ALAMEDA – A British pathologist told a jury on Thursday that plaintiff Terry Leavitt had an identifiable cancer reported in 2013, but treatment did not take place until 2017.
“Mrs. Leavitt developed a right lower lobe cancer,” said Dr. Richard L. Attanoos, a pathologist with the Cardiff University Hospital in Wales, U.K. “It was diagnosed in 2017, although imaging that was present from the records I read, identified that in fact the cancer was identifiable and reported over four years beforehand in March of 2013. There was a 1.5 centimeter mass in the right lower lobe. For reasons unclear there was no follow-up, although follow-up was recommended. Some four years or so later when a further image was taken, the mass that was the cancer was over six centimeters in size.”
Leavitt is at trial against Johnson & Johnson claiming the use of its talc baby powder over a 30-year period caused her to develop mesothelioma, a cancer of the linings of the lungs. The disease in incurable and death usually results a few years after diagnosis.
Attanoos appeared as an expert witness for Johnson & Johnson.
Coverage of the trial in the Alameda County Superior Court is being streamed live courtesy of Courtroom View Network.
Attanoos testified that after the 2017 diagnosis, Leavitt underwent six cycles of chemotherapy treatment. Major surgery was also performed to remove visible tumors in the lungs.
He said mesothelioma is a rare disease with about 2,500 cases diagnosed each year in the U.S. and 2,200 in the U.K. He explained that although England has a much-smaller population, it has about the same number of cases as the U.S. because workers in the U.K. have been exposed to more virulent types of asbestos used. For example, in the construction trades, brown or amosite asbestos, was used to manufacture insulation.
“The most common reason for mesothelioma is commercial occupational exposure,” Attanoos said.
He added that a majority of mesothelioma cases are diagnosed in men because they are more customarily involved in the types of occupations where asbestos exposure is possible.
Based on his review of her medical records, Attanoos said Leavitt did not develop mesothelioma from the use of Johnson & Johnson baby powder. He called it instead “spontaneous in nature,” contracted for no known reason.
Pleural mesotheliomas are more often spontaneously acquired in women, he added.
“Exposure to baby powder did not cause or contribute to her mesothelioma,” Attanoos said.
He said Leavitt’s exposure level to asbestos did not rise above a background level, for example the amount of asbestos fibers breathed by the general population in ambient air. Such lower background levels of exposure do not increase the risk of developing mesothelioma.
“She is not above background level (for asbestos exposure),” Attanoos said.
Attanoos said Leavitt did not show markers of asbestos, including the presence of plural plaques, patches of fibrous thickening on the lining of the lungs.
“Had she had them (plaques), it would have been informative,” Attanoos said.
There was no clinical, radiological, or pathological evidence in Leavitt’s case of a dust-induced disease, Attanoos concluded.
“There was no scarring of the tissue, no pneumoconiosis,” he said.
Attanoos said talc powder glitters when it is back-lit under a microscope. He said the evidence indicated in Leavitt's case the fiber particles found in her tissue samples were inhaled more recently and not decades ago. The minimum latency period for mesothelioma, the time from first exposure to illness, is about 10 years. Some cases take 30 years to develop.
Under cross-examination, Moshe Maimon of Levy Konigsberg, Leavitt’s attorney, asked Attanoos if a person could have mesothelioma without showing pleural plaques.
“That’s correct,” Attanoos agreed.
“Different people can form different asbestos bodies,” Maimon said.
“That is correct,” Attanoos answered.
“Even a low dose of asbestos may increase risk, correct?”
“You’ve never conducted animal studies?” Maimon asked.
“No,” Attanoos said.
“Are you aware that talc in the body can cause an inflammatory response?”
“You looked at Mrs. Leavitt’s tissue under a microscope?”
“Yes,” Attanoos said.
“Is it a fatal cancer?”
Maimon questioned Attanoos’ qualification to challenge the findings of researchers such as Dr. William Longo of the Georgia-based MAS lab, a witness for the plaintiff who said he found asbestos in Johnson & Johnson baby powder samples.
Attanoos qualified that he did not challenge mineralogical identifications made from Leavitt’s tissue samples.
Maimon asked Attanoos if his British consultant firm A.P.C. Pathology LTD had billed $500,000 from litigation cases in the U.S. involving asbestos last year.
He was asked if his firm had made more than $2 million over the past several years from U.S. cases.
Again, Attanoos agreed.
Maimon exhibited a document from the 1990s in which Attanoos had written “anthophyllite and tremolite have been responsible for environmental diseases such as pleural plaques and mesothelioma.”
Attanoos said he was talking about industrial-grade talc powder.
“It has nothing to do with cosmetic talc,” he said. “They are different.”
Closing arguments in the two-month-old trial will begin on Monday.