Asbestos from natural geologic deposits is known as “Naturally Occurring Asbestos” (NOA). Health risks associated with exposure to NOA are not yet fully understood, and current US federal regulations do not address exposure from NOA. Many populated areas are in proximity to shallow, natural deposits which occur in 50 of 58 California counties and in 19 other U.S. states. In one study, data was collected from 3,000 mesothelioma patients in California and 890 men with prostate cancer, a malignancy not known to be related to asbestos. The study found a correlation between the incidence of mesotheliomas and the distance a patient lived from known deposits of rock likely to include asbestos, the correlation was not present when the incidence of prostate cancer was compared with the same distances. According to the study, risk of mesothelioma declined by 6 percent for every 10 kilometers that an individual had lived away from a likely asbestos source.^[22]

Portions of El Dorado County, California are known to contain natural asbestos formations near the surface.^[23][22] The USGS studied amphiboles in rock and soil in the area in response to an EPA sampling study and subsequent criticism of the EPA study. The study found that many amphibole particles in the area meet the counting rule criteria used by the EPA for chemical and morphological limits, but do not meet morphological requirements for commercial-grade-asbestos. The executive summary pointed out that even particles that do not meet requirements for commercial-grade-asbestos may be a health threat and suggested a collaborative research effort to assess health risks associated with “Naturally Occurring Asbestos.”^[24]

Large portions of Fairfax County, Virginia were also found to be underlain with tremolite. The county monitored air quality at construction sites, controlled soil taken from affected areas, and required freshly developed sites to lay 6 inches (150 mm) of clean, stable material over the ground.^[22]

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos can put a person at risk for developing mesothelioma.^[2] Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases risk of other asbestos-induced cancer.^[3] Compensation via asbestos funds or lawsuits is an important issue in mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.

Signs and symptoms

Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). 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.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion
• Pulmonary emboli, or blood clots in the arteries of the lungs
• Severe ascites

A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.