On May 13, 2022, there was a published report in the MMWR titled “Malignant Mesothelioma Mortality in Women – United States, 1999-2020” (Mazurek et al., 2022). The authors of this MMWR relied upon the National Vital Statistic System’s Multiple Cause of Death (MCD) records to analyze trends for this disease in women….
The MMWR reported that the MCD records showed an increased incidence of 25% in malignant mesothelioma mortalities in women between 1999 and 2020 (Mazurek et al., 2022), and this statement was placed in headlines in the popular press (American Industrial Hygiene Association (AIHA), 2022). While this statement is correct, the more important observation was that the age-adjusted death rate for women remained flat throughout this time period (fluctuating between 4.12 and 4.99 per 1 million from 1999 to 2020) (Mazurek et al., 2022), which suggests that the net increase in mesotheliomas amongst women was due to longer life-spans and not associated with exposures to asbestos.
Mesothelioma (certainly pleural mesothelioma) has long been considered a hallmark disease of asbestos exposure in men, but this is not the case in women (Ilgren and Wagner, 1991; Pavlisko and Sporn, 2014; Price, 2022; Price and Ware, 2009; Wagner et al., 1960). The exposure-response relationship for asbestos and mesothelioma is believed to be consistent across genders. However, due to historic occupational trends, few women have been exposed to significant cumulative airborne concentrations (doses) of any fiber type of asbestos. As a result, mesothelioma occurrences among women do not correlate with asbestos consumption in the United States, in contrast to the correlation observed with men (Moolgavkar et al., 2023)….
In order to address the underlying topics relevant to the MMWR article by Mazurek et al., a non-systematic review on the scientific community’s state-of-the-art understanding of mesothelioma incidence and asbestos exposures amongst women in the United States, as well as a critical investigation of the methods and references in the MMWR [“Malignant Mesothelioma Mortality in Women” report], was conducted….
We concluded that [in their “Malignant Mesothelioma Mortality in Women” report] the MMWR should have provided a more thorough discussion of the many factors that need to be considered when assessing trends in the incidence of mesothelioma. In this paper, we address (1) shortcomings in the national database regarding anatomical location and occupational classification deaths, (2) the importance of asbestos fiber type, (3) the historical trends of women’s occupational exposures to asbestos in the United States, (4) the likelihood that take-home and para-occupational exposures have caused mesothelioma in women, (5) the potential for various exposures to asbestos in the post-OSHA era (after 1970), and (6) the risk factors of mesothelioma when asbestos exposure is absent.
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