.  Diagnosing mesothelioma can be difficult and your GP will refer you for tests.  Cancer Research UK explains about tests for mesothelioma.

Mesothelioma International.  I know the name seens to go against the intention of this page, but MI UK focused, with some international news.  The medical information is concise but first rate.  Mesothelioma International.

The book.  If you are seriously into the medical aspects you can consult the medical tome by Kenneth O’Byrne and Valerie Rusch Malignant Pleural Mesothelioma.  You’ll need a sizeable amount of cash or a trip to your reference library!  OK – this link is to a commercial site – Oxford University Press – but it’s the book I’m referencing.  And I don’t make any money from the link.

Chemotherapy.  Treatment for mesothelioma is a developing field.  Chemotherapy treatment is reviewed in the 2008 paper from Nature, Advances in the systemic therapy of malignant pleural mesothelioma.

Pemetrexed disodium and NICE.  There has been much debate on NICE (National Institute for Health and Clinical Excellence) approval/non-approval for use of this drug.  You can find the papers on the NICE pages for Mesothelioma - Pemetrexed disodium

Inquests.  When someone dies of mesothelioma in the UK, there has to be an inquest.  The British Thoracic Society has advice to clinicians on information they should share with those involved in mesothelioma inquests in England and Wales

NHS Framework.  In 2007 the Department of Health issued guidelines on how the NHS should organise services for mesothelioma.  It is quite a hefty document but it contains useful general information as well as the guideline.  Down load the Mesothelioma Framework.

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Trails and research into mesothelioma in the UK

Meso VATS.  The Cancer Research UK Meso VATS trial is comparing two procedures for reducing the build up of fluid around the lungs in pleural mesothelioma.

Cancer Research UK trials ‘Lung cancer: mesothelioma’ clinical trials

Research charities:

The Mick Knighton Mesothelioma Research Fund

The June Hancock Mesothelioma Research Fund

The John MacDougall Mesothelioma Trust

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Making claims for mesothelioma in the UK

There are any number of solicitors’ practices who specialise in industrial injury, including mesothelioma claims.  You can find them just by googling “mesothelioma”.  What I’ve tried to do here is provide sources of background information.

Advice from charities.  McMillan, financial help and compensation for mesothelioma June Hancock Fund, financial and legal advice

Lump sum payment.  People suffering from mesothelioma may be entitled to a one-off lump sum payment.  Get access to details and a claim form from Direct Gov at diffuse mesothelioma payments.

The rules.  Not strictly rules, but the Ministry of Justice issues Practice Directions for solicitors’ practices.  They lay out the procedures practices should follow when persuing claims.  Here is the practice direction for mesothelioma claims.

DWP consultation.  In 2006 the DWP consulted on how to improve on how claims are handled.  See their consultation report on Improving Claims Handling for Mesothelioma Cases.

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Getting help with mesothelioma in the UK

Coping with mesothelioma.  Those of us not living with cancer, including mesothelioma, can only image the emotional and practical difficulties it brings.  Cancer Help offers advice on coping with mesothelioma.  They also have a free telephone helpline.

Support groups.  The Asbestos Victims Support Groups Forum UK (AVSGF-UK) is an umbrella organisation representing asbestos victims support groups across the UK.  Find them here.

Local groups.

Clydebank Asbestos Group

Ridings Asbestos Support and Awareness Group (RASAG)

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Mesothelioma charities in the UK

I’ve listed just the big ones here.  Many of the resources linked from this page are charities and you may like to support the ones you found most useful to you.

Cancer Research UK    Research on mesothelioma and other cancers.    Donate

Mesothelioma UK  Specialist mesothelioma information and support to patients and carers.   Donate

The British Lung Foundation (BLF) The UK charity working for people affected by any lung disease.   Donate.

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Blogs on mesothelioma in the UK

These links come with a health warning of their own.  I believe they meet my criteria for “trusted sites”: that is, they are by knowledgeable people providing sound information.  However, it is the nature of some blogs that they reflect the blogger’s views, some strongly held – and quite right too.  But just bear this in mind.

The British Asbestos newsletter.  Well-established quarterly.  Full of news and updates with a UK focus but with some overseas information.  Crusading, and contains personal opinions of some authors.

