Mesothelioma Risk Factors
What are the risk factors for mesothelioma?
Asbestos
The main risk factor for developing mesothelioma is exposure to
asbestos. Asbestos refers to a family of magnesium-silicate mineral
fibers. In the past, asbestos was used widely for insulation because
it does not conduct heat well and it is resistant to melting or
burning. As the link between asbestos and mesothelioma has become
well known, the use of this material has decreased. However, up
to 8 million Americans may already have been exposed to asbestos.
According to the United States Environmental Protection Agency,
as many as 733,000 schools and public buildings in the country today
contain asbestos insulation. As many as 10% to 15% of schools in
the United States may contain asbestos insulation. People who may
be at risk for occupational asbestos exposure include some miners,
factory workers, insulation manufacturers, railroad workers, ship
builders, gas mask manufacturers, and construction workers, particularly
those involved with installing insulation. Several studies have
shown that family members of people exposed to asbestos at work
have an increased risk of developing mesothelioma, because asbestos
fibers are carried home on the clothes of the workers.
There are two main forms of asbestos -- serpentine and amphiboles.
Serpentine fibers are curly and pliable. Chrysotile is the only
type of serpentine fiber and it is the most widely used form of
asbestos. Amphiboles are thin, rod-like fibers of which there are
5 main types-crocidolite, amosite, anthrophylite, tremolite, and
actinolyte. Amphiboles (particularly crocidolite) are considered
to be the most carcinogenic (cancer-causing). However, even the
more commonly used chrysotile fibers have been associated with malignant
(cancerous) mesotheliomas and should be considered dangerous as
well.
It may be that asbestos causes cancer by physically irritating
cells rather than by a chemical effect. When fibers are inhaled,
most are cleared in the nose, throat, trachea (windpipe), or bronchi
(large breathing tubes of the lungs). Fibers are cleared by sticking
to mucus inside the air passages and being coughed up or swallowed.
The long, thin, fibers are less readily cleared, and they may reach
the ends of the small airways and penetrate into the pleural lining
of the lung and chest wall. These fibers may then directly injure
mesothelial cells of the pleura, and eventually cause mesothelioma.
Asbestos fibers can also damage cells of the lung and result in
asbestosis (formation of scar tissue in the lung), and/or lung cancer.
The risk of lung cancer among people exposed to asbestos is increased
by 7 times, compared with the general population. Indeed, asbestosis,
mesothelioma, and lung cancer are the three most frequent causes
of death and disease among people with heavy asbestos exposure.
Peritoneal mesothelioma, which forms in the abdomen, may result
from coughing up and swallowing inhaled asbestos fibers. Cancers
of the larynx, pancreas, esophagus, colon, and kidney have also
been linked to asbestos exposure, but the increased risk is not
as great as with lung cancer.
The risk of developing a mesothelioma is related to how much asbestos
a person was exposed to and how long this exposure lasted. People
exposed at an early age, for a long period of time, and at higher
levels are most likely to develop this cancer. Mesotheliomas take
a long time to develop. The time between exposure to asbestos and
diagnosis of mesothelioma is usually between 20 and 40 years.
Although the risk of developing mesothelioma rises with the amount
of asbestos exposure, it is clear that genetic factors also play
a role in determining who develops the disease. This explains why
not all persons exposed to high levels of asbestos dust develop
mesothelioma.
Radiation
There have been a few published reports of pleural and peritoneal
mesotheliomas that developed following exposure to thorium dioxide
(Thorotrast). This material was used in the past by doctors for
certain x-ray tests. Because Thorotrast was found to cause cancers,
it has not been used for many years.
Zeolite
This is a silicate mineral, chemically related to asbestos, common
in the soil of the Anatoli region of Turkey. A few cases of mesothelioma
have been described in this region and may have been caused by this
mineral.
Simian Virus 40 (SV40)
This virus has recently been identified by researchers in human
mesothelioma cells, and has been shown to induce mesothelioma in
the animal model. Polio vaccines administered as a primary prevention
measure during 1955 - 1961 have been shown to be contaminated with
SV40. However the implications of these facts are not totally understood
and further research will be needed to clarify the link between
malignant mesothelioma and a viral etiology.
Tobacco
Although tobacco smoking has not been associated with the development
of mesotheliomas, the combination of smoking and asbestos exposure
greatly increases the risk of lung cancer. Asbestos workers who
also smoke have a lung cancer risk 50 to 90 times greater than that
of the general population. More asbestos workers die of lung cancer
than of mesothelioma.
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