Natural history and epidemiology of malignant mesothelioma

Our plain-English summary of Natural history and epidemiology of malignant mesothelioma, by K.H. Antman (Chest, 1993).

The study

• Author: K.H. Antman
• Journal: Chest
• Published: 1993;103(4 Suppl):373S-376S
• Type of article: Review
• Cited by: 97 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos exposure constitutes the primary cause of pleural and peritoneal mesothelioma in humans. Risk relates to the duration and intensity of exposure. Thus, those exposed at younger ages are at higher lifetime risk. Families of asbestos workers exposed to asbestos on hair and clothing as well as to asbestos items brought home from the workplace are also at risk, as are employees working in the same vicinity as asbestos workers. The public health significance of exposure from asbestos in public and private buildings remains controversial. Malignant mesothelioma is difficult to diagnose and carries a poor prognosis. Chemotherapy with single or multiple agents has thus far been disappointing, but doxorubicin and cisplatin or mitomycin and cisplatin are probably most active with response rates in measurable disease of 25%. Palliative radiotherapy is also problematic since differences between tumor cytotoxicity and pulmonary tolerance are small and radiation pneumonitis may significantly impair quality of life.

In plain English

This article was a narrative review, not an original study. The author reviewed asbestos use, fiber types and possible mechanisms of cancer, and then the diagnosis and treatment of malignant mesothelioma. The review drew on published research and on experience at the Dana-Farber Cancer Institute in Boston. It stated that amphibole fibers are about 10 times as carcinogenic as chrysotile, with crocidolite associated with a high risk of malignant mesothelioma and amosite with an intermediate risk. It said present data did not allow conclusions about whether there is a safe threshold for asbestos exposure. It reported that families of asbestos workers have about a 1% risk of malignant mesothelioma, and that even a thorough history may fail to establish asbestos exposure in about 30% of cases. On treatment, it described a Cancer and Leukemia Group B trial in which cisplatin combined with doxorubicin or with mitomycin gave response rates of 25% in patients with measurable disease. The author concluded that initial trials showed some encouraging preliminary data in selected subsets of patients.

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 asbestos use, mineralogy and mechanisms of carcinogenicity, and of the diagnosis and management of malignant mesothelioma
• Who was studied: No study population of its own. The review summarized published literature and experience at the Dana-Farber Cancer Institute, Harvard Medical School, Boston.
• Exposure: Asbestos in general: serpentine chrysotile and the amphiboles crocidolite, amosite, anthophyllite, tremolite and actinolite. Exposures discussed included occupational exposure, household exposure of workers' families, and asbestos sprayed in public and private buildings.
• Main results:
  • The review stated that amphiboles are about 10 times as carcinogenic as chrysotile. It said crocidolite has been associated with a high risk of malignant mesothelioma, amosite appears to carry an intermediate risk, and chrysotile shows the weakest association.
  • The review said it remains controversial whether human mesothelioma cases linked to past chrysotile exposure were caused by chrysotile itself or by amphibole contamination.
  • The review stated that present data do not allow conclusions about whether there is a safe threshold level for asbestos exposure.
  • The review reproduced lung cancer death-rate data adapted from Hammond et al. The rates were 1 for nonsmokers without asbestos exposure, 11 for smokers without asbestos exposure, 6 for nonsmokers with asbestos exposure and 59 for smokers with asbestos exposure. On this basis the review described the lung cancer risk for smokers with asbestos exposure as increased almost 60-fold.
  • The review stated that a person first exposed at age 20 has no higher risk per year for a given exposure but accumulates a higher lifetime risk than someone first exposed at age 50.
  • The review stated that asbestos workers with heavy exposure have a higher risk of peritoneal mesothelioma, while those exposed for relatively brief periods are at higher risk of pleural mesothelioma.
  • The review stated that families of asbestos workers have an approximately 1% risk of malignant mesothelioma, in most cases because of asbestos contamination of work clothes.
  • The review stated that even the most comprehensive history may fail to establish asbestos exposure in about 30% of cases.
  • The review stated that single-agent chemotherapy response rates are generally 0% to 20%. It described a Cancer and Leukemia Group B trial of cisplatin combined with either doxorubicin or mitomycin, which found no difference in response rates (25%) in patients with measurable disease. Patients given cisplatin and doxorubicin lived somewhat longer.
  • The review described an earlier Dana-Farber phase I trial in which four of six carefully selected patients with malignant peritoneal mesothelioma were disease-free.
• The authors' conclusion: The author concluded that the cause and natural history of malignant pleural mesothelioma had been well documented over the past 2 decades, and that initial treatment trials were under way with some encouraging preliminary data in selected subsets of patients.

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Malignant Mesothelioma, Asbestos Exposure, Peritoneal Mesothelioma, Prognosis, Chemotherapy, Doxorubicin, Cisplatin.

Related studies

• Epidemiology, biologic behavior, and natural history of mesothelioma — L. Zellos, D.C. Christiani (2004)
• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)
• Multimodality therapy for malignant mesothelioma based on a study of natural history — K.H. Antman, R.H. Blum, et al. (1980)
• 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)
• 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)

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