Women are statistically less likely to develop mesothelioma than men, largely due to a lack of occupational asbestos exposure. However, women often face secondhand or environmental exposure to the toxin and are still susceptible to asbestos diseases. According to the most recent data, in 2015 nearly 40% of all mesothelioma cases occurred in women.
Along with different sources of asbestos exposure, mesothelioma and other asbestos-related diseases typically develop differently in women compared to men. Often, women are diagnosed at earlier ages and face different kinds of symptoms as the disease develops. Female patients also tend to have better survival rates than men.
Asbestos Exposure in Women
Although female mesothelioma patients most often experience secondary exposure, they can also be exposed to asbestos on the job. Regardless of exposure source, there is no safe level of contact with asbestos. Studies have shown that trace amounts of asbestos or single exposures can be just as dangerous as prolonged exposure to high concentrations of the toxin.
Researchers have found that women face increased risk of mesothelioma from smaller instances of exposure compared to men. They believe the heightened danger stems from the smaller lung size and shorter tracheae found in women. The smaller respiratory systems cause greater fiber retention than larger male lungs.
In the majority of mesothelioma cases among women, asbestos exposure was not a result of occupational contact with the toxin. One study of over 90 female mesothelioma patients found that about 64% had non-occupational asbestos exposure. In the United States, women were often exposed to asbestos when laundering their husband’s work clothing. After direct contact with asbestos-containing products, work clothes may harbor microscopic asbestos fibers or be covered with asbestos dust that could easily become airborne and lead to toxic exposure.
Long-time mesothelioma survivor Heather Von St. James was exposed in a similar way. Her father worked with asbestos products often and came home with a coat covered in asbestos dust. Heather frequently wore the coat during her chores, and the non-occupational exposure during childhood led to her development of pleural mesothelioma. Heather was diagnosed at 36 years old and given a prognosis of 15 months. After receiving treatment, which included aggressive surgery and chemotherapy, she is now living cancer-free and continues to share her story with others, while spreading awareness about mesothelioma and the risks of asbestos exposure.
Across the globe, domestic duties frequently led to women’s exposure to asbestos. One of the most prolific instances of female asbestos exposure occurred in Turkey, where whitewashing homes with asbestos-containing soil was once a common practice. In one Turkish village, researchers recorded an average annual incidence rate of malignant pleural mesothelioma of 114.8 per 100,000 male villagers and 159.8 per 100,000 female villagers.
In addition to exposure resulting from domestic work, reports have shown that some women experienced asbestos exposure from the use of talcum powder. Studies have shown certain talc products may be contaminated with asbestos fibers. With repeated use of these products, especially in enclosed spaces, there is ample opportunity for inhalation of the toxic mineral. One study found a woman who died from mesothelioma likely developed the disease as a result of her use of talcum powder. Researchers identified amosite asbestos fibers in the talc product, which could also be detected in her lungs during posthumous analysis. Their findings validated a similar study completed in 1970. Both cohorts of researchers found that the low level of exposure to asbestos from talcum powder can cause pleural mesothelioma cancer.
Workplace Asbestos Exposure
While historically the number of women in high-risk asbestos occupations has been minimal compared to men, there was a large influx of women in factories, shipyards and other risky occupations during World War II. Around six million women entered the workforce between 1942 and 1945, when asbestos use as a fire retardant was on the rise. According to the United States National Archives, there were 90,000 women who became factory workers and shipyard workers in Mobile, Alabama alone. These workers were among the most at risk of exposure, as they handled numerous asbestos products including insulation, brake materials, tiling and pipes.
In recent years, women have entered the blue collar and emergency services workforce more frequently. For example, the International Association of Women in Fire & Emergency Services estimates there are over 6,000 female firefighters working fulltime in the United States today. These women put their lives on the line in order to keep Americans safe from blazes, but they may also be putting themselves at risk of asbestos exposure and resulting mesothelioma, lung cancer or asbestosis. In fact, the first mesothelioma death resulting from the terror attack on the World Trade Center in New York was a female firefighter.
As the gender gap in at-risk occupations continues to close, it will become increasingly important for women to understand the risks associated with occupational asbestos exposure.
Diagnosing Mesothelioma in Women
The diagnostic process for female mesothelioma patients is largely similar to that experienced by male patients. On average, it takes 10 – 50 years for mesothelioma symptoms to manifest after asbestos exposure, though women tend to be diagnosed at a younger age than men. Female patients often present with different symptoms than male patients. The most common symptom associated with mesothelioma cancer is difficulty breathing, but female patients often present with cough or chest pain.
The difference in the presentation of symptoms might also be because women are more likely to develop peritoneal mesothelioma, which develops in the lining of the abdomen, than men. Though pleural mesothelioma, which develops in the lining of the lungs, is the most common type of the disease, studies have found that there are more instances of peritoneal mesothelioma in female patients. In a Danish study, researchers found that women who had experienced primary asbestos exposure were more likely to develop peritoneal mesothelioma. The women who had secondary exposures developed pleural mesothelioma more often.
