Dr. Raphael Bueno calls himself a “mythbuster.” The mesothelioma doctor believes a misconception has circulated for years regarding this rare cancer.

“The myth that everyone dies in a few years is false,” he said.

Dr. Bueno is Chief of the Division of Thoracic and Cardiac Surgery at Brigham and Women’s Hospital. He leads one of the highest-volume cancer centers in the United States. Brigham and Women’s Hospital sees one of the largest number of cases of malignant mesothelioma.

He notes a patient of his from 1996 underwent surgery for her cancer and is still living today. She’s a 25-year survivor, one of the longest with pleural mesothelioma.

“She just sent me a ‘Happy 25th anniversary’ text in January,” Dr. Bueno said, noting more than 100 patients have surpassed the five-year survival milestone.


Correcting Misbeliefs About Mesothelioma

Dr. Bueno aims to bust many of the misconceptions about mesothelioma. He said it’s not the death sentence many doctors say it is. He also believes surgery is the best option for most patients, including a subset of those with sarcomatoid cell type.

He mentioned some sarcomatoid cases have reached five-year survival after multimodal combination of surgery, chemotherapy and immunotherapy. Many surgeons don’t operate on sarcomatoid mesothelioma cases. This type of mesothelioma has added aggressiveness, spreading in a unique manner and making removal difficult. Recurrence rates are high for sarcomatoid mesothelioma, making surgery less beneficial as a long-term solution.

The main task in accomplishing this feat is proper patient selection.

“We have some ideas for how we can select and identify them,” Dr. Bueno said. “Everything is nuanced. The focus of this decade in mesothelioma is to hone down selection strategies for patients who will do well.”

When determining surgical candidacy, Dr. Bueno looks at tumor volume in the chest cavity, lymph node involvement and diffuse chest invasion. He also examines physical health and lung function. This process, plus his surgical expertise, led to a five-year survival of 22% for his patients.

The key is multimodal treatment, starting with surgery.

“The myth is that mesothelioma is different from any other solid cancer and surgery shouldn’t have a role,” he said. “That’s the myth. The answer is it’s like lung cancer and breast cancer and colon cancer. You identify the disease early and operate on them.”

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