Understanding Mesothelioma & Addressing Racial Equity In Healthcare
- Tamron Little was pregnant with her first child at age 21 when she was misdiagnosed with a fibroid tumor. Five months after giving birth to her son, she discovered that the tumor was actually a rare and aggressive cancer called peritoneal mesothelioma, a type of cancer that attacks the lining of the abdomen. Now, a 39-year-old mom of four, Little is raising awareness for mesothelium and urging others to push for answers when it comes to their health.
- Mesothelioma is a rare cancer that impacts the thin tissue lining the lungs, chest wall, and abdomen. Asbestos is a significant risk factor for this type of cancer, the National Cancer Institute says.
- Clinical trials help doctors better understand cancer and discover more effective treatment methods. They also allow patients to try a treatment before it’s approved by the U.S. Food and Drug Administration (FDA), which can potentially be life-changing. For help finding a clinical trial that’s right for you, try our easy-to-use Clinical Trial Finder.
- SurvivorNet experts recommend emphasizing earlier, more frequent screenings, increased access to clinical trials, and providing more access to oncologists to help Close the Gap in care.
Mesothelioma is predominantly caused by asbestos, a carcinogen popularly used in commercial products in the U.S. until the 1970s, which is linked to cancer.
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As a contributor for Asbestos.com, Little has explained how doctors first found the growth in her abdomen amid a routine ultrasound, but she was later confirmed to have mesothelioma in 2007.
Little, who battled the disease in North Carolina and now resides in Florida, has recovered from the disease after undergoing “successful cytoreductive surgery, hyperthermic intraperitoneal chemotherapy and intensity modulated radiation therapy” in the months following the birth of her son Caleb.
Sharing her story in an earlier interview with the Scott Hamilton Cares Foundation, Little, who is also an ordained minister, said, “Just by looking at me, I bet you couldn’t guess that I am a 15 year and counting peritoneal Mesothelioma survivor. Most times when I tell people their mouth drops, and then they proceed to ask ‘What’s mesothelioma?’
“To be honest, when I first found out I had peritoneal Mesothelioma, I didn’t know what it was either. Mesothelioma is a type of cancer that’s caused by asbestos exposure. If you look online now, you will probably see that the statics show that the typical patient is an older man in his mid-60s who has worked in a blue-collar industry. I didn’t check all the boxes – I was a 21-year-old African American female. Talk about not being your typical patient.”
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Recounting the shocking diagnosis, Little said she was given only 18 months to live, but thanks to a groundbreaking HIPEC surgery, otherwise known as hyperthermic intraperitoneal chemotherapy, a specialized cancer treatment involving surgery with a heated chemotherapy.
“Throughout my journey, I remained hopeful, I kept pushing and never gave up. When I couldn’t see the light, I searched for it and thought about being present for my son,” she explained further.
“I’ve been told I have a way with words and I use my talents and story to inspire others. Whether it’s cancer patients, caregivers, or anyone to give them hope. The hope and joy that I see in people when they hear my story just confirms I’m in the right space. I’m grateful that I am able to share my experience and story through writing for asbestos.com.”
Addressing Disparities in Cancer Care
- Cancer Trials Need More Black Participants; Here’s How We Can Close the Gap on Racial Disparities in Cancer Care
- Breast Cancer Thriver, Ananda Lewis, Addresses Racial Disparities In Cancer Care And The Importance Of Early Detection
- Engage At The Grassroots And Invest In Education– How Merck’s Executive Director of Health Equity Is Addressing Racial Disparities In Cancer
- Community Engagement & Resources are Key to ‘Closing the Gap’ on Racial Disparities in Cancer Care
- How to Address Racial Disparities in Cancer Care
- Handling Diversity in Healthcare: SurvivorNet’s Annual “Close the Gap” Conference
In a more recent interview, according to USA Today, Little said, “I can just imagine my other counterparts, women of color, who go through that every day, but may not know how to respond to it, or may think that that’s normal.
“You have a right as a patient to respectfully disagree with your doctor, and you have a right to lay those expectations down beforehand.”
According to Memorial Sloan Cancer Kettering Center, “Mesothelioma is a cancer that affects tissue called the mesothelium, a lining that covers and protects many internal organs. Pleural and peritoneal mesothelioma account for most of the 2,000 to 3,000 new cases of the disease diagnosed in the United States each year. Less common types of mesothelioma include pericardial mesothelioma, which affects the lining surrounding the heart, and testicular mesothelioma.”
The two primary forms of mesothelioma are pleural mesothelioma, which impacts the pleura—the lining that surrounds and protects the lungs—and peritoneal mesothelioma, which affects the peritoneum, the membrane encasing the abdominal organs
Meanwhile, peritoneal cancer is a type of cancer which spreads throughout the lining of the abdomen, and has links to other types of cancers including ovarian cancer, colorectal cancer, and mesothelioma. It is considered an extremely rare type of cancer, affecting only 10% of women, and patients are often given only a five-year survival rate at the time of diagnosis. However, there are ways to detect signs of the disease in order to keep the cancer maintained and prolong survival.
