A Long Shadow: Mapping Mesothelioma’s Uneven Decline Across the United States

By: Monica Smith | June 11, 2026 | 9 min. read |

Abstract digital rendering of a human brain formed by glowing interconnected nodes and lines within a high-tech data environment, with icons representing research, mentorship, discovery and impact displayed alongside.

Summary

Mesothelioma rates have declined nationally, but the number of people affected continues to rise due to population aging and long disease latency.
Progress has been uneven, with a growing burden among women and persistent hot spots in several high‑risk states.
Survival has not meaningfully improved, underscoring the need for stronger prevention and more effective treatments.

Mesothelioma is often described as a disease of the past, an echo of an era when asbestos was woven into ships, factories and buildings across the country. But new research from investigators at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, shows that this rare cancer still casts a long and uneven shadow across the United States, shaped by geography, sex and decades‑old exposures that continue to surface today.

In the most comprehensive national and state‑level analysis to date, researchers tracked mesothelioma incidence, mortality and disability burden across all 50 states from 1990 to 2023. Their findings reveal a paradox. While rates have declined overall, the absolute burden of disease continues to rise and progress has not been shared equally. The study, “Geographic, Temporal, and Sex-Specific Trends in Mesothelioma Burden in the United States, 1990–2023,” appears in JCO Global Oncology.

Dr. Chinmay Jani in white clinic coat, standing on the Miller School campus — Dr. Chinmay Jani is co-leading an analysis of mesothelioma trends.

“Mesothelioma behaves like a time capsule,” said Chinmay Jani, M.D., medical oncologist at Sylvester and co-lead author of the study. “What we’re seeing today reflects exposures that happened 30 or 40 years ago and, in some cases, exposures that are still happening in quieter, less visible ways.”

Falling Rates, Rising Numbers

At first glance, the national trend appears encouraging. Age‑standardized incidence and mortality rates for mesothelioma declined by roughly one‑third over the 33‑year study period, mirroring decades of asbestos regulation and reduced industrial use.

But those falling rates mask a more serious reality. Because the U.S. population has grown and aged, the number of people diagnosed with mesothelioma increased by nearly 30%. Annual deaths climbed, as well. The disease’s disability burden, measured in disability‑adjusted life years (DALYs), rose 14% since 1990.

“Declining rates don’t necessarily mean fewer lives affected,” said Kyle Edwards, co-lead author and an M.D./M.P.H. student at the Miller School. “When you look at absolute numbers and disability, mesothelioma remains a substantial public health problem.”

A Persistent Gap Between Men and Women

The study uncovered stark differences between men and women, differences that are widening rather than closing.

Among men, both incidence and mortality rates fell sharply, reflecting the gradual aging out of cohorts historically exposed to asbestos in shipbuilding, construction and insulation work. Among women, however, declines were modest and often statistically insignificant. In fact, female incidence increased in 20 states. Female mortality rose in 18 states, particularly in parts of the Midwest and Appalachia.

Infographic showing U.S. mesothelioma trends from 1990 to 2023, with declining incidence and mortality rates but a rising overall disease burden, including a roughly 30% increase in diagnoses. Data highlights gender disparities, with rates falling among men but slower declines and increases in some states among women, and identifies high-burden states such as Maine, Alaska, Washington, and Minnesota.

This divergence points toward exposure pathways that extend beyond the factory floor.

“For women, mesothelioma often doesn’t come with a neat occupational history,” said Estelamari Rodriguez, M.D., M.P.H., Sylvester’s clinical research lead of the Thoracic Site Disease Group and associate director of outreach. “Environmental exposure, para‑occupational exposure from family members and legacy asbestos in schools, homes and public buildings likely play a much larger role.”

Geography Matters

States such as Maine, Alaska, Washington and Minnesota consistently carried the highest incidence, mortality and disability burdens in 2023. Each tells a different story: shipyards along the Atlantic and Pacific coasts, naturally occurring asbestos disturbed during construction or mineral fibers associated with iron ore mining.

National averages, the authors note, can blur these place‑based risks. The map of mesothelioma in the United States looks less like a smooth gradient and more like a patchwork quilt, stitched together by local industry, geology and history.

“Mesothelioma is a geographic disease,” Dr. Jani said. “State‑level data allow us to see where prevention, remediation and surveillance efforts are most urgently needed.”

Survival Has Not Meaningfully Improved

Perhaps the most sobering finding lies in what has not changed. Across three decades, the mortality-to-incidence ratio, a population‑level proxy for survival, remained high, hovering near 1. This means most people diagnosed with mesothelioma still die from it. Population‑level survival gains have been minimal.

Even as new therapies, including immune checkpoint inhibitors, have entered clinical practice in recent years, their impact has not yet shifted outcomes at a national scale.

Dr. Gilberto Lopes, Sylvester’s chief of medical oncology, says efforts to prevent and treat mesothelioma need to be bolstered.

“From a patient’s perspective, this is the hardest message,” said Gilberto Lopes, M.D., Sylvester’s chief of medical oncology, associate director and medical director for international affairs. Dr. Lopes is also a professor of medical oncology at the Miller School. “Despite all our scientific advances, mesothelioma remains one of the most lethal solid tumors.”

A Largely Preventable Cancer

The study also reaffirmed a critical truth. Mesothelioma is overwhelmingly preventable. In 2023, nearly 96% of U.S. mesothelioma deaths were attributable to occupational asbestos exposure, a proportion that has changed little since 1990.

That persistence reflects the durability of asbestos embedded in older buildings, ships and infrastructure, and the reality that the United States has never fully banned its use.

The authors argue that reducing mesothelioma’s future burden will require continued vigilance in asbestos remediation and environmental protection, alongside sustained investment in more effective treatments.

“Mesothelioma reminds us that prevention and treatment are inseparable,” said Dr. Lopes. “We have to keep people from being exposed in the first place, while also doing better for those who are diagnosed.”

Looking Forward

Together, these findings challenge the notion that mesothelioma is simply fading away. Instead, the disease is evolving, shifting across populations and places, shaped by legacy exposures and modern inequities.

The Sylvester research implores clinicians to maintain awareness of mesothelioma in women and in patients without obvious occupational exposure. For researchers, the high fatality rates signal an urgent need for new therapeutic breakthroughs.

“Mesothelioma reminds us that the consequences of exposure can last a lifetime, but so can our responsibility to patients,” said Dr. Jani. “By understanding where this disease still concentrates and who it continues to affect, we move closer to a future where prevention is stronger, treatments are more effective and no community is left behind.