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CA Cancer J Clin. 2019 Sep;69(5):402-429. doi: 10.3322/caac.21572. Epub 2019 Jul 8.

Mesothelioma: Scientific clues for prevention, diagnosis, and therapy.

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Thoracic Oncology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
National Research Council Institute of Nanotechnology, La Sapienza University, Rome, Italy.
Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Laboratory of Molecular Oncology, Division of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland.
MESOPATH, Department of Biopathology, Leon Bernard Cancer Center, Lyon, France.
Thoracic Oncology, Department of Surgery, Helen Diller Cancer Center, University of California at San Francisco, San Francisco, California.
Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada.
Pathology, Immunology, and Microbiology Laboratory, University of California at Davis, Sacramento, California.
Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Cancer Medicine, Department of Thoracic and Head/Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.


Mesothelioma affects mostly older individuals who have been occupationally exposed to asbestos. The global mesothelioma incidence and mortality rates are unknown, because data are not available from developing countries that continue to use large amounts of asbestos. The incidence rate of mesothelioma has decreased in Australia, the United States, and Western Europe, where the use of asbestos was banned or strictly regulated in the 1970s and 1980s, demonstrating the value of these preventive measures. However, in these same countries, the overall number of deaths from mesothelioma has not decreased as the size of the population and the percentage of old people have increased. Moreover, hotspots of mesothelioma may occur when carcinogenic fibers that are present in the environment are disturbed as rural areas are being developed. Novel immunohistochemical and molecular markers have improved the accuracy of diagnosis; however, about 14% (high-resource countries) to 50% (developing countries) of mesothelioma diagnoses are incorrect, resulting in inadequate treatment and complicating epidemiological studies. The discovery that germline BRCA1-asssociated protein 1 (BAP1) mutations cause mesothelioma and other cancers (BAP1 cancer syndrome) elucidated some of the key pathogenic mechanisms, and treatments targeting these molecular mechanisms and/or modulating the immune response are being tested. The role of surgery in pleural mesothelioma is controversial as it is difficult to predict who will benefit from aggressive management, even when local therapies are added to existing or novel systemic treatments. Treatment outcomes are improving, however, for peritoneal mesothelioma. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.


BRCA1-associated protein 1 (BAP1); asbestos; cancer syndromes; chromothripsis; gene-environment interaction; immunotherapy; mesothelioma

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