The widespread use of asbestos during the 20th century has produced a legacy of ill-health, death and contamination which will endure well into the current century. Epidemics of asbestos illness have been reported in industrialized countries for many years; now, data are being collated which document an escalation of these diseases in developing countries such as Brazil, Thailand and Egypt. Asbestos manufacturing began in Egypt more than 50 years ago. By 2004, there were 14 asbestos factories employing thousands of workers. Asbestos is imported from Russia and Canada and is used for the manufacture of asbestos-cement pipes, roofing and wall materials, valves, joints, sealants, clothing, cords, strings, clutches, brake linings and pads; crocidolite and amosite were used in pipes and corrugated sheets until fairly recently. The working conditions in these factories were poor and included occupational exposure to various asbestos types on a daily basis. In the first 5 years of the 3rd millennium (2000-2004), 832 cases of mesothelioma were diagnosed at NCI, and Abbassia Chest Hospital, Cairo. Both hospitals drain and serve most of the high risk population living in the neighborhoods of the oldest asbestos production plants. Median age was 53 (19-90) years. Females represented 39.2% and young adults = 40 years represented 19.1%. Residential exposure was evidenced in 64.7% of cases (Shobra El-khema, 35.6%, El-Maasara and surrounding area 23.6%, El Zytoon 5.2%, and others 0.5%). Twenty five percent came from other Cairo areas and 9.8% from other governorates. The NCI hospital based-registry showed an increase in the relative frequency of MPM from 0.47% in 2001, to 1.4% in 2004. In a trial to find a relation between residency and asbestos exposure, a field study was done to investigate the residential areas surrounding the oldest factory in El-Maasara, Cairo. Heaps of asbestos wastes with breaks of cement pipes and sheets were visualized outside the fence of the factory, improperly disposed off. Repeated airborne asbestos samples were collected using National Institute for Occupational Safety and Health (NIOSH) method No 7400. Results showed the presence of asbestos fibers in those residential areas in counts ranging from 0.002 f/cc, 7 kilometers from the factory, to levels beyond permissible exposure limits and excursion limit (3.02 f/cc) few meters from the factory. Although the Egyptian Minister of Foreign Trade and Industry prohibited the import and manufacture of all types of asbestos and asbestos materials in 2006, it is believed that chrysotile is still being used in the manufacture of asbestos-cement materials. The NCI, Cairo recommendations include periodic monitoring of the environment inside and outside the factories for permissible exposure limits (PEL), increasing awareness of the public regarding the risk of asbestos exposure, education and protection of Egyptian asbestos workers, follow up and if possible periodical medical checks for population at risk of occupational and/or residential exposure. There is a clear need for stronger legislative measures to eliminate asbestos entirely in order to combat the coming epidemic of mesothelioma in Egypt.