The Bob Tolly Asbestos Charity.  Another well established blog with straight reporting of developing news on mesothelioma and fund-raising events.

Doing something positive.  A very personal blog about knowing someone with mesothelioma.  The name says it all.  Links to other blogs and information.  

Surviving mesothelioma and other cancers.  Not a UK site this one, but it has good news updates and manages to put over some positive messages about mesothelioma.

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Asbestos FAQs

Asbestos – Frequently Asked Questions

Asbestos FAQsBy Niall Evans

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The 8 questions I am most frequently asked about asbestos:

 

Q.  What is asbestos?

Asbestos is a mineral that is mined in countries like Russia, China, Brazil and Canada.  It is a fibre that is tough, strong and heat resistant; properties that once made it very desirable as an ingrediant in building and other products.  Most western countries have banned its use in new products, but many buildings still contain it.  Top

Q.  What are the types of asbestos?

There are six known types, but only three were used in commercial products.  White asbestos (Chrysotile) is the most common but brown (amosite) and blue (crocidolite) were also widely used.  All of them can cause cancer. Top

Q.  Where can asbestos be found?

Asbestos was used in thousands of products including many in buildings.  These products are also known as ACMs (Asbestos Containing Materials).  Buildings constructed before 2000 may contain asbestos products unless they have been fully removed.  Common applications were:

  • Sprayed insulation on walls and steelwork
  • Pipe and boiler insulation
  • Asbestos insulation board (AIB) in walls and other areas
  • Asbestos ceiling tiles
  • Asbestos cement roofs and sheets
  • Gaskets, ropes and seals
  • ‘Plastic’ floor tiles
  • Textured wall and ceiling coatings
  • Roof felt

 

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Q.  Do all these products have the same asbestos risk?

No.  There is some risk from all, but the risk partly depends on how much asbestos the product contains.  All insulation products, including ceiling tiles, contain higher amounts of asbestos.  They are easily broken or damaged to realease fibres into the air.  Cement products contain less asbestos and are leass easily damaged.  ‘Plastic’ floor tiles, textured coatings and roof felt contain small amounts and are difficult to break and release fibre. The risk of fibres in the air will be greater if the material is already damaged before it is disturbed.  And much more fibre will be released if they are broken agressively or with power tools.

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Q.  How does asbestos cause ill health?

When asbestos materials are disturbed, they release fibres.  They fibres are tiny enough to be breathed into the lungs are invisible in normal lighting.  The fibres stay in the lungs for many years.  Further exposures will add to the fibres already there.  The more fibres people are exposed to in their lifetime, the greater the risk of them getting illnesses, including cancer. People will be exposed to more fibres if they:

  • Beathe air that contains many fibres
  • Are exposed many times
  • Are exposed for a long time each time
  • Their exposures occur over many years

 

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Q.  Who is at risk from asbestos?

Anyone who works with asbestos will be at risk if they are not properly protected.  It is possible to work safely with asbestos – but some materials require great care, knowledge  skills and equipment.  Work with insulation materials usually requires a licence from the Health and Safety Executive.

But the people most at risk from asbestos are tradesmen who work on the repair, maintenance or refurbishment of buildings.  Plumbers, electricians, joiners and others can disturb asbestos materials without knowing it.  Many small exposures put them at great risk.  In the UK, 20 tradesmen a week die from asbestos cancers.  It is vital that tradesmen receive asbestos awareness training.

Occupying a building that contains asbestos is perfectly safe provided that the asbestos materails are in good condition and are not disturbed in a way that will release fibres.

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Q.  What is asbestos cancer?

Cancer from asbestos occurs many years after people have been exposed.  There are two forms of cancer known to be caused by asbestos.

Mesothelioma is cancer of the chest and lung lining, or sometimes the abdominal wall lining.  Almost all mesotheliomas are caused by asbestos and there is no cure.  Mesothelioma is caused by brown and blue asbestos.  It is not thought to be caused by white asbestos.   Mesothelioma can occur after 15 to 60 years or more after exposure for the first time.  Mesothelioma UK.

