Frontiers in Public Health

Our medical research library holds 33 studies published in Frontiers in Public Health (2021–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 32 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Frontiers Editorial Office
• Published: 2013 to the present, Switzerland
• Language: English
• ISSN: 2296-2565 (electronic)
• Its record in the NLM Catalog

2020s

• The provision of psychological care for patients with mesothelioma and their caregivers: an Italian survey. A. Granieri, I.G. Franzoi, M.D. Sauta, et al. 2026;14:1879469. PubMed · Publisher · Free full text

  Abstract

  Background: Mesothelioma is a rare, aggressive tumor that profoundly affects patients and caregivers. However, few studies address psychological interventions for this population, either nationally or internationally. This study therefore aims to map the current state of psychological care provided by the Regional Operating Centers. (CORs) of the Italian National Mesothelioma Registry and other health and welfare facilities in Italy.

  Methods: The survey lasted approximately 15 min.

  Results: The final sample includes 15 CORs and 57 other facilities. Among them, 66.7% (n = 10) of CORs and 5.3% (n = 3) of other facilities lack a psychologist. Only one COR includes a psychologist at diagnosis, compared to 12.9% of other facilities. Psychological interventions are offered by only 25% of all centers. Where psychologists are present, 100% of respondents consider them useful; in their absence, 45.5% of CORs and all other facilities consider their inclusion valuable. Interventions for mesothelioma patients and families are provided in two of four CORs and in 37 of 52 other facilities with a psychologist. In seven facilities, interventions target only patients, and in three, they are specific to this population of patients and caregivers.

  Conclusions: Although national and international guidelines emphasize the importance of interdisciplinary care for mesothelioma patients and their families, many still lack adequate support. Closing this gap is urgent, as most healthcare professionals recognize the value of such integration-both when they experience it and when it is absent in their workplace.

  Copyright © 2026 Granieri, Franzoi, Sauta, Barbagli, Mensi, Marinaccio and Bonafede.

• Application of artificial intelligence in the analysis of asbestos fibers. R. Lee, D. Van Orden, S. Blanda, et al. 2025;13:1584136. Review PubMed · Publisher · Free full text

  Abstract

  Automated asbestos fiber detection and identification has been the goal of asbestos microscopists for decades. The advent of inexpensive memory, fast digital processing, machine learning, and microscope automation provide the enabling platform for success. This paper will review recent developments in fiber detection and identification by PCM and SEM and will present recent progress in employing artificial intelligence in the TEM classification of asbestos and non-asbestos amphiboles in the evaluation of elongated minerals in raw materials. To date, this project has been self-funded.

  Copyright © 2025 Lee, Van Orden, Blanda, Mihalick, Bickford and Metsch.

• Associated minerals in chrysotile deposits and their potential health risks. E.J. Chatfield. 2025;13:1583469. PubMed · Publisher · Free full text

  Abstract

  Chrysotile samples from different deposits and the UICC-A and UICC-B standards have been analyzed by a procedure in which the chrysotile is removed by successive treatments in hydrochloric acid and sodium hydroxide, followed by transmission electron microscopy (TEM) examination of the residues. Two separate TEM fiber counts of a minimum of 100 fibers each were made for each sample: fibers longer than 5 μm and fibers with lengths between 0.5 μm and 5 μm. The tremolite/actinolite in each sample was quantified in terms of fibers/gram of chrysotile and as mass fraction in parts per million (ppm). Chrysotile from almost all of the commercial deposits examined was found to contain tremolite/actinolite. In particular, UICC-B Canadian chrysotile was found to contain an average of approximately 180 ppm tremolite/actinolite, equivalent to 1.25 × 107 fibers per gram (longer than 5 μm) of tremolite/actinolite, a proportion of which is asbestiform. The results also showed that both the UICC-B and UICC-A chrysotile standards are contaminated by Amosite. The primary grades of chrysotile from Coalinga, United States, and Minaçu, Brazil, were found to contain substantially less than 1 ppm of tremolite/actinolite. An asbestiform variety of the pyroxene diopside was detected in chrysotile from the Balangero mine in Italy. The asbestiform diopside has a fiber concentration and mass fraction comparable to those of tremolite/actinolite in chrysotile from other sources. Some of the diopside fibers are considerably longer than the tremolite/actinolite fibers found in other sources of chrysotile. Low levels (<4 ppm) of tremolite/actinolite were detected in Balangero chrysotile. No fibers with compositions consistent with Balangeroite were detected. It was found that Balangeroite does not survive the acid-alkali dissolution procedure, and it probably has durability comparable to that of chrysotile. Publications that claim the absence of tremolite/actinolite in UICC-B chrysotile were based on analytical methods that had insufficient sensitivity. Use of these analytical methods permitted only a 1 in 5 chance that a single tremolite/actinolite fiber would be detected. The concentrations of tremolite/actinolite and Amosite found in the reference UICC chrysotile standards raise questions as to the validity of historical biological experiments carried out using these materials.

  Copyright © 2025 Chatfield.

• Burden and trends of cancer attributable to occupational asbestos exposure in China from 1990 to 2021. B. Chen, X. Zheng, H. Zheng, et al. 2025;13:1672598. PubMed · Publisher · Free full text

  Abstract

  Background: Occupational exposure to asbestos remains a major public health concern in China, particularly due to the long latency of asbestos-related diseases and the persistent use of asbestos in male-dominated industries. However, the long-term trends and drivers of asbestos-related cancer burden have not been fully quantified.

  Methods: This study used data from the Global Burden of Disease Study 2021 to estimate the burden of total cancer attributable to occupational asbestos exposure in China from 1990 to 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), disaggregated by age, sex, cancer type, and time period. Joinpoint regression and age-period-cohort analyses were conducted to explore temporal dynamics, while decomposition analysis assessed the contributions of population growth, aging, and epidemiological changes.

  Results: In 2021, occupational asbestos exposure led to 29,020 deaths and 535,732 DALYs in China, with a significantly higher burden among males. The number of cases rose steadily from 1990, with sharp increases between 2000 and 2010, plateauing thereafter and rising again after 2017. Age-standardized rates showed dynamic trends: increasing until 2010-2011, declining until 2018, and rebounding modestly, particularly among females. The burden was highest among individuals aged 85-94 and showed a rightward shift over time. Lung cancer accounted for over 85% of asbestos-related DALYs, followed by mesothelioma, ovarian, and laryngeal cancers. Joinpoint and age-period-cohort analyses highlighted long-latency effects and generational shifts, while decomposition showed that aging and epidemiological changes were the dominant drivers of increased deaths, whereas DALYs were primarily driven by epidemiological factors and population growth.

  Conclusion: The burden of asbestos-related cancers in China remains substantial and is rising due to demographic aging and persistent exposure risks. Stronger occupational safety regulations, exposure surveillance, and asbestos bans are urgently needed to curb future disease burden.

  Copyright © 2026 Chen, Zheng, Zheng, Chen, Xu, Li, Lin, Yu, Xu, Guo and Zhan.

