Rare lung cancer is leaving sorrowful legacy among working class
Mesothelioma, caused by asbestos, may one day strike rescuers and survivors of World Trade Center attacks
By Marylynne Pitz, Post-Gazette Staff Writer, January 21, 2003

For more than 40 years, people who contracted a deadly form of cancer caused by inhaling asbestos fibers had no hope of survival. Nancy Buszinski, of Carnegie and Alice Steigerwald of Brighton Heights lost their husbands to mesothelioma. Still, Nancy Buszinski and Alice Steigerwald, both of the Pittsburgh area, remained hopeful as they tried everything to save their second husbands whose love had given them another chance for lifelong companionship. As the women grieved, they forged a friendship and joined a growing movement among doctors, lawyers, survivors and scientists to find a cure for mesothelioma, the disease that claimed their husbands.

The rare cancer has slowly suffocated at least 90,000 Americans who worked in steel mills, shipyards, power plants and construction. Now, the children of those workers, who washed their parents' dusty clothes or sat in their laps when they arrived home from work, are dying, too. Often mistaken for pneumonia initially, this cancer of the lining of the lungs is difficult to diagnose. By the time it is detected, few patients live longer than a year. It is rare enough that few doctors have diagnosed or treated it.

Now, the 4,000 people diagnosed each year with mesothelioma have some hope of living a bit longer. A new drug called Alimta, made by Eli Lilly, is being tested in a clinical trial led by Dr. Nicholas J. Vogelzang at the University of Chicago. The drug works by attacking folic acid, a vitamin that is essential for dividing cancer cells.

In that trial, which has tracked 448 patients in more than 30 countries, Alimta caused tumors to shrink in 46 percent of participants. Patients who took the drug with chemotherapy, lived longer and had less pain than those who took only an older drug. Alimta is on a fast track for Food and Drug Administration approval and is available on a compassionate-use basis. "We're pretty excited about that," said Dr. Harvey Pass, a thoracic surgical oncologist with the Karmanos Cancer Institute at Wayne State University in Detroit. "We don't know whether that's going to hit a home run, and it probably will not. We need everything we can get with this disease and we'll take a couple of singles."

Finding a cure takes on a new urgency in the wake of the destruction of the World Trade Center on Sept. 11, 2001, which exposed thousands of people to asbestos dust. Inhaling just one asbestos fiber can trigger the development of the lung cancer in some people, a process that may take 30 years. The U.S. Environmental Protection Agency agrees there is no safe minimum level of exposure and in the 1970s imposed strict regulations on its use and removal.

"We often say that mesothelioma takes America's heroes. All the men who served in the military. All the men who got up early and went to work every day to work in factories, building the country. All the wives who gave them a hug and washed their clothes," said Christopher Hahn, executive director of the Mesothelioma Applied Research Foundation in Santa Barbara, Calif. "That statement becomes that much more poignant now that you're talking about rescue workers who rushed to the scene [of the World Trade Center]. People, through their heroism, wind up increasing their risk for mesothelioma."

Tony and Rich
Tony Buszinski, 49, never smoked. He traced his cancer to the 15 years he spent working on pipes, boilers and furnaces as a maintenance welder at a large steel mill in Homestead. Asbestos, once considered an excellent fireproofer and insulator, has been used in manufacturing since the late 19th century and is in the walls and ceiling tiles of older buildings. But its tiny hook-ended fibers break free whenever asbestos is disturbed and can be inhaled into the lungs.

After Buszinski was diagnosed in February 1998, his wife scoured the Internet searching for a doctor with expertise. There were also battles with health insurance companies reluctant to pay for consultations with them. "When you went on the Internet, all you saw was gloom and doom," said Nancy, who lives in Carnegie. She searched for a support group at the American Cancer Society's local chapter, but there weren't enough people to form one. She watched helplessly as Tony withered away. He died on Aug. 3, 1999.

Rich Steigerwald, 60, a computer technician who lived in Brighton Heights, had worked as an apprentice for three years with Steamfitters Local 449 when he was young. He never smoked and could not pinpoint how or where he was exposed. Was it the vermiculite his mother used in her garden? The brake linings he worked with doing car repairs? He could have inhaled asbestos while doing home remodeling jobs, installing telephone lines in Pittsburgh public schools or working as a pipe fitter at a Homestead steel mill. Ten years after he married Alice in November 1988, he became short of breath on his regular walks from Davis Avenue to Riverview Park. "He was tired. When he sang at church, he couldn't seem to sing," Alice Steigerwald recalled.  After he was diagnosed on Sept. 10, 1999, he sought treatment in a clinical trial at the National Institutes of Health. Alice Steigerwald stayed with her family in Bethesda, Md.

"We called it a mission of hope. You don't want any 'what ifs,' " she said. But he eventually was admitted to Forbes Hospice. During six hours on Sept. 7, 2001, Rich Steigerwald's breathing became more and more labored. As he died, Alice held his hand to her heart. "You can't even hold them because they're in so much pain. Your life is never the same again."

Finding a cure
While it's too late to save their husbands, Nancy Buszinski and Alice Steigerwald are determined to help find a cure and have worked to raise money toward that cause. Buszinski also serves on the family advocacy board of the nonprofit Mesothelioma Applied Research Foundation, which was founded in 1999. It has awarded more than $600,000 in grants to scientists working toward a cure.

More info
Alimta, the drug being tested to treat mesothelioma, is available for compassionate use. Patients who wish to obtain it can ask their doctors to call 1-866-347-9503. A clinical trial to study the effectiveness of a gene therapy treatment for mesothelioma awaits approval. For years, no research was done on mesothelioma. "It's a blue-collar disease," Buszinski said, characterizing the attitude of corporations that knew about the dangers of asbestos as "We can sacrifice a few lives for the money."

A day after Alice Steigerwald buried her husband, terrorists rammed two planes into the World Trade Center in New York City, killing more than 2,800 people and blasting tons of asbestos fibers into the air. Hahn, the executive director of the mesothelioma foundation, said occupational physicians in New York are already treating people who were exposed to asbestos during the trade center's destruction and the site clean-up.

"It is well-known that there was a lot of asbestos in the two World Trade Center buildings. They think that there might have been as much as 10 tons released by the explosion of the buildings," he said. "What you worry about with asbestos is that when it's disturbed and when it's shattered, that releases the small fibers, which are the most dangerous. We're talking about an incredible impact on the World Trade Center, pulverizing that dust into tiny sizes, which makes it that much more dangerous."

Many experts, Hahn said, believe the incidence of mesothelioma will rise among the people who were exposed at Ground Zero. "Thirty years from now, when some of them develop mesothelioma, it will be a crime if the treatments we have to offer them then are as inadequate as the ones we have today," Hahn said.

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