Additionally, doctors have found that women are more prone to distant metastasis, or spreading, than men. As mesothelioma progresses, patients may face limited treatment options and a worse prognosis. With this in mind, it’s important for women experiencing any mesothelioma symptoms to talk to their doctor as soon as possible.
Prognosis for Female Mesothelioma Patients
Female mesothelioma patients tend to have a better prognosis and survival rates than male patients. While they comprise a smaller percentage of malignant pleural mesothelioma patients, women make up a larger portion of the long-term survivors.
A retrospective study analyzed pleural mesothelioma data from the Surveillance, Epidemiology and End Results (SEER) databases from 1973 to 2009 and found that the 5-year survival rate for women was 13.4%, while men had a 5-year survival rate of 4.5%. The women in the study had longer survival than the male patients, regardless of age. Additionally, the women had better survival rates at the one- and five-year marks regardless of treatment type. In particular, researchers found there were considerable improvements in women’s survival rates after surgery when compared to male patients who also underwent the procedure. Of the patients that elected to have cancer-directed surgery, 65.8% of the female patients achieved 1-year survival, compared to 53.8% of the male patients.
A second study found that women with epithelial mesothelioma tumors have a more favorable prognosis and increased survival when compared to men with the same tumor type. The female patients in the study experienced a median survival of more than 30 months, compared to the average mesothelioma life expectancy of 12 – 21 months.
Researchers believe that the increased survival may be due to a link between estrogen and mesothelioma suppression. They found that the female estrogen receptors also work as a cancer growth suppressor. The benefits of estrogen could play a role in why younger women tend to have improved survival rates when compared to older women, who may be producing less estrogen. Regardless of estrogen levels in women, utilizing aggressive treatment options is the best way to improve patient prognosis.
Mesothelioma Treatment Options for Women
Women have the same treatment options available to them as male patients. Typically, mesothelioma is treated with a multimodal approach of radiation, chemotherapy and surgery. Because women are often diagnosed at an earlier age, they typically have more viable treatment options and can withstand more aggressive treatments.
Women also tend to have better outcomes following surgery than men. In a retrospective study, researchers looked at patients who underwent extrapleural pneumonectomy for malignant mesothelioma between 1987 and 2008. They found that the female patients had lower rates of perioperative (during the surgical process) mortality.
Receiving mesothelioma treatment improves patient prognosis. Mesothelioma patients who receive no treatment for the disease live on average six months. Even for women who are diagnosed with mesothelioma in the later stages of disease, treatment can prolong life and improve overall quality of life. Palliative care is also an option to help alleviate symptoms during treatment.
Author: Linda Molinari
Editor in Chief, Mesothelioma Cancer AllianceRead about Linda
Reviewer: Dr. James Stevenson
Medical Reviewer and Thoracic Medical OncologistRead about Dr. Stevenson
Brandão M, Rocha M. 222P Women: The other face of malignant pleural mesothelioma. Journal of Thoracic Oncology. April 2018; 13(4) Suppl: S133. doi: 10.1016/S1556-0864(18)30494-5
Cristina S. From Empowerment to Domesticity: The Case of Rosie the Riveter and the WWII Campaign. Frontiers in Sociology. December 2016; 1:16. doi: 10.3389/fsoc.2016.00016
Gordon R, Fitzgerald S, et al. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women. International Journal of Occupational and Environmental Health. September 2014; 20(4): 318-332, doi: 10.1179/2049396714Y.0000000081
Haber S, Haber J. Malignant Mesothelioma: A Clinical Study of 238 Cases. Industrial Health. December 2010; 49(2):166-72. doi: 10.2486/indhealth.MS1147
International Association of Women in Fire & Emergency Services. FAQs on Women in the Fire & Emergency Services.
Mazurek J, Syamlal G, et al. Malignant Mesothelioma Mortality — United States, 1999–2015. MMWR Morb Mortal Wkly Rep. March 2017;66(8):214–218. doi: 10.15585/mmwr.mm6608a3
Metintaş S, Fevzi H, et al. Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program. International Journal of Environmental Research and Public Health. November 2017; 14(11): 1293. doi: 10.3390/ijerph14111293
National Archives. Women in the Work Force during World War II. Updated August 2016.
National Cancer Institute. Mesothelioma Recent Trends in SEER Incidence Rates, 2000-2015 By Sex. Surveillance, Epidemiology, and End Results Program. Updated April 2018.
Taioli E, Wolf A, et al. Women With Malignant Pleural Mesothelioma Have a Threefold Better Survival Rate Than Men. The Annals of Thoracic Surgery. September 2014; 98(3): 1020–1024. doi: 10.1016/j.athoracsur.2014.04.040
Panou V, Vyberg, et al. Malignant mesothelioma in 91 danish women: The environmental asbestos exposure. Journal of Clinical Oncology. May 2017; Suppl: 8560. doi: 10.1200/JCO.2017.35.15_suppl.8560
Wolf A, Richards W. Characteristics of Malignant Pleural Mesothelioma in Women. The Annals of Thoracic Surgery. September 2010; 90(3): 949–956. doi: 10.1016/j.athoracsur.2010.04.110