The silent malignant mesothelioma epidemic: a call to action

Malignant mesothelioma, recognised as a new disease in the 1950s, is almost exclusively caused by asbestos exposure and usually diagnosed decades after first exposure. The disease was initially restricted to asbestos workers, but diagnoses after non-occupational exposure continue to surge. Despite the acknowledgment by WHO and the International Agency for Research on Cancer (IARC), more than 40 years ago, that all forms of asbestos are carcinogenic, global asbestos use increased exponentially,1 leading to an almost ubiquitous presence of these minerals in homes, commercial buildings, ships, vehicles, and thousands of products. When asbestos bans were introduced in Europe and Australia, their use surged in countries where traders suggested that chrysotile asbestos were safe.2 Despite mounting evidence of the carcinogenicity, many countries have yet to recognise the urgency of banning asbestos and do not support WHO's aim of reducing or ending the incidence of asbestos-related cancers (figure 1). Representatives of ten countries—Russia, Kazakhstan, Syria, Zimbabwe, Kyrgyzstan, Venezuela, Pakistan, Cuba, India, and Iran—continue to block a 15-year-old UN motion to label chrysotile asbestos as especially hazardous. As the global malignant mesothelioma epidemic shows no sign of abating,3, 4 oncologists should reinforce the idea that the continued harm caused by asbestos cannot be reduced without ceasing all asbestos mining and trade, increasing public awareness, enforcing regulations, and improving diagnosis and treatment. In this Essay, we re-examine how asbestos has silently caused a global epidemic and summarise mesothelioma carcinogenesis, prevention, and novel treatments. The role of the pro-asbestos lobby will be exemplified. Further reading can be found in the appendix.