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Epidemiology of mesothelioma in the 21 century in Europe and the United States, 40 years after restricted/banned asbestos use

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Research has established a strong association between asbestos exposure and malignant mesothelioma, a deadly form of cancer. Since the early 1980's many countries have restricted or banned the production of asbestos, leading to a decline of occupational asbestos exposure in many industrialized countries. However, some countries continue to use asbestos, and worldwide rates of mesothelioma are still increasing. Because of the long latency between exposure and mesothelioma occurrence and the persistence of environmental exposure, incidence rates (IR) may decrease very slowly for several years ahead. In this review, we examine estimates of asbestos consumption before widespread asbestos regulations and the trends in incidence and mortality rates, as well as changes over time for the United States and Europe. In some countries with earlier asbestos restrictions, mesothelioma incidence has been in a modest decline over time. However, asbestos exposure is still a burden worldwide and legislative action is needed to obtain a full ban. The pattern of mesothelioma is shifting from a mostly male disease to a disease that affects females as well in substantial numbers. Studies on unknown sources of asbestos exposure, of other sources of natural exposure to asbestos and asbestos-like fibers, as well as of individual genetic susceptibility to asbestos fibers are needed.
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© Translational lung cancer research. All rights reserved. Transl Lung Cancer Res 2020;9(Suppl 1):S28-S38 | http://dx.doi.org/10.21037/tlcr.2019.11.11
Introduction
Mesothelioma is a rare, but deadly form of cancer, arising
in the mesothelial surfaces (1) in the pleura, peritoneal,
and pericardial cavities; the most common form of
mesothelioma, accounting for 65–70% of all cases, is
malignant pleural mesothelioma followed by peritoneal
(30%) and pericardial mesothelioma (1–2%) (2). There are
three subtypes, according to the histological morphology:
epithelial, sarcomatoid, and biphasic (1).
Mesothelioma has a very poor prognosis with a median
survival from the time of presentation of approximately
9–12 months (3). Despite the introduction of modern
therapeutic interventions, only modest changes in survival
are observed over time (1). There is a well-established
causal relationship between asbestos exposure and
malignant mesothelioma, although the latency period can
be long. Research suggests that the average latency period
is approximately 40 years, although in some cases, it may be
as long as 60–70 years (4-9). The association with asbestos
exposure is especially strong for the pleural site, where
80% of patients report a history of asbestos exposure (2).
Among asbestos highly exposed individuals, the lifetime
risk of mesothelioma can vary from 5–10% to 25% (3,4,10).
Increased knowledge and better regulations since the early
1980’s, with restrictions or bans on production and use of
Review Article
Epidemiology of mesothelioma in the 21st century in Europe and
the United States, 40 years after restricted/banned asbestos use
Naomi Alpert1, Maaike van Gerwen1,2, Emanuela Taioli1,3,4
1Institute for Translational Epidemiology, 2Department of Otolaryngology-Head and Neck Surgery, 3Department of Thoracic Surgery, 4Tisch
Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: None;
(IV) Collection and assembly of data: N Alpert; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final
approval of manuscript: All authors.
Correspondence to: Emanuela Taioli, MD, PhD. Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1133, New York, NY
10029, USA. Email: Emanuela.Taioli@mountsinai.org.
Abstract: Research has established a strong association between asbestos exposure and malignant
mesothelioma, a deadly form of cancer. Since the early 1980’s many countries have restricted or banned
the production of asbestos, leading to a decline of occupational asbestos exposure in many industrialized
countries. However, some countries continue to use asbestos, and worldwide rates of mesothelioma are still
increasing. Because of the long latency between exposure and mesothelioma occurrence and the persistence
of environmental exposure, incidence rates (IR) may decrease very slowly for several years ahead. In this
review, we examine estimates of asbestos consumption before widespread asbestos regulations and the trends
in incidence and mortality rates, as well as changes over time for the United States and Europe. In some
countries with earlier asbestos restrictions, mesothelioma incidence has been in a modest decline over time.
However, asbestos exposure is still a burden worldwide and legislative action is needed to obtain a full ban.
The pattern of mesothelioma is shifting from a mostly male disease to a disease that affects females as well in
substantial numbers. Studies on unknown sources of asbestos exposure, of other sources of natural exposure
to asbestos and asbestos-like bers, as well as of individual genetic susceptibility to asbestos bers are needed.
Keywords: Carcinogen regulation; environmental exposure; incidence trends; mortality
Submitted Jul 24, 2019. Accepted for publication Nov 07, 2019.
doi: 10.21037/tlcr.2019.11.11
View this article at: http://dx.doi.org/10.21037/tlcr.2019.11.11
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asbestos in many developed countries has led to abatement
of exposure, particularly in the occupational setting. Four
subsequent bans on asbestos between 1973 and 1989 in the
United States (US) resulted in decreased asbestos consumption
and production, followed by a decline of mesothelioma
incidence and mortality rates 20 years later (11). However,
despite bans, people may still be exposed to asbestos, due
to its presence in several structures such as schools or
public buildings, and the construction of residential areas
in close proximity to former asbestos mines, factories,
or soil containing natural asbestos. Thus the disease
burden associated with environmental asbestos exposure
remains difficult to quantify and is understudied (6,7,12).
Furthermore, a ban on the use and production of asbestos
has not been implemented globally; countries that have a
ban instituted it at different points in time (5), making the
estimate of the future mesothelioma risk in the general
population uncertain.
The goal of this report is to provide an overview of
asbestos use, and mesothelioma incidence and mortality
in the US and Europe [defined as the 53 countries in
the European region of the World Health Organization
(WHO)] (13), within the context of changes in asbestos
policies around the world.
Data sources and methods
This report used several publicly available data sources.
Asbestos consumption (calculated as production plus imports
minus exports) was assessed per capita, in 1980 and 2007,
using reports from the United States Geological Survey
(USGS) (14,15), with population estimates compiled by the
World Bank (16). Negative values of asbestos consumption
(reflecting export of storage from previous years) were
treated as zero. Overall and age specific mesothelioma
incidence rates (IR) [2008–2012] were extracted from the
Cancer Incidence in Five Continents Volume XI (CI5 Vol.
XI) data made available by the WHO and the International
Agency for Research on Cancer (IARC) (17). IR over time
were calculated using Surveillance, Epidemiology, and
End Results (SEER) data (18) (US) and WHO C15plus
data (Europe) (17,19), which includes annual incidence of
selected cancers for the longest possible period. For this
analysis, only registries with continuous information from
1980–2012 were included (SEER-9 Registries for the US;
Denmark, France Calvados, France-Doubs, France-Isere,
Germany-Saarland, Iceland, Israel, Italy-Parma, Norway,
Switzerland-Geneva and UK-Scotland for Europe).
