title: Consensus Report of the 2015 Weinman International Conference on Mesothelioma.
abstract: 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.
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii. Electronic address: mcarbone@cc.hawaii.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Carbone
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii; Samuel Oschin Comprehensive Cancer Institute and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Shreya
authors.initials: S
authors.lastname: Kanodia
authors.affiliation: Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Ann
authors.initials: A
authors.lastname: Chao
authors.affiliation: National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina.
authors.forename: Aubrey
authors.initials: A
authors.lastname: Miller
authors.affiliation: Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Anil
authors.initials: A
authors.lastname: Wali
authors.affiliation: Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
authors.forename: David
authors.initials: D
authors.lastname: Weissman
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Alex
authors.initials: A
authors.lastname: Adjei
authors.affiliation: ERIM, University of New Caledonia, Noumea, New Caledonia.
authors.forename: Francine
authors.initials: F
authors.lastname: Baumann
authors.affiliation: Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Geoscience, University of Nevada Las Vegas, Las Vegas, Nevada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Buck
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.affiliation: Chemical and Biochemical Engineering Department and Center for Global and Regional Environmental Research, University of Iowa, Iowa City, Iowa.
authors.forename: A Umran
authors.initials: AU
authors.lastname: Dogan
authors.affiliation: Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina.
authors.forename: Steve
authors.initials: S
authors.lastname: Gavett
authors.affiliation: Chemical/Earth Sciences Department, University of Modena, Modena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gualtieri
authors.affiliation: Thoracic Oncology Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland.
authors.forename: Raffit
authors.initials: R
authors.lastname: Hassan
authors.affiliation: Mesothelioma Applied Research Foundation, Alexandria, Virginia.
authors.forename: Mary
authors.initials: M
authors.lastname: Hesdorffer
authors.affiliation: University of Colorado Cancer Center, Denver, Colorado.
authors.forename: Fred R
authors.initials: FR
authors.lastname: Hirsch
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: David
authors.initials: D
authors.lastname: Larson
authors.affiliation: Cancer Research Institute, Zhejiang Cancer Hospital and Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang, Hangzhou, People's Republic of China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Mao
authors.affiliation: National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina.
authors.forename: Scott
authors.initials: S
authors.lastname: Masten
authors.affiliation: Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York.
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.affiliation: Cancer Research UK, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Julian
authors.initials: J
authors.lastname: Peto
authors.affiliation: Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Pira
authors.affiliation: Notre Dame Integrated Imaging Facility, Notre Dame University, Notre Dame, Indiana.
authors.forename: Ian
authors.initials: I
authors.lastname: Steele
authors.affiliation: Department of Thoracic and Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Anne
authors.initials: A
authors.lastname: Tsao
authors.affiliation: Thoracic Surgery, University of California at San Francisco, San Francisco, California.
authors.forename: Gavitt Alida
authors.initials: GA
authors.lastname: Woodard
authors.affiliation: Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii.
authors.forename: Haining
authors.initials: H
authors.lastname: Yang
authors.affiliation: Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Shakun
authors.initials: S
authors.lastname: Malik
mesh_terms: D014408:Biomarkers, Tumor; D004781:Environmental Exposure; D005260:Female; D019398:Genes, BRCA1; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000401:mortality; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000401:mortality; D000086002:Mesothelioma, Malignant; D009154:Mutation; D053495:Osteopontin / Q000097:blood; D025521:Tumor Suppressor Proteins / Q000235:genetics; D043222:Ubiquitin Thiolesterase / Q000235:genetics
chemical_list: C400134:BAP1 protein, human; D014408:Biomarkers, Tumor; D025521:Tumor Suppressor Proteins; D053495:Osteopontin; D043222:Ubiquitin Thiolesterase
keywords: Asbestos; BAP1; Biomarkers; Erionite; Genetics; Mesothelioma; Therapy