• Cellular defense mechanisms against asbestos fibers. C.A. Barlow, B.T. Mossman. 2025;13:1566473. Review PubMed · Publisher · Free full text

  Abstract

  Although inhalation of sufficient doses and dimensions of airborne asbestos dusts in an occupational setting can produce cancer in the lungs, pleura and peritoneum, tumors occur in <5-10% of exposed individuals, even among persons with considerable historical exposures. In this perspective, we review cell defense mechanisms that are involved in protective and adaptive responses to asbestos exposure. These adaptive responses are orchestrated through a multifaceted cellular program involving the concerted action of diverse stress response pathways, including antioxidant responses, DNA repair mechanisms, molecular mechanisms for intracellular signaling leading to proliferation, apoptosis, and inflammation, and cell cycle regulation. These cell defenses suggest that humans can adjust to moderate levels of stress or change without experiencing negative effects, implying the existence of a threshold dose. Likewise, reported no-observed adverse-effect levels (NOAELs) for various asbestos fiber types and asbestos-related cancers in experimental and epidemiological data further support the existence of a threshold dose and are discussed here.

  Copyright © 2025 Barlow and Mossman.

• Cigarette smoking decreases macrophage-dependent clearance to impact the biological effects of occupational and environmental particle exposures. A.J. Ghio, M. Stewart, R.G. Sangani, et al. 2025;13:1558723. Review PubMed · Publisher · Free full text

  Abstract

  The retention of occupational and environmental particles in the lung is a primary determinant of biological effects. In the distal respiratory tract, particle clearance includes phagocytosis by alveolar macrophages (AMs), migration to the terminal bronchiole, and transport of AMs and particles by the mucociliary escalator. With increasing particle exposure, a focal collection of particle-laden macrophages results at the respiratory bronchiole (RB) which is that site in the clearance pathway demanding the greatest traverse by these cells after a commencement from the alveoli. With the greatest particle doses, there is "particle overload" and impaired mobility which is reflected by an excess accumulation of particle-laden macrophages throughout the RBs, alveolar ducts, and alveoli. With deposition of fibrous particles in the distal respiratory tract, the AM is unable to extend itself to enclose fibers with a major diameter of 10-20 microns or longer resulting in "frustrated phagocytosis" and longer retention times. Clearance pathways for particles are shared. There can be a summation of particle exposures with exhaustion in the capacity of the AMs for transport. Cigarette smoking (CS) is the greatest particle challenge humans encounter. Associated with its enormous magnitude, CS profoundly impacts the clearance pathways and subsequently interacts with other particle exposures to increase biological effects. Interstitial lung disease, pulmonary function, chronic obstructive pulmonary disease, infections, lung cancer, and mortality can be altered among smokers exposed to occupational and environmental particles (e.g., silica, coal mine dust, air pollution particles, other particles, and asbestos). It is concluded that both decreasing CS and controlling particle exposures are of vital importance in occupational and environmental lung disease.

  Copyright © 2025 Ghio, Stewart, Sangani, Pavlisko and Roggli.

• Comparative analysis of asbestos body and fiber content in formalin-fixed vs. paraffin-embedded lung tissue. B.K. Kuhn, B. Vrugt, A. Low, et al. 2025;13:1590802. PubMed · Publisher · Free full text

  Abstract

  Introduction: Asbestos body and fiber burdens may be determined using different preparations of lung tissue. Paraffin-embedded tissue requires more complex steps than formalin-fixed tissue. A prior study highlighted potential variations in the measurement of retained mineral fibers in different lung preparations and prompted this expanded interlaboratory analysis. Data from exposed subjects referred to a Swiss laboratory were compared with the results of mineral analysis obtained from a laboratory based in the United Kingdom.

  Methods: Numbers of asbestos bodies were determined in formalin-fixed tissue and corresponding paraffin blocks of 62 subjects in Zurich by NaOCl digestion. Fiber burden was measured in a total of 104 subjects (62 subjects in Zurich and 42 subjects in Cardiff).

  Results: Asbestos body and amphibole asbestos fiber counts obtained from paraffin blocks were noted to be, in general, lower than counts obtained from formalin-fixed tissue. The limits of detection were higher in paraffin blocks than in formalin-fixed tissue. Similar trends were obtained in the two laboratories.

  Discussion: In this comparative mineral analytic study, the authors focused on the potential significance of differing specimen preparations (formalin-fixed wet lung versus paraffin wax-embedded block extraction) investigating paired samples. The results generally reflect numerically higher fiber burdens in samples analyzed from wet lungs compared with counterpart paraffin wax tissue. Mineral analysis by electron microscopic analysis remains the most objective measure of the respirable fraction of mineral dust as it correlates most directly with disease risk.

  Copyright © 2025 Kuhn, Vrugt, Low, Goodman and Attanoos.

• Comparison of various methodological approaches to model asbestos thresholds for mesothelioma. J.E. Goodman, A. Korchevskiy, A.G. Wylie. 2025;13:1569343. Review PubMed · Publisher · Free full text

  Abstract

  Background: There is evidence to support several modes of action (MoAs), and particularly non-genotoxic MoAs, for mesothelioma induced by asbestiform elongate mineral particles (EMPs). In turn, these MoAs provide biological support for dose-response relationships that are non-linear and that include a threshold. However, statistical models of human data have not adequately addressed threshold dose-response relationships for asbestiform EMPs and mesothelioma. In addition, unlike other carcinogens, asbestiform EMPs are not uniform materials and display a range of properties.

  Objectives: Our objective was to review various approaches for applying threshold dose-response models to asbestiform EMPs and mesothelioma.

  Materials And Methods: We collected data from several sources, including the Surveillance, Epidemiology, and End Results (SEER) Program and published case-control studies, cohort studies, and a meta-analysis that evaluated various mineral types of asbestos and mesothelioma risk. Several threshold-based models were fit to the available data. We also evaluated thresholds for certain fiber characteristics.

  Results: Certain characteristics of asbestiform EMPs, such as width, length, and surface area, likely have thresholds for mesothelioma. Theoretical models and models based on epidemiology data supported thresholds. A Monte Carlo evaluation of the threshold hypothesis for mesothelioma in a meta-analysis of occupational exposures to various mineral fiber types, using a cumulative exposure metric, demonstrated the likelihood of a threshold to be 72% for non-textile chrysotile, 80.9% for textile chrysotile, 84% for amosite, and 60% for crocidolite. A multi-stage clonal expansion (MSCE) model applied to the SEER mesothelioma registry data demonstrated a good fit with the inclusion of a threshold by a surrogate predictor of cumulative exposure to amphiboles. Finally, lung burden studies also support a threshold. Our preliminary estimate of a central-tendency cumulative exposure threshold level for non-textile chrysotile is ~90 f/cc-years. Based on our proposed approach, we suggest thresholds of 1.04 f/cc-years for amosite, 0.25 f/cc-years for crocidolite, and 4.3-10.9 f/cc-years for tremolite. Future studies should be conducted to support these estimates.

  Conclusions: While uncertainties remain, many angles of scientific evidence support the existence of mineral-specific thresholds for mesothelioma.

  Copyright © 2025 Goodman, Korchevskiy and Wylie.

• Deaths burden of laryngeal cancer attributable to occupational exposure in the male working age population: findings from global burden of disease study 2021. D. Wang, S. Yang, W. Yu, et al. 2025;13:1605654. PubMed · Publisher · Free full text

  Abstract

  Objectives: Laryngeal cancer (LC) is a major health threat to the male working-age population, with occupational exposures (asbestos and sulfuric acid) being key risk factors. However, the deaths burden of LC attributable to occupational exposure in this population remains unclear. This study analyzes the deaths burden from 1990 to 2021 using Global Burden of Disease (GBD) data, providing insights for optimizing prevention strategies.

