A new study from Memorial Sloan Kettering Cancer Center is raising questions about who develops mesothelioma and why. Researchers identified 273 pleural mesothelioma patients at or under the age of 50 who were treated at the center between 1990 and 2023 and found many had no occupational asbestos exposure history, including a significant share of women. For decades, mesothelioma has been documented primarily in men with direct occupational asbestos exposure including military veterans and former workers in construction, shipbuilding, and manufacturing. With a latency period of 20 to 60 years from initial exposure to diagnosis, patients are typically older than 65. For physicians, the data raises practical questions about risk assessment and early detection of pleural mesothelioma in patients who didn’t fit the established profile. The results point to gaps in how risk is understood and whether younger patients are being identified early enough.
Memorial Sloan Kettering spotlighted the case of a doctor in the Dominican Republic to showcase how unpredictable the disease can be in younger people. An orthopedic surgeon in the Dominican Republic was 43 when colleagues urged her to get a scan for a persistent cough. She had no family history of cancer, no known genetic predisposition and hadn’t identified a known source of asbestos exposure. Her diagnosis was mesothelioma. The study, published in JCO Precision Oncology, is the first report on the growing appreciation of mesothelioma in younger people. Many of those patients, especially those diagnosed under the age of 35, did not know they may have been exposed to asbestos. Women with mesothelioma made up a disproportionately high share of the studied group, and about 70 percent had a family history of cancer, most often breast, lung, or colon cancer. Experts have long established that asbestos exposure is the primary cause of mesothelioma. Certain inherited gene mutations like those in BAP1 and BRCA1/BRCA2 may add to the risk of someone exposed to asbestos developing mesothelioma. While this study found mutations in some younger patients, the doctor had none. Cases like hers are pushing doctors to look more carefully at potential asbestos exposures younger people may have experienced.
Doctors at Memorial Sloan Kettering pointed to the collapse of the World Trade Center towers on September 11, 2001, as a possible asbestos exposure source for the younger patient population. The towers contained an extensive amount of asbestos building materials, and their destruction released a massive cloud of toxic dust into the air, exposing hundreds of thousands of people. Because mesothelioma typically takes 20 to 60 years to develop after exposure, children exposed in the wake of September 11 are entering the window when symptoms could become more pronounced. Secondary exposure is another possibility. First responders and recovery workers faced the heaviest exposure from 9/11 and could have unknowingly brought asbestos home on their clothing., skin, or hair. Family members who regularly worked around asbestos in firefighting, construction, or manufacturing could have unknowingly brought fibers home as well. Older apartment buildings, homes, and military housing also often contain legacy asbestos. The mineral was widely used in construction materials throughout much of the 20th century. People who grew up in older homes with asbestos could have had extensive exposure. Baby powder containing asbestos-contaminated talc was widely used on infants and children for decades. Talc has also been a primary ingredient in makeup and other personal hygiene products. Asbestos and talc form near each other and talc can become contaminated when mined. Studies have linked asbestos-contaminated cosmetic talc to mesothelioma cases where it was the only identified source of exposure.
According to Memorial Sloan Kettering, the medical community should consider mesothelioma when a younger person presents with symptoms like a persistent cough, chest pain, or shortness of breath that doesn’t improve with antibiotics. The above doctor’s case illustrates how easy it can be to dismiss those symptoms. She had been coughing for two weeks before colleagues urged her to get a scan, and her first instinct was that they were overreacting. Early mesothelioma diagnosis changes outcomes. Because the doctor was diagnosed early and was in excellent physical shape, she was told that her cancer was treatable and her prognosis was very good. She had four cycles of chemotherapy, then surgery and a month of daily radiation, continuing to see her patients and performing surgeries throughout her treatment. Her most recent scans show no signs of the cancer returning. Mesothelioma treatment for someone in their 30s or 40s can differ significantly from treatment for a patient in their 70s. Doctors can analyze tumor tissue to identify specific characteristics of the cancer cells and match patients to targeted therapies or clinical trials. Younger patients should seek care at a comprehensive cancer center. Where a patient first receives treatment matters. The study’s authors hope their findings push the medical community to think differently about who gets mesothelioma and how quickly it gets identified.
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