Article Text

Download PDFPDF
Original article
Asbestos exposure and histological subtype of malignant mesothelioma
  1. P Franklin1,
  2. H Alfonso2,
  3. A Reid2,
  4. N Olsen1,
  5. K B Shilkin3,
  6. F Brims1,4,
  7. N de Klerk1,5,
  8. A W Musk1,4
  1. 1School of Population Health, University of Western Australia, Nedlands, Western Australia, Australia
  2. 2School of Public Health, Curtin University, Bentley, Western Australia, Australia
  3. 3PathWest, Queen Elizabeth II Medical Centre and University of Western Australia, Nedlands, Western Australia, Australia
  4. 4Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  5. 5Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr P Franklin, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6102, Australia; peter.franklin{at}


Background Malignant mesothelioma (MM) has distinct histological subtypes (epithelioid, sarcomatoid and biphasic) with variable behaviour and prognoses. It is well recognised that survival time varies with the histological subtype of MM. It is not known, however, if asbestos exposure characteristics (type of asbestos, degree of exposure) are associated with different histological subtypes.

Aim To determine if the pathological MM subtype is associated with the type of asbestos or the attributes of asbestos exposure.

Methods Cases of MM for the period 1962 until 2012, their main histological subtype and their most significant source of asbestos exposure were collected from the Western Australian Mesothelioma Registry. Exposure characteristics included, degree of asbestos exposure (including total days exposed, years since first exposure and, for crocidolite only, calculated cumulative exposure), source of exposure (occupational or environmental), form of asbestos handled (raw or processed) and type of asbestos (crocidolite only or mixed fibres).

Results Patients with the biphasic subtype were more likely to have occupational exposure (OR 1.83, 1.12 to 2.85) and exposure to raw fibres (OR 1.58, 1.19 to 2.10). However, differences between subtypes in the proportions with these different exposure characteristics were small and unlikely to be biologically relevant. Other indicators of asbestos exposure were not associated with the histological subtype of mesothelioma.

Conclusions There was no strong evidence of a consistent role of asbestos exposure indicators in determining the histological subtype of MM.

  • exposure

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • PF and HA have joint first authorship.

  • Funding National Health and Medical Research Council (NHMRC) Project grant number 634458.

  • Competing interests None declared.

  • Ethics approval Western Australian Department of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data were made available to us by the Western Australian Mesothelioma Registry and can be obtained by request, and with relevant approvals, through the Department of Health Cancer Registry.