Malignant mesothelioma is one of the more difficult diseases that doctors, patients, and families have to face. It is almost always caused by inhalation of asbestos fibre many years before presentation. Diagnosis can be difficult, there is little hope of a cure, and the disease has the potential for extremely unpleasant symptoms.

The incidence is increasing rapidly and the position of mesothelioma in the league table of cancer related deaths is rising. However, few doctors have managed sufficient numbers of patients to have acquired comprehensive clinical experience of the disease. Furthermore, the relative rarity of the condition and lack of extensive research mean that clinicians do not have reliable evidence on which to base their practice.

The British Thoracic Society (BTS) Standards of Care Committee was asked by the National Health Executive in England to consider what could be done to improve management in the light of the increasing incidence. A Working Party was established, comprising clinicians with interest and experience of the condition, with a view to compiling guidelines to assist in the management of mesothelioma (both pleural and peritoneal) in the UK. The Working Party was supplemented by co-opted specialists. These included radiologists, pathologists, and oncologists and full details are given in Appendix .

The draft was reviewed by the whole membership of the BTS from whom extensive comments were gratefully received. The document was also sent to expert groups and representatives of patients and the government for opinion, and the statement is the result of this consultation process. It is compiled primarily for clinicians who may be involved in the care of patients with mesothelioma, and is based on literature searches and reviews by members of the Working Party responsible for particular sections. However, it is not strictly evidence based as we did not attempt to review …