Mortality rates were queried from the IARC WHO Cancer
Mortality Database (20). All incident and mortality rates are
age-adjusted to the world standard population (21).
Results
Worldwide bans on asbestos and asbestos consumption
Since the 1970’s, countries have banned asbestos to varying
degrees, with 67 countries worldwide having a total ban, as
of July 15, 2019 (22). Although the US banned some forms
of asbestos in 1973, and attempted to ban most asbestos-
containing products in 1989 through the Toxic Substances
Control Act, the ban was overturned in 1991 (23). To
this day, the US does not have a full nationwide ban on
asbestos. However there are many laws regulating the use of
asbestos at the federal, state, and local level (24). In Europe,
individual regulations banning asbestos were passed from
the 1980’s through the early 2000’s in many countries
(13,22,25,26). Member states of the European Union (EU)
banned five of the six types of asbestos in 1991 (amosite,
crocidolite, anthophyllite, tremolite, and actinolite) and a
ban prohibiting the new use of chrysotile went into effect
on January 1, 2005 (27). Details of asbestos bans, by country
are shown in Table 1 (13,22,25,26).
Previous research (5,13) has defined asbestos
consumption >1 kg/capita/year as “high”, as it corresponded
to a 2.4- and 1.6-fold increase in mesothelioma deaths
among men and women, respectively. Consumption
>2 kg/capita/year was considered “very high”. Data from
1980 (14), before asbestos bans were widely implemented,
show that asbestos consumption was very high in some
parts of Europe, exceeding 5 kg/capita in the former
Soviet Union (estimates for Russian Federation and
Kazakhstan: 9.6 kg/capita), Cyprus (7.4 kg/capita), Germany
(5.6 kg/capita), and former Yugoslavian states (combined
estimates for all former Yugoslav nations: 5.2 kg/capita).
Asbestos consumption for Belgium and Luxembourg
(4.7 kg/capita), Hungary (4.0 kg/capita), Switzerland
(3.3 kg/capita), Italy (3.2 kg/capita), Czech Republic
and Slovakia combined (3.1 kg/capita), Austria
(2.7 kg/capita), Denmark (2.7 kg/capita), Ireland
(2.5 kg/capita), Poland (2.3 kg/capita), France
(2.3 kg/capita), and Portugal (2.04 kg/capita) all exceeded
2 kg/capita, while it exceeded 1 kg/capita in Spain, Greece,
United Kingdom, Netherlands, and Finland. Consumption
in the US was also high at 1.6 kg/capita (Figure 1A), although
it was already in decline from its peak in the early 1970’s (28).
S30 Alpert et al. Epidemiology of mesothelioma in Europe and the US
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Table 1 Asbestos bans and regulations in the United States and Europe
Country Year Description
United States 1973 Ban on spray-applied surfacing asbestos-containing material for fireproofing and insulation
1989 Toxic Substances Control Act bans most asbestos-containing products
1991 Ban overturned, no current nationwide ban
European Union
Austria1990 Ban on chrysotile asbestos
Belgium1998 Ban on chrysotile asbestos is introduced
Bulgaria 2005 Ban on import, production, and use of all asbestos
Croatia 1993 Ban on crocidolite and amosite
2006 Asbestos added to list of prohibited substances, in line with EU regulations, but ban is not thought
to be well enforced
Cyprus2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Czech Republic1998 Ban on the import of asbestos
2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Denmark1980 Ban on uses of asbestos, with exceptions
1985 Extends ban to include asbestos cement products, further restrictions in 1986–1988
Estonia2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Finland1992 Phase-out ban on chrysotile
France1996 Ban on chrysotile
Germany1993 Ban on chrysotile asbestos (minor exemptions), amosite and crocidolite were banned previously
Greece2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Hungary1988 Ban on amphibole asbestos, with further bans on non-chrysotile asbestos in 1992, 2001, and 2003
2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Ireland2000 Ban on chrysotile asbestos
Italy1992 Ban on all types of asbestos (with some exceptions until 1994)
Latvia2001 Ban on asbestos (some exemptions)
Lithuania1998 First law restricting asbestos use
2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Luxembourg2002 Phase out ban on asbestos
Malta2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Netherlands1991 First in a series of bans on chrysotile
Poland1997 Ban on all asbestos
Portugal2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Romania 2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Slovakia2005 Prohibits new use of chrysotile, other forms of asbestos previously banned under EU regulations
Slovenia1996 Ban on production of asbestos cement products
Table 1 (continued)
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Table 1 (continued)
Country Year Description
Spain2002 Phase out ban on asbestos
Sweden1982 First in a series of bans on various uses of asbestos
1986 Ban on use of all asbestos products
United Kingdom1999 Ban on chrysotile asbestos, with minor exceptions
Other European nations
Albania No ban
Andorra No ban
Armenia No ban
Azerbaijan No ban
Belarus No ban
Bosnia and
Herzegovina
No ban
Georgia No ban
Iceland 1983 Ban on all types of asbestos (with exceptions); bans updated in 1996
Israel 1980 Series of restrictions on asbestos, which eventually became a de facto ban
Kazakhstan No ban
Kyrgyzstan No ban
Monaco 2016 Total ban on all forms of asbestos
Montenegro No ban
North Macedonia 2014 Total ban on all forms of asbestos
Norway 1984 Ban on all asbestos
Republic of Moldova No ban
Russian Federation No ban
San Marino No ban
Serbia 2011 Ban on all asbestos
Switzerland 1989 Ban on crocidolite, amosite, and chrysotile
Tajikistan No ban
Turkey 2010 National regulation banning use of all types of asbestos
Turkmenistan No ban
Ukraine 2017 Complete ban on asbestos announced, implementation may be delayed
Uzbekistan No ban
, members of the European Union as of 2005, subject to the directive mandating all member states ban new uses of chrysotile. Other
forms of asbestos were banned in 1991 for EU member states. All member states of the EU, Iceland, Israel, Macedonia, Monaco, Norway,
Serbia, Switzerland, and Turkey have banned the use of all types of asbestos, as of July 15, 2019. EU, European Union.
S32 Alpert et al. Epidemiology of mesothelioma in Europe and the US
© Translational lung cancer research. All rights reserved. Transl Lung Cancer Res 2020;9(Suppl 1):S28-S38 | http://dx.doi.org/10.21037/tlcr.2019.11.11
The most recent available data refer to 2007 (15),
and indicates that asbestos consumption has declined
considerably in most countries in the years since bans were
enacted (or attempted) (Figure 1B). US consumption was
0.003 kg/capita in 2007, while most of the countries in the
EU had decreased to 0 (or nearly 0) kg/capita. Asbestos
consumption remained high or very high in Kazakhstan
(7.0 kg/capita), Kyrgyzstan (4.0 kg/capita), Belarus
(3.5 kg/capita), Uzbekistan (3.2 kg/capita), Russian
Federation (2.0 kg/capita), and Ukraine (1.8 kg/capita).
