Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

What is mesothelioma?
Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.

Who is at increased risk for developing mesothelioma?
Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

How is mesothelioma diagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

How is mesothelioma treated?
Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

Are new treatments for mesothelioma being studied?
Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's http://www.cancer.gov Web site, located at http://www.cancer.gov/clinical_trials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

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Cancer Information Service
Toll-free: 1–800–4–CANCER (1–800–422–6237)
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Cancer Information Specialists offer online assistance through the LiveHelp link on the NCI's Web site.

Cancer Facts
Asbestos Exposure: Questions and Answers

Key Points
“Asbestos” is the name given to a group of minerals that occur naturally as bundles of fibers (see Question 1).
Exposure to asbestos may increase the risk of asbestosis, lung cancer, mesothelioma, and other cancers (see Question 3).
Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer (see Question 6).
Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job or at home via a family contact should inform their physician of their exposure history and any symptoms (see Question 7).
Government agencies can provide additional information on asbestos exposure (see Questions 8, 9, and 11).
References

What is asbestos?
“Asbestos” is the name given to a group of minerals that occur naturally as bundles of fibers which can be separated into thin threads. These fibers are not affected by heat or chemicals and do not conduct electricity. For these reasons, asbestos has been widely used in many industries. Four types of asbestos have been used commercially:

Chrysotile, or white asbestos;
Crocidolite, or blue asbestos;
Amosite, which usually has brown fibers; and
Anthophyllite, which usually has gray fibers.
Chrysotile asbestos, with its curly fibers, is in the serpentine family of minerals. The other types of asbestos, which all have rod-like fibers, are known as amphiboles.

Asbestos fiber masses tend to break easily into a dust composed of tiny particles that can float in the air and stick to clothes. The fibers may be easily inhaled or swallowed and can cause serious health problems.

How is asbestos used?
Asbestos was mined and used commercially in North America beginning in the late 1800s. Its use increased greatly during World War II. Since then, it has been used in many industries. For example, the building and construction industry has used it for strengthening cement and plastics as well as for insulation, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steampipes, and hot water pipes. The automotive industry uses asbestos in vehicle brakeshoes and clutch pads. More than 5,000 products contain or have contained asbestos. Some of them are listed below:

Asbestos cement sheet and pipe products used for water supply and sewage piping, roofing and siding, casings for electrical wires, fire protection material, electrical switchboards and components, and residential and industrial building materials;

Friction products, such as clutch facings, brake linings for automobiles, gaskets, and industrial friction materials;

Products containing asbestos paper, such as table pads and heat-protective mats, heat and electrical wire insulation, industrial filters for beverages, and underlying material for sheet flooring;

Asbestos textile products, such as packing components, roofing materials, and heat- and fire-resistant fabrics (including blankets and curtains); and

Other products, including ceiling and floor tile; gaskets and packings; paints, coatings, and adhesives; caulking and patching tape; artificial ashes and embers for use in gas-fired fireplaces; plastics; vermiculite-containing consumer garden products; and some talc-containing crayons.
In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. Additionally, asbestos was voluntarily withdrawn by manufacturers of electric hair dryers. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; uses established prior to 1989 are still allowed. The EPA has established regulations that require school systems to inspect for damaged asbestos and to eliminate or reduce the exposure to occupants by removing the asbestos or encasing it. In June 2000, the CPSC concluded that the risk of children’s exposure to asbestos fibers in crayons was extremely low. However, the U.S. manufacturers of these crayons agreed to reformulate their products within a year. In August 2000, the EPA recommended that consumers reduce possible asbestos exposure from vermiculite-containing garden products by limiting the amount of dust produced during use. The EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite use into the home on clothing; and use premixed potting soil, which is less likely to generate dust.

The regulations described above and other actions, coupled with widespread public concern about the hazards of asbestos, have resulted in a significant annual decline in U.S. use of asbestos: Domestic consumption of asbestos amounted to about 719,000 metric tons in 1973, but it had dropped to about 9,000 metric tons by 2002. Asbestos is currently used most frequently in gaskets and in roofing and friction products.

What are the health hazards of exposure to asbestos?
Exposure to asbestos may increase the risk of several serious diseases:

Asbestosis—a chronic lung ailment that can produce shortness of breath, coughing, and permanent lung damage;

Lung cancer;

Mesothelioma—a relatively rare cancer of the thin membranes that line the chest and abdomen; and

Other cancers, such as those of the larynx, oropharynx, gastrointestinal tract, and kidney.

Who is at risk?
Nearly everyone is exposed to asbestos at some time during their life. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.

Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, brake repair, and a variety of other trades. Demolition workers, drywall removers, and firefighters also may be exposed to asbestos fibers. As a result of Government regulations and improved work practices, today’s workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past.

