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a woman coughing imageFebruary 20 2018

New British Thoracic Society guidelines on pleural mesothelioma include some key recommendations for primary care.


The BTS guideline give recommendations and good practice points around predicating the presence of mesothelioma. Specifically, it says:

  • do not rule out a diagnosis of malignant pleural mesothelioma (MPM) on the basis of symptoms and examination findings alone;
  • offer an urgent chest X-ray to patients with symptoms and signs as outlined in the NICE guideline NG12;
  • refer all patients with a chest X-ray suggestive of MPM urgently (via the 2-week wait suspected cancer pathway in England and Wales);
  • consider referral for further investigation in patients with persistent symptoms and history of asbestos exposure despite normal chest X-ray;
  • a thorough occupational history should be taken to cover all occupations throughout life, and also consider para-exposure by exploring details of relative and/or partner occupations.

The new guideline on the investigation and management of malignant pleural mesothelioma has been published by the BMJ journal, Thorax.

Highlighting the guideline, the Primary Care Respiratory Society has endorsed the recommendations on symptom recognition, management and follow-up.

“The use of products containing asbestos was banned in the UK in 1999 but mesothelioma takes a long time to develop (often 30-40 years after exposure) and symptoms can be non-specific, especially breathlessness, cough and chest pain,” said the PCRS. There were approximately 2,250 cases of mesothelioma in the UK in 2014, 97% of which were pleural, and 3% were peritoneal.

Dr Steve Holmes, who represented PCRS-UK on the BTS guideline development group, added: “Primary care clinicians should carefully read the recommendations in this guideline on symptom recognition, management and follow-up of these patients.

“The symptoms of MPM can be non-specific so primary care clinicians should always be asking themselves when assessing patients complaining of breathlessness, cough and chest pain, ‘What else could it be?’.”

Links
BTS Guideline for the Investigation and Management of Pleural Mesothelioma   
I Woolhouse et al. BTS guideline. ‘British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma’. Thorax. 2018; 73: i1-i30.        
PCRS statement            
NICE guideline NG12 ‘Suspected cancer: recognition and referral’          

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