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Epidemiology of malignant pleural mesothelioma

Daniel H Sterman, MD
Leslie A Litzky, MD
Larry R Kaiser, MD
Section Editors
Andrew Nicholson, MD
James R Jett, MD
Rogerio C Lilenbaum, MD, FACP
Joseph S Friedberg, MD
Deputy Editor
Sadhna R Vora, MD


Mesothelioma is an insidious neoplasm arising from the mesothelial surfaces of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium. Eighty percent of cases are pleural in origin. The predominant cause of malignant mesothelioma is inhalational exposure to asbestos, with approximately 70 percent of cases of pleural mesothelioma being associated with documented asbestos exposure.

This topic will discuss the epidemiology and risk factors of pleural mesothelioma.

The pathology, clinical presentation, evaluation, and staging, and treatment of malignant pleural mesothelioma are discussed separately. (See "Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma" and "Pathology of malignant pleural mesothelioma" and "Initial management of malignant pleural mesothelioma".)

Peritoneal mesothelioma is discussed separately. (See "Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging" and "Malignant peritoneal mesothelioma: Treatment".)


The annual incidence of mesothelioma in the United States is estimated to be approximately 3300 cases per year [1]. The incidence of mesothelioma in the United States peaked around the year 2000 and is now declining, secondary to control of exposure to asbestos [2].