An advance report from the USGS for 2016 (29)
indicates that consumption has started to decline in Ukraine
(0.4 kg/capita) and Belarus (0.6 kg/capita), although it
remains high or very high in the Russian Federation
(1.6 kg/capita), Kazakhstan (1.4 kg/capita), Kyrgyzstan
(1.1 kg/capita), and Uzbekistan (2.2 kg/capita).
Mesothelioma IR
Research has shown that IR of mesothelioma are lower in
women than in men, and this difference has been attributed
to historical differences in occupational asbestos exposure
(30,31). From 2008 to 2012, the world standardized IR
(WSIR), per 100,000 persons in the US was 0.9 for males
and 0.3 for females. Overall in Europe, the WSIR per
100,000 was 1.7 for males and 0.4 for females. Data is
limited for nations of the former Soviet Union, Russian
Federation and former Yugoslavia, but for those with data,
reported WSIR for males and females were 0.5 and 0.3
(Russian Federation), 1.5 and 0.3 (Croatia), and 1.5 and
0.5 (Slovenia) per 100,000 persons. In some of the other
countries with very high asbestos consumption, WSIR
remain high, particularly for males versus females: 2.0
and 0.4 (Belgium), 2.0 and 0.3 (Switzerland), 1.9 and 0.3
Apparent Consumption
of Asbestos (kg/capita)
Apparent Consumption
of Asbestos (kg/capita)
1 3 5 7 9
1 3 5 7
A
B
Figure 1 Apparent consumption (kg/capita) of asbestos in (A) 1980 and (B) 2007 in the United States and Europe.
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(Denmark), 1.8 and 0.6 (Italy), and 1.6 and 0.3 (Germany)
per 100,000 persons. WSIR are also very high in the
Netherlands (2.8 in males and 0.4 in females), and United
Kingdom (3.4 and 0.6) (Figure 2). As women generally are
less likely to be occupationally exposed, the high WSIR
in females observed in certain countries, such as Italy,
United Kingdom, and Turkey may indicate other sources
of exposure that are difficult to detect, such as higher
levels of environmental exposure. The classification of
environmental, non-occupational exposure to asbestos is
very heterogeneous in the literature and often includes (I)
areas with naturally occurring asbestos, (II) neighborhood
exposure based on residence in close proximity to industrial/
mining sources of asbestos, and (III) household exposure
for family members of occupationally exposed people, of
which the latter two are more specic exposure risk factors
for females (6). Furthermore, a caveat when comparing
data collected in different countries is that there may be
differences in patterns of reporting for mesothelioma,
misclassification in diagnosis, or lack of the medical
resources required to accurately diagnose the disease.
Age related patterns
Mesothelioma is extremely rare in younger subjects,
with a sharp uptick in IR starting between 50–60 years of
age (4). Prior to age 50, the annual WSIR in the US for
males is 0.3 per 100,000 persons, while for females it is
0.2. In Europe, the rates are 0.6 per 100,000 for males
and 0.4 per 100,000 for females for the same age group.
In the US, the IR for males aged 50–54 years is 0.6 per
100,000, while for females it is 0.4 per 100,000. The rate
Figure 2 World standardized incidence rates of mesothelioma in the United States and Europe for (A) men and (B) women, 2008–2012.
Incidence Rate
(per 100,000)
Incidence Rate
(per 100,000)
1 2 3
0.2 0.4 0.6
A
B
S34 Alpert et al. Epidemiology of mesothelioma in Europe and the US
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starts climbing faster in Europe, with an IR of 1.4 per
100,000 for males, and 0.6 per 100,000 for females at age
50–54 years. As people age, this gap across the US and
Europe continues to widen, particularly for males. For
those 80 years, the IRs for males in the US and Europe are
18.9 and 22.8 per 100,000, respectively; for females, it is 3.0
and 3.4 per 100,000 (Figure 3).
Time trends
Given the long latency period of mesothelioma
(approximately 40 years, on average) (4), we may now
just be beginning to see the effects of asbestos bans. In
the US there is no ofcial ban in place, however attempts
were made to ban asbestos as far back as 1973, and as a
result general consumption was lower in 1980 in the US
as compared to Europe. Over time, the IR has started to
decline in the US from 1980–2016, mostly driven by a
decline in the IR for males, while females have mostly held
steady (Figure 4A). In Europe, rates of mesothelioma were
rising sharply in the early 2000’s, and may just now be
beginning to level off (Figure 4B). This may be partly due to
the later introduction of asbestos bans in parts of Europe,
and the higher consumption observed at least 40 years
ago in many geographic areas. As overall rates have slowly
fallen in the US, and risen in Europe, with steady rates for
females, females now make up a larger portion of those with
mesothelioma in the US than in Europe (Figure 4C).
Mesothelioma mortality
Survival rates for mesothelioma are low, with estimated
median survival of 9–12 months (3). Research has shown
that females have significantly better overall survival
(32-34), and speculated reasons include less amount
and duration of exposure (35), more favorable clinical
characteristics (36,37), and protective effects of estrogen
(38,39). For countries in which IR and mortality rates
were available, the ratio of the mortality rate to the IR was
calculated. In almost all cases, this ratio exceeds 0.5, and
in many cases exceeds 0.75, indicating high mortality rates
among those with mesothelioma. Generally, the ratio was
lower for females (Table 2), reflecting the better survival
reported by individual studies for females with all forms of
mesothelioma.
Comment
Although the US recognized the dangers of asbestos
exposure early and in 1973 produced the first asbestos
regulation followed by a complete ban in 1989, the country
currently has no nationwide ban. Many countries in Europe
independently implemented partial or total asbestos bans
in the 1980’s and 1990’s, while member states of the EU
banned most types of asbestos in 1991, with a complete
ban on all remaining types of asbestos in effect starting in
2005. However, many non-EU states implemented bans
Figure 3 Age specic annual incidence rates [2008–2012], for (A) United States and (B) Europe, by gender.
Incidence Rate
(Per 100,000)
Incidence Rate
(Per 100,000)
Age (years) Age (years)
Female Male
0-4
0-4
10-14
10-14
20-24
20-24
30-34
30-34
40-44
40-44
50-54
50-54
60-64
60-64
70-74
70-74
≥80
≥80
20
15
10
5
0
20
15
10
5
0
A B
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later, while some still have no ban in place. The difference
in the timeframe for asbestos ban legislation in the US and
Europe, combined with a latency period of decades between
exposure and mesothelioma partly explains why a slight
decrease in mesothelioma standardized IR is seen in the US,
consistent with previous research (11), while the incidence
has just started to level off in Europe. There is speculation
that the observed decrease in mesothelioma incidence is
slower than projected (40), and that other factors, including
individual genetic susceptibility, could play a role (41).
