Mesothelioma remains deadly despite declining asbestos exposure rates

Mesothelioma deaths and diagnoses continue to rise in the United States despite decades of asbestos regulation and reduced industrial use, according to a new national analysis from Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. The study also found little improvement in survival and showed that this overwhelmingly preventable cancer continues to disproportionately affect women and several high-risk states tied to shipbuilding, mining and legacy asbestos exposure.

Mesothelioma is often described as a disease of the past, an echo of an era when asbestos was woven into ships, factories and buildings across the country. But the new study shows that this rare cancer still casts a long and uneven shadow across the United States, shaped by geography, sex and decades‑old exposures that continue to surface today.

Chinmay Jani, M.D., chief fellow at Sylvester and co-lead author of the studyMesothelioma behaves like a time capsule. What we're seeing today reflects exposures that happened 30 or 40 years ago, and in some cases, exposures that are still happening in quieter, less visible ways."

At first glance, the national trend appears encouraging. Age‑standardized incidence and mortality rates for mesothelioma declined by roughly one‑third over the 33‑year study period, mirroring decades of asbestos regulation and reduced industrial use.

But those falling rates mask a more serious reality. Because the U.S. population has grown and aged, the number of people diagnosed with mesothelioma increased by nearly 30%, and annual deaths climbed as well. The disease's disability burden, measured in disability‑adjusted life years (DALYs), also rose, up 14% since 1990.

"Declining rates don't necessarily mean fewer lives affected," said Kyle Edwards, co-lead author and M.D./M.P.H. student at the University of Miami Miller School of Medicine. "When you look at absolute numbers and disability, mesothelioma remains a substantial public health problem."

The study uncovered stark differences between men and women, differences that are widening rather than closing.

Among men, both incidence and mortality rates fell sharply, reflecting the gradual aging out of cohorts historically exposed to asbestos in shipbuilding, construction and insulation work. Among women, however, declines were modest and often statistically insignificant. In fact, female incidence increased in 20 states, and female mortality rose in 18 states, particularly in parts of the Midwest and Appalachia.

This divergence points toward exposure pathways that extend beyond the factory floor.

"For women, mesothelioma often doesn't come with a neat occupational history," said Estelamari Rodriguez, M.D., M.P.H., clinical research lead of the Thoracic Oncology Site Disease Group at Sylvester. "Environmental exposure, para‑occupational exposure from family members and legacy asbestos in schools, homes and public buildings likely play a much larger role."

Where a person lives still matters profoundly for mesothelioma risk.

States such as Maine, Alaska, Washington and Minnesota consistently carried the highest incidence, mortality and disability burdens in 2023. Each tells a different story: shipyards along the Atlantic and Pacific coasts; naturally occurring asbestos disturbed during construction; or mineral fibers associated with iron ore mining.

National averages, the authors note, can blur these place‑based risks. The map of mesothelioma in the United States looks less like a smooth gradient and more like a patchwork quilt, stitched together by local industry, geology and history.

"Mesothelioma is a geographic disease," Jani said. "State‑level data allow us to see where prevention, remediation and surveillance efforts are most urgently needed."

Perhaps the most sobering finding lies in what has not changed. Across three decades, the mortality-to-incidence ratio, a population‑level proxy for survival, remained stubbornly high, hovering near 1. In practical terms, this means that most people diagnosed with mesothelioma still die from it, and population‑level survival gains have been minimal.

Even as new therapies, including immune checkpoint inhibitors, have entered clinical practice in recent years, their impact has not yet shifted outcomes at a national scale.

"From a patient's perspective, this is the hardest message," said Gilberto Lopes, M.D., Sylvester's chief of medical oncology. "Despite all our scientific advances, mesothelioma remains one of the most lethal solid tumors."

The study also reaffirmed a critical truth: mesothelioma is overwhelmingly preventable. In 2023, nearly 96% of U.S. mesothelioma deaths were attributable to occupational asbestos exposure, a proportion that has changed little since 1990.

That persistence reflects the durability of asbestos embedded in older buildings, ships and infrastructure, and the reality that the United States has never fully banned its use.

The authors argue that reducing mesothelioma's future burden will require a dual approach: continued vigilance in asbestos remediation and environmental protection, alongside sustained investment in more effective treatments.

"Mesothelioma reminds us that prevention and treatment are inseparable," said Lopes. "We have to keep people from being exposed in the first place, while also doing better for those who are diagnosed."

Together, these findings challenge the notion that mesothelioma is simply fading away. Instead, the disease is evolving, shifting across populations and places, shaped by legacy exposures and modern inequities.

For clinicians, the message is clear: maintain awareness of mesothelioma in women and in patients without obvious occupational exposure. For researchers, the persistently high fatality rates signal an urgent need for new therapeutic breakthroughs.

"Mesothelioma reminds us that the consequences of exposure can last a lifetime-but so can our responsibility to patients. By understanding where this disease still concentrates and who it continues to affect, we move closer to a future where prevention is stronger, treatments are more effective, and no community is left behind," said Jani.

Source:

University of Miami Miller School of Medicine

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