Although it is known that the risk to workers increases with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years for symptoms of an asbestos-related condition to appear.

There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma. This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. This type of exposure is called paraoccupational exposure. To decrease these exposures, people exposed to asbestos at work are required to shower and change their clothing before leaving the workplace.

How great is the risk?
Not all workers exposed to asbestos will develop diseases related to their exposure. The risk of developing asbestos-related diseases varies with the type of industry in which the exposure occurred and with the extent of the exposure. Asbestos that is bonded into finished products such as walls and tiles poses no risk to health as long as it is not damaged or disturbed (for example, by sawing or drilling) in such a way as to release fibers into the air. When asbestos fibers are set free and inhaled, however, exposed individuals are at risk of developing an asbestos-related disease.

In addition, different types of asbestos fibers may be associated with different health risks. For example, results of several studies suggest that amphibole forms of asbestos may be more harmful than chrysotile, particularly for mesothelioma. Even so, no fiber type can be considered harmless, and people working with asbestos should always take proper safety precautions to limit exposure.

How does smoking affect risk?
Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a greatly increased risk of lung cancer. However, smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma.

There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers. People who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke. If they smoke, they should stop.

Who needs to be examined?
Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job or at home via a family contact should inform their physician of their exposure history and any symptoms. Asbestos fibers can be measured in urine, feces, mucus, or material rinsed out of the lungs. A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. It is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any lung changes resulting from asbestos exposure. Interpretation of the chest x-ray may require the help of a specialist who is experienced in reading x-rays for asbestos-related diseases. Other tests also may be necessary.

As noted earlier, the symptoms of asbestos-related diseases may not become apparent for many decades after exposure. If any of the following symptoms develop, a physical examination should be scheduled without delay:

Shortness of breath;
A cough or a change in cough pattern;
Blood in the sputum (fluid) coughed up from the lungs;
Pain in the chest or abdomen;
Difficulty in swallowing or prolonged hoarseness; and/or
Significant weight loss.

How can workers protect themselves?
Employers are required to follow regulations dealing with asbestos exposure on the job that have been issued by the Occupational Safety and Health Administration (OSHA), the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. The Mine Safety and Health Administration (MSHA) enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended work practices and safety procedures. For example, National Institute of Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.

Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the “United States Government” section of telephone directories’ blue pages (under “Department of Labor”). Regional offices can also be located at http://www.osha-slc.gov/html/RAmap.html on the Internet, or by contacting OSHA’s national office at:

Organization:
Office of Public Affairs
Occupational Safety and Health Administration
U.S. Department of Labor
Address:
Room N–3647
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone:
202–693–1999
1–800–321–6742 (1–800–321–OSHA)
TTY (for deaf or hard of hearing callers):
1–877–889–5627
Internet Web site:
http://www.osha.gov/as/opa/worker/index.html (Worker’s Page)

Mine workers may contact:

Organization:
Office of Information and Public Affairs Mine Safety and Health Administration (MSHA)
U.S. Department of Labor
Address:
23rd Floor
1100 Wilson Boulevard
Arlington, VA 22209–3939
Telephone:
202–693–9400
Internet Web site:
http://www.msha.gov

The National Institute for Occupational Safety and Health (NIOSH) is another Federal agency that is concerned with asbestos exposure in the workplace. The Institute conducts asbestos-related research, evaluates work sites for possible health hazards, and makes exposure control recommendations. In addition, NIOSH distributes publications on the health effects of asbestos exposure and can suggest additional sources of information. NIOSH can be contacted at:

Organization:
Information Resources Branch
National Institute for Occupational Safety and Health (NIOSH)
Address:
Robert A. Taft Laboratories
Mailstop C–18
4676 Columbia Parkway
Cincinnati, OH 45226–1998
Telephone:
1–800–356–4674 (1–800–35–NIOSH)
E-mail:
pubstaft@cdc.gov
Internet Web site:
http://www.cdc.gov/niosh

Will the Government provide examinations and treatment for asbestos-related conditions? What about insurance coverage?
Medical services related to asbestos exposure are available through the Government for certain groups of eligible individuals. In general, individuals must pay for their own medical services unless they are covered by private or Government health insurance. Some people with symptoms of asbestos-related illness may be eligible for Medicare coverage. Information about benefits is available from the Medicare office serving each state. For the telephone number of the nearest office, call toll-free 1–800–633–4227 (1–800–MEDICARE) or visit http://www.medicare.gov on the Internet.

