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how much asbestos do you actually need to get meso - is there a safe amount

Patient · · 73 views
So I've been asking my doc this since my diagnosis in December and he keeps giving me the vague answer which honestly doesn't help. Basically wanted to know if there's like a threshold where you're safe or if any amount of that stuff can get you sick down the road.

From what I'm getting from him and some stuff I read, there's no real safe level. Like with brake pads back in the 70s and 80s when I was working on cars, nobody knew what we were breathing in and I didn't use a mask because nobody did back then. Could've been a little, could've been a lot, who knows. But apparently even tiny fibers can sit in your lungs for decades and cause problems.

The thing that gets me is my doc said it's not like smoking where more is definitely worse. It's kinda random. Some guys work with the stuff their whole life and never get it, other guys get exposed once or twice and develop meso twenty years later. Doesn't make sense but that's what he said.

Anybody else get a straight answer on this or is it just one of those things nobody can really predict?

10 Replies

Family
Yeah I get this question too, honestly my mom's oncologist said basically the same thing yours did. Like there's no magic number where you're safe, and that randomness part is what drives me crazy some days. We don't even know exactly when she got exposed, could've been years ago, could've been from something totally random. It's this helpless feeling of like... you can't undo it.

What I've learned is the doctors aren't being vague to avoid you, they literally just don't have the answer. My mom worked around asbestos in the 1980s without knowing it and didn't get diagnosed until August this year, so we're talking forty plus years of it sitting there. Her pulmonologist said even one fiber can potentially cause problems if it lands wrong, but also some people breathe in way more and never get sick. It's genetics, luck, where the fibers lodge, all of it.

The brake pad thing hits different though because at least you know your exposure. That's actually helpful for your doctors to know the timeline and type of work you did. I wish I could give you a reassuring answer like "oh you're fine" or "yeah you're definitely at risk" but honestly nobody can predict this stuff. It's one of the worst parts of it all.
Attorney ✓ Expert Response
From a legal standpoint this question actually matters a lot, and the answer your doc is giving you lines up with what courts have wrestled with for decades. There's no established "safe" threshold in U.S. occupational law either. OSHA's current permissible exposure limit is 0.1 fibers per cubic centimeter of air over an 8-hour shift, but that number exists to reduce risk, not eliminate it.

What gets complicated in litigation is exactly what you described with the brake work. In cases I've handled going back to the early 2000s, defendants often argued "de minimis" exposure, basically claiming the amount was too small to be legally significant. Courts in most jurisdictions have rejected that argument when plaintiffs can show repeated occupational contact, which regular automotive work in the 70s and 80s typically qualifies as.

The randomness your doc mentioned, some guys heavily exposed never getting sick while others get meso from less, actually comes up in expert testimony too. It doesn't mean causation can't be established legally, it just means the science works differently than, say, a toxin with a clear dose-response curve.

If you haven't already, getting your full occupational history documented somewhere official could matter down the road. Talk to your own attorney about your specific situation though, because how this plays out varies pretty significantly by state.
3 found this helpful
Patient
Yeah man I've been down this road and honestly your doc is giving you the straight answer even if it sucks to hear. There's no safe amount, period. I worked brake jobs for thirty years without any real protection and I'm sitting here with stage 1 because of it. Could've been one bad day or could've been the accumulation, but it doesn't really matter now does it.

What I've learned since my diagnosis last December is that asbestos is kinda like a loaded gun. You don't know when it's gonna go off. My buddy Tommy worked alongside me the whole time and he's fine at 72. I got hit with it. The randomness part is real and it drives you crazy trying to figure out the "why me" angle, but I stopped doing that pretty quick because it wasn't helping anything.

The thing nobody really told me straight up is that those fibers just live in your lungs. They don't break down. So whether you got exposed to a little cloud one afternoon or breathed it in steadily for years, once it's in there it's in there. Your immune system can't get rid of it. Some people's bodies just don't react to it, some people's do. Nobody can predict which way you'll go.

After my EPP surgery in February I asked my oncologist the same thing and he basically said "Carl if there was a safe threshold we'd know it by now and we'd be telling you." So that's when I stopped asking and started focusing on the stuff I can control. Got through my treatment and now I'm doing okay. Don't waste energy on the "what if I'd been more careful" stuff because back then we were all just doing our jobs without knowing any better.
Medical ✓ Expert Response
Your doctor is actually giving you the most accurate answer available, even if it doesn't feel that way. There genuinely isn't a known safe threshold for asbestos exposure and mesothelioma. The IARC (International Agency for Research on Cancer) classified all forms of asbestos as Group 1 carcinogens back in 1987, meaning no exposure level has been established as safe.

