Patel Krishna, Tuminello Stephanie, Taioli Emanuela
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Institute for Translational Epidemiology, New York, NY, United States.
Front Public Health. 2025 May 22;13:1588415. doi: 10.3389/fpubh.2025.1588415. eCollection 2025.
Although the association between exposure to asbestos and malignant mesothelioma has been established, occupational exposure has been historically present in males, while the ascertainment of female exposures is more nuanced. We reviewed the literature to assess differences in environmental exposure in mesothelioma cases according to sex.
A new PubMed search was conducted with the key words "mesothelioma" and "environmental exposure" on October 11, 2024 with a start date of January 1, 2016, to supplement our previous qualitative review that included publications up through June 2016. Studies conducted in occupational settings were excluded.
Out of the 26 eligible papers, 11 were excluded because they did not report information on exposure by sex, leaving 15 published studies that were added to the 9 from our previous qualitative synthesis (24 total studies). 19 studies were cross-sectional, 2 were cohort and 3 were case control studies. The average NIH Study Quality tool score was 7.4/14 (minimum 3, maximum 12). Occupational exposure was more frequently observed in males than in females. While a male to female ratio favored males, there was variation in the strength of the association. There was a large proportion of cases with "unknown exposure," and these were more frequently observed among female cases. In some studies, up to 40% of female cases had unknown exposure profiles. Quality assessment showed a generalized lack of standardization in the definition of environmental exposures across studies.
Although recent studies have continued to improve our understanding of environmental exposure to asbestos and other elongated fibers, challenges remain, including but not limited to lack of rigorous, high-quality evidence and difficulty standardizing definitions across countries and datasets to enable appropriate comparison across studies.
尽管接触石棉与恶性间皮瘤之间的关联已经确立，但职业接触在历史上一直以男性为主，而女性接触情况的确定则更为微妙。我们回顾了文献，以评估间皮瘤病例中根据性别划分的环境接触差异。
2024年10月11日，以“间皮瘤”和“环境接触”为关键词进行了一次新的PubMed搜索，起始日期为2016年1月1日，以补充我们之前的定性综述，该综述涵盖截至2016年6月的出版物。排除在职业环境中进行的研究。
在26篇符合条件的论文中，11篇因未报告按性别划分的接触信息而被排除，剩下15篇已发表的研究被添加到我们之前定性综合分析中的9篇（共24项研究）。19项研究为横断面研究，2项为队列研究，3项为病例对照研究。国立卫生研究院研究质量工具的平均得分是7.4/14（最低3分，最高12分）。男性比女性更常观察到职业接触。虽然男性与女性的比例有利于男性，但关联强度存在差异。有很大比例的病例“接触情况不明”，且在女性病例中更常观察到这种情况。在一些研究中，高达40%的女性病例接触情况不明。质量评估显示，各研究中环境接触定义普遍缺乏标准化。
尽管最近的研究不断增进我们对石棉和其他细长纤维环境接触的理解，但挑战依然存在，包括但不限于缺乏严格、高质量的证据，以及难以在各国和各数据集之间标准化定义，以便能够在各项研究之间进行适当比较。
