Malignant mesothelioma in females: the institutional failure by WHO and IARC to protect the public health
Malignant mesothelioma in females
A Commentary, published in The Journal of Scientific Practice and Integrity (JoSPI) on August 11,
2023, calls to task both the World Health Organization (WHO) and the International Agency for
Research on Cancer (IARC). It shines a light on their failure to recognize and correct the
misrepresentation of malignant mesothelioma (MM) risk in females exposed to asbestos in Chapters
2 of the Fourth and Fifth Editions of the Blue Book series published in 2015 and 2021, respectively.
The title of the Commentary is “Malignant mesothelioma in females: the institutional failure by
WHO and IARC to protect the public health.” The authors are Xaver Baur, Arthur L. Frank, Corrado
Magnani, L. Christine Oliver, and Colin L. Soskolne. The article is accessible at the following link:
https://doi.org/10.35122/001c.75390. A PDF copy is also attached for ease of access.
The inaccurate statements about the proportion of malignant mesotheliomas attributable to
asbestos in females are as follows: “only about 20%” in North America and France and “<50%” in
western Europe and Australia (Fourth Edition); and “only 20-40%” in the USA and France (Fifth
Edition). That these figures misrepresent the science was shown in a previously published
Commentary by the authors of this more recent Commentary (Bauer X et al. Am J Ind Med. 2021) at
Males and females are at close-to-equal risk for malignant mesothelioma following exposure to
asbestos. What is different is the way in which the exposure had occurred. For males, it is more likely
to have been occupational. For females, asbestos exposure is more likely to have occurred through
household contact or environmental exposures. Carefully detailed exposure histories are needed to
ferret out a history of asbestos exposure and to place physicians and patients on notice about
associated risk for the occurrence of malignant mesothelioma, an aggressive highly fatal and often
misdiagnosed (early on) tumour. Ironically, the Blue Book series has pulmonary physicians,
oncologists, thoracic radiologists, epidemiologists, and cancer registrars as an important audience.
The authors of the most recent Commentary attempted to correct the record by communicating
directly with the authors of the two Chapters as well as the editors of the Fourth and Fifth Editions
of the WHO Classification of Tumours. A corrigendum was requested. In the absence of an
acceptable response, we approached the IARC Editorial Board. Failing to achieve a satisfactory
outcome, we bring our failed attempts and the potential consequences to public attention.
In our efforts to correct the inaccuracies, we discovered what can be described only as gender bias in
the attribution of malignant mesothelioma in females. Identified as a likely contributing factor were
undisclosed conflicting interests. The victims here are at-risk females, their families, and the public
Protecting the public’s health, preventing disease, and promoting well-being in a social justice
context must be the unambiguous goal of education and research in occupational and
environmental health. Even our most august institutions should be open to correction.