However, observational data from cancer registries
prove that legislation on asbestos use and production is an
effective way to decrease occupational exposure to asbestos,
and therefore, mesothelioma rates in the general population,
especially in males. Current legislation is insufficient to
address neighborhood asbestos exposure based on residence
in close proximity to industrial/mining sources of asbestos
and household asbestos exposure for family members of
occupationally exposed people, as well as other sources
of environmental exposure. To further decrease risk from
environmental asbestos exposure, legislation for building
in regions with naturally occurring asbestos should be
explored. These results stress the need for a global forum to
urge countries that currently don’t have an asbestos ban to
start implementing appropriate legislation.
One interesting observation is that any change in IR is
mainly caused by a decrease in mesothelioma occurrence
among males, while the IR of mesothelioma for females
remains more stable. This may reflect the fact that
asbestos exposure has shifted from occupational, mostly
present in males, to environmental exposure, and indicates
that current asbestos regulations do not sufficiently
consider all sources of environmental exposure. The male/
female (M/F) ratio has been used as a relatively reliable
surrogate to distinguish environmental from occupational
exposure (6,7), with a M/F ratio approaching one as a sign
Figure 4 World standardized incidence rates (per 100,000) over time, overall and by gender in the (A) United States, and (B) Europe. (C)
Ratio of world standardized incidence rates for females vs. males, over time in the United States and Europe.
WSIR (Per 100,000)
WSIR (Per 100,000)
WSIR Ratio (female vs. male)
Year Year
Year
Female Male Overall
Europe US
1980
1980 1980
1984
1984
1984
1988
1988
1988
1992
1992
1992
1996
1996
1996
2000
2000
2000
2004
2004
2004
2008
2008
2008
2012
2012
2012
2016
2.0
1.5
1.0
0.5
0
2.0
1.5
1.0
0.5
0
0.3
0.2
0.1
A B
C
S36 Alpert et al. Epidemiology of mesothelioma in Europe and the US
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that environmental exposure plays a more important role.
The identification of current sources of environmental
exposure to asbestos and the associated health effects in
the general population remains an important area of future
research, including the identication of geographic areas
where asbestos is naturally present in the environment (42).
The difference in incidence with gender is of special
importance because females with malignant mesothelioma
have a significantly better survival than males, although
the precise reasons for this observation are still uncertain
(32,33). Given the positive effects of legislation on
occupational exposure to asbestos, the next step will be to
shift the focus of research and legislation to environmental
sources of asbestos exposure, in order to target all potential
avenues of asbestos exposure. Because mesothelioma is a
rare but deadly disease, and combined with the changing
landscape of asbestos exposure, mesothelioma registries
capturing mesothelioma cases in real-time are of utmost
importance to investigate the many unanswered scientic
questions. Countries with mesothelioma registries are
able to research and respond to the current scientic and
legislative needs associated with mesothelioma incidence
and mortality.
In conclusion, we report here the status of mesothelioma
epidemiology in the recent years, and observe that asbestos
exposure is still a burden worldwide, and legislative
action is needed to obtain a complete ban. The pattern of
mesothelioma is shifting from a mostly male disease to a
disease that affects females as well in substantial numbers.
Studies on unknown sources of asbestos exposure, of other
sources of natural exposure to asbestos and asbestos-like
fibers, as well as of individual genetic susceptibility to
asbestos bers are needed.
Acknowledgments
Funding: None.
Footnote
Conicts of Interest: The authors have no conicts of interest
to declare.
Ethical Statement: The authors are accountable for all
aspects of the work in ensuring that questions related
to the accuracy or integrity of any part of the work are
Table 2 Ratio of annual world standardized mortality rates to
incidence rates [2008–2012], by country, for males and females
Country Mortality rate to incidence rate ratio [2008–2012]
Male Female
United States 0.89 0.67
Austria 0.82 1.00
Belgium 0.80 0.75
Bulgaria 0.20 0.00
Croatia 0.87 1.00
Cyprus 0.62 0.33
Czech Republic 0.75 0.50
Denmark 0.68 1.00
Estonia 1.00 0.50
France 0.85 0.75
Germany 0.69 0.67
Iceland0.42 1.00
Ireland 0.90 0.50
Israel 0.86 0.50
Italy 0.83 0.67
Latvia 1.00 1.00
Lithuania 1.00 1.00
Malta 0.74 1.00
Netherlands 0.89 0.75
Norway 0.80 0.67
Poland 0.80 0.67
Portugal 0.60
Slovakia 0.29 0.50
Slovenia0.60 0.80
Spain 0.67 1.00
Switzerland 0.90 0.67
United Kingdom 0.88 0.83
, combined incidence rates are available from 2008–2012.
Combined mortality rates are queried from all years available
from 2008–2012 for each country. For some countries, not
all years from 2008–2012 were available. , due to data from
difference sources, some mortality rates exceed incidence
rates for the same time frame. Those ratios are recorded as 1.
Russian Federation, Turkey, Ukraine, and Belarus reported
incidence rates, but no mortality information. Armenia, Finland,
Georgia, Hungary, Kazakhstan, Kyrgyzstan, Luxembourg,
Republic of Moldova, Romania, Serbia, and Sweden, reported
mortality rates, but not incidence information. Albania, Andorra,
Azerbaijan, Bosnia and Herzegovina, Greece, Macedonia,
Monaco, Montenegro, San Marino, Tajikistan, Turkmenistan, and
Uzbekistan reported no mesothelioma information.
S37
Translational Lung Cancer Research, Vol 9, Suppl 1 February 2020
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Cite this article as: Alpert N, van Gerwen M, Taioli E.
Epidemiology of mesothelioma in the 21st century in Europe
and the United States, 40 years after restricted/banned asbestos
use. Transl Lung Cancer Res 2020;9(Suppl 1):S28-S38. doi:
10.21037/tlcr.2019.11.11
... Its onset is frequently linked to exposure to asbestos. With the implementation of bans on asbestos, it is anticipated that the rates of both incidence and mortality related to mesothelioma will reach their highest levels in the middle of the 21st century [1]. Additionally, mesothelioma is characterized by the frequent loss or mutation of tumor suppressor genes such as cyclin dependent kinase inhibitor 2 A (CDKN2A), BRCA1 associated protein 1 (BAP1), neurofibromin 2 (NF2), and cullin 1 (CUL1) [2]. ...
