Opinion: Asbestos’s deadly legacy in Wisconsin

Implementing the National Mesothelioma Registry will combat misdiagnosis and late detection of this asbestos-exposure-causing cancer. 

Although mesothelioma cases have declined in the past few decades because of stricter asbestos regulations, this rare cancer remains a serious concern, particularly for veterans and industrial workers exposed up to the mid-1990s.  With misdiagnosis and late detection still prevalent in these groups, the need for a National Mesothelioma Registry remains valid. However, little progress has been made five years after its proposal, leaving at-risk populations without the necessary research and healthcare advancements. If policymakers and healthcare organizations fail to act, the opportunity to improve diagnosis and treatment may be lost, even as asbestos-related risks remain a threat due to the aging infrastructure across the country.

A national registry to solve a decades-old problem

In 2019, the Centers for Disease Control and Prevention (CDC) opened a public forum to discuss implementing a National Mesothelioma Registry to combat the high rates of misdiagnosis and late detection of this rare cancer. Mesothelioma, a cancer caused by prolonged asbestos exposure, is now a rare occurrence with the implementation of stringent regulations on asbestos use. However, this condition can emerge decades after exposure took place, meaning that cases detected today are the legacy of asbestos exposure that occurred from the 1940s to the 1990s.

To date, at-risk populations include veterans who were exposed to asbestos during service but also industry workers who handled asbestos for many years before any protective measures were set in place. Today, only about 3,000 cases are detected annually in the US, and it is estimated that around 900 are veterans. Although the number of cases is low, patient care for mesothelioma is extremely poor. Cancer is difficult to detect, and minimal research has been conducted on its specificities. This results in late detection and survival rates of under a year.

While the CDC hopes to solve this problem by implementing a national mesothelioma registry, it has been more than five years since this common shared database was proposed. Some feasibility research was conducted for the registry, and many other things are yet to be addressed, including detection methods, patient confidentiality, and others.

In the meantime, with asbestos regulations, mesothelioma rates continue to decline, and though this may be a positive aspect of public health action, research interest in mesothelioma may also decline.

If this is the case, then the mesothelioma registry may not see the light of day without support from social and healthcare policymakers and organizations. Yet this registry is imperative for furthering research on diagnosis and treatment in mesothelioma care, as, despite decreasing prevalence, the risk persists. For example, as mesothelioma takes decades to develop, those exposed up to the 1990s are still at risk, especially veterans from war zones, where asbestos inhalation was quite common.

Asbestos risks in Wisconsin

Between 1999 and 2017, Wisconsin recorded 6,815 asbestos-related deaths, including 1,295 from mesothelioma and 362 from asbestosis. The state’s long history of industrial activity, including manufacturing, paper milling, and shipbuilding, made asbestos exposure a significant concern. Additionally, Wisconsin has a large veteran population of 283,767 people, and nearly half of these veterans served before protective regulations were in place.

Although Wisconsin, like other states, has clear laws on asbestos containment, incidents may still occur. For example, in 2016, the Monroe Clinic was cited by OSHA for exposing maintenance workers to asbestos without proper safety measures. Although the administration knew of the contamination, the clinic failed to inform employees or implement protective protocols. As a result, workers were unknowingly exposed to asbestos while maintaining the building.

Other than exposure through negligence, various industrial sites in Wisconsin are still contaminated and pose a health threat to the public. In 2024, EPA launched a cleanup operation at the former 5R Processors facility in West Bend, where asbestos-contaminated debris remained dangerous. Nonetheless, this is not the only contaminated site in the state, and clean-up efforts are likely to cost a lot of taxpayer money.

Considering the extent of asbestos exposure in the past and current risks caused by the historical use of this mineral, creating the National Mesothelioma Registry is essential for providing patients with proper care. As veterans represent a significant portion of the population at risk of mesothelioma, the Departments of Defense (DoD) and Veterans Affairs (VA) are among the top institutions that should advocate for the registry implementation.

Failing to implement the National Mesothelioma Registry will result in continued poor patient care, driven by significant rates of misdiagnosis, and late initiation of treatments. Concomitantly, research efforts may subside without proper tracking and data collection of mesothelioma cases as prevalence continues to decline. In this context, policymakers and healthcare institutions must recognize that all people who were unknowingly exposed to asbestos are now owed adequate care, which can only be achieved with sufficient knowledge and data on mesothelioma.