  Methods: Data from GBD 2021 database were used to calculate age-standardized death rates (ASDR) and estimated annual percent changes (EAPC). Decomposition analysis and Bayesian age-period-cohort (BAPC) models were applied to assess trends, drivers, and predict future trends to 2040. Frontier analysis exploring the relationship between SDI and ASDR for 204 countries and territories.

  Results: Globally, deaths burden of LC attributable to occupational exposures exhibited divergent trends from 1990 to 2021. Asbestos-related deaths decreased by 22% (533.6 cases in 2021; ASDR 0.02/100,000, 95% CI 0.01-0.04), with an EAPC of -3.23% (95% CI -3.32 to -3.14). Sulfuric acid-associated mortality increased by 16.19% (2,131.2 cases; ASDR 0.09/100,000, 95% CI 0.04-0.16), though with an EAPC decline of -1.90% (-1.98 to -1.82), suggesting improving age-standardized rates. Regional disparities were striking: High-SDI regions showed elevated asbestos burdens (Western Europe ASDR 0.06 vs. global 0.02), while middle-SDI regions dominated sulfuric acid mortality (South Asia ASDR 0.18 vs. global 0.09). Decomposition analysis revealed distinct drivers - asbestos burden growth (415% from epidemiological factors) reflected latency effects of historical exposures, whereas sulfuric acid increases stemmed from population expansion (336%) and aging (148%). Projections to 2040 indicate continued divergence: asbestos-related deaths are predicted to decline to 372.8 cases (ASDR 0.011/100,000), while sulfuric acid-associated mortality may rise to 2,543.8 cases (ASDR 0.078/100,000), with middle/low-SDI regions accounting for 78% of sulfuric acid burden.

  Conclusion: Laryngeal cancer burden attributable to occupational exposure shows a contrasting trend with asbestos-related deaths appearing to decrease while sulfuric acid-related cases are rising. High-SDI regions face legacy asbestos risks, while middle and low-SDI regions are increasingly exposed to sulfuric acid. Targeted prevention strategies are needed, high-SDI regions should focus on asbestos risk management, and middle/low-SDI regions need to strengthen industrial protections, promote alternative materials, and enhance screening.

  Copyright © 2025 Wang, Yang, Yu, Tang, Wang, Fang and Li.

• Defining control reference ranges in biologic samples in analytical laboratories. B. Vrugt, B.K. Kuhn, R. Attanoos. 2025;13:1618114. Review PubMed · Publisher · Free full text

  Abstract

  Mineral analytic laboratories define control reference ranges to interpret the significance of an individual's prior exposures. Control reference ranges are internally compiled and defined for two scenarios: background controls-only subjects with ambient asbestos exposure and no increased risk of asbestos related disease, and asbestosis range controls, utilized for the diagnosis of asbestos-related lung fibrosis/asbestosis and for asbestos-related lung cancer causation. The objective of this study was to evaluate how different analytic laboratories have established their internal control reference ranges and to comment on their significance. The study comprised a review of the scientific literature generated from a Pubmed search of mineral analytic data from lung tissue in laboratories determining background exposures to asbestos and other elongate minerals. Twenty-six publications were found from 17 laboratories across Europe, North America, and Asia which had internally defined background control populations. The studies showed marked heterogeneity having been conducted over decades, using different criteria, different microscopic methodologies, and assessment of different fiber dimension. The most common criterion to define background control subjects was to establish individuals with no known occupational history of asbestos exposure and/or no evidence of asbestos-related diseases. In background controls with no disease, chrysotile was reported most frequently. Chrysotile and amphiboles were variably detected in lung tissue from control subjects in virtually all studies. Interlaboratory variations exist so individual results obtained in one laboratory do not transfer significance to another laboratory. The use of negative control groups in case-control studies is discussed alongside their relevance in ensuring the validity of results related to asbestos exposure and its diseases.

  Copyright © 2025 Vrugt, Kuhn and Attanoos.

• Fluorescent labeling of asbestos fiber for enhanced asbestos detection under fluorescence microscopy. A. Kuroda. 2025;13:1568581. Review PubMed · Publisher · Free full text

  Abstract

  The application of fluorescence microscopy (FM) for detecting micro- and nano-scale inorganic materials has historically been limited by the lack of specific fluorescent probes. However, recent research has demonstrated that asbestos-binding proteins can act as effective fluorescent probes, significantly enhancing the sensitivity and selectivity of FM for asbestos fiber detection. This advancement enables the identification of nano-scale fibers at lower magnifications, reducing the labor costs associated with asbestos contamination detection. Based on these advantages, two FM-based methods have been developed: (i) phase-contrast microscopy (PCM)-FM, a differential counting approach fully compatible with PCM-based epidemiological data, and (ii) portable FM, which shows strong potential for rapid on-site asbestos screening. Additionally, FM may enable multicolor labeling and live-cell fluorescent imaging of asbestos, opening new avenues for asbestos research. Despite these advancements, several challenges remain. Fluorescent probes alone cannot definitively identify asbestos, and issues such as cross-reactivity need to be addressed. This review highlights future perspectives and challenges for advancing FM methods in asbestos detection and research.

  Copyright © 2025 Kuroda.

• Global trend analysis and risk evolution of asbestos-related ovarian cancer: a population-based study and future prediction (1990-2021). X. Li, J. Li, D. Shan, et al. 2025;13:1698477. PubMed · Publisher · Free full text

  Abstract

  Existing evidence demonstrates that asbestos exposure is an environmental risk factor for ovarian cancer (OC). Using comprehensive data from the 2021 Global Burden of Disease Study, this research quantified the epidemiological burden of asbestos-related ovarian cancer. In 2021, asbestos exposure accounted for 5,587 OC deaths-a 51.2% increase from 1990. However, the age-standardized mortality rate (ASMR) decreased from 0.11 (95% UI: 0.05-0.17) to 0.07 (95% UI: 0.03-0.11) per 100,000 people between 1990 and 2021. Similarly, the disability-adjusted life-year (DALY) rate declined from 1.93 (95% UI: 0.92-3.03) to 1.15 (95% UI: 0.56-1.85) per 100,000 people, reflecting a 40.4% reduction in total DALYs. Projections based on the Bayesian age-period-cohort (BAPC) model indicate declining incidence and mortality rates over the next 25 years. These findings suggest asbestos' role as an independent OC risk factor is diminishing, warranting further investigation into its synergistic effects and co-pathogenesis with other etiological factors.

  Copyright © 2026 Li, Li, Shan, Zhou, Mengna, Li, Xia and Deng.

• Global, regional and national mortality burden of laryngeal cancer attributable to occupational exposure to sulfuric acid and asbestos: 1990-2021 and projections to 2040. X. Gong, Y. Xu, Y. Hao, et al. 2025;13:1602789. PubMed · Publisher · Free full text

  Abstract

  Background: Laryngeal cancer (LC) is the most prevalent form of head and neck cancer, significantly impacting patients' health. Occupational exposure to sulfuric acid (OESA) and asbestos (OEA) is a recognized risk factor for LC, but the associated mortality burden remains unclear. This study aimed to evaluate the global trends of LC attributable to OESA and OEA, and to project future trends.

  Methods: Based on the Global Burden of Disease Study 2021, we analyzed the number of deaths, age-standardized death rates (ASDR), and estimated annual percentage changes by age, sex, and socio-demographic index (SDI) of LC attributed to OESA and OEA. Decomposition analysis was used to identify the drivers of disease burden changes. Frontier analysis was used to estimate achievable outcomes based on development levels. Additionally, Bayesian age-period-cohort model was used to predict future trends up to 2040.

