Epidemiology, biologic behavior, and natural history of mesothelioma

Our plain-English summary of Epidemiology, biologic behavior, and natural history of mesothelioma, by L. Zellos, D.C. Christiani (Thoracic Surgery Clinics, 2004).

The study

• Authors: L. Zellos, D.C. Christiani
• Journal: Thoracic Surgery Clinics
• Published: 2004;14(4):469-77, viii
• Type of article: Review
• Cited by: 40 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma has a well described natural history but poorly defined pathogenesis. It is strongly associated with asbestos exposure. A predominantly locally invasive disease, the success of more aggressive life-prolonging therapies has increased the potential for the development of distant metastases in survivors. Recently described new risk factors may increase the incidence of this disease in future generations, underscoring the need for a more in-depth understanding of its pathobiology. This article reviews the current body of knowledge about the occurrence, distribution, presentation, and natural history of malignant pleural mesothelioma.

In plain English

This article was a review, not a new study. The authors summarized published research on the occurrence, distribution, presentation and natural history of malignant pleural mesothelioma. They reported that case-control studies from several countries found relative risks of 2.3 to 7.0 for occupational asbestos exposure. In one North American study of pleural and peritoneal mesothelioma, relative risk estimates included 2.6 for construction work and 46.1 for insulation work. In the cohort studies reviewed, crocidolite was associated with the highest risk, while chrysotile seemed to increase risk. In a cited mortality study of South African miners, 4.7% (20/423) of crocidolite miners and 0.6% (4/648) of amosite miners developed the disease. A cited review of 1105 asbestos-exposed patients reported a mean latency of 32 years. A cited analysis of patients irradiated for breast cancer or lymphoma found a relative risk of 1.56 (95% confidence interval 0.18 to 5.63), not statistically significant. Most survival studies reviewed reported a median survival with chemotherapy of 5.9 to 8.4 months. They wrote that the long latency means cases will continue well into the future.

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: Narrative review of published literature (no new data collected)
• Who was studied: No new patients were studied. The article reviewed published case-control, cohort, latency and survival studies of malignant pleural mesothelioma from several countries.
• Exposure: The main exposure discussed was asbestos: chrysotile (serpentine) and the amphiboles crocidolite, amosite, anthophyllite, tremolite and actinolite, in occupational settings. The review also discussed other suggested risk factors: SV40, chest radiation therapy, Thorotrast, erionite and genetic susceptibility.
• Main results:
  • Across the case-control studies reviewed (Table 1, from McDonald and McDonald 1996), relative risk for occupational asbestos exposure ranged from 2.3 to 7.0.
  • In McDonald and McDonald's study of 344 cases of pleural and peritoneal mesothelioma, occupation-specific relative risks were 2.6 for construction, 2.8 for shipyard work, 4.4 for heating trades, 6.1 for the group the text calls asbestos mining, and 46.1 for insulation work.
  • In the same study's table, the 'Other' occupational group had a relative risk of 1.0.
  • In the cohort studies reviewed, chrysotile exposure seemed to increase mesothelioma risk, and crocidolite exposure was associated with the highest risk.
  • In a cited SEER study by Neugut et al of patients irradiated for breast cancer or lymphoma, the overall relative risk was 1.56 (95% confidence interval 0.18 to 5.63), which was not statistically significant.
  • In a cited mortality study of South African miners, crocidolite miners developed malignant pleural mesothelioma at a rate of 4.7% (20/423), with a mean latency of 44.9 years.
  • In the same miner study, amosite miners had a 0.6% (4/648) rate, with a latency of 51 years.
  • In the same miner study, miners exposed to both crocidolite and amosite had a 3.9% (6/154) rate, with a latency of 12.3 years.
  • In a cited review by Lanphear and Buncher of 1105 asbestos-exposed patients with mesothelioma, mean latency was 32 years, and 99% of cases occurred 15 or more years after exposure.
  • Most of the survival studies reviewed reported a median survival of 5.9 to 8.4 months with chemotherapy.
  • A cited projection by Peto et al predicted a doubling of mesothelioma mortality rates in Europe between 1998 and 2018.
• The authors' conclusion: The authors stated that, because of the long latency between exposure and disease, cases of malignant pleural mesothelioma will continue to be seen well into the future.
• Limitations the authors state:
  • The authors noted that different asbestos fiber types can coexist in one product, which makes it harder to estimate the risk for each fiber type.
  • The authors suggested that the cited SEER radiation analysis may have had a design flaw: follow-up may have been too short to detect an association, given the long latency.
  • The authors noted that the SEER database covers only 9% of the US population and may underrepresent mesothelioma cases.

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Mesothelioma, Pleural Mesothelioma, Asbestos Exposure.

Related studies

• Natural history and epidemiology of malignant mesothelioma — K.H. Antman (1993)
• Natural history and staging of malignant mesothelioma — K.H. Antman (1989)
• Natural history of pleural thickening after exposure to crocidolite — N.H. de Klerk, W.O. Cookson, et al. (1989)
• Multimodality therapy for malignant mesothelioma based on a study of natural history — K.H. Antman, R.H. Blum, et al. (1980)
• Low dose exposure to natural and man made fibres and the risk of cancer: towards a collaborative European epidemiology. Report of a workshop held in Paris , 10-12 June, 1991 — A.J. Valleron, J. Bignon, et al. (1992)
• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)

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