Malignant mesothelioma in females: the institutional failure by WHO and IARC to protect public health

Abstract

Malignant mesothelioma (MM) is a highly aggressive and difficult-to-diagnose tumor that is almost always caused by asbestos or other asbestiform fibers. Chapter 2 in the Fourth (2015) and Fifth (2021) Editions of the WHO/IARC Classification of Tumours is devoted to the classification and pathologic diagnosis of MM. The authors of these Chapters state that most of the cases of MM in females do not show asbestos as the cause when, in fact, the epidemiologic literature shows that the risk of MM in females exposed to asbestos approaches that in males. While it is correct that the overall incidence of MM in females is lower than in males, the view that MM in females is not caused by asbestos is unsupported. This view results from an inadequate occupational history, the failure to recognize the importance of environmental exposures, and the misrepresentation of published literature by the selection of limited literature and biased bibliographies, often by authors with financial conflicting interests. In this article, we present an example of the institutional failure (1) to protect the public health by permitting the publication of inaccurate statements about the adverse health effects of exposure to asbestos among females, and (2) to make suggested corrections that more accurately reflect reality. Responsibility for correcting the misinformation lies, in our assessment, both with the authors of the erroneous statements and with the editors and publisher of the books that contain these statements. At issue is nothing less than scientific accuracy, the fate of at-risk females for whom early diagnosis could result in improved health outcome, a missed opportunity to promote primary and secondary prevention, and the social injustice of the loss of compensation for females so affected. We describe the steps that we took to correct the inaccuracies, and to expose the dereliction of duty among responsible parties based, at least in part, on what we believe to be undisclosed conflicting interests. Our efforts failed.