n engl j med
new england journal
Advances in Malignant Mesothelioma
Bruce W.S. Robinson, M.D., and Richard A. Lake, Ph.D.
From the School of Medicine and Pharma-
cology (B.W.S.R., R.A.L.), the Department
of Respiratory Medicine (B.W.S.R.), and the
Western Australian Institute for Medical
Research (B.W.S.R., R.A.L.), Sir Charles
Gairdner Hospital, Nedlands, Perth, Aus-
tralia. Address reprint requests to Dr. Rob-
inson at the School of Medicine and Phar-
macology, 4th Fl., G Block, Sir Charles
Gairdner Hospital, University of Western
Australia, Nedlands, Perth 6009, Australia,
or at email@example.com.
N Engl J Med 2005;353:1591-603.
Copyright © 2005 Massachusetts Medical Society.
alignant mesothelioma is an aggressive tumor of serosal
surfaces, such as the pleura and the peritoneum.
This tumor was once
rare, but its incidence is increasing worldwide, probably as a result of wide-
spread exposure to asbestos, a factor with which it is associated (Table 1).
substantial interest in this disease on the part of the medical community and the gen-
eral public, because millions of people have been exposed to asbestos fibers, and many
articles about the dangers of asbestos have appeared in the press.
In addition to its substantial personal and health care costs, malignant mesothelioma
is associated with compensation costs that are a considerable problem for industry and
government. The predicted total economic burden of malignant mesothelioma relat-
ed to compensation for asbestos exposure in the next 40 years is up to $200 billion
for the United States
and $80 billion for Europe.
In this article we review the key advances in the understanding, diagnosis, and man-
agement of malignant mesothelioma that have occurred in the past 5 to 10 years.
Eighty percent of patients with pleural malignant mesothelioma are male, and patients
commonly present with a