Symptoms of peritoneal cancer can be difficult to detect, as per Cedars Sinai, however, the most common signs include abdominal swelling and discomfort, nausea, vomiting and fatigue. Depending on the stage of the cancer and type of tumor, treatment options can include surgery (if eligible), oral or intravenous chemotherapy, or targeted drugs. Many of the treatment options depend on certain factors of the diagnosis, so it’s extremely important to discuss best options with your doctor.
According to the National Cancer Institute, “Exposure to asbestos causes most mesotheliomas (a relatively rare cancer of the thin membranes that line the chest and abdomen); it can also cause cancers of the lung, larynx, and ovary.”
Mesothelioma is a rare and aggressive cancer with a survival rate of only one to two years, and it’s considered one of the deadliest cancers, Dr. Joseph Friedberg, thoracic surgeon-in-chief at the Temple University Health System, previously told SurvivorNet.
RELATED: Asbestos Causes Cancer, But Now the Government is Opening the Door to its Comeback
Understanding Mesothelioma
Mesothelioma is a rare cancer that impacts the thin tissue lining the lungs, chest wall, and abdomen. Asbestos is a significant risk factor for this type of cancer, the National Cancer Institute says.
Asbestos is a known carcinogen. It was widely used in commercial products and buildings in the United States until the 1970s, when indisputable data linked it to mesothelioma.
WATCH: The Link Between Asbestos and Mesothelioma Explained.
Dr. Joseph Friedberg, Head of the Division of Thoracic Surgery at the University of Maryland School of Medicine, said mesothelioma’s survival rate is generally no longer than one to two years.
“So maybe a few thousand cases a year in the United States,” Dr. Friedberg told SurvivorNet in a previous conversation. “It’s the cancer which is the overwhelming majority of the time–is caused by asbestos.”
Shortness of breath is the most prevailing symptom of mesothelioma.
“Most often, they’ll get diagnosed as having pneumonia or something else because someone listens to them, they have decreased breathing sounds, and they get treated,” Dr. Friedberg said. “So, because it’s such a rare cancer, it is often misdiagnosed for several months.”
Dr. Thomas Sporn, pathologist at Duke University Hospital, previously told SurvivorNet, “In order for [asbestos] to be dangerous, you have to be able to breathe it in — not just any kind of asbestos, but certain forms of long skinny fibrous asbestos.
“With cosmetic products, they contain talc, and talc is a naturally occurring silicate product. It’s just magnesium silicate, and it itself is not fibrous. For any of these to be dangerous, they have to fibrous, which means long skinny needles.”
New Treatment Options
The American Cancer Society describes mesothelioma as “difficult to treat” but improvements in treatment approaches are constantly being worked on.
“The exact roles of surgery, radiation therapy, and chemotherapy in the treatment of mesothelioma are being studied. Combinations of these treatments are now being tested and may provide the most promising option for some patients. And newer types of treatment that are being tested in clinical trials may give patients and their doctors even more options,” the ACS says.
Treatments for mesothelioma have been slow over the years, but now there are a few options for those facing the disease. In October 2020, the Food and Drug Administration (FDA) approved a new first-line mesothelioma treatment called Opdivo-Yervoy Drug Therapy, which combines two immunotherapy drugs Opdivo (nivolumab) and Yervoy (ipilimumab) to help destroy cancerous cells. While evaluating results of this therapy, researchers found that these two drugs may be able to limit tumor growth by increasing the function of patients’ T-cells.
In a clinical trial, patients diagnosed with mesothelioma were divided into two groups where one set of patients received only chemotherapy while the others received the combination of drugs. According to results, patients who received by Opdivo and Yervoy survived an average of 18.1 months after diagnosis while the patients who received chemotherapy alone survived only 14.1 months.
In 2019, the FDA approved NovoCure’s NovoTTF-100L System, which is a wearable medical device about the size of a backpack that uses electric fields to disrupt solid tumor cancer cell division. This development marked the first treatment to be approved for mesothelioma in the last 15 years.
Before the NovoTTF-100L approval, the only FDA-approved therapy for patients with these types of mesothelioma was a combination of chemotherapy drugs called pemetrexed and cisplatin. The NovoCure system is also used in combination with chemotherapy. While testing this treatment, researchers found that the median survival rate for people treated with the new system plus chemotherapy was 18.2 months. However, it’s important to note that only 80 people participated in the trial.
“Typically, mesothelioma patients who cannot have surgery receive palliative care to mitigate their symptoms,” Mary Hesdorffer, former executive director of the Mesothelioma Applied Research Foundation, previously told SurvivorNet.
