Mesothelioma is a topic covered in the 5-Minute Clinical Consult.

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  • Mesothelioma is a rare, aggressive malignancy of the mesothelial or serous tissues primarily found in the pleura (65–70%) or peritoneum (20–33%), tunica vaginalis (1–2%) or pericardium (1–2%) (1).
  • Inhalation of asbestos is the predominant cause of mesothelioma, most often from occupational exposure.


  • The incidence in the United States is decreasing, but it is increasing in other countries, particularly Great Britain and Australia.
  • It is expected that rates of mesothelioma will start to drop after 2015 to 2025 related to reduced exposure and better understanding of the process of development of mesothelioma after exposure to asbestos (2).
  • The incidence increases with age, peaking in the 6th decade, with 70% of pleural disease occurring in males. Peritoneal involvement is slightly higher in women.
  • Main risk factor is asbestos exposure, but tumors have arisen after prior radiation or exposure to talc, erionite, or mica or in patients with familial Mediterranean fever and diffuse lymphocytic leukemia.

There are 3,300 cases of mesothelioma diagnosed in the United States annually (3).

Etiology and Pathophysiology

  • The predominant cause of mesothelioma is exposure to asbestos (hydrated magnesium silicate fibrous minerals).
  • There is a long latent period of up to 44 years between exposure and development of mesothelioma (2).
  • Inhaled or ingested asbestos fibers become trapped in pleural or peritoneal membranes, causing changes of irritation and inflammation.

Loss of nuclear deubiquitinase BAP1 is associated with incidence of mesothelioma in some families as well as with other cancers such as melanoma.

Risk Factors

  • The predominant risk factor is exposure to asbestos.
  • Occupational exposures involve mining or milling of fibers, work with textiles, cement, friction materials, insulation, or shipbuilding.
  • Nonoccupational exposures include renovation or destruction of asbestos-containing buildings, exposure to industrial sources in the community or natural geologic sources, or exposure to soiled clothing of asbestos workers (1,3,4).
  • Radiation exposure, smoking, proximity to naturally occurring asbestos deposits, or inhalation of other fibrous silicates can contribute to malignant mesothelioma.

General Prevention

  • Avoidance of asbestos exposure
  • Strict adherence to protective protocols for workers in buildings where asbestos is found
  • Continued aggressive remediation of asbestos-affected buildings and homes

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