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Asbestos may cause as many as 600 cases of mesothelioma in American women each year. This is far lower than the number of cases in men. Women also experience mesothelioma differently. They tend to have better survival, fewer treatment complications and less occupational asbestos exposure than men.


01. Overview

How Is Mesothelioma in Women Different Than in Men?

Asbestos exposure causes malignant mesothelioma in women and men. However, there are a number of differences among mesothelioma cases in women versus men.

For instance, women account for a greater proportion of peritoneal mesothelioma cases than pleural. The opposite is true for men.

Mesothelioma in women has several other distinguishing characteristics.

Women tend to have better survival than men in cases of peritoneal and pleural mesothelioma. Female mesothelioma patients also seem to present certain symptoms more often than men. These include coughing and chest pain.

02. Survival and Prognosis

Survival for Women With Mesothelioma

Survival in mesothelioma patients depends on a number of factors. These include mesothelioma stage, treatment protocol and patient health. However, female gender has been generally associated with prolonged survival for mesothelioma patients. Researchers have observed this in both pleural and peritoneal mesothelioma cases.

Types of Mesothelioma

Mesothelioma can form in three places for women:

  • The Pleura: Mesothelioma can form in the external lining around the lungs
  • The Peritoneum: Mesothelioma can form in the lining surrounding the lower abdomen
  • The Pericardium: Mesothelioma can form in the lining surrounding the heart

Pleural Mesothelioma

The median survival for pleural mesothelioma patients undergoing treatment is around 18 months. Reported survival for women with pleural mesothelioma is even more favorable.

One study examined pleural mesothelioma cases from 1987 to 2008. In this study, patients underwent surgical treatment. Women achieved a median survival better than 30 months, exceeding the survival reported for patients of all genders.

Peritoneal Mesothelioma

Peritoneal mesothelioma patients undergoing treatment have achieved median survival ranging from two to more than six years.

However, experts have reported even better survival for women specifically. One study looked at peritoneal mesothelioma patients undergoing multimodal treatment. Men in the study had a median survival of 41 months. Women in the same study had a median survival of approximately ten years.

That means female patients in the study lived nearly three times as long as the men in the study.

5-Year Survival Rate for Women With Mesothelioma Versus Men

Gender 5-Year Survival Rate
Women 17.7%
Men 7.1%

Source: The National Cancer Institute, Cancer Statistics Review 1975 – 2017
Note: These survival rates include all reported forms of mesothelioma. The rates may include patients who chose not to undergo therapeutic treatment for mesothelioma.

Factors Affecting Survival in Women With Mesothelioma

Experts have suggested explanations for better survival rates in women with mesothelioma compared to men. Some theorize women seek medical attention at an earlier point than men. Thus, women may be diagnosed at an earlier stage. With early detection, patients may have more viable, aggressive treatment options. As a result, diagnosis at an earlier stage may lead to improved life expectancy for mesothelioma.

Other experts note women tend to have tumors with favorable characteristics. For example, women accounted for approximately 21% of pleural mesothelioma cases in one study. Female participants also accounted for 25% of epithelioid tumors in the study. For reference, epithelioid mesothelioma is generally associated with a more favorable prognosis than non-epithelioid cell types.

Mesothelioma occurs in three histological cell types: epithelioid, sarcomatoid and biphasic. Women may be more prone to the epithelioid cell type than others.

Women may also develop certain rare mesothelioma cell types more often than men. For instance, well-differentiated papillary mesothelioma (WDPM) occurs most frequently in women of reproductive age. In one study, patients with WDPM had a five-year survival rate of 90% with treatment.

This tendency to develop favorable mesothelioma cell types may contribute to women’s superior survival in mesothelioma.

Some researchers propose that estrogen may affect mesothelioma prognosis. They point to the existence of estrogen receptor-beta on tumor cells. The effect of women’s circulating estrogen on this receptor may slow the growth of tumor cells. By slowing tumor growth, estrogen may help women achieve superior survival in mesothelioma compared to men.

03. Symptoms

Mesothelioma Symptoms in Women

The symptoms of mesothelioma in women and men can vary based upon the type, stage and location of the tumor. In the early stages, patients may not have symptoms at all. When symptoms do arise, some have been reported as more frequent in women than men.

For instance, in one study, researchers found female pleural mesothelioma patients experienced higher rates of certain symptoms compared to men.