Article
Full-text available
Background Mesothelioma is a rare cancer that originates from the pleura and peritoneum, with its incidence increasing due to asbestos exposure. Patients are frequently diagnosed at advanced stages, resulting in poor survival rates. Therefore, the identification of molecular markers for early detection and diagnosis is essential. Methods Three mesothelioma datasets were downloaded from the GEO database for differential gene expression analysis. Instrumental variables (IVs) were identified based on expression quantitative trait locus (eQTL) data for Mendelian randomization (MR) analysis using mesothelioma Genome-Wide Association Study (GWAS) data from the FINNGEN database. The intersecting genes from MR-identified risk genes and differentially expressed genes were identified as key co-expressed genes for mesothelioma. Functional enrichment analyses, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA), as well as immune cell correlation analysis, were performed to elucidate the roles of key genes in mesothelioma. Additionally, the differential expression of key genes in mesothelioma was validated in independent GEO datasets and TCGA datasets. This integrative research combining multiple databases and analytical methods established a robust model for identifying mesothelioma risk genes. Results The research conducted in our study identified 1608 genes that were expressed differentially in mesothelioma GEO datasets. By combining these genes with 192 genes from MR analysis, we identified 14 key genes. Notably, MPZL1, SOAT1, TACC3, and CYBRD1 are linked to a high risk of mesothelioma, while TGFBR3, NDRG2, EPAS1, CPA3, MNDA, PRKCD, MTUS1, ALOX15, LRRN3, and ITGAM are associated with a lower risk. These genes were found to be enriched in pathways associated with superoxide metabolism, cell cycle regulation, and proteasome function, all of which are linked to the development of mesothelioma. Noteworthy observations included a significant infiltration of M1 macrophages and CD4 + T cells in mesothelioma, with genes SOAT1, MNDA, and ITGAM showing a positive correlation with the level of M1 macrophage infiltration. Furthermore, the differential expression analyses conducted on the GEO validation set and TCGA data confirmed the significance of the identified key genes. Conclusion This integrative eQTL and Mendelian randomization analysis provides evidence of a positive causal association between 14 key co-expressed genes and mesothelioma genetically. These disease critical genes are implicated in correlations with biological processes and infiltrated immune cells related to mesothelioma. Moreover, our study lays a theoretical foundation for further research into the mechanisms of mesothelioma and potential clinical applications.
... The incidence of MPM is generally higher in males than in females, primarily due to historical differences in asbestos exposure. Worldwide, the standardized incidence rates per 100,000 persons are 0.7 in males and 0.3 in females in the United States and 1.7 in males and 0.4 in females in Europe (1). In 2021, the World Health Organization (WHO) updated the histological classification of MPM. ...
Article
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Malignant Pleural Mesothelioma (MPM) is an aggressive tumor associated with asbestos exposure, characterized by a poor prognosis, managed with surgery, chemotherapy and radiotherapy. Recently, immunotherapy gives a survival advantage compared to chemotherapy, but limited to the non-epithelioid histotype, the rarest type. Radical hemithorax radiotherapy (RHRT) improves the Overall Survival (OS) of MPM patients, irrespective of histotype, and is able to induce immunomodulatory effects. In this study we aim to investigate changes in circulating T lymphocytes phenotype and activity, in MPM patients undergoing RHRT, to evaluate a possible therapeutic space for immunotherapy in this setting. To assess immunomodulatory effects of RHRT we evaluate peripheral blood samples of 35 MPM patients collected before treatment, at the end of RT, and 1 month later. We first notice that higher Lymphocyte-to-Monocyte Ratio (LMR) levels, before RT, are associated with an improved OS. The immune monitoring performed by ELISA assays reveals a significant increase in the serum levels of soluble PD-L1 (sPD-L1) and IFN‐γ at the end of RHRT. Furthermore, the percentage of PD‐1⁺ cells, evaluated by flow cytometry, significantly raise after RHRT in T cells, both CD4⁺ and CD8⁺. Also the proportion of proliferative cells is significantly expanded after RHRT in all T cell subtypes. After treatment we observe a significant increase in the number of patients showing WT-1 specific CD4⁺ T cells, measured by intracellular staining. The TCR repertoire analysis, investigated by Next Generation Sequencing, reveals an increased number of expanded T-cell clones after RHRT, and an association between TCR clonality and the percentage of proliferating cytotoxic T lymphocytes. The comparison of TCR sequences obtained in our cohort with those described in a literature cohort of MPM patients, reveals common entries, specific for MPM-associated antigens including WT-1. In this setting, pre-treatment levels of LMR seem to have a positive prognostic role, and RHRT would appear to induce immunomodulating effects, potential biomarkers for immunotherapy eligibility: i.e. increased PD-1⁺ T lymphocytes, proliferating T cells, expanded T cell clones and augmented levels of sPD-L1. These data suggest the design of a prospective study evaluating a maintenance immunotherapy after RHRT in MPM, even in the epithelioid histotype.
... Mesothelioma is a highly aggressive malignancy primarily linked to asbestos exposure, representing a significant global health challenge, particularly in industrialized regions with high occupational asbestos use [1][2][3][4]. This cancer primarily originates in serosal tissues, including the pleura, peritoneum, and pericardium, and exhibits considerable geographical variability in its incidence [5][6][7]. ...
Article
Full-text available
Background Malignant mesothelioma is a highly aggressive cancer with a poor prognosis and limited therapeutic options. The tumor microenvironment (TME) plays a pivotal role in driving tumor progression, with immune cells influencing disease outcomes. However, the molecular mechanisms underpinning mesothelioma’s progression remain insufficiently understood. HLA-C, a class I major histocompatibility complex (MHC) molecule, has been implicated in immune modulation and cancer progression, but its specific role in mesothelioma has yet to be thoroughly investigated. Methods This study employed a comprehensive multi-omics approach, integrating single-cell RNA sequencing, expression quantitative trait loci (eQTL) analysis, and Mendelian randomization (MR), to elucidate the role of HLA-C in mesothelioma progression. We first analyzed HLA-C expression within the TME, with particular focus on immune cells, especially macrophages. Survival analysis was conducted using data from the TCGA mesothelioma cohort to assess the clinical relevance of HLA-C expression. We utilized mediated MR analysis to investigate the impact of DNA methylation on HLA-C expression, identifying key mediators such as inflammatory cytokines, immune cell populations, blood cell types, and metabolites that could potentially influence patient prognosis. Results HLA-C was predominantly expressed in macrophages, T cells, and NK cells within the TME, and higher expression levels were associated with improved patient survival. MR analysis revealed that DNA methylation regulates HLA-C expression, which in turn impacts mesothelioma outcomes. Mediated MR analysis, encompassing 91 inflammatory cytokines, 731 immune cell populations, 91 blood cell types, and 1400 metabolites, highlighted several critical mediators of HLA-C’s effect on prognosis, including IL-10, CD33 expression on CD33dim HLA DR- myeloid cells, the reticulocyte perturbation response, and the ADP-to-citrate ratio. Gene set enrichment analysis (GSEA) showed significant enrichment of immune-related and inflammatory pathways in patients with high HLA-C expression. Conclusion HLA-C, regulated by DNA methylation, plays a central role in mesothelioma prognosis by modulating immune responses, inflammatory cytokines, blood cell populations, and metabolic processes within the TME. Our findings suggest that HLA-C could serve as both a prognostic biomarker and a potential therapeutic target for mesothelioma, offering new insights into the molecular mechanisms driving this aggressive cancer.
