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The first British Thoracic Society (BTS) statement on mesothelioma was published in 2001 by a Working Party of the Standards of Care Committee of the BTS 1 in response to a request by the National Health Executive in England. In the last 5 years enough progress has been made to justify the preparation of a second statement. The most significant updates are in sections reviewing radiology and biopsy techniques and interpretation, the potential use of tumour markers, chemotherapy, radical treatment and the roles of the specialist nurse and multidisciplinary team approach in management. Recent major clinical trials are also reviewed.
As before, this updated statement was written by a Working Party of clinicians with an interest and experience in the disease with the aim of compiling a document to assist in the management of pleural and peritoneal malignant mesothelioma in the UK. We were again assisted by co-opted specialists, including radiologists, pathologists, nurses and oncologists, whose full details are given in Appendix 1. The draft was reviewed by the whole membership of the BTS and also sent to expert groups and patient representatives for whose comments we are grateful. Our statement is the result of this consultation process.
This statement is compiled primarily for clinicians who may be involved in caring for patients with mesothelioma and is based on literature searches and reviews by members of the Working Party responsible for particular sections. However, like its predecessor, it is not strictly evidence-based as we did not attempt a comprehensive review of all available literature. Moreover, in most aspects of this subject there are still no randomised trials on which to base guidelines. The management of mesothelioma remains subject to debate and variations in practice, so we have retained the term "statement" rather than "guidelines" in this revision.
This statement should be read in conjunction with the Mesothelioma Framework produced by the Department of Health's Lung Cancer and Mesothelioma Advisory Group. 2 The latter document is directed mainly at Strategic Health Authorities, cancer networks, primary care trusts and NHS trusts in England, and provides advice on how to organise mesothelioma services in order to improve standards of care to a uniformly high level.
Summary of key points
Malignant mesothelioma will increase in incidence over the next...