Pleural Mesothelioma Symptoms in Women Versus Men

  • Cough: Reported in 82% of women versus 33% of men
  • Chest pain: Reported in 73% of women versus 28% of men
  • Pleural plaques: Reported in 36% of women versus 72% of men

Source: Journal of Thoracic Oncology

Peritoneal Mesothelioma Symptoms in Women

The symptoms of peritoneal mesothelioma differ from those of pleural mesothelioma. Women diagnosed with peritoneal mesothelioma have reported the following symptoms:

  • Abdominal/pelvic pain
  • Abdominal swelling/bloating
  • Diarrhea
  • Vomiting
  • Bowel obstruction
  • Swelling of the lymph nodes above the collar bone (supraclavicular lymphadenopathy)
  • Fever
  • Weight loss
  • Fatigue
  • Neck pain
  • Ascites/peritoneal effusion (fluid collecting in the abdominal cavity)

The symptoms above were reported by women, but men could experience the same symptoms. Men and women experiencing any of the symptoms above should report past asbestos exposure to their doctor. This can help the doctor determine an accurate diagnosis.

How Long Does It Take for Symptoms to Arise?

The latency period is the amount of time between asbestos exposure and the development of mesothelioma. Reported latency periods range from about 10 to 50 years. Multiple studies have reported differences in latency between men and women.

Women experienced a latency period about six years longer than men in one study. In a different study, researchers found the opposite in peritoneal mesothelioma. Women had a latency period nine years shorter than that of men.

Given this conflicting information, the difference in latency between men and women is unclear. Regardless, all individuals with past asbestos exposure have an elevated risk of lung cancer and other asbestos-related conditions.

04. Diagnosis

Diagnosis and Misdiagnosis of Women With Mesothelioma

Mesothelioma diagnosis in women follows the same steps as diagnosis of mesothelioma in general. Doctors administer various tests to diagnose mesothelioma, including imaging scans and biopsies. These tests determine the cause of symptoms, rule out other illnesses and help doctors make a definitive mesothelioma diagnosis.

However, women with peritoneal mesothelioma have experienced substantial rates of misdiagnosis in the past. This may be due to a number of factors, including the lengthy latency period and the ambiguous nature of certain symptoms.

Women with known asbestos exposure should report their history to a physician. This can help the doctor narrow down the true cause of the patient’s symptoms.

General Diagnostic Steps for Mesothelioma in Women

Diagnosis of mesothelioma may include any of the following:

  • Physical examination: May help rule out more common conditions
  • Blood tests: May help rule out other conditions
  • Imaging scans: May include X-rays, CT scans, MRI scans and PET scans
  • Biopsies: Can definitively confirm a mesothelioma diagnosis by analyzing tumor tissue

Misdiagnosis of Mesothelioma in Women

Given the nature of mesothelioma symptoms, misdiagnosis is a possibility for any patient. At least one study demonstrates this point in peritoneal mesothelioma among women. Nearly half of the women in the study were initially misdiagnosed. These misdiagnoses included cancerous and non-cancerous conditions.

Despite the misdiagnoses, more than 74% of the study patients survived for three years or more.

Patients should still proactively report any known asbestos exposure to their doctor. A health care professional can help monitor for signs of mesothelioma and other asbestos illnesses. This can aid early diagnosis. Patients diagnosed in earlier stages tend to have more treatment options and better survival.

05. Treatment

Treatment Options for Women With Mesothelioma

Women with mesothelioma have the same treatment options as any other mesothelioma patient. Mesothelioma doctors often recommend a multimodal treatment approach. This approach has been successful in extending survival.

Surgery

Surgical treatment for mesothelioma can take many forms. Some minor surgeries, such as pleurocentesis, are used palliatively to alleviate symptoms. More invasive procedures, such as cytoreductive surgery, physically remove as much tumor as possible. Doctors often incorporate surgery within a multimodal treatment plan.

Chemotherapy

Chemotherapy treatment uses chemicals to kill fast-growing cells. Chemotherapy damages and kills cancer cells, but healthy cells can also be affected. As such, chemotherapy may cause substantial side effects. Heated intraperitoneal chemotherapy (HIPEC) treats cancer within the abdomen, such as peritoneal mesothelioma. Median survival in HIPEC studies ranges from 53 to 77 months.

