Mesothelioma in Australia: a review

Arthur (Bill) W Musk, Nicholas de Klerk and Fraser J Brims
Med J Aust 2017; 207 (10): . || doi: 10.5694/mja17.00397
Published online: 13 November 2017



  • The incidence of malignant mesothelioma in Australia is among the highest in the world as a result of widespread use of asbestos by industry and in construction throughout the 20th century.
  • The risk of developing malignant mesothelioma after asbestos exposure is dose-related; a transient, low dose exposure confers a correspondingly very low risk of disease.
  • Malignant mesothelioma is a heterogeneous disease, partly explaining the limited role of biomarkers in screening and diagnosis.
  • The prognosis remains poor, and early advice on medico-legal compensation and a collaborative team approach to managing malignant mesothelioma are both essential.
  • Chemotherapy can have a modest treatment effect in some people. New therapies, such as immunotherapy, do not yet have a defined role in the treatment of malignant mesothelioma.
  • As treatment options for malignant mesothelioma are limited and no cure is available, there is no established role for early detection or screening of at risk populations.
  • A multidisciplinary approach to caring for patients with malignant mesothelioma and their carers is vital.


  • 1 Sir Charles Gairdner Hospital, Perth, WA
  • 2 Telethon Kids Institute, University of Western Australia, Perth, WA
  • 3 University of Western Australia, Perth, WA


Competing interests:

No relevant disclosures.

  • 1. Australian Mesothelioma Registry, Monash Centre for Occupational and Environmental Health. Mesothelioma in Australia 2015: 5th annual report. Canberra: AMR, 2016. (accessed Sept 2017).
  • 2. Berry G, Reid A, Aboagye-Sarfo P, et al. Malignant mesotheliomas in former miners and millers of crocidolite at Wittenoom (Western Australia) after more than 50 years follow-up. Br J Cancer 2012; 106: 1016-1020.
  • 3. Olsen NJ, Franklin PJ, Reid A, et al. Increasing incidence of malignant mesothelioma after exposure to asbestos during home maintenance and renovation. Med J Aust 2011; 195: 271-274. <MJA full text>
  • 4. Landrigan P. The third wave of asbestos disease: exposure to asbestos in place. Ann NY Acad Sci 1991; 643: xv-xvi.
  • 5. Flanagan D. Asbestos. In: US Geological Survey. Mineral commodity summaries 2017. Reston (VA): US Department of the Interior, Geological Survey, 2017; pp. 28-29. (accessed Sept 2017).
  • 6. de Klerk N, Alfonso H, Olsen N, et al. Familial aggregation of malignant mesothelioma in former workers and residents of Wittenoom, Western Australia. Int J Cancer 2013; 132: 1423-1428.
  • 7. Hodgson JT, Darnton A. The quantitative risks of mesothelioma and lung cancer in relation to asbestos exposure. Ann Occup Hyg 2000; 44: 565-601.
  • 8. Franklin P, Alfonso H, Reid A, et al. Asbestos exposure and histological subtype of malignant mesothelioma. Occup Environ Med 2016; 73: 749-752.
  • 9. Testa JR, Cheung M, Pei J, et al. Germline BAP1 mutations predispose to malignant mesothelioma. Nat Genet 2011; 43: 1022-1025.
  • 10. De Klerk NH, Musk AW. Epidemiology of mesothelioma. In: Robinson BWS, Chahinian AP, editors. Mesothelioma. London: Martin Dunitz; 2002; pp. 339-350.
  • 11. Musk AW, de Klerk NH, Ambrosini GL, et al. Vitamin A and cancer prevention. I. Observations in workers previously exposed to asbestos at Wittenoom, Western Australia. Int J Cancer 1998; 75: 355-361.
  • 12. Alvarez JM, Hasani A, Segal A, et al. Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy. ANZ J Surg 2009; 79: 734-738.
  • 13. Hasani A, Alvarez JM, Wyatt JM, et al. Outcome for patients with malignant pleural mesothelioma referred for trimodality therapy in Western Australia. J Thorac Oncol 2009; 4: 1010-1016.
  • 14. Brims FJ, Murray CP, de Klerk N, et al. Ultra-low-dose chest computer tomography screening of an asbestos-exposed population in Western Australia. Am J Respir Crit Care Med 2015; 191: 113-116.
  • 15. Reid A, de Klerk N, Ambrosini G, et al. The additional risk of malignant mesothelioma in former workers and residents of Wittenoom with benign pleural disease or asbestosis. Occup Environ Med 2005; 62: 665-669.
  • 16. Creaney J, Olsen NJ, Brims F, et al. Serum mesothelin for early detection of asbestos-induced cancer malignant mesothelioma. Cancer Epidemiol Biomarkers Prev 2010; 19: 2238-2246.
  • 17. Pass HI, Levin SM, Harbut MR, et al. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med 2012; 367: 1417-1427.
  • 18. Creaney J, Dick IM, Meniawy TM, et al. Comparison of fibulin-3 and mesothelin as markers in malignant mesothelioma. Thorax 2014; 69: 895-902.
  • 19. Muruganandan S, Alfonso H, Franklin P, et al. Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma. Br J Cancer 2017; 116: 703-708.
  • 20. Musk AW, Olsen N, Alfonso H, et al. Predicting survival in malignant mesothelioma. Eur Respir J 2011; 38: 1420-1424.
  • 21. Brims FJ, Meniawy TM, Duffus I, et al. A novel clinical prediction model for prognosis in malignant pleural mesothelioma using decision tree analysis. J Thorac Oncol 2016; 11: 573-582.
  • 22. Brims FJ, Maskell NA. Prognostic factors for malignant pleural mesothelioma. Curr Respir Care Rep 2013; 2: 100-108.
  • 23. Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. JAMA 2012; 307: 2383-2389.
  • 24. Treasure T, Lang-Lazdunski L, Waller D, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 2011; 12: 763-772.
  • 25. Rintoul RC, Ritchie AJ, Edwards JG, et al. Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial. Lancet 2014; 384: 1118-1127.
  • 26. Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 2003; 21: 2636-2644.
  • 27. Calabro L, Morra A, Fonsatti E, et al. Efficacy and safety of an intensified schedule of tremelimumab for chemotherapy-resistant malignant mesothelioma: an open-label, single-arm, phase 2 study. Lancet Respir Med 2015; 3: 301-309.
  • 28. Quispel-Janssen J, Zago G, Schouten R, et al. A phase II study of nivolumab in malignant pleural mesothelioma (NivoMes): with translational research (TR) biopsies. J Thorac Oncol 2017; 12 (Suppl): S292-S293.
  • 29. Davies HE, Musk AW, Lee YC. Prophylactic radiotherapy for pleural puncture sites in mesothelioma: the controversy continues. Curr Opin Pulm Med 2008; 14: 326-330.
  • 30. Gunatilake S, Brims FJ, Fogg C, et al. A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): study protocol for a randomised controlled trial. Trials 2014; 15: 367.
  • 31. Asbestos Diseases Research Institute. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. Sydney: ADRI, 2013. (accessed Sept 2017).


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