People with asbestos-related diseases also may qualify for financial help, including medical payments, under state workers’ compensation laws. Because eligibility requirements vary from state to state, workers should contact the workers’ compensation program in their state. Contact information for the workers’ compensation program in each state may be found in the blue pages of a local telephone directory or at http://www.dol.gov/esa/regs/compliance/owcp/wc.htm on the Internet.

If exposure occurred during employment with a Federal agency (military or civilian), medical expenses and other compensation may be covered by the Federal Employees’ Compensation Program. Workers who are or were employed in a shipyard by a private employer may be covered under the Longshoremen and Harbor Workers’ Compensation Act. Information about eligibility and how to file a claim is available from:

Organization:
Office of Worker’s Compensation Programs
Employment Standards Administration
U.S. Department of Labor
Address:
Room S–3229
200 Constitution Avenue, NW.
Washington, DC 20210
Telephone:
202–693–0040
E-mail:
OWCP-Mail@dol-esa.gov
Internet Web site:
http://www.dol.gov/esa/owcp_org.htm

Workers also may wish to contact their international union for information on other sources of medical help and insurance matters.

Eligible veterans and their dependents may receive health care at a Department of Veterans Affairs (VA) Medical Center. Treatment for service-connected and nonservice-connected conditions is provided. If the VA cannot provide the necessary medical care, they will arrange for enrolled veterans to receive care in their community. Information about eligibility and benefits is available from the VA Health Benefits Service Center at 1–877–222–8387 (1–877–222–VETS) or on the VA Web site at http://www.va.gov/health_benefits/ on the Internet.

Is there a danger of nonoccupational exposure from the environment and products contaminated with asbestos fibers?
Asbestos is so widely used that the entire population has been exposed to some degree. Air, drinking water, and a variety of consumer products all may contain small amounts of asbestos. In addition, asbestos fibers are released into the environment from natural deposits in the earth and as a result of wear and deterioration of asbestos products. Disease is unlikely to result from a single, high-level exposure, or from a short period of exposure to lower levels of asbestos.

What other organizations offer information related to asbestos exposure?
The organizations listed below can provide more information about asbestos exposure.

The Agency for Toxic Substances and Disease Registry (ATSDR) is responsible for preventing exposure, adverse human health effects, and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. The ATSDR provides information about asbestos and where to find occupational and environmental health clinics. The ATSDR Information Center can be reached at:

Organization:
Agency for Toxic Substances and Disease Registry Division of Toxicology
Address:
Mailstop E–29
1600 Clifton Road, NE.
Atlanta, GA 30333
Telephone:
404–498–0160
1–888–422–8737 (1–888–42–ATSDR)
E-mail:
ATSDRIC@cdc.gov
Internet Web site:
http://www.atsdr.cdc.gov

The U.S. Environmental Protection Agency (EPA) regulates the general public’s exposure to asbestos in buildings, drinking water, and the environment. The EPA’s Toxic Substances Control Act (TSCA) Assistance Information Service, or TSCA Hotline, can answer questions about toxic substances, including asbestos. Printed material is available on a number of topics, particularly on controlling asbestos exposure in schools and other buildings. The EPA’s Asbestos and Vermiculite Home Page has suggestions for homeowners who suspect asbestos in their homes, lists laws and regulations applicable to asbestos, and links to the Agency’s findings on asbestos exposure at the World Trade Center and the Pentagon. Questions may be directed to:

Organization:
TSCA Assistance Information Service
U.S. Environmental Protection Agency
Address:
Mailcode 74080
401 M Street, SW.
Washington, DC 20460
Telephone:
202–554–1404
TDD: 202–554–0551
E-mail:
tsca-hotline@epa.gov
Internet Web site:
http://www.epa.gov/asbestos/

The U.S. Consumer Product Safety Commission (CPSC) is responsible for the regulation of asbestos in consumer products. The CPSC maintains a toll-free information line on the potential hazards of commercial products; the telephone number is 1–800–638–2772. In addition, CPSC provides information about laboratories for asbestos testing, guidelines for repairing and removing asbestos, and general information about asbestos in the home. Publications are available from:

Organization:
Office of Information and Public Affairs
U.S. Consumer Product Safety Commission
Address:
4330 East-West Highway
Bethesda, MD 20814–4408
Telephone:
1–800–638–2772
TTY (for deaf or hard of hearing callers): 1–800–638–8270
E-mail:
info@cpsc.gov
Internet Web site:
http://www.cpsc.gov

Information about asbestos is also available from the U.S. Department of Health and Human Services Web site at http://www.hhs.gov/news/press/2001pres/20010916a.html on the Internet. In addition, people can contact their local community or state health or environmental quality department with questions or concerns about asbestos.

Materials about cancer and how to quit smoking are available by calling the Cancer Information Service (CIS) (see below).

