The 'Blue-Collar' Disease

Rare cancer caused by asbestos exposure leaves victims with little hope

By Denise Bachman, Observer-Reporter

Before Arthur Bannister was taken into the operating room to have tissue from his lung removed, each of his family members leaned over his bed and tenderly kissed him.

"They were giving me a kiss like it was my last kiss," he recalled.

"I think we were scared to death," his wife, Roberta, quickly chimed in.

They had good reason.

The Canton Township resident was diagnosed with mesothelioma, a malignant cancer of the lining of the lungs caused by inhaling asbestos fibers. Most patients diagnosed with the disease are given eight to 12 months to live. Even with early detection and the best treatment, the average five-year survival rate is only 20 percent.

"There is no cure. Even in the early stages, it's very unlikely it will be cured. Less than 5 percent survive," said Dr. Wayne J. Pfrimmer, a medical oncologist on staff at Washington Hospital.

In addition, he said mesothelioma is harder to palliate than other cancers because it tends to produce symptoms in areas of the body that are most susceptible to pain, such as the chest cavity, diaphragm and lungs. Colon cancer, for example, can metastasize to the liver, but Pfrummer said, the liver is immune to pain.

"Mesothelioma is worse. There are fewer drugs that work... and it's more symptomatic," he said. "The last resort is chemotherapy, and that's just for palliation. Even with the best combinations of chemotherapy drugs, the best response is 20 percent. So we're looking at a very poor prognosis."

Bannister underwent radiation and chemotherapy, and he received one dose of Alimta, a drug being tested in clinical trials to treat mesothelioma. But that treatment, combined with medication he was taking to improve his appetite, left him extremely weak and exhausted. He had to rely on oxygen to help him breathe and a cane to help him maintain his balance.

On Monday evening, two days before he was scheduled to receive another dose of the drug, Bannister died at age 73, ending a courageous two-year struggle against the insidious disease.

America's Heroes
Each year, only 3,000 patients are diagnosed with the disease. However, mesothelioma has killed at least 90,000 American who worked in shipyards, steel mills, power plants and construction. Even family members who were exposed to their husbands' and fathers' contaminated clothing are at risk.

Until recently, little research had been done to find an effective treatment because mesothelioma was considered primarily a "blue collar" disease and is not widespread.

"That's the tragedy," said Christopher Hahn, executive director of the Mesothelioma Applied Research Foundation in Santa Barbara, Calif. "You have a person who was kind of like the American ideal. He worked hard all his life to build a life for himself and his family.

"He gets around to retirement age and expects to enjoy his golden years, and the payoff for a life of hard work is a deal sentence. Basically, that's the reality. Mesothelioma takes America's heroes."

Bannister worked as a bricklayer for 57 years. His job with the local union, BAC No. 9, took him to various work sites, such as Brockway Glass, Corning Glass, Jessop Steel, Taggart Valley and U.S. Steel.

"They gave us no warning we were in danger," Bannister said.

It wasn't until the mid-1970s that the use of asbestos, once considered a good - and cost-efficient - insulator and fireproofing agent, was substantially curtailed in the United States.

"By them, there was nothing I could do except keep going forward," Bannister said.

"The disease has a latency period of 15 to 50 years, so asbestos exposure from the 1970s could lead to mesothelioma diagnoses for another two decades.

"Let's be clear. Mesothelioma is primarily going to strike because of long-term exposure," Hahn said, "but it's also a fact there is no safe minimum exposure to asbestos. Theorhetically, one asbestos fiber can cause mesothelioma."

The Onset
Bannister didn't begin experiencing trouble until April 2001, when it became harder and harder for him to catch his breath. He had chest X-rays and a CAT scan, and doctors drained fluid from his lungs five times.

"Everyone was at a loss," said his daughter, Kathy Willis. "He was always healthy, strong and full of life."

Mesothelioma is often mistaken for viral pneumonia, and it is rare enough that few doctors have treated it. According to Pfrimmer, only 14 patients at Washington Hospital have been diagnosed with the disease in the last 13 years.

Bannister wasn't diagnosed until doctors in Pittsburgh biopsied his lung in August 2001.

"I was really surprised to find out I had it," said Bannister, who never smoked. "I heard about it, but I was not knowledgeable about it."

That's why the family has been ravenously digesting as much information as they can and, in the process, trying to educate otheres.

"We want it out so people know it's there," Willis said. "As a family, we're at such a loss. We were learning about it in bits and pieces. This man has always been strong for the family, so you can understand why we're not letting him go anywhere."

The diagnosis was especially difficult for his wife. The couple started dating when they were 13 years old, and they celebrated their 52nd wedding anniversary last July.

"He was so healthy. He never got sick before," Mrs. Bannister said. "We want people to know about mesothelioma, to try to find out before it's too far progressed."

Sometimes, surgery is performed to remove a lunch, Pfimmer said that's rare, though, since the lining of the lungs infringes on too many other organs.

Surgery was never an option for Bannister. "The doctors feared he would not survive the operation," said his daughter, Candi Borkowski.

The Physical Toll
Instead, Bannister underwent radiation treatments twice a month for six months, followed by 12 chemotherapy treatments. The radiation produced an irregular heartbeat, which was corrected with medication, and the chemotherapy resunted in neuropathy in his feet and hands.

He also lost about 13 pounds, but was able to stabilize his weight by forcing himself to eat the hearty foods his family diligently prepared for him.

After nine months, a CT scan showed the size of the tumor had not changed. In January, there was more bad news - the tumor had grown slightly. "It sort of set off an alarm," Bannister said.

But the family still had hope thanks to Bannister's unwavering faith and positive attitude, plus the encouraging results of the Alimta clinical trials.

"Alimta is a very clear breakthrough compared to all of the established treatments," Hahn said. "Alimta has a 46 percent response... but still less than half are responding to the drug, and the ones who do, typically, the tumor at some point will stop responding. It's a breakthrough, but not a home run."

Since the drug has yet to receive approval from the Food and Drug Administration, Alimta is given to patients on a compassionate-use basis. Bannister received his only dose in March.

He didn't respond well and had to be hospitalized. When he was released, he tried to increase his strength via physical therapy. But four days before his death, Borkowski reluctantly began to accept the fact that her father was losing his battle against the disease.

"He's having a hard time walking across the room," she said. "It's such a horrible thing to go through. He gets panicked when he walks. He's getting so breathless now when he exerts himself. When he sits, he's okay."

Bannister and his wife moved from Canonsburg to a one-story home in Canton after he was diagnosed with mesothelioma to be closer to their family - and to make navigating his home easier.

Still, he was rarely able to leave the house. He and his wife no longer could enjoy dinners at fine restaurants, and he could not attend services at Third United Presbyterian Church, where he was an active member until he became ill.

One of the last promises he made to his family was that he would try his best to attend the Easter baptism of his first great-grandchild, Alexis Borkowski.

He couldn't do it.

"I know a lot of people who died with mesothelioma," Bannister said. "I'm probably the last of the old-timers."

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