Lung cancer caused by asbestos is the same as lung cancer caused by smoking.  For this reason, anyone who smokes and is exposed to asbestos is at much greater risk.  Lung cancer is caused by all asbestos types: white, brown and blue.  The illness appears 20 or more years after expsure for the first time.  As with other lung cancers, it can be fatal and treatments are themselves quite agressive.

Non-cancer illnesses from asbestos include asbestosis.  This is a scarring of the lungs and occured in asbestos workers with very high exposures.  It is rarer these days.  Pleural plaques are markings on the chest and lung lining seen on X-ray.  They do not appear to cause harm but are a sign of asbestos expsoure.  For this reason, the government used to award industrial compensaton for people with pleural plaques.  However, because they cause no harm, this compensation was withdrawn a few years ago. Top

Q.  What do the asbestos regulations say?

The UK regulations: Control of Asbestos Regulations 2006, are comprehensive and may appear complex.  However, they cover four main areas:

  • A duty to manage the risks from asbestos materials in non-domestic premises in a way that protects people, particularly tradesmen, from exposure.
  • Many regulations that protect people who work with asbestos – for example, asbestos removers – and others who may be affected by their work.
  • Requiring firms who work with asbestos insulation materials to be licensed with HSE, unless the work is very minor.
  • Prohibition on the importation, supply and use of asbestos.

 

New regulations are expected in 2012.  These will not change overall duties very much as they are being rewritten to cover some rather technical issues applying to lower risk materials.

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Asbestos Regs – consultation on proposed amendments

by Niall Evans

Earlier this year the EU told the UK that it had not fully implemented the Directive that protects workers from asbestos.  The infringements were relatively minor but HSE has concluded that a rewrite of parts of CAR (Control of Asbestos Regulations 2006) is needed, together with additional guidance. It has now published its proposals for consultation.  The issue is around use of the terms “non-friable” and “without deterioration of non-degraded material” which currently don’t appear in CAR but are in the Directive.

Briefly, the proposals are that some work that is now non-licensed will go into a new category of Notifiable Non-Licensed Work (NNLW). HSE’s proposal is that the category will include:
- minor maintenance work on insulation that doesn’t need a licence
- minor removal of AIB that doesn’t need a licence
- removal of artex where there is deterioration of the material (ie not all artex removal)
- removal of asbestos paper and card that is not bonded
- longer periods of maintenance on asbestos cement
- removal of asbestos cement that is substantial degraded (eg, in a fire)

The outcome is that NNLW work would have to be notified to HSE or the LA in a similar way to licensed work, workers would have medicals every three years, employers would have to keep health reccords. All other work would be either licensed (as now, no change) or non-licensed (as now).

Comment:

I’d like to see more clarity of the grouping of asbestos work into three categories (licensed, non-licensed and NNLW).  Particularly, we need to ensure that workers who remove large amounts of asbestos cement are covered by the new requirements.  The definitions and particularly the use of the terms “sporadic”, “low intensity”, “noncontinuous”, “short duration” and “below the control limit” need to be rationalised.

For the full story, and to have your say if you wish, see the consultation document at http://consultations.hse.gov.uk/gf2.ti/f/15426/400357.1/pdf/-/CD237.pdf

It’s fairly long, but you need only read three or four pages – starting at about page 16 – to get the meat of the subject, though you’ll need to read more to get the full story.

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Mythbuster – COSHH data sheets

by Niall Evans

There are so many myths in health and safety I’ve decided to write occasional Mythbuster articles to address them.  This time the myth is “COSHH Data Sheets” and particularly the common myth that if you have these sheets you’ve done what the COSHH Regulations require.

COSHH. Symbol for substances harmful to healt

What are they? COSHH Data Sheets are actually called Safety Data Sheets or Material Safety Data Sheets.  The name is usually shortened to SDS.  SDS’s should come with any materials that contain hazardous substances and that you buy for use in business.  These materials could be a single chemical, like xylene used as paint thinner, or a mixture of chemicals, like paint itself.  Your suppliers have to send you these sheets when you buy the material for the first time, or when there is a change in the information.  But they don’t have to send you information about substances in an article, like a painted work tool, for example.