  Results: In 2021, global LC deaths attributable to OESA and OEA were 3,612.35 (95% uncertainty intervals (UI): 1,504.31-6,492.29) and 3,392.00 (95% UI: 1,892.13-5,134.88), respectively, representing increases of 37.5% and 21.4%, respectively, from 1990. The ASDRs for OESA and OEA in 2021 were both 0.04 per 100,000 (95% UI: 0.02-0.07 and 0.02-0.06, respectively), both lower than in 1990. LC deaths attributable to OESA and OEA mainly occur in elderly patients, and men consistently showed higher LC deaths and ASDR than females. The ASDR for OESA was negatively correlated with the SDI, while OEA was positively correlated. Decomposition analysis highlighted differences in disease burden drivers across SDI regions. Frontier analysis showed that countries like Cuba and Pakistan were farthest from the OESA-related mortality burden frontier, while Monaco and Lesotho were farthest from OEA-related mortality burden. From 2022 to 2040, LC deaths attributable to OESA and OEA are projected to increase to 4,810.90 (95% UI: 1,628.04-8,010.74) and 3,648.48 (95% UI: 1,016.75-6,322.42), respectively.

  Conclusions: Although the ASDR decreased from 1990 to 2021, OESA and OEA remain contributors to LC mortality worldwide, with the number of deaths expected to increase over the next two decades. Disease burden varies significantly across SDI regions, suggesting that preventive measures should be tailored to specific SDI levels.

  Copyright © 2025 Gong, Xu, Hao, Yi, Yuan, Zheng, Gong, Shen and Dong.

• Global, regional, and national trends in the incidence of pneumoconiosis among populations aged 20 and above from 1990 to 2021. Q. Cheng, S. He, Y. Hu, et al. 2025;13:1608109. PubMed · Publisher · Free full text

  Abstract

  Background: Pneumoconiosis remains one of the most critical occupational health hazards globally. Utilizing data from the Global Burden of Disease (GBD) 2021, we have updated the epidemiological trends of pneumoconiosis.

  Methods: We conducted and analyzed pneumoconiosis-related data from the GBD 2021 study for individuals aged ≥20 years. Our analysis described the incident cases and age-standardized incidence rates (ASIRs) across various global regions and age groups. Temporal trends were evaluated using Estimated Annual Percentage Change (EAPC) for ASIRs between 1990 and 2021.

  Results: The ASIR of pneumoconiosis among individuals aged ≥20 years declined globally at an annual average of 0.48% between 1990 and 2021. Except for high socio-demographic index (SDI) regions, the ASIR of pneumoconiosis declined across all other SDI categories. Males had significantly higher incidence rates than females, especially in older adults. Silicosis emerged as the predominant type of pneumoconiosis, constituting ~56.7% of cases. While the ASIRs for silicosis, coal workers' pneumoconiosis, and other pneumoconiosis decreased, the ASIRs for asbestosis exhibited a notable upward trend, with an EAPC of 1.21%. A strong negative correlation was observed between the EAPC of pneumoconiosis incidence and the 1990 ASIRs values. Notably, the EAPC showed a statistically significant but very weak positive correlation with the 2021 Human Development Index (HDI) values.

  Conclusion: Despite a gradual global decline in the ASIR of pneumoconiosis, the disease burden remains substantial in certain regions. Our findings could inform governments and policymakers in developing targeted prevention strategies to mitigate this burden. Future strategies should integrate technological innovation with regulatory frameworks, prioritizing male-dominated high-risk sectors through strengthened global asbestos bans and lifetime health surveillance for workers in pneumoconiosis-prone occupations worldwide.

  Copyright © 2025 Cheng, He, Hu, Pan, Hu, Liao, Wang and Li.

• Projecting future mortality risk of pleural mesothelioma in Italy (2020-2034): Bayesian age-period-cohort analysis over 40 years of death registration. A. Sartore, G. Stoppa, G. Minelli, et al. 2025;13:1741506. PubMed · Publisher · Free full text

  Abstract

  Introduction: Italy, a major former producer, banned asbestos in 1992. A high incidence of mesothelioma, one of the asbestos legacies, is still observed due to the long latency and exposure from residual asbestos-containing materials. Future mortality forecasts at both national and subnational levels are still lacking. This work aims to project future age-stratified mortality rates (2020-2034) for pleural mesothelioma (PM) in Italy, both nationally and for each administrative region.

  Methods: Data on pleural cancers and PM in Italy between 1980 and 2019 were extracted from death registries, adjusted for PM misclassification in ICD-9, and aggregated in eight periods, eighteen age classes, and fifteen birth cohorts. Bayesian age-period-cohort models were implemented to generate age-specific mortality projections, stratified by sex assigned at birth.

  Results: Between 1980 and 2019, 33,889 people died from PM in Italy, and 19,092 more deaths are expected between 2020 and 2034. The national peak is predicted for 2020-2024, with 6,740 deaths. Age groups under 75 years have already reached the peak of mortality rates. Region-specific trends by sex and time reflect the country's industrialization history.

  Discussion: These results align with the literature in predicting the timing of the mesothelioma peak and offer new insights into age-specific trends, the rate of decline, and geographical patterns. They provide valuable evidence on the heterogeneous asbestos legacy across regions, supporting targeted public health actions and health planning.

  Copyright © 2026 Sartore, Stoppa, Minelli, Mensi, Consonni, Manno, Marinaccio, Fazzo, Biggeri and Catelan.

• Sex differences in asbestos exposure. K. Patel, S. Tuminello, E. Taioli. 2025;13:1588415. Review PubMed · Publisher · Free full text

  Abstract

  Background: Although the association between exposure to asbestos and malignant mesothelioma has been established, occupational exposure has been historically present in males, while the ascertainment of female exposures is more nuanced. We reviewed the literature to assess differences in environmental exposure in mesothelioma cases according to sex.

  Methods: A new PubMed search was conducted with the key words "mesothelioma" and "environmental exposure" on October 11, 2024 with a start date of January 1, 2016, to supplement our previous qualitative review that included publications up through June 2016. Studies conducted in occupational settings were excluded.

  Results: Out of the 26 eligible papers, 11 were excluded because they did not report information on exposure by sex, leaving 15 published studies that were added to the 9 from our previous qualitative synthesis (24 total studies). 19 studies were cross-sectional, 2 were cohort and 3 were case control studies. The average NIH Study Quality tool score was 7.4/14 (minimum 3, maximum 12). Occupational exposure was more frequently observed in males than in females. While a male to female ratio favored males, there was variation in the strength of the association. There was a large proportion of cases with "unknown exposure," and these were more frequently observed among female cases. In some studies, up to 40% of female cases had unknown exposure profiles. Quality assessment showed a generalized lack of standardization in the definition of environmental exposures across studies.

  Conclusion: Although recent studies have continued to improve our understanding of environmental exposure to asbestos and other elongated fibers, challenges remain, including but not limited to lack of rigorous, high-quality evidence and difficulty standardizing definitions across countries and datasets to enable appropriate comparison across studies.

  Copyright © 2025 Patel, Tuminello and Taioli.

• Size-dependent retention of elongate mineral particles in human lungs: modeling and implications for risk assessment. A. Korchevskiy, R. Attanoos, A.G. Wylie. 2025;13:1646016. PubMed · Publisher · Free full text

  Abstract

  Introduction: Lung deposition of elongate amphibole particles is an important process impacting the risk of cancer. There is, however, a significant gap in scientific literature characterizing the role of particle size in the differences observed for deposition and clearance rate in the human respiratory system. The purpose of the paper is to explore the relationship between size distribution of elongate mineral particles in human lungs compared to corresponding distribution in the airborne exposure.

