Malignant pleural mesothelioma: Overview of the North American and European experience

Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Thoracic Surgery Clinics (Impact Factor: 0.77). 12/2004; 14(4):435-45. DOI: 10.1016/j.thorsurg.2004.06.009
Source: PubMed


MPM is an uncommon disease with limited treatment options. Early diagnosis, a standardized staging system, early referral to centers experienced in MPM, and efforts to develop collaborative multicenter trials are essential to improving treatment for patients with MPM. Efforts to manage this malignancy, which is projected to peak in the twenty-first century, constitute an important international health concern, particularly because the use of asbestos, despite successful regulatory efforts in many parts of the world, continues unabated in others.

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    • "The association of mesothelioma with past asbestos exposure is very strong, with an aetiological fraction well over 80% [4] [5] [6] that reached 94.9% among occupationally exposed subjects [7]. Because of this strong correlation, many Western countries are currently suffering from a MM epidemic, which reflects the industrial applications of asbestos occurred between the 1940s and 1980s [8] [9] [10]. Forecasts of the incidence or mortality from MPM in various countries have proven to be strongly influenced by the asbestos consumption patterns of the past [11] [12] [13] [14] [15] [16] [17]. "
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    ABSTRACT: Background: Malignant Mesothelioma (MM) is so associated with (professional, familial or environmental) asbestos exposure that trends in incidence and mortality parallel, after 30-40 years, the trend in asbestos consumption. In recent decades, the industrialized countries have witnessed a steady growth of pleural MM (MPM), following a stabilization or decline in rates in the countries that first adopted restrictive policies. The aim of this study was to evaluate the temporal variations of pleural MM incidence in the Veneto Region of Italy in the period 1987-2010. Methods: We included only MPM with histological or cytological diagnosis. Age-Period-Cohort (APC) models were used to assess the trend in the incidence of MPM in both genders. Future predictions were evaluated by using a Bayesian APC model. Results: In the period 1987-2010, 1600 MPMs have occurred. We observe a positive trend in the incidence in the whole period considered. The APC model showed that in both genders the cohort at higher risk is the one born between the years 1940-1945. Future projections indicate that the trend will decrease after the incidence peak of 2010; yet 1234 men are expected to develop a mesothelioma between 2011 and 2026. Among women, the future MPM rates will be stable or slightly decreasing. Conclusions: The asbestos ban introduced in Italy in the year 1992 as a prospective result will certainly determine a decreasing incidence. However, the extremely long latency of MPM means that its influence is not yet observable.
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