A recent article by Marinaccio and colleagues examined gender differences and modalities of asbestos exposure in malignant mesothelioma (MM). The results are some of the first to examine gender differences in mesothelioma risk, with significantly more cases of MM attributed to occupational asbestos exposure in men than women. The author concluded that non-occupational exposure to asbestos (i.e., familial “take-home” exposure) plays a fundamental role in causing MM in women. But could it be something else? Indeed, when mesothelioma is believed to be non-occupational or of an “unknown” cause, asbestos defendants should also consider the underlying genetic factors that may make an individual more prone to developing MM.

Non-Occupational Asbestos Exposure Linked to MM in Women

Using the Italian national mesothelioma resister (ReNaM), the authors extracted the incidence of MM between 1993 and 2012. During the period of study, more than 20,000 cases of MM were reported. Mesothelioma was associated with asbestos exposure in both males and females. However, males were occupationally exposed to asbestos, whereas females were not. In females, MM was more likely due to non-occupational asbestos exposure (i.e., familial, environmental, leisure activities) or had no known asbestos link. The authors concluded that their analysis demonstrated an important role of non-occupational asbestos exposure, mainly familial, in causing MM in women.

In a response, Dr. Murray Finkelstein argued that Marinaccio et al. failed to consider the possibility of asbestos exposure from use of talcum powder. He showed data that indicate more than 65% of MM patients (significantly more women) tested positive for the presence of talc, suggesting that a portion of the cases reported in Marinaccio et al. as having no known exposure may actually be attributable to inhaled asbestos exposure from contaminated talc products. However, Marinaccio et al. countered that only 30 women were identified in ReNaM as having heavy talc exposure in the context of occupation or personal use.

Something Other than Asbestos Exposure?

Marinaccio and colleagues linked non-occupational asbestos exposure to MM in women, whereas Finkelstein would have us believe that the culprit is asbestos-contaminated talc. But when mesothelioma is non-occupational or of an “unknown” cause, it is essential that asbestos defendants consider genetic predisposition to MM or vulnerability to asbestos exposure. Further exploration of mesothelioma rates between men and women may reveal genetic differences in asbestos-induced MM and non-asbestos-induced MM as well as in individual susceptibility to developing MM.

Citations:

Finkelstein MM. Response to: ‘The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure’ by Marinaccio et al. Occup Environ Med. 2018 Nov; 75(11): 844.

Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Scarselli A, Ferrante P…ReNaM Working Group. The epidemiology of malignant mesothelioma in women: Gender differences and modalities of asbestos exposure. Occup Environ Med. 2018 Apr; 75(4): 254-262.

Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Scarselli A, Ferrante P…ReNaM Working Group. Letter concerning: ‘Response to: ‘The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure’ by Marinaccio et al’. Occup Environ Med. 2018 Nov; 75(11): 844-845.