Malignant mesothelioma: Ongoing controversies about its etiology in females

Our plain-English summary of Malignant mesothelioma: Ongoing controversies about its etiology in females, by X. Baur, A.L. Frank, C.L. Soskolne, et al (American Journal of Industrial Medicine, 2021).

The study

• Authors: X. Baur, A.L. Frank, C.L. Soskolne, L.C. Oliver, C. Magnani
• Journal: American Journal of Industrial Medicine
• Published: 2021;64(7):543-550
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) is one of the most aggressive cancers with the poorest of outcomes. There is no doubt that mesothelioma in males is related to asbestos exposure, but some authors suggest that most of the cases diagnosed in females are "idiopathic." In our assessment of the science, the "low risk" of mesothelioma in females is because of the nonsystematic recording of exposure histories among females. Indeed, asbestos exposure is mentioned in only some of the studies that include females. We estimate the risk of MM among females to be close to that in males. The absence of detailed exposure histories should be rectified in future studies involving ​women. As a matter of social justice, the ongoing failure to recognize asbestos as the cause of a majority of cases of MM in females does them, and their kin, a profound disservice.

© 2021 Wiley Periodicals LLC.

In plain English

This commentary, not a new study, reviewed published research on asbestos and malignant mesothelioma in females. It responded to World Health Organization tumour classification chapters stating that in the USA and France, 80-90% of mesotheliomas in males but only 20-40% in females are caused by asbestos. The authors argued those figures rested largely on three selectively chosen studies and lacked detailed exposure histories that include nonoccupational asbestos exposures. They stated that females show higher prevalence of domestic exposure than males.

Among cited studies, a French case-control study found an asbestos attributable risk for pleural mesothelioma of 64.8% (99% confidence interval 45.4% to 84.3%) in females and 87.3% (99% CI 78.9% to 95.7%) in males. An Italian registry found asbestos exposure in 62% of 3969 women with pleural mesothelioma who had interview data. A cohort of asbestos textile workers had a higher standardized mortality ratio for pleural malignancy in females than males. A peritoneal mesothelioma study found definite exposure more often in males (74.4%) than females (36.6%).

The authors concluded that asbestos causes mesothelioma in females, with pleural mesothelioma risk similar to, and sometimes exceeding, that in males.

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: Commentary reviewing published literature (no new data collected)
• Who was studied: Published studies of mesothelioma and asbestos exposure in females, including cohort, case-control, registry, geographical and lung-fiber studies, selected by the authors to contrast with WHO/IARC classification chapters
• Exposure: Occupational, para-occupational, domestic (for example, laundering asbestos workers' clothes), environmental and do-it-yourself asbestos exposure, plus cosmetic talc. Fibers named in cited studies include crocidolite (Wittenoom) and amphibole fibers. The authors stated that females show a higher prevalence of domestic exposure than males.
• Main results:
  • The authors quoted the WHO Fifth Edition chapter as stating that in the USA and France, 80-90% of mesotheliomas in males but only 20-40% in females are caused by asbestos.
  • The authors argued that the WHO chapters' low figure for females is based largely on three selectively chosen studies. They called it an artifact of the lack of detailed exposure histories that include nonoccupational asbestos exposures.
  • Cited French case-control study (Lacourt et al., 437 pleural mesothelioma cases): overall asbestos attributable risk was 87.3% (99% CI 78.9%-95.7%) in males and 64.8% (99% CI 45.4%-84.3%) in females.
  • Cited Italian mesothelioma registry (ReNaM): 5496 women with pleural mesothelioma were included. Among the 3969 with interview data, 1321 (33%) were occupationally exposed and 1151 (29%) were nonoccupationally exposed, a total of 62% with asbestos exposure.
  • Cited asbestos textile worker cohort (Pira et al.): the standardized mortality ratio (SMR) for pleural malignancy was 60.8 (95% CI 42.6-84.2) in females and 20.2 (95% CI 13.0-30.1) in males.
  • Cited residential cohort around an asbestos cement plant in Amagasaki, Japan: the mesothelioma SMR was 6.75 (95% CI 5.83-7.78) in males and 14.99 (95% CI 12.34-18.06) in females.
  • Cited lung-fiber database study (Pavlisko et al., 354 female mesothelioma cases): 92% had evidence of asbestos exposure, a large proportion of them household exposure only.
  • Cited peritoneal mesothelioma case-control study (Consonni et al.): risks were similar for both sexes, but the proportion of cases with definite asbestos exposure was higher in males (74.4%) than in females (36.6%).
• The authors' conclusion: The authors concluded that asbestos causes mesothelioma in females. They stated that the risk of peritoneal mesothelioma may possibly be smaller in females, but that the risk of pleural mesothelioma in females is similar to, and in certain cases exceeds, that in males.

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, Etiology, Mesothelioma, Asbestos Exposure, Idiopathic.

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