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What are the risk factors for malignant mesothelioma?A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, smoking is a risk factor for cancers of the lung, mouth, larynx (voice box), bladder, kidney, and several other organs. But risk factors don’t tell us everything. Having a known risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may not have had any known risk factors. Researchers have found some factors that increase a person’s risk of mesothelioma.
Asbestos
The main risk factor for developing mesothelioma is exposure to asbestos. In fact, most cases of mesothelioma have been linked to asbestos exposure in the workplace. Asbestos is a group of minerals that occur naturally as bundles of fibers. These fibers, found in soil and rocks in many parts of the world, are made of silicon, oxygen, and other elements. There are 2 main forms of asbestos: Serpentine asbestos fibers are curly. The most common asbestos in industrial use, known as chrysotile, or white asbestos, has curly fibers. Amphibole asbestos fibers are straight and needle-like. There are several types of amphibole fibers, including amosite, crocidolite, tremolite, actinolite, and anthophyllite. Amphibole fibers (particularly crocidolite) are considered to be more likely to cause cancer, but even the more commonly used chrysotile fibers are linked with mesotheliomas. When asbestos fibers in the air are inhaled, they tend to stick to mucus in the throat, trachea (windpipe), or bronchi (large breathing tubes of the lungs). Chrysotile fibers tend to be cleared from the lungs by being coughed up or swallowed. But the long, thin amphibole fibers are harder to clear, and they may stay in the lungs, traveling to the ends of the small airways and penetrating into the pleural lining of the lung and chest wall. These fibers may then injure mesothelial cells of the pleura, and eventually cause mesothelioma. Asbestos fibers can also damage cells of the lung and result in asbestosis (scar tissue in the lung) and/or lung cancer. Indeed, asbestosis, mesothelioma, and lung cancer are the 3 most frequent causes of death and disease among people with heavy asbestos exposure. Peritoneal mesothelioma, which forms in the abdomen, may result from coughing up and swallowing inhaled asbestos fibers. Many people are exposed to very low levels of naturally occurring asbestos in outdoor air that comes from dust from rocks and soil containing asbestos. The potential for such exposure is higher in areas where rocks have higher asbestos content. In some areas, asbestos may be detected in the water supply as well as in the air. Because of its heat and fire resistant properties, asbestos has been used in many products such as insulation, floor tiles, door gaskets, soundproofing, roofing, patching compounds, fireproof gloves, ironing board covers, and brake pads. The link between asbestos and mesothelioma has become well known, so its use in the United States has decreased dramatically. Most use stopped after 1989, but it is still used in some products. Still, millions of Americans may already have been exposed to asbestos. People at risk for workplace asbestos exposure include some miners, factory workers, insulation manufacturers and installers, railroad and automotive workers, ship builders, gas mask manufacturers, and construction workers. Family members of people exposed to asbestos at work also have an increased risk of developing mesothelioma because asbestos fibers can be carried home on the clothes of the workers.
The rate of mesothelioma in men appears to be dropping, probably because there is now much less direct exposure to asbestos in the workplace. Asbestos was also used in the insulation of many older homes, as well as commercial and public buildings around the country, including some schools. Because these particles are contained within the building materials, they are not likely to be found in the air in large numbers.
The risk of exposure is thought to be much less hazardous unless the particles are somehow escaping into the air, such as when building materials begin to decompose over time, or during remodeling or removal. The risk of developing mesothelioma is related to how much asbestos a person was exposed to and how long this exposure lasted. People exposed at an early age, for a long period of time, and at higher levels are more likely to develop this cancer. Mesotheliomas take a long time to develop. The time between first exposure to asbestos and diagnosis of mesothelioma is usually between 20 and 50 years. Unfortunately, the risk of mesothelioma does not go down over time after the exposure to asbestos stops. The risk appears to be lifelong. Absolute risk is the probability that an individual will contract a particular disease within a specified period of time. For instance when epidemiologists say that American men face a 1:4000 chance of developing mesothelioma, what they are describing is an absolute risk, as relevant to the average risk or general population group. This statistic is applicable to the general population on the whole, and cannot be associated with any specific person. Different groups of people have different risk estimates. Military veterans past age 60 face a higher absolute risk of developing mesothelioma in comparison to younger men. Relative risk compares two different groups, with one group facing a specific risk factor whereas the other group does not face any specific risks. For instance, researchers can study two groups of people, with both the groups sharing common characteristics such as same age and socioeconomic profile. However, one group has people who have specific risk factors such as asbestos exposure. The researchers seek to determine the number of individuals in each group who may develop cancer over a specified period of time. If twice as many individuals develops mesothelioma in the exposed group as the in the non-exposed group, then individuals in the exposed group will be said to have a relative risk of 2.0. Both absolute and relative risk number can help tell the story about whether an individual faces the chance of contracting mesothelioma and can be useful in diagnosing the disease.
The absolue risk of getting mesothelioma is low for all groups. However, repeated studies have shown that people exposed to asbestos fibers have higher relative risk of mesothelioma than those who have not been exposed.
The SV40 Controversy
Over the past several years, some research studies have indicated a possible link between SV40 (the simian virus) and the risk of developing mesothelioma. Based on the assumption that injectable polio vaccines prepared between 1955 and 1963 were contaminated with the virus, it is estimated that 10 to 30 million people could have been exposed. In early tests with laboratory animals, researchers found that intentional infection with SV40 could cause mesotheliomas to develop, and that asbestos increased the cancer-causing effect of SV40 on these cells. Other researchers studying human biopsy specimens of mesotheliomas had also detected SV40 DNA, however, it was found that the SV40 DNA was also present in non-cancerous tissue, leading them to believe the viruses were contaminants. Later tissue studies of both mesothelioma patients and healthy people where there did not appear to be contaminants, showed the SV40 virus was not linked to mesothelioma unless the person was also exposed to asbestos. These researchers determined that the SV40 infection was not caused by the polio vaccine, but occurred naturally as do other types of viral infections. The largest human studies to date have not found any increased risk for mesothelioma among those who received the contaminated vaccines as children, however, some researchers feel the peak age for developing mesothelioma has not yet been reached by many of the subjects involved. Research is ongoing.
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