Mesothelioma in patients with nonoccupational asbestos exposure. An evidence-based approach to causation assessment.

Ann Diagn Pathol. 2006 Aug;10(4):241-50.
Marchevsky AM, Harber P, Crawford L, Wick MR.
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. marchevsky@cshs.org

The specific parameters of nonoccupational asbestos exposures (NOAE) that can distinguish an idiopathic from an asbestos-caused malignant mesothelioma (MM) are controversial. A systematic literature review yielded 1028 cases with this putative association. Only 287 of those reports had a defined single exposure to a household, building occupant, or neighborhood/community asbestos source. The available "evidence" was used to develop semiarbitrary evidence-based causation guideline rules for the assessment of putative associations between malignant mesothelioma and nonoccupational asbestos exposures. The rules are classified into class A (tissue burden analysis shows asbestos body counts or fiber counts in lung tissues comparable to MM caused by occupational exposure to asbestos) and classes B to D based on whether certain combinations of NOAE features and MM (evidence) have been described in over 15% (class B), 5% to 15% (class C), and less than 5% (class D) of the patients reviewed. The proposed 4 classes of evidence-based causation guidelines provide a semiarbitrary framework to evaluate the causes of individual MM patients by NOAE based on decreasing levels of currently available evidence. The neoplasms in classes A to C patients are probably caused by NOAE, with decreasing weight of evidence in the 3 groups. There is minimal evidence to support the causation of MM by NOAE in class D patients. There is no evidence or only anecdotal evidence to support a causal association between MM and NOAE in individuals who cannot be classified into any of the 4 classes. Future studies are needed to provide more comprehensive data regarding the association between malignant mesothelioma and NOAE.

Source

PMID: 16844568 [PubMed - indexed for MEDLINE]
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Borys Mychalczak, M.D.
Dr. Borys Mychalczak is Chief of Radiation Oncology at the Memorial Sloan-Kettering regional care facility in Sleepy Hollow, New York.

Thierry Marie Jahan, M.D.
Dr. Thierry Marie Jahan is the Associate Clinical Professor of Medicine at the University of California San Francisco and is dedicated to the treatment of mesothelioma.

David Rice, M.D.
Dr. David Rice is an Associate Professor and Assistant Surgeon at The University of Texas M.D. Anderson Cancer Center where he serves as the director of the Minimally Invasive Surgery and Mesothelioma programs.

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