... PM is an uncommon tumor, with a global incidence of 0.46 per 100,000 persons (1,11). PM often goes undiagnosed until it reaches an advanced stage, primarily due to the absence of specific symptoms. ...
Article
Full-text available
Background: Pleural mesothelioma (PM) is a rare and aggressive malignancy primarily linked to asbestos exposure. Up to 80% of patients have a history of such exposure. Several studies have investigated the possibility of a genetic predisposition for a subgroup of PM patients, but the data remains inconsistent. The ataxia-telangiectasia mutated (ATM) gene, crucial for DNA repair, is implicated in cancer susceptibility, with heterozygous mutations increasing risks, notably in breast and pancreatic cancers. Case description: We present a case of a 42-year-old woman, with no asbestos exposure history, diagnosed with metastatic PM. Initial treatment with immunotherapy showed limited efficacy. Given the rarity in young females, she opted for genetic testing via "The Screen Project", revealing a pathogenic ATM mutation. Due to enhanced radiosensitivity in ATM mutation carriers, to reduce adverse events conventional palliative radiotherapy (RT) was chosen over stereotactic hypofractionated RT. A follow-up computed tomography (CT) scan after 4 weeks indicated disease burden reduction. Conclusions: This case highlights the importance of genetic testing in atypical PM cases, guiding treatment decisions tailored to individual genetic profiles. Awareness of ATM mutations can optimize therapeutic strategies, particularly regarding RT choices, in managing this challenging malignancy. Integrating genetic insights into clinical practice holds promise for enhancing treatment outcomes and refining management strategies in PM and related conditions.
... Mesothelioma attributed to asbestos exposure has an average latency period of 40 years, and in some cases, it could reach 60-70 years (28). Asbestos exposure may lead to MM in 5-10% or up 25% of the highly exposed cases depending on the research conducted (28,29). Chronic stress may potentially increase risk as induced immune dysregulation, and the release of stress-related hormones such as norepinephrine may further exacerbate inflammatory responses, promoting tumor progression in an already inflamed microenvironment (30). ...
Article
Full-text available
Malignant mesothelioma (MM) is a rare but aggressive cancer linked to asbestos exposure and characterized by advanced‑stage disease at presentation. Despite advances in treatment, prognosis remains abysmal, highlighting the imperative for the development of novel biomarkers and treatment approaches. Telomere biology plays a pivotal role in the tumorigenic process and has emerged as a key area in oncology research. Short telomeres have been associated with genomic instability, and substantially shorter telomere length (TL) has been identified in MM, showcasing the potential of TL in risk assessment, early detection, and disease progression monitoring. MM predominantly maintains TL through telomerase activity (TA), which in research has been identified in >90% of MM cases, underscoring the potential of TA as a biomarker in MM. Telomerase reverse transcriptase (TERT) polymorphisms may serve as valuable biomarkers, with research identifying associations between single nucleotide polymorphisms (SNPs) and the risk and prognosis of MM. Additionally, TERT promoter mutations have been associated with poor prognosis and advanced‑stage disease, with the non‑canonical functions of TERT hypothesized to contribute to the development of MM. TERT promoter mutations occur in ~12% of MM cases; C228T, C250T and A161C are the most common, while the distribution and frequency differ depending on histological subtype. Research reveals the promise of the various approaches therapeutically targeting telomerase, with favorable results in pre‑clinical models and inconclusive findings in clinical trials. The present review examines the role of telomere biology in MM and its implications in diagnosis, prognosis, and therapy.
... However, studies in the second half of the past century, have revealed that inhaling fibrous asbestos particles could lead to severe health issues, including asbestosis, lung cancer, and mesothelioma of the pleura and peritoneum (e.g., [2][3][4]). Despite the European Union (EU) implementing a full ban on asbestos use in 2005 [5], it continues to be the leading cause of occupational cancer in the EU. ...
Article
Full-text available
Hazardous pollutant containment zones in buildings should be depressurized by a dedicated mechanical ventilation system to prevent pollutants from escaping from the indoor to the outdoor atmosphere. Depressurization can be affected by atmospheric wind conditions, which can cause a momentary breach. The goal of this study is to analyze the effect of wind velocity and direction on depressurization and potential containment breaches and to validate a ventilation network model for indoor pressure and breach prediction. Wind-tunnel (WT) tests are performed on a reduced-scale isolated building model equipped with a properly downscaled mechanical ventilation system. The time series of the external pressures (pe) on the building surfaces and the indoor pressure (pi) are measured simultaneously. As an alternative approach, a ventilation network model is designed that uses the pe data from the WT tests to determine pi. The network model is then validated by comparing the pi and breach occurrence results by the WT tests versus those by the network model. It is shown that although negative pi can be maintained continuously, containment breaches occur locally where and when pe exceeds pi. The breach probability depends strongly on both wind speed and direction. The network model is successfully validated, where the deviation in breach prediction by the network model is less than 10% compared to the results from WT data alone. The results also show that a -20 Pa depressurization may not be sufficient to avoid a containment breach, which stresses the importance of this and future research on this topic.
