The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure

Abstract

IntroductionThe epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register.MethodsIncident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated.ResultsIn the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries.ConclusionsThe consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

Non-occupational exposure to asbestos is the main cause of malignant mesothelioma in women in North Jutland, Denmark

“…Moreover, in our cohort one year's environmental exposure was enough to be associated with MM, which is consistent with the literature; a dose-effect relationship between asbestos exposure and MM has been recognized but no minimum threshold of exposure to asbestos identified (25)(26)(27). The disease latency varies from one to seven decades, but the median latency is higher than observed in previous studies (28,29). Latency depends on exposure intensity and duration as well as unknown factors that probably are genetic (2).…”

The significance of non‐occupational asbestos exposure in women with mesothelioma

“…Non‐occupational exposure occurs predominantly in women . The three cases presented here echo the analysis of female mesothelioma cases in Italy where the important role of non‐occupational exposure was shown . With the cessation of asbestos mining, milling, and manufacturing of asbestos‐containing products it is expected that occupationally acquired cases of mesothelioma will decline.…”

“…A sex difference in asbestos-related mesothelioma cases has been reported. The rates of women with mesothelioma are lower than those of men as more men than women were exposed through their occupations [6].…”

Response to: ‘The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure’ by Marinaccioet al

“…Marinaccio and colleagues1 compared asbestos exposures of men and women with mesothelioma in Italy and found that women were less likely to have had occupational exposures and more likely to have experienced non-occupational and familial exposures. They did not consider possible asbestos exposures arising from the use of talcum powders, an exposure common in North America, that may have been in Italy as well.…”