Mesothelioma deaths and diagnoses continue to increase in the United States despite longstanding asbestos regulation and reduced industrial use, according to a national analysis from Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, released on June 11. The study found little improvement in survival rates and reported that this preventable cancer continues to disproportionately affect women and certain high-risk states associated with shipbuilding, mining, and legacy asbestos exposure.
Researchers tracked mesothelioma incidence, mortality, and disability burden across all 50 states from 1990 to 2023. Although age-standardized incidence and mortality rates declined by about one-third over the period studied—reflecting reduced industrial use—the absolute number of cases increased by nearly 30%, with annual deaths also rising. The disability burden measured by disability-adjusted life years grew by 14% since 1990.
"Declining rates don't necessarily mean fewer lives affected," said Kyle Edwards, co-lead author and M.D./M.P.H. student at the University of Miami Miller School of Medicine. "When you look at absolute numbers and disability, mesothelioma remains a substantial public health problem."
The study highlighted widening differences between men and women regarding disease trends. Among men, both incidence and mortality rates fell sharply due to aging out of historically exposed cohorts in shipbuilding or construction work. However, for women declines were modest or statistically insignificant; female incidence rose in 20 states while female mortality increased in 18 states—particularly in parts of the Midwest and Appalachia.
"For women, mesothelioma often doesn't come with a neat occupational history," said Estelamari Rodriguez, M.D., M.P.H., clinical research lead at Sylvester's Thoracic Oncology Site Disease Group. "Environmental exposure, para-occupational exposure from family members, and legacy asbestos in schools, homes, and public buildings likely play a much larger role." Geographic risk remained significant: Maine, Alaska, Washington, and Minnesota had consistently high burdens linked to local industry or natural mineral fibers.
Despite new therapies such as immune checkpoint inhibitors entering clinical practice recently, survival outcomes have not improved nationally; the mortality-to-incidence ratio remains close to one over the three decades studied. Gilberto Lopes, M.D., chief of medical oncology at Sylvester, said, "Despite all our scientific advances, mesothelioma remains one of the most lethal solid tumors." Nearly 96% of U.S. mesothelioma deaths were attributed to occupational asbestos exposure as recently as last year—a proportion unchanged since 1990.
The authors called for continued vigilance around asbestos remediation alongside investment into more effective treatments: "We have to keep people from being exposed in the first place while also doing better for those who are diagnosed," Lopes said.