Radiation

Radiation uses a beam of high energy to kill cancer cells. Doctors have used radiation more often in pleural than peritoneal mesothelioma. Radiation therapy is often part of a multimodal treatment strategy.

Multimodal Treatment

Multimodal treatment entails combining more than one form of mesothelioma treatment. Clinical trials are currently testing combinations that include newer therapies such as immunotherapy and photodynamic therapy.

06. Asbestos Exposure

Asbestos Exposure in Women

Female mesothelioma patients most often experience secondary exposure. However, they can also be exposed to asbestos on the job. Experts refer to this form of asbestos exposure as occupational exposure. Regardless of exposure source, there is no safe level of contact with asbestos.

Women may face an increased risk of mesothelioma from smaller instances of exposure compared to men. Researchers believe the heightened danger stems from lung size differences. Women generally have smaller lungs and tracheae than men. The smaller respiratory systems cause greater fiber retention than larger male lungs.

Non-Occupational Exposure

Researchers attribute most mesothelioma cases in women to asbestos exposure outside of work. One study investigated asbestos exposure in 91 women with mesothelioma. About 64% of those women had non-occupational asbestos exposure.

In the United States, women may have encountered asbestos when laundering their husband’s work clothing. Such work clothes could have carried asbestos fibers or dust into the home. Those fibers and dust could easily become airborne. Thus, women and children in the home could have been exposed to asbestos.

Heather Von St. James’ Secondary Exposure Led to Mesothelioma Diagnosis

Long-time mesothelioma survivor Heather Von St. James faced secondhand exposure. Her father worked with asbestos products. He often came home with a coat covered in asbestos dust. Heather frequently wore the coat during her chores. This 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. She received treatment, which included aggressive surgery and chemotherapy. She is now living cancer free and continues to share her story with others. Heather uses her story to spread awareness about mesothelioma and the risks of asbestos exposure.

Across the globe, domestic duties frequently led to women’s exposure to asbestos. One such instance was in Turkey. Some villages made a habit of whitewashing homes with asbestos-containing soil. In one Turkish village, the average annual incidence rate of malignant pleural mesothelioma was:

  • 114.8 per 100,000 male villagers
  • 159.8 per 100,000 female villagers

Researchers have suggested this higher rate of mesothelioma in women may be due to higher asbestos exposure. Whitewashing with asbestos may have exposed the village women to sustained, high levels of asbestos. These levels may have been in excess of those experienced by the men.

Talcum Powder, Asbestos and Women

In addition to domestic work-related asbestos exposure, some women experienced asbestos exposure from talcum powder. Studies have shown certain talc products may be contaminated with asbestos fibers. Repeated use of these products may have allowed for inhalation of asbestos fibers.

One study linked a woman’s mesothelioma to her use of talcum powder. Researchers identified amosite asbestos fibers in the talc product. Posthumous analysis revealed similar fibers in the woman’s lungs.

A more recent study examined mesothelioma cases in 75 individuals with a history of talcum powder use. Experts analyzed tissue samples from 11 of these individuals. Tissue samples from all 11 patients contained asbestos. The authors attributed the presence of asbestos fibers to talcum powder usage.

Experts have linked cases of mesothelioma, lung cancer and ovarian cancer to asbestos-contaminated talc.

Compensation for Asbestos-Contaminated Talc

Many women used Johnson & Johnson’s talcum powder products for decades. Some of these products tested positive for asbestos as early as the 1970s.

In one case, a woman used Johnson & Johnson Baby Powder and Shower to Shower for years. Then she was diagnosed with pleural mesothelioma.

In 2017, the victim joined the ranks of more than 22,000 women who have filed lawsuits against Johnson & Johnson. At trial, her lawyers presented evidence showing Johnson & Johnson knew their products contained asbestos.

The court initially awarded the plaintiff $325 million in legal damages, but Johnson & Johnson appealed. The New York Supreme Court lowered the award to $120 million.

Compensation in cases like this can help cover medical costs, lost wages and other financial impacts of mesothelioma.

Workplace Asbestos Exposure

Historically the number of women in high-risk asbestos occupations has been minimal compared to men. However, 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. Asbestos usage as a fire retardant was rising at this time. In Mobile, Alabama, alone, 90,000 women became factory workers and shipyard workers. These workers were among the most at risk of exposure. 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, there are more than 6,000 female firefighters working full time in the United States today.

These women put their lives on the line in order to keep Americans safe from blazes. 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.

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