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Nearly 25% of mesothelioma cases in the U.S. occur in women. Women have better survival rates after diagnosis of the asbestos-related cancer than men.
One year after diagnosis, 45% of women are alive versus approximately 38% of men. There are several reasons for the female survival advantage with this cancer.
Doctors use the same diagnostic tools, such as PET scans, biopsies and other tests, to identify mesothelioma in women as those used to diagnose the disease in men.
However, women are somewhat more likely than men to be diagnosed with peritoneal mesothelioma.
A 2018 Italian study used national mesothelioma registry data and found different ratios of female-to-male cases for pleural and peritoneal mesothelioma, too.
Among 16,458 patients, the ratio of female to male cases was 0.38 for pleural disease and 0.70 for peritoneal tumors. This means there were 2.6 cases of pleural mesothelioma in men for each case in women, and 1.4 male cases of peritoneal disease for every female case.
Nearly everyone who develops mesothelioma had prior asbestos exposures.
In exceptionally rare cases, some individuals have developed mesothelioma without ever coming into contact with asbestos. These patients often are young women who develop rare types of the cancer.
Well-differentiated papillary mesothelioma (WDPM), for example, is most commonly diagnosed in women in their 30s. It mostly occurs in the peritoneum, which is the lining of the abdominal cavity. However, the disease has been diagnosed in the pleura, which is the thin lining that covers the lungs.
People diagnosed with WDPM have a better prognosis than typical mesothelioma patients, with life expectancies ranging from three to more than 10 years.
Deciduoid cell is another rare mesothelioma predominantly affecting women. The term deciduoid reflects this cell’s resemblance to cell changes occurring in early pregnancy. It most often occurs in young women. Fewer than 50 cases are documented in medical literature.
All people with mesothelioma face the challenge of misdiagnosis, but women may struggle with this the most. Because the disease remains more common in men, many physicians don’t consider mesothelioma as a possible female diagnosis.
The majority of asbestos exposures occur in the workplace, and historically, these industrial and military jobs weren’t open to women.
Symptoms of early mesothelioma are vague and nonspecific, too. An ongoing cough, intermittent constipation and diarrhea, bloating and pains in the chest and belly are easily written off as less serious diseases.
Pleural mesothelioma patients may be told they have bronchitis, asthma, the flu or pneumonia. Women with the peritoneal type of this cancer may be told its irritable bowel syndrome, menstrual problems or food allergies and intolerances.
Kasie Coleman, who was diagnosed with peritoneal mesothelioma in 2010, represents many of the hundreds of women who receive a late diagnosis because doctors didn’t initially consider the rare cancer. She experienced 18 months of recurring symptoms before learning she had peritoneal mesothelioma.
She urges women to “keep digging” if they feel a diagnosis is inaccurate.
This disease is so rare; it’s not like people are looking for it,” she said. “I would tell women to definitely pay attention to their bodies. I was persistent, and it took a year and a half. I had it the whole entire time.Kasie ColemanPeritoneal mesothelioma survivor
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Depending on the cancer stage at diagnosis and the type of mesothelioma, women have similar treatment options as men:
Women may have treatment advantages over men, however. For example, women tend to be diagnosed at younger ages, which means they are in better health and open to more treatment options.
According to the 2018 ASCO Treatment of Malignant Pleural Mesothelioma guidelines, patients must have adequate cardiovascular (heart) and pulmonary health to withstand aggressive surgeries. Women may be more likely to meet these guidelines than men.
With early-stage disease, typically stages 1 and 2, surgery can be undertaken with a curative intent. Surgeons attempt to remove the entire cancer with the goal of curing the patient, and younger women can be better candidates for this curative option.
If the disease is more advanced and prognosis is poor, patients may opt to use surgery as a palliative option. Palliative treatments are used to alleviate symptoms and improve quality of life, even if the cancer is not expected to be cured.
Women are more likely than men to be diagnosed with peritoneal disease — a more treatable form of mesothelioma than pleural — have a treatment advantage here, too.
A 2021 research study followed 164 women over 21 years and found that 88.9% of patients treated with cytoreductive surgery and heated intraperitoneal chemotherapy lived for over three years. Almost 78% of patients who received this treatment lived for five years or longer.
