Jonathan Sharp is the chief financial officer of the Environmental Litigation Group in Birmingham, Alabama.
Veterans are often honored for their sacrifices, courage on the battlefield, long overseas deployments and decades of service. However, many still face a silent but dangerous threat after returning home. Mesothelioma, an orphan disease predominantly connected with asbestos exposure, severely impacts numerous veterans, as the military once depended on toxic minerals in the construction and upkeep of its infrastructure and equipment. Yet, despite the known risks, early detection remains elusive, mainly due to the lack of targeted surveillance that contributes to the rampant misdiagnosis of this cancer.
This issue is not hypothetical but a reality affecting several states — including Delaware, whose military bases and industrial facilities historically relied on asbestos. What’s needed now is a coordinated and proactive response. It can only be delivered by establishing a national mesothelioma registry — a centralized database that tracks high-risk veterans and ensures that they undergo timely screenings for accurate diagnoses.
Mesothelioma and its drastic effects on veterans
Mesothelioma is a lethal malignant tumor caused almost exclusively by exposure to asbestos — a natural mineral occurring in certain rock formations. This cancer usually affects the lining of the lungs, abdomen or heart, but detecting it is very difficult, as its symptoms can take up to 40 years to appear. And, because the disease is considered rare, it often receives inadequate attention, with clinical expertise remaining scarce for the past years. As a result, doctors frequently misdiagnose mesothelioma, causing it to advance to a late stage, when treatment options get fewer, and survival rates drop critically. This health crisis is even more troubling for the veteran community, which accounts for a third of about 3,000 patients diagnosed with mesothelioma annually.
Delaware’s military history makes it especially relevant in this context, considering that several installations have widely utilized toxic materials in various applications. Among these was Dover Air Force Base — one of the major bases in Kent County that has a documented history of asbestos use, particularly in its old hangars, boiler rooms and housing units. While many facilities have undergone remediation, the risk remains for those who served before the 1980s, when asbestos use was prevalent. Making the situation more pressing is the presence of industrial shipbuilding and manufacturing sectors in Wilmington, where civilians and military personnel worked side-by-side in asbestos-heavy environments.
The consequences of heavy reliance on asbestos are severe. Between 1999-2017, Delaware recorded 1,256 asbestos-related deaths, of which 211 were due to mesothelioma, and another 211 were asbestosis cases. In Kent County alone, the toll reached 169. These numbers are not abstractions but tragic results of the rapid progression of an illness that could have been mitigated or even prevented with more proactive health surveillance.
The disconcerting high misdiagnosis rates
Adding to the urgency of the issues surrounding mesothelioma is the frequency of its misdiagnosis. The latest data indicates that 80.8% of stage one cases were incorrectly diagnosed and later “upstaged” to a more alarming stage, while 69.5% of stage two diagnoses were similarly inaccurate. Stage three and four cases saw 35.4% and 12.8% misdiagnosis rates, respectively. Such errors delay critical treatment until the disease is in its final stages, and treatment choices are limited.
For Delaware veterans, this is not just a simple drawback in the country’s current health care system — it is a matter of life and death. Given this population’s elevated risk, they should not have to self-advocate for mesothelioma screenings. Yet a national registry could change that, linking service history with known asbestos exposure sites, such as Dover Air Force Base and surrounding industrial zones, and prompting automatic checkups for susceptible individuals.
National mesothelioma registry is the missing link
Establishing a national mesothelioma registry — much like those for burn pits and Agent Orange-related diseases — would revolutionize early detection and care for direly affected veterans. This database should be jointly managed by the Department of Veterans Affairs and the Department of Defense, incorporating electronic health records, military occupational data and known exposure sites. Through this infrastructure, veterans flagged as high-risk could be invited to regular and specialized screenings, making their referrals to mesothelioma specialists even faster.
A system like this could also leverage existing patient information to help complete crucial clinical studies focused on understanding the broader nature of mesothelioma. With this, researchers could develop updated disease progression models and innovate better and more effective treatments.
Creating a national mesothelioma registry is not just about data collection but also about driving proactive care. Instead of waiting for veterans to seek help after symptoms emerge, a registry can serve as a lifeline — encouraging those vulnerable to participate in screenings, learn from educational resources and connect to local treatment centers equipped to handle their rare cases.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