 

What’s the problem with the myth? It’s still common to find firms who believe that a collection of “COSHH Data Sheets” is all they need to do to complete a COSHH assessment.  In fact, they’ve only completed one of the initial steps.  There are three main problems:

  • The SDS gives vital information about the hazard of the material, but only you know how you will use it in your workplace and what risk will be generated.  The COSHH regulations say you must do an assessment of risk.
  • You won’t get an SDS for everything.  You won’t for example get one for articles like planks of wood – so you won’t be told about the hazards of wood dust; or an SDS for food stuffs like flour – so you won’t be told of the hazards of flour dust in the workplace.
  • The SDS won’t always tell you what happens if you change the substance, by heating it or mixing it with other substances for example.

 

What’s the answer? Use your SDSs to complete your COSHH assessment.  Observe how the substances are used.  Could workers breathe in vapour or dust, could they get it on their skin, or ingest it accidentally or with food or drink.  If so there may be a risk and you need to decide if you need to do something about it, and then take those actions.  That’s a COSHH assessment. HSE’s COSHH Essentials might help.  COSHH assessments can be quite straight forward.  But if you are struggling you may need to go on a training course or get professional help from an occupational hygienist.

 

Will things change in future? Yes.  REACH is a European regulation: Registration, Evaluation, Authorisation and restriction of CHemicals – they couldn’t quite get the abbreviation to work.  REACH puts additional duties on suppliers, including telling users how to protect workers from the harmful effects of their substances.  You’ll start seeing longer SDSs with control information gradually being issued in the next few years.  You’ll still have to do a COSHH assessment, but the REACH-style SDS should be much more helpful.

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Asbestos Management FAQs

by Niall Evans

Asbestos management can be a complex area.  Here are answers to FAQs – the questions I am most frequently asked by managers.

Who is responsible for managing asbestos? Anyone who has employees, or workers in a similar capacity, who do work in buildings that may expose them to asbestos.  This particularly applies to tradesmen and maintenance workers, because they have the jobs where they are most likely to disturb asbestos.  In practice, responsibility can fall on a number of organisations with responsibility for the same premises.

Do I have to have an asbestos survey? The quick answer is, no – you are not obliged to have a survey done.  The more helpful answer is that if you operate a building that may contain asbestos you will probably need a survey at some stage.  Without a survey, you are meeting your obligations if you treat all suspect materials as if they did contain asbestos.

What are the types of asbestos survey? There are now two types.  ‘Management’ suveys give you enough information to operate the building safely day to day, including routine maintenance work.  ‘Refurbishment and demolition’ surveys give more detailed information that is required when workmen will make major alterations to the fabric of the building.  The old survey descriptions of Type 1, 2 and 3 are now defunct.

Should I remove the asbestos? You don’t have to, and unless the material is in very poor condition you are probably best leaving it in place.  If the material is damaged, you can seal and encapsulate it to prevent fibres being released.  This may require licensed contractors depending on the type of asbestos material.  If the material is liable to further damage, you may also need to protect it with a covering or barrier.

Is all asbestos equally dangerous? There are two answers to this question.  Asbestos itself comes in three common types, usually known as blue, brown and white.  The colours refer to what it looks like when it is mined, you can very rarely see the colour once it is in a product.  Blue is the most hazardous followed by brown and then white.  But all are dangerous and all cause lung cancer.  The other answer is that ‘asbestos’ in a building will be in different materials.  Some give off fibres easily (friable) and so are more dangerous than those that do not.

Once I have the asbestos survey report, is that enough? No, you need to use the information to carry out a risk assessment, produce an action plan and put it into effect.  This can be the more complex task and calls for some careful judgements.

Who do I have to tell? You need to inform anyone who works in the building and who may disturb asbestos.  The people at most risk are tradesmen and maintenance workers.  If you use contractors, permanent or temporary, you need to tell them too.




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Mesothelioma – now it’s personal

by Niall Evans     [Photo courtesy of This is Derbyshire]

Ronald Kirkland died of asbestos related cancer

You and I know that the death toll from asbestos in the UK is staggering – 2249 deaths a year from mesothelioma according to the latest statistics, and double that if you include lung cancer.  And we know that tradesmen are the group currently showing the greatest rise in fatalities.  It’s professional knowledge I carry arround in my head.

