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Abstract
Background: The question of whether chrysotile asbestos-containing brake dust can plausibly serve as a cause of mesothelioma in an exposed individual has become a matter of heated debate in the medical literature despite multiple international, federal, and state governmental agencies acknowledging a causal association.
Objectives: We describe and provide an analysis of various industry and academic perspectives contributing to the debate.
Methods: A framework is presented for evaluating the general and specific causal relationship between brake dust exposure and mesothelioma utilizing the principles of forensic epidemiology, and by applying the Bradford–Hill criteria.
Results and conclusions: We conclude that there is a “net” of evidence favoring a causal relationship between brake dust-associated chrysotile exposure and mesothelioma. The industry-sponsored position that there is insufficient evidence to support a contiguous “chain” of causation is specious from both a methodologic and evidentiary perspective. Finally, we suggest a semiquantitative approach for the evaluation of individual causation in putative cases of mesothelioma with a history of significant brake dust exposure.
Technical contributions from Wendy M. Leith are appreciated. Critical comments from Dr Laura S. Welch have greatly improved the manuscript. Partial funding provided by the National Institutes of Health (SSK).
Disclosure: The authors provide forensic consultation for litigated matters.