Malignant Mesothelioma and Its Non-Asbestos Causes

Our plain-English summary of Malignant Mesothelioma and Its Non-Asbestos Causes, by R.L. Attanoos, A. Churg, F. Galateau-Salle, et al (Archives of Pathology & Laboratory Medicine, 2018).

The study

• Authors: R.L. Attanoos, A. Churg, F. Galateau-Salle, A.R. Gibbs, V.L. Roggli
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2018;142(6):753-760
• Type of article: Review
• Cited by: 164 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: - Although many mesotheliomas are related to asbestos exposure, not all are, and there is increasing information on other causes of mesothelioma.

Objective: - To provide a review of non-asbestos causes for malignant mesothelioma.

Data Sources: - Review of relevant published literature via PubMed and other search engines.

Conclusions: - Currently, most pleural mesotheliomas (70% to 90%) in men in Europe and North America are attributable to asbestos exposure; for peritoneal mesothelioma the proportion is lower. In North America few mesotheliomas in women at any site are attributable to asbestos exposure, but in Europe the proportion is higher and varies considerably by locale. In certain geographic locations other types of mineral fibers (erionite, fluoro-edenite, and probably balangeroite) can induce mesothelioma. Therapeutic radiation for other malignancies is a well-established cause of mesothelioma, with relative risks as high as 30. Carbon nanotubes can also induce mesotheliomas in animals but there are no human epidemiologic data that shed light on this issue. Chronic pleural inflammation may be a cause of mesothelioma but the data are scanty. Although SV40 can induce mesotheliomas in animals, in humans the epidemiologic data are against a causative role. A small number of mesotheliomas (probably in the order of 1%) are caused by germline mutations/deletions of BRCA1-associated protein-1 ( BAP1) in kindreds that also develop a variety of other cancers. All of these alternative etiologies account for a small proportion of tumors, and most mesotheliomas not clearly attributable to asbestos exposure are spontaneous (idiopathic).

In plain English

This review of published literature, found via PubMed and other search engines, covered non-asbestos causes of malignant mesothelioma and reported no new data. The authors wrote that 70% to 90% of pleural mesotheliomas in men in Europe and North America are attributable to asbestos. They estimated that some 60% to 90% of mesotheliomas in US women (pleural and peritoneal, respectively), and a substantial share of peritoneal mesotheliomas in men, are likely unrelated to asbestos. They described erionite and fluoro-edenite as fibers that can cause mesothelioma in certain locations, and called balangeroite's role controversial. They called therapeutic radiation a well-established cause, with relative risks as high as 30. They found no human epidemiologic data on carbon nanotubes and only scanty data on chronic inflammation, and judged SV40's role unconvincing. They wrote that in substantially less than 1% of patients with mesothelioma, when there is no external agent exposure, an inherited mutation induces the tumor, with evidence favoring BAP-1. Their abstract puts BAP-1-caused cases at probably in the order of 1%. The authors concluded that most mesotheliomas not clearly attributable to asbestos are spontaneous (idiopathic).

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: Published studies identified through PubMed and other search engines: case reports, cohort and registry studies, epidemiologic trend analyses, and animal and laboratory experiments on mesothelioma causes
• Exposure: Non-asbestos causes of mesothelioma. Mineral fibers: erionite, fluoro-edenite, balangeroite, carbon nanotubes, and man-made vitreous and refractory ceramic fibers. Also radiation (therapeutic radiation, Thorotrast, nuclear workers), chronic inflammation, simian virus 40 (SV40), germline BAP-1 mutations, and spontaneous (idiopathic) mesothelioma.
• Main results:
  • Pleural mesotheliomas in men in Europe and North America: according to the authors, most (70% to 90%) are attributable to asbestos exposure.
  • US women and peritoneal mesothelioma in men: the authors estimated that some 60% to 90% of mesotheliomas in US women (pleural and peritoneal sites, respectively) are likely unrelated to asbestos, as is a substantial proportion of peritoneal mesotheliomas in men. They wrote that this fraction is greater in the US than in Europe, in women than men, and in peritoneal than pleural tumors.
  • Erionite: the authors expected more cases of erionite-induced mesothelioma to be identified in regions where the fiber is common and people are exposed.
  • Balangeroite: the authors described its role in mesothelioma in Balangero, Italy, as controversial.
  • Therapeutic radiation: the authors called it a well-established cause of mesothelioma, with relative risks as high as 30. They found consistent evidence that radiation is a risk factor in directly irradiated tissue, and to a lesser extent in tissue remote from the target area.
  • Carbon nanotubes: they have caused mesothelioma in animal studies, but the authors stated that a link to human disease cannot currently be evaluated epidemiologically.
  • Man-made vitreous fibers: systematic reviews cited by the authors found little support for any increased mesothelioma risk.
  • Chronic pleural inflammation: the authors wrote that it may be a cause of mesothelioma but that the data are scanty.
  • SV40: the authors judged its role as a cause of human mesothelioma unconvincing.
  • Inherited mutations: the authors wrote that in substantially less than 1% of patients with mesothelioma, when there is no external agent exposure, the tumor is induced by a specific inherited genetic mutation, and that the evidence presently favors BAP-1. Their abstract describes BAP-1-caused mesotheliomas as probably in the order of 1%.
  • Spontaneous mesothelioma: for pericardial and tunica vaginalis testis mesothelioma, the authors wrote that the available evidence suggests most cases are spontaneous (idiopathic).
• The authors' conclusion: The authors concluded that all of these alternative causes account for a small proportion of tumors, and that most mesotheliomas not clearly attributable to asbestos exposure are spontaneous (idiopathic).
• Limitations the authors state:
  • The authors stated that the exact proportion of spontaneous mesotheliomas is hard to determine consistently across studies. They gave as reasons differing study designs, patient selection, views on which jobs involve significant asbestos exposure, and historic use of amphibole versus chrysotile between countries.
  • The authors noted that laboratory and animal findings (for example, on carbon nanotubes) do not necessarily apply to humans.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Chrysotile, Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Asbestos Exposure, Pleural Mesothelioma, Peritoneal Mesothelioma, Mineral Fiber, erionite, fluoro-edenite.

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