  Materials And Methods: Previously published information about lung deposition for amosite and crocidolite particles in various dimensional groups, collected by the team of Pooley and Clark was reanalyzed with application of recently developed methodologies for fiber size analysis. The new metric-deposition selection ratio (DSR) is proposed; it is found by dividing the size fraction of particles in lungs to the corresponding fraction in exposure. The DSR estimations were also compared to theoretical estimations of pulmonary deposition rates of particles based on the United States Environmental Protection Agency (US EPA) Multi-Path Particle Dosimetry (MPPD) model.

  Results: It was demonstrated that DSR values can be approximated by using log-log regressions with length and width of particles as independent variables. For non-asbestiform particles (cleavage fragments), the prediction of DSR from parametric and non-parametric models is demonstrated to be less than 1 (evidence of deselection in lungs). Negative correlation was found for DSR estimations and the theoretical predictions of pulmonary deposition rates by MPPD.

  Discussion: The observed data for size-specific lung deposition of elongate mineral particles can be used for quantitative estimates of risk and analysis of toxicokinetic processes in human lungs. The difference between theoretical model and observed fiber deposition pattern requires further adjustments in the methods to predict lung deposition of elongate particles.

  Copyright © 2025 Korchevskiy, Attanoos and Wylie.

• Understanding public awareness and knowledge of lung cancer screening practices: a cross-sectional study from the Asir region, Saudi Arabia. G. Kandasamy, K. Orayj, A.M. Alshahrani, et al. 2025;13:1678080. PubMed · Publisher · Free full text

  Abstract

  Background: Lung Cancer (LC) remains one of the leading causes of cancer-related deaths globally, primarily due to late-stage diagnosis and inadequate public awareness of early symptoms and available screening methods. In Saudi Arabia, rising smoking rates and environmental risks increase the burden, particularly in regions like Asir. This study assesses public knowledge and awareness of LC symptoms, risk factors, and screening practices in the Asir region.

  Methods: A cross-sectional online survey was conducted from April to June 2025 among adults (≥18 years) in the Asir region, Saudi Arabia. Using convenience sampling, 437 participants completed a validated Arabic questionnaire assessing demographics, knowledge of LC symptoms and risk factors, and awareness of screening practices. Multivariable logistic regression identified factors significantly associated with knowledge levels (p < 0.05).

  Results: Out of 437 participants, only 192 (43.9%) demonstrated good knowledge of LC, while the majority 245 (56.1%) had poor knowledge. Symptom awareness varied, with shortness of breath 277 (63.5%) most commonly identified, while frequent chest infections 198 (45.3%) and shoulder pain 129 (29.5%) were less recognized. Only 212 (48.5%) knew of screening methods, though 267 (61.1%) acknowledged the importance of early detection. Logistic regression showed significantly lower odds of good knowledge among high school graduates (OR = 0.242, 95% CI: 0.133-0.440, p < 0.001), diploma holders (OR = 0.120, 95% CI: 0.061-0.230, p < 0.001), and uneducated individuals (OR = 0.435, 95% CI: 0.215-0.870, p = 0.020) compared to degree holders. Employed participants (175; 40.0%) were more likely to have good knowledge than students (OR = 5.384, 95% CI: 2.650-10.939, p < 0.001). Those with smoker exposure among family/friends 228 (52.2%) had lower knowledge (OR = 0.382, 95% CI: 0.237-0.613, p < 0.001).

  Conclusion: This study highlights insufficient public knowledge of LC in the Asir region, with only 43.9% demonstrating good awareness. While smoking was widely recognized as a major risk factor, awareness of asbestos exposure, chronic obstructive pulmonary disease (COPD), and environmental pollutants was limited, and recognition of less common symptoms was often poor. Knowledge levels were significantly influenced by education, employment, and exposure to smokers. The findings highlight a critical need for targeted educational campaigns and awareness initiatives, particularly among less educated and high-risk populations, to promote early detection and reduce LC burden in the region.

  Copyright © 2025 Kandasamy, Orayj, Alshahrani, Alanazi, Hmlan, Alharthi, Alyami and Khaled.

• Updates on exposure estimation for the Québec cohort of chrysotile miners and millers: implications for risk assessment and threshold hypothesis. B.W. Case, A.A. Korchevskiy, A. Korchevskiy. 2025;13:1654772. PubMed · Publisher · Free full text

  Abstract

  The McGill University cohort of Québec chrysotile miners and millers (total of 11,379 members) has been a major determinant of risk assessment. The U. S. EPA and some other meta-analyses omit this cohort, the largest ever exposed to high concentrations of chrysotile. Preliminary analyses using new data showed average cumulative exposures in the full cohort of 528.5 f/cc-years (95% CI 510.3, 546.7) or 979 f/cc-years (95% CI 945, 1,013), depending on the regression equation used for the modeling. The lowest estimated exposure level observed for any mesothelioma case with diagnostic certainty was 68 f/cc-years. We confirmed that the estimation of potency factor for Québec chrysotile should not be expected to differ significantly from Darnton's estimation for non-textile chrysotile (RM = 0.0014%), if better quality data for correspondence between impinger and fiber count measurements is involved. Among several estimations we made, the average meta-analytical mesothelioma potency factor for all types of chrysotile would be 0.0014% (95% CI 0.0010, 0.0.0018), and for non-textile chrysotile 0.0011% (95% CI 0.0008, 0.0015). Several estimations of a possible threshold that would correspond to non-elevated mesothelioma risk based on the Québec cohort were also made. The minimal cumulative exposure in mesothelioma cases demonstrated values that ranged from 4.8-6 MPCF-years, or 18-50 f/cc-years. Also, based on theoretical models, the threshold can be found at the level of 6.38 MPCF-years (standard deviation 2.6), or in the range from 35.9 f/cc-years (standard deviation of 15.4) to 65.9 f/cc-years (standard deviation of 29.6).

  Copyright © 2025 Case, Korchevskiy and Korchevskiy.

• Clinical investigation of former workers exposed to asbestos: the health surveillance experience of an Italian University Hospital. L. De Maria, F. Pentimone, D. Cavone, et al. 2024;12:1411910. PubMed · Publisher · Free full text

  Abstract

  Background: The need for health surveillance of former workers exposed to asbestos was provided by law in Italy after the asbestos ban in 1992.

  Objectives: We describe the results of the health surveillance of former workers exposed to asbestos, conducted over 27 years, from 1994 to 2020, at the Operative Unit of Occupational Medicine of the University Hospital of Bari.

  Materials And Methods: We adopted the health surveillance protocol, which was validated at the national level in 2018.

  Results: A total of 1,405 former workers exposed to asbestos were examined. We proceeded with diagnosing pathologies in 339 cases (24% of the cohort subjected to surveillance), with diagnoses of some cases involving multiple pathologies. Specifically, pleural plaques were diagnosed in 49.2% of the 339 cases, asbestosis in 35.9%, malignant pleural mesothelioma (MPM) in 20.3%, mesothelioma of the vaginal tunic of the testis (MTVT) in 9.1%, lung cancer in 5.8%, and laryngeal cancer in 0.8%.