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Literature review current through: Nov 2017. | This topic last updated: Sep 15, 2017.
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  1. Teta MJ, Mink PJ, Lau E, et al. US mesothelioma patterns 1973-2002: indicators of change and insights into background rates. Eur J Cancer Prev 2008; 17:525.
  2. Price B. Analysis of current trends in United States mesothelioma incidence. Am J Epidemiol 1997; 145:211.
  3. Hodgson JT, McElvenny DM, Darnton AJ, et al. The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050. Br J Cancer 2005; 92:587.
  4. Robinson BM. Malignant pleural mesothelioma: an epidemiological perspective. Ann Cardiothorac Surg 2012; 1:491.
  5. Antman KH. Natural history and epidemiology of malignant mesothelioma. Chest 1993; 103:373S.
  6. Pisani RJ, Colby TV, Williams DE. Malignant mesothelioma of the pleura. Mayo Clin Proc 1988; 63:1234.
  7. http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/asbestos.
  8. Lanphear BP, Buncher CR. Latent period for malignant mesothelioma of occupational origin. J Occup Med 1992; 34:718.
  9. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9995 (Accessed on October 17, 2013).
  10. Selikoff IJ, Hammond EC, Seidman H. Latency of asbestos disease among insulation workers in the United States and Canada. Cancer 1980; 46:2736.
  11. Hansen J, de Klerk NH, Musk AW, Hobbs MS. Environmental exposure to crocidolite and mesothelioma: exposure-response relationships. Am J Respir Crit Care Med 1998; 157:69.
  12. Pira E, Pelucchi C, Buffoni L, et al. Cancer mortality in a cohort of asbestos textile workers. Br J Cancer 2005; 92:580.
  13. Hillerdal G. Malignant mesothelioma 1982: review of 4710 published cases. Br J Dis Chest 1983; 77:321.
  14. Mossman BT. Carcinogenesis and related cell and tissue responses to asbestos: a review. Ann Occup Hyg 1994; 38:617.
  15. Metintas M, Ozdemir N, Hillerdal G, et al. Environmental asbestos exposure and malignant pleural mesothelioma. Respir Med 1999; 93:349.
  16. Senyiğit A, Babayiğit C, Gökirmak M, et al. Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. Respiration 2000; 67:610.
  17. Senyiğit A, Bayram H, Babayiğit C, et al. Malignant pleural mesothelioma caused by environmental exposure to asbestos in the Southeast of Turkey: CT findings in 117 patients. Respiration 2000; 67:615.
  18. Metintas S, Metintas M, Ucgun I, Oner U. Malignant mesothelioma due to environmental exposure to asbestos: follow-up of a Turkish cohort living in a rural area. Chest 2002; 122:2224.
  19. Pan XL, Day HW, Wang W, et al. Residential proximity to naturally occurring asbestos and mesothelioma risk in California. Am J Respir Crit Care Med 2005; 172:1019.
  20. Gennaro V, Ugolini D, Viarengo P, et al. Incidence of pleural mesothelioma in Liguria Region, Italy (1996-2002). Eur J Cancer 2005; 41:2709.
  21. Bayram M, Dongel I, Bakan ND, et al. High risk of malignant mesothelioma and pleural plaques in subjects born close to ophiolites. Chest 2013; 143:164.
  22. Carbone M, Emri S, Dogan AU, et al. A mesothelioma epidemic in Cappadocia: scientific developments and unexpected social outcomes. Nat Rev Cancer 2007; 7:147.
  23. Bruno C, Tumino R, Fazzo L, et al. Incidence of pleural mesothelioma in a community exposed to fibres with fluoro-edenitic composition in Biancavilla (Sicily, Italy). Ann Ist Super Sanita 2014; 50:111.
  24. Tward JD, Wendland MM, Shrieve DC, et al. The risk of secondary malignancies over 30 years after the treatment of non-Hodgkin lymphoma. Cancer 2006; 107:108.
  25. Teta MJ, Lau E, Sceurman BK, Wagner ME. Therapeutic radiation for lymphoma: risk of malignant mesothelioma. Cancer 2007; 109:1432.
  26. Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 2005; 97:1354.
  27. Deutsch M, Land SR, Begovic M, et al. An association between postoperative radiotherapy for primary breast cancer in 11 National Surgical Adjuvant Breast and Bowel Project (NSABP) studies and the subsequent appearance of pleural mesothelioma. Am J Clin Oncol 2007; 30:294.
  28. Neugut AI, Ahsan H, Antman KH. Incidence of malignant pleural mesothelioma after thoracic radiotherapy. Cancer 1997; 80:948.
  29. Chirieac LR, Barletta JA, Yeap BY, et al. Clinicopathologic characteristics of malignant mesotheliomas arising in patients with a history of radiation for Hodgkin and non-Hodgkin lymphoma. J Clin Oncol 2013; 31:4544.
  30. Gibb H, Fulcher K, Nagarajan S, et al. Analyses of radiation and mesothelioma in the US Transuranium and Uranium Registries. Am J Public Health 2013; 103:710.
  31. Andersson M, Wallin H, Jönsson M, et al. Lung carcinoma and malignant mesothelioma in patients exposed to Thorotrast: incidence, histology and p53 status. Int J Cancer 1995; 63:330.
  32. The Lancet Oncology . Space elevators, tennis racquets, and mesothelioma. Lancet Oncol 2008; 9:601.
  33. Takagi A, Hirose A, Nishimura T, et al. Induction of mesothelioma in p53+/- mouse by intraperitoneal application of multi-wall carbon nanotube. J Toxicol Sci 2008; 33:105.
  34. Poland CA, Duffin R, Kinloch I, et al. Carbon nanotubes introduced into the abdominal cavity of mice show asbestos-like pathogenicity in a pilot study. Nat Nanotechnol 2008; 3:423.
  35. Bocchetta M, Eliasz S, De Marco MA, et al. The SV40 large T antigen-p53 complexes bind and activate the insulin-like growth factor-I promoter stimulating cell growth. Cancer Res 2008; 68:1022.
  36. Comar M, Zanotta N, Pesel G, et al. Asbestos and SV40 in malignant pleural mesothelioma from a hyperendemic area of north-eastern Italy. Tumori 2012; 98:210.
  37. Cristaudo A, Foddis R, Vivaldi A, et al. SV40 enhances the risk of malignant mesothelioma among people exposed to asbestos: a molecular epidemiologic case-control study. Cancer Res 2005; 65:3049.
  38. De Rienzo A, Tor M, Sterman DH, et al. Detection of SV40 DNA sequences in malignant mesothelioma specimens from the United States, but not from Turkey. J Cell Biochem 2002; 84:455.
  39. Lundstig A, Dejmek A, Eklund C, et al. No detection of SV40 DNA in mesothelioma tissues from a high incidence area in Sweden. Anticancer Res 2007; 27:4159.
  40. Ziegler A, Seemayer CA, Hinterberger M, et al. Low prevalence of SV40 in Swiss mesothelioma patients after elimination of false-positive PCR results. Lung Cancer 2007; 57:282.
  41. Manfredi JJ, Dong J, Liu WJ, et al. Evidence against a role for SV40 in human mesothelioma. Cancer Res 2005; 65:2602.
  42. Ji J, Sundquist J, Sundquist K. Incidence and familial risk of pleural mesothelioma in Sweden: a national cohort study. Eur Respir J 2016; 48:873.
  43. Carbone M, Yang H, Pass HI, et al. BAP1 and cancer. Nat Rev Cancer 2013; 13:153.
  44. Carbone M, Ferris LK, Baumann F, et al. BAP1 cancer syndrome: malignant mesothelioma, uveal and cutaneous melanoma, and MBAITs. J Transl Med 2012; 10:179.
  45. Bott M, Brevet M, Taylor BS, et al. The nuclear deubiquitinase BAP1 is commonly inactivated by somatic mutations and 3p21.1 losses in malignant pleural mesothelioma. Nat Genet 2011; 43:668.
  46. Testa JR, Cheung M, Pei J, et al. Germline BAP1 mutations predispose to malignant mesothelioma. Nat Genet 2011; 43:1022.