References

Agency for Toxic Substances and Disease Registry (September 2001). Asbestos. Retrieved March 5, 2003, from: http://www.atsdr.cdc.gov/ToxProfiles/phs9004.html.

Agency for Toxic Substances and Disease Registry (November 25, 2002). Asbestos: Health Effects of Exposure to Asbestos. Retrieved March 5, 2003, from: http://www.atsdr.cdc.gov/asbestos/asbestos_effects.html.

Agency for Toxic Substances and Disease Registry (November 2000). Case Studies in Environmental Medicine: Asbestos Toxicity. Retrieved August 21, 2003, from: http://www.atsdr.cdc.gov/HEC/CSEM/asbestos/index.html.

Agency for Toxic Substances and Disease Registry (September 11, 2001). ToxFAQ’s for Asbestos. Retrieved March 5, 2003, from: http://www.atsdr.cdc.gov/tfacts61.html.

DeVita VT, Hellman S, Rosenberg SA. Etiology of Cancer: Physical Factors. In: Ullrich, R. Cancer principles & practice of oncology. Philadelphia, PA: Lippincott Williams & Wilkins, 2001.

Dollinger M, Jahan T, Rosenbaum EH, Jablons D. Mesothelioma. In: Dollinger M, Rosenbaum EH, Tempero M, Mulvilhill SJ. Everyone’s guide to cancer therapy: how cancer is diagnosed, treated, and managed day to day. 4th ed. Kansas City, MO: Andrews McMeel Publishing, 2002.

Hillerdal G. Mesothelioma: cases associated with non-occupational and low dose exposures. Occupational and Environmental Medicine. 1999;56(8):505–13.

National Cancer Institute. Cancer Rates and Risks, 4th ed. NIH Publication No. 96–691, 1996.

National Cancer Institute. What You Need To Know About™ Cancer of the Larynx. NIH Publication No. 95–1568, 1995.

National Cancer Institute. What You Need To Know About™ Kidney Cancer. NIH Publication No. 96–1569, 1996.

National Cancer Institute. What You Need To Know About™ Lung Cancer. Publication No. 99–1553, 1999.

National Institute of Environmental Health Sciences (August 14, 2000). Asbestos. Retrieved March 5, 2003, from: http://www.niehs.nih.gov/external/faq/asbestos.htm.
National Toxicology Program. 10th Report on Carcinogens. Research Triangle Park (NC): National Institute of Environmental Health Sciences, Public Health Service, U.S. Department of Health and Human Services, 2002. Available online at http://ehp.niehs.nih.gov/roc/toc10.html.

U.S. Consumer Product Safety Commission (June 13, 2000). CPSC Releases Test Results on Crayons. Retrieved March 5, 2003, from: http://www.cpsc.gov/CPSCPUB/PREREL/prhtml00/00123.html.

U.S. Environmental Protection Agency (January 6, 2000). Asbestos Containing Materials. Retrieved March 5, 2003, from: http://www.epa.gov/earth1r6/6pd/asbestos/asbmatl.htm.

U.S. Environmental Protection Agency (November 8, 2000). Asbestos in Your Home. Retrieved March 5, 2003, from: http://www.epa.gov/iaq/pubs/asbestos.html.

U.S. Environmental Protection Agency (June 14, 2001). The Asbestos Informer. Retrieved March 5, 2003, from: http://www.epa.gov/region04/air/asbestos/inform.htm.

U.S. Environmental Protection Agency (August 2000). Sampling and Analysis of Consumer Garden Products That Contain Vermiculite. Retrieved March 5, 2003, from: http://www.epa.gov/asbestos/vermiculite.pdf.

U.S. Environmental Protection Agency (August 2000). Fact Sheet: Asbestos-Contaminated Vermiculite. Retrieved June 25, 2003, from http://www.epa.gov/asbestos/vermfacts.pdf.

U.S. Geological Survey (March 2001). Some Facts About Asbestos. Retrieved March 5, 2003 from: http://pubs.usgs.gov/fs/fs012-01/.

Virta, RL. Asbestos. Mineral Commodity Summaries. U.S. Geological Survey Minerals Information. Retrieved March 5, 2003, from: http://minerals.usgs.gov/minerals/pubs/commodity/asbestos/070303.pdf.





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Sources of National Cancer Institute Information


Cancer Information Service
Toll-free: 1–800–4–CANCER (1–800–422–6237)
TTY (for deaf and hard of hearing callers): 1–800–332–8615

NCI Online
Internet
Use http://www.cancer.gov to reach NCI's Web site.

LiveHelp
Cancer Information Specialists offer online assistance through the LiveHelp link on the NCI's Web site.