Let us take the scenario of a seventy-year-old man, who is a nonsmoker and otherwise fairly healthy, approaching the local doctor with complaints of persistent cough, chest congestion and weight loss. Other symptoms may include difficulty in swallowing and loss of appetite. The physician has several options of diagnosis, but pleural mesothelioma, a lethal cancer that originates in the lining enveloping the lungs, may not be considered.

There are several reasons for this. Recognition of pleural mesothelioma as a separate disease entity started as recently as the 1960s. Currently only about 3000 cases are reported annually in the United States. Many doctors may not have seen a single such case during their career. The symptoms are similar to many lesser afflictions. The only general lead is that the disease seems to be more prevalent in the Pacific and Mid-Atlantic States. It is also known that the major cause for pleural mesothelioma is exposure to asbestos. But how much contact with the material leads to this disease is unclear. Even the family members of an asbestos worker are at risk from the dust he carries home on his body and clothing.

This form of cancer has a long latent period and the symptoms manifest only twenty to forty or more years after exposure to asbestos. This also vitiates the possibility of correct diagnosis.

Once the doctor eliminates the chances of other diseases and pursues the pleural mesothelioma line, the patient is subjected to a battery of tests and imaging procedures like x-ray and CT scan. Fluid collection in the thoracic cavity is an indicator, but not conclusive. Confirmation can be obtained with a pleural (pleura is the membrane covering the lungs) biopsy using an electron microscope.

Since pleural mesothelioma is an aggressive cancer, early detection and immediate introduction of appropriate management are of critical importance. The possibility of a doctor who fails to diagnose pleural mesothelioma or misdiagnoses it, being sued for medical malpractice cannot be totally ruled out. But usually the law applicable is asbestos product liability.

It is generally accepted that pleural mesothelioma is a disease that is difficult to diagnose. To help the doctor, the patient should inform him at the very outset about exposure to asbestos, if any.