Abstract
BACKGROUND: Although the association between exposure to asbestos and malignant mesothelioma has been established, occupational exposure has been historically present in males, while the ascertainment of female exposures is more nuanced. We reviewed the literature to assess differences in environmental exposure in mesothelioma cases according to sex. METHODS: A new PubMed search was conducted with the key words "mesothelioma" and "environmental exposure" on October 11, 2024 with a start date of January 1, 2016, to supplement our previous qualitative review that included publications up through June 2016. Studies conducted in occupational settings were excluded. RESULTS: Out of the 26 eligible papers, 11 were excluded because they did not report information on exposure by sex, leaving 15 published studies that were added to the 9 from our previous qualitative synthesis (24 total studies). 19 studies were cross-sectional, 2 were cohort and 3 were case control studies. The average NIH Study Quality tool score was 7.4/14 (minimum 3, maximum 12). Occupational exposure was more frequently observed in males than in females. While a male to female ratio favored males, there was variation in the strength of the association. There was a large proportion of cases with "unknown exposure," and these were more frequently observed among female cases. In some studies, up to 40% of female cases had unknown exposure profiles. Quality assessment showed a generalized lack of standardization in the definition of environmental exposures across studies. CONCLUSION: Although recent studies have continued to improve our understanding of environmental exposure to asbestos and other elongated fibers, challenges remain, including but not limited to lack of rigorous, high-quality evidence and difficulty standardizing definitions across countries and datasets to enable appropriate comparison across studies.