  Conclusion: Despite the 1992 asbestos ban, asbestos-related diseases remain a serious public health issue. It is important to establish criteria that ensure the health surveillance of formerly exposed workers minimizes costs, reduces the number of invasive examinations, and optimizes achievable results.

  Copyright © 2024 De Maria, Pentimone, Cavone, Caputi, Sponselli, Fragassi, Dicataldo, Luisi, Delvecchio, Giannelli, Cafaro, Sole, Ronghi, Zagaria, Loiacono, Sifanno, Ferri and Vimercati.

• Commentary: The role of single nucleotide polymorphisms related to iron homeostasis in mesothelioma susceptibility after asbestos exposure: a genetic study on autoptic samples. G. Tagarakis, F. Tsolaki, I. Tagarakis. 2024;12:1336545. Comment PubMed · Publisher · Free full text

• Cost-effectiveness analysis of bevacizumab combined with lomustine in the treatment of progressive glioblastoma using a Markov model simulation analysis. Z. Chen, F. Tian, Y. Zhang. 2024;12:1410355. PubMed · Publisher · Free full text

  Abstract

  Background: Progressive glioblastoma (GBM) is a malignancy with extremely poor prognosis. Chemotherapy is one of the approved systemic treatment modalities. The aim of this study is to assess the cost-effectiveness of using bevacizumab (BEV) in combination with lomustine (LOM) regimen for the treatment of progressive glioblastoma in China.

  Methods: The estimation results are derived from a multicenter randomized phase III trial, which demonstrated improved survival in GBM patients receiving BEV+LOM combination therapy. To calculate the incremental cost-effectiveness ratio (ICER) from the perspective of Chinese society, a Markov model was established. Univariate deterministic analysis and probabilistic sensitivity analysis were employed to address the uncertainties within the model.

  Results: Compared to LOM monotherapy, the total treatment cost for BEV+LOM combination therapy increased from $2,646.70 to $23,650.98. The health-adjusted life years (QALYs) for BEV+LOM combination therapy increased from 0.26 QALYs to 0.51 QALYs, representing an increment of 0.25 QALYs. The incremental cost-effectiveness ratio (ICER) was $84,071.12. The cost-effectiveness curve indicates that within the willingness-to-pay (WTP) range of $35,906 per QALY, BEV+LOM combination therapy is not a cost-effective treatment option for unresectable malignant pleural mesothelioma patients.

  Conclusions: Taken as a whole, the findings of this study suggest that, from the perspective of payers in China, BEV+LOM combination therapy as a first-line treatment for GBM is not a cost-effective option. However, considering the survival advantages this regimen may offer for this rare disease, it may still be one of the clinical treatment options for this patient population.

  Copyright © 2024 Chen, Tian and Zhang.

• No causal association between pneumoconiosis and three inflammatory immune diseases: a Mendelian randomization study. Y.J. Du, Z.W. Lu, K.D. Li, et al. 2024;12:1373044. PubMed · Publisher · Free full text

  Abstract

  Objectives: To investigate the causal relationships between pneumoconiosis and rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and gout.

  Methods: The random-effects inverse variance weighted (IVW) approach was utilized to explore the causal effects of the instrumental variables (IVs). Sensitivity analyses using the MR-Egger and weighted median (WM) methods were did to investigate horizontal pleiotropy. A leave-one-out analysis was used to avoid the bias resulting from single-nucleotide polymorphisms (SNPs).

  Results: There was no causal association between pneumoconiosis and SLE, RA or gout in the European population [OR = 1.01, 95% CI: 0.94-1.10, p = 0.74; OR = 1.00, 95% CI: 0.999-1.000, p = 0.50; OR = 1.00, 95% CI: 1.000-1.001, p = 0.55]. Causal relationships were also not found in pneumoconiosis due to asbestos and other mineral fibers and SLE, RA and gout [OR = 1.01, 95% CI: 0.96-1.07, p = 0.66; OR = 1.00, 95% CI: 1.00-1.00, p = 0.68; OR = 1.00, 95% CI: 1.00-1.00, p = 0.20].

  Conclusion: Our study suggests that pneumoconiosis may have no causal relationship with the three inflammatory immune diseases.

  Copyright © 2024 Du, Lu, Li, Wang, Wu, Huang, Jin, Wang, Wang, Geng and Li.

• A reevaluation of selected mortality risks in the updated NCI/NIOSH acrylonitrile cohort study. G.M. Marsh, A. Kruchten. 2023;11:1122346. PubMed · Publisher · Free full text

  Abstract

  Objectives: The study aimed to determine whether the National Cancer Institute's (NCI) recent suggestion of associations between acrylonitrile (AN) exposure and mortality in lung and bladder cancer and pneumonitis is robust to alternative methods of data analysis.

  Materials And Methods: We used the Richardson method to indirectly adjust risk ratios (RRs) in relation to AN exposure for potential confounding by smoking and asbestos. We repeated key analyses omitting workers from Plant 4 to account for possible local, historical shipyard-related asbestos exposures.

  Results: The adjustment of lung cancer RRs for confounding by both smoking and asbestos and omitting Plant 4 workers yielded mostly decreased RRs and much less evidence of a positive association with cumulative AN exposure.

  Conclusion: Overall, our reanalysis provided little evidence to support NCI's suggestion of associations between AN exposure and mortality in lung and bladder cancer and pneumonitis.

  Copyright © 2023 Marsh and Kruchten.

• Burden of ovarian cancer in China from 1990 to 2030: A systematic analysis and comparison with the global level. Y. Wang, Z. Wang, Z. Zhang, et al. 2023;11:1136596. PubMed · Publisher · Free full text

  Abstract

  Introduction: Ovarian cancer (OC) is one of the major diseases threatening women's health and life. Estimating the burden trends and risk factors of OC can help develop effective management and prevention measures. However, there is a lack of comprehensive analysis concerning the burden and risk factors of OC in China. In this study, we aimed to assess and predict the burden trends of OC in China from 1990 to 2030, and make a comparison with the global level.

  Methods: We extracted prevalence, incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) data from the Global Burden of Disease Study 2019 (GBD 2019) and characterized OC burden in China by year and age. OC epidemiological characteristics were interpreted by conducting joinpoint and Bayesian age-period-cohort analysis. We also described risk factors, and predicted OC burden from 2019 to 2030 using Bayesian age-period-cohort model.

  Results: In China, there were about 196,000 cases, 45,000 new cases and 29,000 deaths owing to OC in 2019. The age-standardized rates (ASRs) of prevalence, incidence and mortality have increased by 105.98%, 79.19%, and 58.93% respectively by 1990. In the next decade, OC burden in China will continue to rise with a higher rate than the global level. The OC burden in women under 20 years of age is slowing down, while the burden in women over 40 years of age is getting more severe, especially in postmenopausal and older women. High fasting plasma glucose is the major factor contributing the most to OC burden in China, and high body-mass index has surpassed occupational exposure to asbestos to be the second risk factor. OC burden from 2016 to 2019 in China has increased faster than ever before, indicates an urgent need to develop effective interventions.

  Conclusion: The burden of OC in China has shown an obvious upward trend in the past 30 years, and the increase rate accelerated significantly in recent 5 years. In the next decade, OC burden in China will continue to rise with a higher rate than the global level. Popularizing screening methods, optimizing the quality of clinical diagnosis and treatment, and promoting healthy lifestyle are critical measures to improve this problem.

  Copyright © 2023 Wang, Wang, Zhang, Wang, Peng and Hong.