Preprint
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Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive tumour requiring multidisciplinary treatment. Identifying prognostic biomarkers could improve treatment planning and patient outcomes. CD73 and CD155 are immunomodulatory molecules involved in immune evasion and tumour progression in various cancers; however, their roles in MPM remain unclear. Therefore, this study aimed to investigate the association between CD73 and CD155 expression in resected epithelial MPM specimens and their impact on 5-year progression-free survival (PFS) and 5-year overall survival (OS). Methods: This single-centre retrospective study included 43 consecutive patients with epithelial MPM who underwent curative-intent surgery, with or without chemotherapy and immune checkpoint inhibitor (ICI) treatment, at our institution between January 1, 2013 and December 31, 2020. Immunohistochemical staining for CD73 and CD155 was performed on surgical specimens, and HALO-AI pathology software was used for quantitative analysis. Receiver operating characteristic (ROC) curve analysis determined cutoff values for CD73/CD155 positivity. Patients were categorised into CD73+/CD155+ and non-CD73+/CD155+ groups and survival outcomes (5-year PFS and 5-year OS) were analysed using Kaplan–Meier curves. Cox proportional hazards regression was used for univariate and multivariate analyses to identify independent prognostic factors. Results: Among 35 evaluable cases, patients with CD73+/CD155+ tumours had significantly improved 5-year PFS compared with those with non-CD73+/CD155+ tumours (64.8% vs. 10.8%, p=0.017), though OS differences were not significant (p=0.376). Among CD73+/CD155+ patients, those who underwent postoperative pleurodesis with OK432 demonstrated significantly higher PFS (83.3% vs. 33.3%, p=0.043), suggesting a potential therapeutic benefit. In contrast, in non-CD73+/CD155+ cases, postoperative chemotherapy significantly improved PFS (p=0.03). Multivariate analysis revealed non-CD73+/CD155+ expression and lack of postoperative chemotherapy as independent predictors of disease progression (HR 6.555, p=0.008) and mortality (HR 5.835, p=0.006). Among recurrent cases, patients treated with ICIs had significantly improved OS (p=0.001), highlighting the potential role of immunotherapy in this subgroup. Conclusions: CD73 and CD155 expression patterns may serve as prognostic biomarkers in epithelial MPM. CD73+/CD155+ tumours appear to benefit from pleurodesis with OK432, while non-CD73+/CD155+ tumours may be more responsive to postoperative chemotherapy. These findings suggest that CD73/CD155 status could guide personalised treatment strategies in MPM, warranting further validation in larger cohorts.
Article
Introduction Peritoneal, pericardial and pleural mesothelioma (PeM/PcM/PM) are rare and aggressive diseases with limited survival. Molecularly guided therapy is currently not part of standard care. Methods This study integrates molecular and clinical data from 51 patients (among them 28 PM, one PcM, 21 PeM and one synchronous PeM/PM) enrolled in the National Center for Tumor Diseases and the German Cancer Consortium (NCT/DKTK) Molecularly Aided Stratification for Tumor Eradication Research (MASTER), a multicenter precision oncology registry trial addressing adults with rare advanced-stage cancers. Analysis comprised both somatic and germline whole exome sequencing/whole genome sequencing and transcriptome analysis leading to personalized treatment recommendations issued by a dedicated molecular tumor board. To assess clinical efficacy, progression-free survival (PFS) ratios comparing molecularly informed therapies (PFS2) to preceding systemic therapies (PFS1) were calculated. Efficacy of immune checkpoint inhibition applied during the observation period was assessed accordingly. Results Cancer-related genes altered in more than 5 out of 44 assessable patients were BAP1, CDKN2A, NF2, SETD2 and TP53. Somatic (n = 23) or germline (n = 9) alterations in homologous recombination-related genes were detected in 27/44 patients. In 21/44 cases, they were supported by positive combined homologous recombination deficiency scores or BRCAness signature. Following American College of Medical Genetics and Genomics guidelines, (likely) pathogenic germline variants in autosomal dominant cancer predisposition genes were found in 8/51 patients. Molecular tumor board recommendations were issued in 46 cases and applied in 6 cases. Mean PFS ratio was 2.45 (n = 5). Median PFS2 was 6.5 months (n = 6), median PFS1 was 4.0 months (n = 5). A total of 27 patients received immune checkpoint inhibition during the observation period leading to a mean PFS ratio of 1.69 (n = 19). Conclusions In mesothelioma, comprehensive molecular analysis can provide valuable clinically actionable information. Molecularly informed therapy recommendations can lead to clinical benefit.
Article
Mesothelioma is an incurable, asbestos-exposure-related cancer that typically affects the lining or pleura of the lungs. Symptoms typically develop many decades after initial asbestos exposure, leaving an enduring legacy of disease. The current disease burden is peaking worldwide and thus there is a massive unmet clinical need for curative therapies. Recently, immune checkpoint blockade-based therapy has been adopted as a first-line of treatment for mesothelioma. Vaccine-induced augmentation of immune responses unleashed during checkpoint blockade may provide further clinical benefit in mesothelioma. In this study, we explore the human leukocyte antigen class I landscape (or immunopeptidome) of mesothelioma in patient-derived cell lines and clinical material (pleural effusion samples). We identify a range of peptide antigens derived from targets including cancer testis antigens, endogenous retroviruses as well as novel post-translational modification of peptides. This information will facilitate the characterization of the immune response to these antigens to determine which class of antigen is most immunogenic and has the potential to be tested in future vaccine studies.
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Although some countries have reduced asbestos consumption and instituted bans, other countries continue to produce and consume asbestos even as asbestos-related deaths mount and the associated societal costs are high. Asbestos production and consumption has declined globally; the number of bans has increased; and the speed at which countries have tapered off consumption has increased. Using country-level data, we study the economic impact of historical changes in the production and use of asbestos. We compare changes in gross domestic product (GDP) following the enactment of asbestos bans. We do not find any significant effect on GDP following an asbestos ban. In a regional case study, we compare changes in GDP and employment with changes in asbestos production. Regional-level data revealed a temporary employment decline at the local level that was then reversed.
Article
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Introduction The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. Methods Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. Results In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. Conclusions The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.
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While the association between exposure to asbestos and malignant mesothelioma (MM), particularly malignant pleural mesothelioma (MPM) has been well established, the health impact of environmental exposure (EE) to asbestos is less studied. This review summarizes the most recent studies on the association between MM and EE to asbestos, in order to identify features associated with EE, and quantify the association with MPM. There were 44 studies from eighteen countries that met our selection criteria, with considerable amount of heterogeneity in study design, the measures for exposure, and health outcomes. The male to female ratio (M:F) was close to or less than 1, and generally lower than the ratio reported when both occupational and environmental exposure types were considered. While recent studies continue to improve our understanding of the types of EE to asbestos still present, challenges remain. We highlighted a few new research directions, such as a need for reliable matrixes to identify common and less recognized environmental exposure types, asbestos biomarker studies specifically focusing on environmental exposures, and research focused on populations and geographic areas that have not been previously studied.
