On November 9 and 10, 2015, the International Conference on
Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii
Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of
Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating
malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group's efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure,
biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated
protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated
protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to
asbestos and related
mineral fibers. MM is an almost entirely preventable
malignancy as it is most often caused by exposure to commercial
asbestos or
mineral fibers with
asbestos-like health effects, such as
erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed
asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial
asbestos,
erionite, and other
mineral fibers in soil or rock (termed naturally occurring
asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to
asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood
biomarker validated to be effective for use in screening and identifying MM at an early stage in
asbestos/NOA-exposed populations is not currently available, novel
biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard
chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM.