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Mesothelioma: An Evidence-Based Review

1. Introduction

The initial discovery of mesothelioma can be traced back to 1767 when Dr. Joseph Lieutaud, an anatomy pathologist in France, first identified a tumour in the chest wall of a young boy [1]. Mesothelioma is a rare, aggressive form of cancer that develops from transformed cells originating in the mesothelium, which is the protective lining covering many of the body’s internal organs. Mesothelioma arises in the pleura but also occurs in the peritoneum, the tunica vaginalis, and the pericardium [2]. Mesothelioma tends to have a local progression. While disseminated disease has sometimes been reported in a very late stage of the disease [3– 7], patients usually die from local progression.

2. Incidence

In Canada, there are 459 new reported cases of mesothelioma per year [8], compared to 3,000 in the United States of America. According to Connelly RR et al, the incidence of mesothelioma in the United States is 10 cases per million people per year [9]. Men are more commonly affected than women, with a male predominance of 90%. While there is a correlation between increasing age and reported cases, there is no peak and the mean age at diagnosis is 60 years.

The number of cases recorded in the Quebec Tumour Database from 1982 to 2002 (for the province of Quebec, Canada; see table 1) reveals that the incidence of pleural and peritoneal mesothelioma was higher for men than women. The overall annual rate of increase from 1982 to 2002 in Quebec was estimated to be 3.6%, which was lower than that measured from 1982 to 1996. In comparison to the international level, only Australia and Scotland showed significant increases in mesothelioma among women [10].

3. Epidemiology


The primary risk factor for mesothelioma is asbestos exposure. Asbestos is a generic terms for a group of six naturally occurring silicate minerals classified as either serpentine or amphibole. The amphibole (rod-like) group contains five types: amosite, crocidolite, anthophyllite, tremolite, and actinolite. Serpentine (chrysotile) asbestos has a sheet or layered structure and differs from the amphibole varieties both structurally and chemically. Chrysotile, the only asbestos mineral in the serpentine group, is the main form of asbestos still mined. It is generally accepted that chrysotile asbestos is less dangerous and does less damage to the lungs than the amphiboles. Although 70% to 80% of pleural mesothelioma cases are associated with asbestos exposure, the lifetime risk of developing pleural mesothelioma among asbestos workers is thought to be 10% [11]. Furthermore, despite the lack of evidence between the relationship of asbestos exposure and peritoneal mesothelioma, one study indicates that this correlation is less significant than that between asbestos exposure and pleural mesothelioma [12].

Asbestos is still used industrially for its fire-resistance and sound-absorption properties. The association between asbestos and mesothelioma was first documented in South African miners [13]. Moreover, the Occupational Safety and Health Administration (OSHA) established that 0.2 fibres per cubic millilitre of air is the standard acceptable exposure rate for fibres longer than 5 μm [14]…

Julie Goudreault and Anne Dagnault (2013). Mesothelioma: An Evidence-Based Review, Cancer Treatment – Conventional and Innovative Approaches, Prof. Letícia Rangel (Ed.), InTech, DOI: 10.5772/55292. Available from:


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