• Exposure to insulating materials and risk of coronary artery diseases: a cross-sectional study. S. Moitra, A.F. Tabrizi, F. Khadour, et al. 2023;11:1235189. PubMed · Publisher · Free full text

  Abstract

  Background: Although previous reports link exposure to insulating materials with an increased risk of mesothelioma and chronic respiratory diseases, studies evaluating their associations with the risk of coronary artery diseases (CAD) are lacking.

  Aims: We aimed at evaluating the associations between exposure to insulating materials and the 10-year risk of CAD among insulators.

  Methods: In this cross-sectional study, we recruited 643 adults (≥18 years), full-time insulators from the Local 110 Heat and Frost Insulators and Allied Workers Union in Edmonton, Alberta. We obtained demographic information, personal and family history, and job-exposure history, including experience (years) and types of exposure to insulating materials. Clinical profiling including Framingham risk scores (FRS) was assessed.

  Results: Of all insulators, 89% were men (mean ± SD age: 47 ± 12 years), 27% had a parental history of cardiac diseases, and 22% had a comorbid chronic respiratory disease. In total, 53% reported exposure to asbestos, while 61, 82, and 94% reported exposure to ceramic fibers, fiberglass, and mineral fibers, respectively. In single-exposure multivariable regression models adjusted for experience, marital status, and body mass index (BMI), asbestos was found to be associated with higher FRS (β: 1.004; 95%CI: 0.003-2.00). The association remained consistent in multi-exposure models and a higher association was found between asbestos exposure and FRS among insulators with comorbid chronic respiratory disease.

  Conclusion: Our study demonstrates that apart from cancer and chronic respiratory diseases, asbestos exposure may also have a cardiac effect, thus warranting the need for systematic surveillance to protect workers from the adverse effects of these materials.

  Copyright © 2023 Moitra, Tabrizi, Khadour, Henderson, Melenka and Lacy.

• Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic. L. Fazzo, E. Grande, A. Zona, et al. 2023;11:1243261. PubMed · Publisher · Free full text

  Abstract

  Background And Aim: Patients with interstitial lung diseases, including asbestosis, showed high susceptibility to the SARS-CoV-2 virus and a high risk of severe COVID-19 symptoms. Italy, highly impacted by asbestos-related diseases, in 2020 was among the European countries with the highest number of COVID-19 cases. The mortality related to malignant mesotheliomas and asbestosis in 2020 and its relationship with COVID-19 in Italy are investigated.

  Methods: All death certificates involving malignant mesotheliomas or asbestosis in 2010-2020 and those involving COVID-19 in 2020 were retrieved from the National Registry of Causes of Death. Annual mortality rates and rate ratios (RRs) of 2020 and 2010-2014 compared to 2015-2019 were calculated. The association between malignant pleural mesothelioma (MPM) and asbestosis with COVID-19 in deceased adults ≥80 years old was evaluated through a logistic regression analysis (odds ratios: ORs), using MPM and asbestosis deaths COVID-19-free as the reference group. The hospitalization for asbestosis in 2010-2020, based on National Hospital Discharge Database, was analyzed.

  Results: In 2020, 746,343 people died; out of them, 1,348 involved MPM and 286 involved asbestosis. Compared to the period 2015-2019, the mortality involving the two diseases decreased in age groups below 80 years; meanwhile, an increasing trend was observed in subjects aged 80 years and older, with a relative mortality risks of 1.10 for MPM and 1.17 for asbestosis. In subjects aged ≥80 years, deaths with COVID-19 were less likely to have MPM in both genders (men: OR = 0.22; women: OR = 0.44), while no departure was observed for asbestosis. A decrease in hospitalization in 2020 with respect to those in 2010-2019 in all age groups, both considering asbestosis as the primary or secondary diagnosis, was observed.

  Conclusions: The increasing mortality involving asbestosis and, even if of slight entity, MPM, observed in people aged over 80 years during the 1st year of the COVID-19 pandemic, aligned in part with the previous temporal trend, could be due to several factors. Although no positive association with COVID-19 mortality was observed, the decrease in hospitalizations for asbestosis among individuals aged over 80 years, coupled with the increase in deaths, highlights the importance of enhancing home-based assistance during the pandemic periods for vulnerable patients with asbestos-related conditions.

  Copyright © 2024 Fazzo, Grande, Zona, Minelli, Crialesi, Iavarone and Grippo.

• The role of single nucleotide polymorphisms related to iron homeostasis in mesothelioma susceptibility after asbestos exposure: a genetic study on autoptic samples. P. Grignani, S.D. Visonà, M.V. Fronda, et al. 2023;11:1236558. PubMed · Publisher · Free full text

  Abstract

  Asbestos-related diseases still represent a major public health problem all over the world. Among them, malignant mesothelioma (MM) is a poor-prognosis cancer, arising from the serosal lining of the pleura, pericardium and peritoneum, triggered by asbestos exposure. Literature data suggest the key role of iron metabolism in the coating process leading to the formation of asbestos bodies, considered to be both protective and harmful. Two sample sets of individuals were taken into consideration, both residing in Broni or neighboring cities (Northwestern Italy) where an asbestos cement factory was active between 1932 and 1993. The present study aims to compare the frequency of six SNPs involved in iron trafficking, previously found to be related to protection/predisposition to MM after asbestos exposure, between 48 male subjects with documented asbestos exposure who died of MM and 48 male subjects who were exposed to asbestos but did not develop MM or other neoplastic respiratory diseases (Non-Mesothelioma Asbestos Exposed - NMAE). The same analysis was performed on 76 healthy male controls. The allelic and genotypic frequencies of a sub-group of 107 healthy Italian individuals contained in the 1000 genomes database were considered for comparison. PCR-multiplex amplification followed by SNaPshot mini-sequencing reaction was used. The findings presented in this study show that the allelic and genotypic frequencies for six SNP markers involved in iron metabolism/homeostasis and the modulation of tumor microenvironment are not significantly different between the two sample sets of MM and NMAE. Therefore, the SNPs here considered do not seem to be useful markers for individual susceptibility to mesothelioma. This finding is not in agreement with previous literature.

  Copyright © 2023 Grignani, Visonà, Fronda, Borrelli, Monti, Bertoglio, Conti, Fattorini and Previderè.

• Cost-effectiveness of nivolumab plus ipilimumab as first-line treatment for American patients with unresectable malignant pleural mesothelioma. Z.M. Ye, Z.Q. Tang, Z. Xu, et al. 2022;10:947375. PubMed · Publisher · Free full text

  Abstract

  Background: The treatment paradigm of unresectable malignant pleural mesothelioma (MPM) has changed in recent years. Checkmate 743 demonstrate that nivolumab plus ipilimumab showed good clinical benefits compared with chemotherapy in the treatment of MPM. The study is aim to evaluate the cost-effectiveness of Nivolumab plus ipilimumab vs. platinum plus chemotherapy for the first-line treatment of unresectable MPM.

  Methods: A Markov model was developed to compare the cost and quality-adjusted life-year (QALY) of nivolumab plus ipilimumab and chemotherapy over a 10-year time horizon. Clinical efficacy and safety data were extracted from the CheckMate 743 trials. Health state utilities were obtained from published literature. Costs were collected from an US payer perspective. One-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness's results.

