Malignant mesothelioma in women

Our plain-English summary of Malignant mesothelioma in women, by A. Dawson, A.R. Gibbs, F.D. Pooley, et al (Thorax, 1993).

The study

• Authors: A. Dawson, A.R. Gibbs, F.D. Pooley, D.M. Griffiths, J. Hoy
• Journal: Thorax
• Published: 1993;48(3):269-74
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma reportedly shows different epidemiology and pathology in females, and a proportion are believed to arise spontaneously.

Methods: One hundred and seventy seven cases of malignant mesothelioma in females were reviewed, examined by histochemistry and immunohistochemistry, assessed for asbestosis and lung fibre burden by transmission electron microscopy with energy dispersive x ray analysis, and compared with 31 female controls.

Results: Two of one hundred and three cases tested for carcinoembryonic antigen were positive and were excluded from further analysis. Tumour cases showed increased amphibole burdens; in those in whom exposure information was known, 74 (80%) of 93 patients had a history of exposure to asbestos. Seventy two (47%) of 152 patients had lung fibrosis. Tumour site and histological type were little different from those reported in adult males. Mixed type histological pattern, lung fibrosis, and peritoneal site were associated with heavier lung asbestos burdens, but not exclusively. Thirty five (30%) of 117 patients had amphibole burdens of less than 2 x 10(6) fibres/g; the sites affected and the histological pattern of tumours in this group were similar to those in cases with amphibole fibre counts of > or = 2 x 10(6)/g lung. A higher lung amphibole burden than the mean burden in control females was found in 115 (98%) of 117 patients tested.

Conclusions: The pathology of malignant mesothelioma appears to be similar in women and in men, and in cases associated and unassociated with asbestos.

In plain English

This study reviewed 177 women classified as having malignant mesothelioma in the files of a pathology research unit at Llandough Hospital between 1963 and 1990. The authors re-examined tumour tissue and measured lung asbestos fibres by electron microscopy, comparing counts with 31 unmatched female controls. Of 175 tumours analysed, 125 were pleural and 29 peritoneal. Among 93 women with known exposure information, 74 had a history of asbestos exposure. Of 117 women tested, 115 had higher lung amphibole counts than the control mean. Thirty-five had amphibole counts below 2 million fibres per gram of dried lung, and their tumours differed little in site and type from those with higher counts. Of 152 women assessed, 72 had lung fibrosis, which was associated with peritoneal tumours and higher amphibole burdens. No case with a high chrysotile count lacked amphiboles. The authors concluded that tumour features alone were unlikely to identify tumours arising without asbestos. They noted the cases were a referred, unrepresentative group that included heavily exposed workers.

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: Retrospective review of a case series of women with malignant mesothelioma held in a pathology unit's files, with tissue re-examination and lung fibre analysis compared against unmatched controls
• Who was studied: 177 women classified as malignant mesothelioma in the files of the Environmental Lung Disease Research Group, Llandough Hospital, Penarth, from 1963 to 1990. The controls were 31 women from consecutive post mortem series in Exeter, Liverpool, Belfast, Dublin and Cardiff with no known dust exposure and no mesothelioma or lung cancer.
• Exposure: Asbestos exposure was classified from histories into direct occupational, indirect occupational, paraoccupational (domestic), neighbourhood, ambient air, or no known exposure. Lung fibres (crocidolite, amosite, tremolite, chrysotile) were measured by transmission electron microscopy. Of 93 women with known history, 74 had asbestos exposure.
• Main results:
  • Two of 103 cases tested for carcinoembryonic antigen were positive and were excluded from further analysis.
  • Of the remaining 175 cases, 125 (71%) were pleural, 29 (17%) were peritoneal, and 21 were of unknown site.
  • Tumour site and histological type in these women were little different from those reported (in other publications) in adult males.
  • 115 (98%) of 117 patients tested had a higher lung amphibole burden than the mean burden in the female controls.
  • No amphiboles were detected in 2% of patients, compared with 63% of controls.
  • The peritoneal mesothelioma group had a higher amphibole burden than the pleural group.
  • Among cases of known histological type, the mixed pattern showed the highest amphibole burdens and the spindle pattern the lightest.
  • 35 (30%) of 117 female patients had amphibole levels lower than 2 million fibres per gram of dried lung.
  • The site and histological profile of the group with amphibole counts below 2 million fibres per gram of dried lung differed little from that of the group at or above that level. The exception was a slight preponderance of mixed pattern in those with heavier burdens.
  • 72 (47%) of 152 patients had lung fibrosis. Increasing fibrosis was associated with peritoneal site (p less than 0.001) and with increasing amphibole burden.
  • Of 14 tested cases with no known history of exposure, only one had no amphiboles in the lung, and four had total amphibole counts at or above 2 million fibres per gram of dried lung.
  • No case with a high chrysotile count lacked contaminating amphiboles. The authors therefore could not attribute any case with certainty to chrysotile alone.
• The authors' conclusion: The authors concluded that clinical and pathological features of malignant mesothelioma were similar in women with high and low amphibole burdens, so these features alone are not likely to be useful in identifying spontaneously arising tumours. They also stated that the pathology appears similar in women and in men.
• Limitations the authors state:
  • The cases were a referred population and not completely representative of any community.
  • The series was heavily biased by groups with very heavy asbestos exposure, such as wartime dockyard and gas mask workers.
  • The amount of material available for study was limited, and exposure data were incomplete.
  • The controls were unmatched.
  • There were too few cases to assess the influence of any single fibre type on tumour site or pattern independently of other fibre types.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Epidemiology, Pathology, Immunohistochemistry, Transmission Electron Microscopy (TEM), Carcinoembryonic Antigen (CEA), Amphibole Group, Fibrosis.

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• Asbestos exposure and differences in occurrence of peritoneal mesothelioma between men and women across countries — A. Burdorf, B. Järvholm, et al. (2007)
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