Mesothelioma in Younger Patients: Doctors Want to Know Why
Research & Clinical Trials
Written by Travis Rodgers | Edited by Amy Edel
A new study from Memorial Sloan Kettering Cancer Center is raising questions about who develops mesothelioma and why. Researchers identified 273 patients with pleural mesothelioma diagnosed at or under the age of 50 who were treated at the center between 1990 and 2023 and found that 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: 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 don’t fit the established profile. The results point to gaps in how risk is understood and whether younger patients are being identified early enough.
Why Are Younger People Getting Mesothelioma?
Memorial Sloan Kettering spotlighted the case of Reicy Bobadilla, MD, to illustrate how unpredictable this disease can be in younger people. An orthopedic surgeon in the Dominican Republic, she 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 what Dr. Offin describes as the first report from a hospital on the growing appreciation of mesothelioma in younger people. Many of those patients, especially those diagnosed under 35, didn’t know how they may have been exposed to asbestos. Women with mesothelioma made up a disproportionately high share of the studied group, and about 70% 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, Dr. Bobadilla had none. Cases like hers are pushing doctors to look more carefully at potential asbestos exposures younger people may have experienced.
How Younger People May Have Been Exposed to Asbestos
Doctors at Memorial Sloan Kettering specifically 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 extensively contained 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 fibers home on 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 through much of the 20th century. People who grew up in older homes with asbestos could have had significant 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.
Early Detection and Treatment for Younger Mesothelioma Patients
According to Memorial Sloan Kettering, Dr. Adusumilli says 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. Dr. Bobadilla’s case illustrates how easy it can be to dismiss those symptoms. She’d been coughing for 2 weeks before colleagues urged her to get a scan, and her first instinct was that they were overreacting.
Early mesothelioma diagnosis changes outcomes. Because Dr. Bobadilla was diagnosed early and was in excellent physical shape, Drs. Adusumilli and Offin told her at their first appointment that her cancer was treatable and her prognosis was very good. She had 4 cycles of chemotherapy, then surgery and a month of daily radiation, continuing to see 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. Dr. Offin noted that younger patients should seek care at a comprehensive cancer center, and that where a patient receives their first 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. For younger patients who do receive a diagnosis, our Patient Advocates can help connect them with specialists, navigate treatment options and find supportive services.