Heated intraperitoneal chemotherapy (HIPEC) is combined with cytoreductive surgery to remove all visible tumors in many peritoneal mesothelioma cases. This approach has helped many women with peritoneal disease have a good prognosis.
A 2018 International Journal of Hyperthermia study looked at the outcomes of 76 peritoneal mesothelioma patients treated with HIPEC surgery. Median disease-free survival was nearly five years, and median overall survival was more than eight years
Around 45% of this study population — 36 subjects — were women.
Data suggest women generally live longer after pleural mesothelioma surgery than men, too. In one study, doctors reviewed 702 cases of malignant pleural mesothelioma surgery, all of which had the cancerous lung surgically removed.
The case outcomes were evaluated based on the mesothelioma cell type making up the patients’ tumors.
While women with epithelial mesothelioma in this study lived longer after surgery, men and women with nonepithelial tumors had roughly equivalent, post-surgery survival. Both genders had a median life span of about nine to 10 months.
Asbestos exposure occurs in three primary ways.
Most women in the U.S. with mesothelioma were exposed to asbestos through secondary contact or in the environment. Some female patients, however, do have a history of direct occupational or workplace exposure.
Most mesothelioma patients trace their asbestos exposures to holding a particular job such as factory worker, insulator, mechanic and similar industrial occupations. Because asbestos exposure usually occurs in these male-dominated workplaces, patients tend to be older men.
Although U.S. statistics are not readily available, on-the-job exposure is commonly believed to affect far more men than women.
A 2018 study from Italy found men are more often exposed at work, but some female mesothelioma patients came into contact with the cancer-causing mineral on the job, too.
Italian women tended to be exposed in the chemical and plastics industry or working in the nonasbestos textile sector. This last category suggests even when people do not believe they are working with asbestos, they may be exposed to it.
In the U.S., women who experienced job-related exposure may have held positions that were not as labor-intensive as where men have been exposed. For example, there have been reported cases of male and female school teachers who developed mesothelioma.
They were found to have worked in school buildings containing asbestos. Some interior decorators were exposed to asbestos from spray-on asbestos materials. Even bakers have developed mesothelioma because of asbestos in and around ovens.
Cases of female mesothelioma are on the rise in other parts of the world, and many researchers are hoping to develop concrete evidence that women remain highly susceptible to the disease.
Some asbestos experts note environmental exposures can be particularly harmful to women. A 2019 study of occupational and environmental exposures found in the groups of people exposed environmentally, the malignant mesothelioma risk was higher in women.
The study included 21 cohorts of asbestos-exposed individuals in rural areas. The authors concluded the contribution of environmental exposure to mesothelioma development is as important as occupational exposures.
Secondary exposure is the most common method women come into contact with the deadly mineral. Exposure takes place when a friend, family member, or loved one brings asbestos fibers into the home (usually on work clothes) from an exterior setting.
For example, the majority of men who worked in the shipbuilding industry prior to the 1990s were heavily exposed to asbestos and routinely brought asbestos fibers home on their clothing. Due to the jagged structure of asbestos fibers, the tiny particles easily attach to clothing, shoes, skin and hair.
Simply dusting off shoes would release asbestos fibers into the home, and women were especially exposed if they took care of their spouse’s contaminated laundry.
Recent legal cases on talcum powder and its potential contribution to ovarian cancer risk have been in the news. This highlights the connection between talc and asbestos, particularly in hygiene products.
Asbestos and talc are two minerals that can occur in the earth together. This means talc mines can be contaminated with asbestos and vice versa. For women, the primary concern comes from talcum powder used in the home.
But ovarian cancer is only part of the picture. Women can be diagnosed with mesothelioma linked to asbestos exposure from talc products, too.
Because most women have had secondary exposure, they often face a unique set of challenges to obtaining favorable legal judgements and financial compensation.
Coleman explained her frustrations with insurance.
“Honestly, I’m more afraid of insurance than I am of my own body. I think insurance companies need to be more educated,” Coleman said. “They treat all cancers as the same, and they’re not. Mesothelioma is not breast cancer. They’re paying it the same, but it’s not the same.”
Despite these hurdles, some women have had success obtaining legal and financial support for previous asbestos exposures that contributed to their mesothelioma diagnosis.
These cases highlight the importance of expert legal counsel for all women diagnosed with mesothelioma or other asbestos-related cancers.
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