Results of a retrospective study of a series of patients with malignant diffuse mesothelioma from a single institution showed that most women with the disease had a history of household exposure to a worker in industries that used asbestos. These findings were reported in the American Journal of Surgical Pathology.
Although the association between asbestos exposure and mesothelioma, occurring in either the pleura or peritoneum, has been well established, the focus of many of the studies of patients with mesothelioma has been on men exposed to asbestos through their occupation. Although some studies have addressed rates of mesothelioma in women, few have provided correlation with physical evidence of asbestos exposure, and data related to the location and histopathology of the disease in women, their history of asbestos exposure, as well as their survival are scarce.
In this study, cases of mesothelioma histologically confirmed between 1983 and 2010 were identified through a review of a medical records database from a single institution. Of the 2858 cases identified, 354 (12.4%) occurred in women, with 78% and 22% of these cases diagnosed as pleural mesothelioma and peritoneal mesothelioma, respectively.
Although the median age at diagnosis for the overall cohort of women was 60 years, there was a statistically significant difference in age at diagnosis for those with pleural (65 years) vs peritoneal disease (52 years; P <.0001). Disease histology was described as epithelioid in 72% of pleural mesothelioma cases and 82% of peritoneal tumors, with the remaining cases classified as biphasic or sarcomatoid.
For those patients with either pleural or peritoneal disease who were included in the survival analysis, median survival was 12.8 months and 15.0 months for patients with pleural compared with peritoneal disease, respectively.
In addition, a survival analysis based on mesothelioma histology revealed median survival was 16.5 months, 9.0 months, and 3.5 months, respectively, for those with disease characterized by epithelioid, biphasic, and sarcomatoid histology. When considering only those patients with disease characterized by epithelioid histology, median survival was 16.0 months and 28.3 months for those with disease located in the pleura and peritoneum, respectively. In contrast, corresponding median survival was only 8.0 months and 4.8 months in these location-based subgroups of patients with nonepithelioid disease.
Notably, there were data regarding asbestos exposure history for 92% (n=325) of the women included in this analysis, with 62% (n=200) reporting a household contact who most commonly worked in industries/occupations classified as insulation, shipyard, construction, and automotive as their only source of asbestos exposure.
“Women whose exposure began in childhood through asbestos brought into the home on their father’s clothing tended to be in their 30s and 40s at the time of diagnosis, whereas women whose exposure was through their husbands tended to be in their 50s and 60s.” the study authors noted.
One or more objective markers of asbestos exposure, such as asbestosis, parietal pleural plaques, or evidence of asbestos fibers, was observed in 57% of the women with a household contact as their only reported source of asbestos exposure, leading the study authors to conclude that “there are some cases of mesothelioma in women which cannot be attributed to asbestos exposure.”
Pavlisko EN, Liu B, Green C, Sporn TA, Roggli VL. Malignant diffuse mesothelioma in women: a study of 354 cases.Am J Surg Pathol. 2020;44:293-304.