  Results: In the base case analysis, the incremental healthcare costs and QALYs for Nivolumab plus Ipilimumab vs. chemotherapy are $196,604.22 and 0.53, respectively, resulting an incremental cost-effectiveness ratio (ICER) of $372,414.28/QALYs for the model cohort of patients with locally advanced or metastatic MPM. However, Probabilistic sensitivity analysis showed that there was no probability that Nivolumab plus ipilimumab was cost-effective within the fluctuation range of other model parameters in first-line in unresectable MPM. The results of one-way sensitivity analysis showed that the cost of Nivolumab was the most sensitive parameter.

  Conclusions: The ICER of Nivolumab plus ipilimumab is above the theoretical willingness-to-pay threshold in the U.S, which suggests that first-line nivolumab plus ipilimumab for unresectable MPM may be not a cost-effective choice.

  Copyright © 2022 Ye, Tang, Xu, Zhou and Li.

• Systematic review of the scientific evidence of the pulmonary carcinogenicity of talc. H.N. Lynch, D.J. Lauer, W.J. Thompson, et al. 2022;10:989111. Systematic review PubMed · Publisher · Free full text

  Abstract

  We conducted a systematic review to assess the potential pulmonary carcinogenicity of inhaled talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM) and several United States (US) Environmental Protection Agency (EPA) frameworks for systematic reviews. A comprehensive literature search was conducted. Detailed data abstraction and study quality evaluation, adapting the US Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 23 primary studies that assessed exposure to talc and pulmonary cancer risks in humans (n = 19) and animals (n = 3). Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between inhaled talc and lung cancer and pleural mesothelioma at human-relevant exposure levels.

  Copyright © 2022 Lynch, Lauer, Thompson, Leleck, Freid, Collins, Chen, Ierardi, Urban, Cappello, Boffetta and Mundt.

• The Burden of Trachea, Bronchus, and Lung Cancer Attributable to Occupational Exposure From 1990 to 2019. H. Li, J. Guo, H. Liang, et al. 2022;10:928937. PubMed · Publisher · Free full text

  Abstract

  Objectives: Occupational exposure to carcinogens is associated with trachea, bronchus, and lung (TBL) cancer. The objective of this study was to provide global and regional estimates of the burden of TBL cancer associated with occupational carcinogens (OCs) between 1990 and 2019.

  Methods: Age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) of TBL cancer related to exposure to OCs at the global and regional levels were extracted for 1990-2019 from the Global Burden of Disease 2019. Joinpoint regression was used to analyze trends in the ASMR and ASDR of TBL cancer burden related to OCs, and the annual percent change and the average annual percent change (AAPC) were recorded.

  Results: The mortality from TBL cancer related to exposure to OCs increased globally. The ASMR and ASDR decreased in both sexes and in men between 1990 and 2019. The AAPC of ASMR and ASDR decreased in men between 1990 and 2019, but increased in women. Asbestos accounted for the highest death number and beryllium accounted for the lowest; diesel engine exhaust caused the largest percentage change in death number (145.3%), in ASDR (14.9%), and in all ages DALY rates (57.6%). Asbestos accounted for the largest death number in high social development index (SDI) countries, whereas low-middle SDI countries had the largest percent change (321.4%). Asbestos was associated with decreased ASDR in high SDI countries and increased ASDR in low-middle SDI countries, and similar changes were observed for other OCs.

  Conclusions: The overall mortality and DALYs of TBL cancer burden related to OCs showed a decreasing trend between 1990 and 2019, whereas death number increased. Asbestos accounted for the highest death number. TBL cancer burden related to OCs decreased to different degrees in high, low, low-middle, and middle SDI countries, which showed variable levels of TBL cancer burden related to exposure to OCs (except asbestos).

  Copyright © 2022 Li, Guo, Liang, Zhang, Zhang, Wei, Shi, Zhang and Wang.

• Disease Burden and Attributable Risk Factors of Ovarian Cancer From 1990 to 2017: Findings From the Global Burden of Disease Study 2017. Z. Zhou, X. Wang, X. Ren, et al. 2021;9:619581. PubMed · Publisher · Free full text

  Abstract

  Aim: We aimed to estimate the disease burden and risk factors attributable to ovarian cancer, and epidemiological trends at global, regional, and national levels. Methods: We described ovarian cancer data on incidence, mortality, and disability-adjusted life-years as well as age-standardized rates from 1990 to 2017 from the Global Health Data Exchange database. We also estimated the risk factors attributable to ovarian cancer deaths and disability-adjusted life-years. Measures were stratified by region, country, age, and socio-demographic index. The estimated annual percentage changes and age-standardized rates were calculated to evaluate temporal trends. Results: Globally, ovarian cancer incident, death cases, and disability-adjusted life-years increased by 88.01, 84.20, and 78.00%, respectively. However, all the corresponding age-standardized rates showed downward trends with an estimated annual percentage change of -0.10 (-0.03 to 0.16), -0.33 (-0.38 to -0.27), and -0.38 (-0.32 to 0.25), respectively. South and East Asia and Western Europe carried the heaviest disease burden. The highest incidence, deaths, and disability-adjusted life-years were mainly in people aged 50-69 years from 1990 to 2017. High fasting plasma glucose level was the greatest contributor in age-standardized disability-adjusted life-years rate globally as well as in all socio-demographic index quintiles and most Global Disease Burden regions. Other important factors were high body mass index and occupational exposure to asbestos. Conclusion: Our study provides valuable information on patterns and trends of disease burden and risk factors attributable to ovarian cancer across age, socio-demographic index, region, and country, which may help improve the rational allocation of health resources as well as inform health policies.

  Copyright © 2021 Zhou, Wang, Ren, Zhou, Wang and Kang.

• Evaluation of Deposition and Clearance of Asbestos (Detected by SEM-EDS) in Lungs of Deceased Subjects Environmentally and/or Occupationally Exposed in Broni (Pavia, Northern Italy). S.D. Visonà, S. Capella, S. Bodini, et al. 2021;9:678040. PubMed · Publisher · Free full text

  Abstract

  Biodurability is one of the main determinants of asbestos hazardousness for human health. Very little is known about the actual persistence of asbestos in lungs and its clearance, nor about differences in this regard between the different mineralogical types of asbestos. The aim of the present study was to evaluate the amount, the dimensional characteristics and the mineralogic kinds of asbestos in lungs (measured using SEM-EDS) of a series of 72 deceased subjects who were certainly exposed to asbestos (mainly crocidolite and chrysotile) during their life. Moreover, we investigated possible correlations between the lung burden of asbestos (in general and considering each asbestos type), as well as their dimension (length, width, and l/w ratio) and the duration of exposure, the latency- in case of malignant mesothelioma (MM), the survival and the time since the end of exposure. In 62.5% of subjects, asbestos burden in lungs was lower that the threshold considered demonstrative for occupational exposure. In 29.1% of cases no asbestos was found. Chrysotile was practically not detected. The mean length of asbestos fibers and the length to width ratio were significantly related to the duration of exposure to asbestos. No other statistically significant correlations were found between the amount and dimensional characteristics of asbestos (nor with the relative amount of each asbestos type) and the other chronological variables considered. In conclusion, it was pointed out that chrysotile can be completely removed from human lungs in <8 years and, instead, amphiboles persist much more time. The present results suggest, as well, that the finding of no asbestos in lungs cannot rule out the attribution of MM to asbestos (in particular, chrysotile) inhaled in an occupational setting. This point is of crucial importance from a legal point of view.

  Copyright © 2021 Visonà, Capella, Bodini, Borrelli, Villani, Crespi, Colosio, Previderè and Belluso.

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