An evaluation of trends for mesothelioma mortality in American women: Addressing the content of a recent Morbidity and Mortality Weekly Report (MMWR)

Our plain-English summary of An evaluation of trends for mesothelioma mortality in American women: Addressing the content of a recent Morbidity and Mortality Weekly Report (MMWR), by M.E. Stevens, B.P. Tuttle, D.W. Brew, et al (Toxicology and Industrial Health, 2025).

The study

• Authors: M.E. Stevens, B.P. Tuttle, D.W. Brew, D.J. Paustenbach
• Journal: Toxicology and Industrial Health
• Published: 2025;41(1):40-60
• Type of article: Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is a fatal disease that has historically been associated with exposure to airborne asbestos. Because occupational asbestos exposures dropped dramatically in the late 1960s and early 1970s, far fewer cases of mesothelioma today are due to these fibers but, instead, are usually a result of the aging process or genetic predisposition. In May of 2022, a Morbidity and Mortality Weekly Report (MMWR) was issued by the Centers for Disease Control and Prevention (CDC) regarding malignant mesothelioma incidence in women from 1999 to 2020. While this MMWR alerted citizens to the continued presence of the disease, after reading this article one might have thought that the CDC was suggesting that the disease was increasing in women due to asbestos exposures (which it is not). In the present analysis, we investigate several factors related to the interpretation of epidemiological data for mesothelioma, including the role of asbestos as a risk factor over time. The authors conducted a review of the scientific community's understanding of mesothelioma incidence and asbestos exposures amongst women, as well as an investigation of the methods and references in the MMWR article. Although various articles have recently discussed the incidence of both peritoneal and pleural mesothelioma in women, it is fortunate that the age-adjusted rates for mesothelioma have remained flat (neither increased nor decreased significantly) in women for the past 50 years. Incredibly few women in the U. S. have had appreciable cumulative exposures to any type of asbestos (chrysotile, amosite, or crocidolite) in the workplace or from the ambient environment, especially since about 1965-1970. In this paper, we highlight six factors that should be considered when evaluating the incidence of mesothelioma amongst American women in the current era. Without sufficient consideration of these factors, improper conclusions have been drawn over the past several years.

In plain English

This article was a non-systematic review. It responded to a 2022 CDC report (an MMWR by Mazurek and colleagues) on mesothelioma deaths among U.S. women from 1999 to 2020. It drew on published literature up to April 2024 and excluded studies of women outside the United States. The authors noted that the MMWR reported a 25% increase in mesothelioma deaths in women over that period, while the age-adjusted death rate fluctuated between 4.12 and 4.99 per 1 million. In the MMWR's figures for women over age 25, 72.3% of mesothelioma deaths were recorded with the tumor's body site unspecified. The authors argued that the MMWR's occupation percentages, such as those for homemakers, teachers and nurses, were not informative because they did not account for how many women worked in those jobs. They also argued that take-home exposure to amphibole asbestos has not occurred appreciably for almost 50 years. They discussed causes other than asbestos, including radiation therapy and inherited gene mutations such as BAP1. The authors concluded that increased longevity was the primary, if not the sole, reason for the rise in deaths.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Non-systematic literature review and critique of a CDC Morbidity and Mortality Weekly Report (Mazurek et al., 2022)
• Who was studied: Published literature on mesothelioma and asbestos exposure among women in the United States, current through April 2024, plus the mortality data reported in the 2022 MMWR (U.S. women, 1999 to 2020); studies of women outside the U.S. were excluded
• Exposure: Asbestos exposure of U.S. women by fiber type (chrysotile, amosite, crocidolite and other amphiboles) from occupational, take-home (para-occupational), building and post-1970 sources, as well as non-asbestos risk factors
• Main results:
  • The authors noted that the MMWR reported a 25% increase in malignant mesothelioma deaths in women between 1999 and 2020 (MMWR data, not new data from this review)
  • According to the MMWR data cited by the authors, the age-adjusted mesothelioma death rate for women fluctuated between 4.12 and 4.99 per 1 million from 1999 to 2020; the authors described this rate as flat
  • Among malignant mesothelioma deaths in women above the age of 25 in the MMWR data (reproduced in the authors' Table 1), 8,842 deaths (72.3%) were classified as unspecified anatomical site
  • The authors argued that the MMWR's percentages of deaths by occupation (for example homemakers, elementary and middle school teachers, and registered nurses) were not informative because they did not account for the number of women in those occupations
  • The authors argued that take-home exposure to amphibole asbestos has not occurred appreciably in the United States for almost 50 years
  • The authors discussed causes of mesothelioma other than asbestos, including radiation therapy for earlier cancers
  • The authors wrote that available human data lean toward the view that inherited (germline) mutations such as BAP1 may cause mesothelioma independent of asbestos exposure
• The authors' conclusion: The authors concluded that increased longevity was the primary, if not the sole, reason for the increase in mesothelioma deaths in the United States after the OSHA regulations, especially in women

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Pleural Mesothelioma, Cumulative Exposure, Chrysotile, Amosite, Crocidolite.

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