Now and again you hear a story that brings home the individual reality, and this week I read of the death of Ronald Kirkland.  Ronald was a plumber and in the coroner’s court his wife said, “He loved his work, he really did.” His son added, “Had he known about the dangers, he would have still done that job, but with greater protection.”  Says it all really.





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Offshore COSHH Essentials – but why?

by Niall Evans
[Photo courtesy of laserweldsolutions.com]

Offshore Platform - COSHH EssentialsHSE recently launched Offshore COSHH and you can find the links to the guidance on the HSE website. This latest release provides Offshore COSHH Essential (OCE) and Offshore COSHH Method (OCM) sheets.  They join the wider offshore series of Offshore Food Essentials (OFE) and Offshore Radiation Essentials (ORE).

 

But I have to ask why HSE is producing this guidance.  COSHH Essentials (CE) was originally aimed at helping SMEs complete their assessments and control regimes, and the oil industry doesn’t fall into that category, even allowing for contractors.  Also, CE is restricted by its format and doesn’t add up to comprehensive guidance.  For example, is four pages of advice for managers sufficient for such a complex industry as offshore oil production?

HSE says that the guidance was “prepared in partnership by an HSE/Industry/Unions working group”.  With HSE taking 30% cuts in its budget elsewhere (but not in off-shore I believe) should they be using valuable resources to help produce and promote basic guidance for a multi-billion pound industry?  I think not, but I’m happy to take your views.





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Asbestos – latest prosecutions and enforcement

Prosecutions and other enforcement action against poor asbestos work remains a priority for HSE.  Here are the latest, and it seems to me there is a theme of poor preparation and poor management.

27 Oct.  Swansea workers exposed – no asbestos survey.   A building contractor has been sentenced after its workers were exposed to asbestos fibres during refurbishment work at premises in Swansea.  Work at the former Ace Electrics building in The Strand was being carried out without an asbestos survey.  More …

Plymouth workers exposed to asbestos. Plymouth company, CLC Contractors Ltd, were fined when four workers became contaminated with asbestos and had to be decontaminated.  The company had failed to sequence the work properly to prevent exposure.  More…

Nightclub refurbishment leads to asbestos exposure. The former owner of Wrexham nightclub Scotts was fined after workers were ordered to remove limpet asbestos without proper protection.  No asbestos survey had been carried out and the HSE descibed the exposure as a serious incident that could have been easily avoided.  More…

Liverpool Topshop fined for botched refurbishment work. Topshop and their shopfitter contractors were both fined when workers were exposed to asbestos.  Desite having the results of an asbestos survey, poor control of the work resulted in exposure of up to 45 workers.  More…

HSE Asbestos Enforcement Notices. HSE served forty four enforcement notices on asbestos activities in the first two months of 2011.  This is made up of twenty one Improvement Notices – where companies have to make improvements within a certain time, and thirteen Prohibition Notices – for more serious deficiencies, where the work activity is prohibited until deficiencies have been corrected.  Search HSE Public Register of Enforcement Notices.

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What does asbestos look like?

What does asbestos look like?From Niall Evans

To help you identify potential asbestos containing materials (ACMs) on your premises, HSE provides a useful picture gallery.

If there is asbestos in your building it is obviously important to know what the materials that contain asbestos look like.  Many buildings in the UK will contain asbestos if they were built before about the year 2000.  Asbestos was used in a bewildering variety of materials and in large quantities.  It is true that asbestos has been wholly or partially removed from many buildings, but the work was not always done well and asbestos may have been intentionally or unintentionally left behind.

Unfortunately, there is no quick way of knowing whether certain materials contain asbestos or not.  However, by law you are allowed to assume materials contain asbestos and take the same precautions you would do if asbestos was confirmed.  But what do materials that may contain asbestos look like?  HSE provides a useful gallery of pictures to help you.  Do you have any of these materials?  If you have, you need to ensure no one can be exposed to asbestos fibre from damaging or disturbing them.  This may mean you have to have a survey done by a competent person.  You certainly need to do a risk assessment and put in place an asbestos management plan.





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