Asbestos Exposure and Malignant Pleural Mesothelioma: A Systematic Review of Literature

Background:The relationship between exposure to asbestos and malignant pleural mesothelioma (MPM) is already well established. Nevertheless, much remains to be known about exposure thereto and the incidence and mortality from MPM. Objective: This systematic review aims to map the relationship between asbestos and MPM by studying the exposure to asbestos and the incidence and mortality of MPM. Methods: A systematic review was conducted relating asbestos and MPM. Exposure to asbestos, incidence, and mortality by MPM was reviewed. PubMed, Web of Science, Cochrane Library, RCAAP, DART-Europe, and the reference lists of included studies were searched, from January 1, 1960, to December 31, 2020. Methodological quality was checked, the risk of bias analysis was performed, a level of evidence grade was assigned, and descriptive data analysis was performed. Results: 3,484 unique citations were identified, which included seventeen observational studies that met inclusion criteria with a total of 1,104 patients. Heterogeneity is present between the included studies which range from a case series of 16 retrospective studies and 1 prospective study. Studies were mostly conducted in Europe, particularly in Italy (6), and were published between 1969 and 2020. The mean age of patients is approximately 66 years with a latency period between the first exposure and diagnosis of approximately 42 years. 14 studies present data regarding the occupational context and chrysotile and crocidolite are the most studied types of fibre. The incidence of cases occurred between the interval 1966 and 2014 and in 9 studies the mortality rate was 100% of patients. Conclusion: There is high evidence to support the relationships between asbestos and MPM. However, the relatively scant information provided by the studies reinforces the need for well-conducted research and implementation of National Mesothelioma Surveillance Centres at a global level. Introdu & ccedil;& atilde;o:: A rela & ccedil;& atilde;o entre a exposi & ccedil;& atilde;o ao amianto e o mesotelioma maligno da pleura (MMP) j & aacute; est & aacute; bem estabelecida. No entanto, ainda muito h & aacute; a saber sobre a exposi & ccedil;& atilde;o ao mesmo e a incid & ecirc;ncia e mortalidade do MMP. Objetivo:: Esta revis & atilde;o sistem & aacute;tica visa mapear a rela & ccedil;& atilde;o entre o amianto e o MMP, estudando a exposi & ccedil;& atilde;o ao amianto e a incid & ecirc;ncia e mortalidade do MMP. M & eacute;todos:: Foi realizada uma revis & atilde;o sistem & aacute;tica relacionada com o amianto e o MMP. A exposi & ccedil;& atilde;o ao amianto, incid & ecirc;ncia, e mortalidade por MMP foram revistas. PubMed, Web of Science, Cochrane Library, RCAAP, DART-Europe e as listas de refer & ecirc;ncia dos estudos inclu & iacute;dos foram pesquisados, de 1 de janeiro de 1960 a 31 de dezembro de 2020. A qualidade metodol & oacute;gica foi verificada, bem como o risco de an & aacute;lise de enviesamento, e foi realizada uma an & aacute;lise descritiva dos dados. Resultados:: Foram identificadas 3,484 cita & ccedil;& otilde;es & uacute;nicas, que inclu & iacute;am 17 estudos observacionais, que preenchiam os crit & eacute;rios de inclus & atilde;o com u mu m total de 1,104 pacientes. A heterogeneidade est & aacute; presente entre os estudos inclu & iacute;dos, que variam entre uma s & eacute;rie de 16 estudos retrospetivos e 1 estudo prospetivo. Os estudos foram realizados principalmente na Europa, particularmente em It & aacute;lia (6), e foram publicados entre 1969-2020. A idade m & eacute;dia dos pacientes, & eacute; de aproximadamente 66 anos, com u mu m per & iacute;odo de lat & ecirc;ncia entre a primeira exposi & ccedil;& atilde;o e o diagn & oacute;stico de aproximadamente 42 anos. 14 estudos apresentam dados relativos ao contexto ocupacional e o cris & oacute;tilo e a crocidolite s & atilde;o os tipos de fibra mais estudados. A incid & ecirc;ncia de casos ocorreu entre o intervalo 1966-2014 e em 9 estudos a taxa de mortalidade foi de 100% dos pacientes. Conclus & atilde;o:: A evid & ecirc;ncia demonstra a rela & ccedil;& atilde;o entre o amianto e MMP. No entanto, a informa & ccedil;& atilde;o relativamente escassa fornecida pelos estudos, refor & ccedil;a a necessidade de investiga & ccedil;& atilde;o dirigida e mais aprofundada e implementa & ccedil;& atilde;o de Centros Nacionais de Vigil & acirc;ncia do Mesotelioma a n & iacute;vel mundial.