The randomness you're describing is real and it's one of the most frustrating aspects of this disease from a clinical standpoint. The current thinking involves individual genetic susceptibility, specifically variations in the BAP1 gene and a few others, which seem to explain why some heavily exposed workers never develop disease while others with brief exposures do. A 2011 study by Testa et al. in Nature Genetics was one of the first to really map this out.

What your doc is right about is that the dose-response relationship here doesn't follow the same rules as something like smoking. With chrysotile versus amphibole fibers, with occupational versus paraoccupational exposure, the math just doesn't add up the same way. Brake work specifically has been studied quite a bit given how many men of your generation did exactly what you're describing.

So no, you're not going to get a cleaner answer than the one you have, and that's genuinely where the science sits right now. Please keep that conversation going with your oncologist about what it means for your specific treatment planning, because that's where the individualized information actually lives.
3 found this helpful
Medical ✓ Expert Response
Your doc is actually giving you the straight answer, even if it doesn't feel like one. The research really does support what he's saying. There's no established safe threshold for asbestos exposure, and the dose-response relationship with mesothelioma is genuinely different from something like lung cancer from smoking. A 2014 study in the Annals of Occupational Hygiene looked at exactly this and found that even brief, low-level exposures can be sufficient. It's frustrating because our brains want a line we can point to.

The randomness piece is real and I think it's one of the hardest things for people to sit with emotionally. I've worked with guys who had thirty years of heavy exposure and never developed anything, and others who had maybe a few months of contact with the material and here we are. Some of it comes down to individual biology, fiber type, where the fibers land in the lung tissue... honestly medicine doesn't have the full picture yet.

What I hear from people in our Thursday evening support group at St. Catherine's is that the "why me" question can really take hold, especially early after diagnosis. December wasn't that long ago. Journaling sometimes helps with that, just getting the anger and confusion out somewhere. And if you find it's sitting heavy and not lifting, talking to someone who specializes in oncology-related anxiety is worth considering. Not because anything is wrong with you, just because this is a lot to carry.
3 found this helpful
Family
Yeah the randomness is what gets me too, especially since I can look at my dad's exposure history from his nursing career in the 80s and 90s and it was probably minimal compared to yours but here we are. I think what helps me stop spiraling about it is accepting that we can't change what happened, only manage what's going on now.
Medical ✓ Expert Response
Something Dr. Chen and Carl both touched on that I want to build on a little, from a counseling standpoint... the randomness piece you're describing, that "why me and not the other guys in the shop" question, that's one of the hardest things I see people sitting with after a December diagnosis. It doesn't have a clean answer and your brain keeps looking for one anyway.

In our Thursday support groups at the cancer center we've started doing a specific exercise around this. Not to find the answer but to sort of... make peace with not having one. Journaling about what you do know, what you can control right now, sometimes helps more than the medical explanation ever will. Talk to your own doctor or a counselor about what feels right for you.
3 found this helpful
Medical ✓ Expert Response
Something I can add that nobody's touched on yet: the fiber type actually matters in terms of risk profile, even if there's no "safe" amount of any of them.

Crocidolite (blue asbestos) and amosite (brown asbestos) have a much more aggressive association with meso than chrysotile (white asbestos), which is what was most common in brake pads. The Helsinki Criteria from 1997 actually tried to establish cumulative exposure thresholds for compensation purposes, not because there's a safe level, but because they needed some framework. It's been debated ever since.

So when you're thinking about brake jobs in the 70s and 80s, you were mostly dealing with chrysotile, which... still got people sick, clearly. But the randomness your doc mentioned isn't totally random. It's more like the science just can't tell us why individual susceptibility varies so much. Some genetic factors are being studied now. The BAP1 gene mutation keeps showing up in meso research and may explain some of why one person gets it and another doesn't after similar exposures.

Talk to your oncologist about whether genetic testing makes sense in your case. It won't change what happened but it can matter for your family.
3 found this helpful
Patient
yeah that fiber type thing is what my doc mentioned too but he kinda glossed over it. so if the brake pads were mostly the white stuff, does that mean I had better odds than some of the guys who worked around the other types? not that it matters much now I guess lol but just curious how that plays into the whole prognosis thing.
Family
Yeah, my dad's pulmonologist said the same thing - no safe threshold, and honestly the randomness of it is what messes with me most. The fibers just need to get lodged in there and your body can't clear them, so even minimal exposure decades ago can be the culprit.

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