“NovoTTF-100L provides unresectable (malignant pleural mesothelioma) patients with a treatment option that may improve survival. We are encouraged by the FDA approval and hope it is just the beginning of innovation in the treatment of this aggressive disease.”
Understanding the Environment’s Role in Cancer Risk — Diet, Exposure & Genetics
Stories about a new food, drink, or substance being linked to cancer risk seem to arise every day. We’ve been told we should avoid red meat, alcohol, processed foods, and so many others. However, removing these suspected triggers doesn’t always stop cancer from developing — and indulging in them doesn’t necessarily mean a person will get cancer. There’s a bit more to understanding cancer risk than that.
SurvivorNet previously spoke to Dr. Robert Wright, chair of the Department of Environmental Medicine and Public Health at Mount Sinai, about which environmental risks people should be aware of — and why some triggers may be dangerous to some people and completely safe for others.
When it comes to dietary advice that applies to everyone, Dr. Wright’s was pretty straightforward — eat more vegetables and stay active.
“What we haven’t figured out for cancer is, what is the combination of risk factors that end up leading to a particular person getting cancer,” Dr. Wright said. “The goal [in the future] is to identify those people who are more susceptible to cancer and to give them counseling and foods that they can eat and other habits like exercise that can reduce their risk. Right now, we’re not really good at predicting that.”
While some cancers do develop from inherited genes, most don’t, so researchers are working on ways to understand how lifestyle factors like diet, exercise, and chemical exposures put people at risk. With that in mind, Dr. Wright stressed that eating well and staying active are still important — for all of us.
“In the end, prevention is actually kind of simple,” he said. “It’s what we always know. It’s exercise and eat well. That means eating more vegetables and less meats, particularly red meats.”
How Do Environmental Triggers Cause Cancer?
Throughout our lives, we are continuously exposed to carcinogens, or substances that can can lead to cancer, however, many people will not go on to develop the disease.
“We create carcinogens all the time in our foods when we cook them, and very few of us get cancer because our bodies can handle them,” Dr. Wright explained. “But some people have susceptibilities to these environmental carcinogens, which might be genetic or might be caused by combinations of carcinogens.”
Remember, no one trigger is going to definitively cause cancer, Dr. Wright said, but it could be a combination of triggers in the environment.
“Cancer isn’t caused by one event, typically, it’s usually a series or combination of events,” he added. “So, it may be that you ate a lot of charred food, it may be that you’re also a smoker, it may be that you’ve inherited a genetic susceptibility to be a little bit more sensitive to those chemicals.”
Overcoming Cultural Barriers to Improve Healthcare for Black Women
Clinical trials and medical studies are crucial to understanding how medicine works. However, most people participating in these studies and clinical trials are white.
The American Society of Clinical Oncology (ASCO) says Black Americans are “under-represented in cancer clinical trials,” which can limit our understanding of therapeutic response to Black populations.
The Federal Drug Administration (FDA) said in a 2020 report that studied demographic data on clinical trials for drug participation 75% of participants were white, 8% were Black African Americans, 6% were Asian, and 11% were Hispanic.
WATCH: Black Americans and cancer screenings.
The federal agency noted that patient recruitment and retention were critical to understanding the effectiveness of clinical trial results.
“As it is, patient recruitment in oncology clinical trials is quite low. For Black patients, it is about 4%,” Dr. Kathie-Ann Joseph, a breast surgeon and vice chair for diversity and health equity in the Department of Surgery at NYU Langone Health Perlmutter Cancer Center previously told SurvivorNet, regarding the need for more diverse participation in this critical area of medicine.
Dr. Joseph highlighted some key areas the healthcare community must address to improve Black and other racial groups’ participation in medical studies and clinical trials.
“Trust has to be built not only between the doctor and the patient but also between the hospital and the community.”
“Moreover, there should be efforts to recruit minority patients by having diverse staff and ensuring that the language used in the recruitment literature is at the appropriate reading level and translated into the languages common in the community,” Dr. Joseph explained.
Building Trust
“It all comes down to trust and familiarity,” psychologist and founder of InnoPsych Dr. Charmain Jackman explained to SurvivorNet in an earlier interview.
“Our shared heritage engenders trust and serves as a first step to Black people trusting the medical field. However, there is still so much inherent bias in the way we are trained that if the Black professional is not doing the work of decolonizing (i.e., removing bias) their practice, my guess is that trust will be hard to keep, and the Black patient may not return for care,” Dr. Jackman adds.
Efforts to get more Black Americans to heed medical information, even from legitimate sources, become easier once past racism in medicine is fully atoned.
WATCH: Merck’s Josette Gbemudu explains how to improve outcomes for Black cancer patients.
Contributing: SurvivorNet Staff
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