Article
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Background Australia is known to have had one of the highest per-capita asbestos consumption rates, yet there are few contemporary reports on malignant mesothelioma trends. Methods Data on 10 930 people with malignant pleural mesothelioma (MPM) and 640 people with malignant peritoneal mesothelioma diagnosed in Australia during 1982–2009 were analysed. Observed incidence rate trends were quantified. Incidence rates were projected up to 2030 using observed incident cases during 1982–2012. The relative per-decade change in excess mortality during 1999–2009 was estimated. Results During 1982–2009, acceleration in MPM age-standardised incidence rates were highest for women and those aged 75 years and above, with average annual percentage changes of +4.9 (95% CI 3.6 to 6.2) and +7.2 (95% CI 5.4 to 9.0), respectively. Age-standardised incidence rates for men with MPM aged 0–64 years decelerated rapidly during 2003–2009, an average annual percentage change of −5.1% (95% CI −7.6% to −2.5%). Overall, male age-specific MPM incidence rates in the age group of 65–74 year during 2010–2030 are projected to decline with rates projected to increase for older men and women with MPM. There was a statistically significant 16% relative reduction in the excess mortality rate (EMR) up to 5 years postdiagnosis for people diagnosed with malignant pleural and peritoneal mesothelioma combined in 2009 compared with those diagnosed in 1999, an EMR ratio of 0.84 (95% CI 0.77 to 0.92). Conclusions Australia's malignant mesothelioma incidence rates appear to have reached maximum levels but with differences over time by age, gender and tumour location. Improvements over time in survival provide a glimpse of hope for this almost invariably fatal disease.
Article
Malignant pleural mesothelioma (MPM) is a rare disease with a very poor prognosis. Previous studies have indicated that women experience longer survival compared with men. We analyzed 16 267 eligible patients (21.3% females) in the National Cancer Database to evaluate which clinical factors are independently predictive of longer survival. After adjusting for all covariates, survival was significantly better in females compared with males [HRadj: 0.81, 95% confidence interval (CI): 0.77-0.85]. Other factors significantly associated with better survival were younger age at diagnosis, higher income, lower comorbidity score, epithelial histology, earlier stage and receipt of surgical or medical treatment. After propensity matching, survival was significantly better for females compared with males [hazard ratio (HR): 0.86, 95% CI: 0.80-0.94]. After propensity matching within the epithelial group, survival remained significantly better for females compared with males (HR: 0.85, 95% CI: 0.74-0.97). This study adds information to the known significant gender survival difference in MPM by disentangling the effect of gender from the effect of age and histology, two known independent factors affecting survival. Circulating estrogen, present in young but not older women, and higher expression of the estrogen receptor beta in epithelial mesothelioma have been suggested to play a role in gender survival differences. These findings may lead to exploring new therapeutic options, such as targeting estrogen receptor beta, and considering hormonal therapy including estrogens for patients with otherwise limited prognosis.
Article
Background Temporal trends and broad geographical distributions of asbestos use and the incidence of malignant mesothelioma (MM) in the US still need to be studied. Methods Data on asbestos consumption and production between 1900 and 2015 and MM mortality and incidence rates between 1975 and 2015 in the US were examined. Spatial distributions of MM mortality and incidence rates and their association with climate zone were analyzed. Results Decline of MM incidence and mortality rates in the US occurred about 20 years after the peak of asbestos consumption‐production in 1973. There are apparent north‐south (N‐S) gradients in MM mortality and incidence rates in the US. Conclusion Recent decline of MM incidence and mortality rates in the US may be associated with reduced US asbestos consumption. N‐S MM gradients between 1999 and 2015 were likely related to larger asbestos requirements in building materials in the northern states.
Article
Mesothelioma is commonly considered an occupational disease occurring as a result of asbestos exposure in the workplace. Several avenues for environmental asbestos exposures have been described and may be associated with asbestos related disease, including mesothelioma. Worker take-home asbestos, or para-occupational exposure, has been well documented and is the most commonly reported pathway for asbestos exposure among mesothelioma cases that do not have history of occupational asbestos exposure. Observational studies have evaluated several communities with elevated mesothelioma incidence and environmental exposures attributed to local asbestos-related industries. Potential, but uncertain, mesothelioma risk also may be associated with general population asbestos exposure through contact with asbestos-containing commercial products, particularly housing materials that can be easily disturbed through normal activity. Finally, studies have described elevated mesothelioma incidence in several areas where populations are exposed to naturally occurring asbestos materials. These various environmental asbestos exposure pathways are poorly understood, and further studies should be pursued to evaluate their respective importance for population mesothelioma risk.
Article
This Circular updates and supersedes U.S. Geological Survey (USGS) Open-File Report 03-083, "Worldwide Asbestos Supply and Consumption Trends from 1900 to 2000," with the addition of supply and consumption estimates and analysis from 2001 through 2003 and revisions to the consumption estimates for 1998 through 2000. The text from Open-File Report 03-083 also has been updated in this Circular to include revisions to and expansion of the time-series coverage. The use of asbestos is one of the most controversial issues surrounding the industrial minerals industry. Its carcinogenic nature, an overall lack of knowledge of minimum safe exposure levels, its widespread use for more than 100 years, and the long latency for the development of lung cancer and mesothelioma are the main contributing factors to these controversies. Another factor is that, despite decades of research, the mechanisms responsible for its carcinogenic properties are still largely unknown. The United States produced about 3.29 million metric tons (Mt) of asbestos and used approximately 31.5 Mt between 1900 and 2003. About half of this amount was used after 1960. In 2002, the last asbestos mine in the United States closed, marking the end of more than 110 years of U.S. asbestos production. Cumulative world production from 1900 through 2003 was about 181 Mt. If one assumes that unusually large stocks were not maintained and that world consumption roughly equaled production, then about half of the world production and consumption occurred between the end of 1976 and the end of 2003. The United States and Western European nations were the largest consumers of asbestos during the first two-thirds of the 20th century. They were surpassed by the collective production and consumption of Kazakhstan and Russia by the 1970s. After the onset of the health issues concerning asbestos in the late 1960s and early 1970s, the decline in world production and consumption began to be evident in the late 1970s and early 1980s. The 1991 breakup of the Soviet Union, a major user of asbestos, resulted in a significant decline in asbestos consumption and production in former Soviet-bloc countries. Consumption and production in Kazakhstan and Russia increased through 2003 from 2001, albeit to a much lower level than in the 1980s. In 2003, world consumption was estimated to be 2.11 Mt, about 45 percent that of 1980. Relatively few countries in Asia, the Middle East, South America, and the former Soviet Union remained as the leading users of asbestos. China was the leading consuming nation, using an estimated 492,000 metric tons (t) in 2003. China was followed, in decreasing order of consumption, by Russia (429,000 t), India (192,000 t), Kazakhstan (174,000 t), Ukraine (156,000 t), Thailand (133,000 t), Brazil (78,400 t), and Iran (75,800 t). These eight countries accounted for 82 percent of the world's apparent consumption in 2003. Following Iran, in decreasing order of consumption by tonnage, were Uzbekistan (42,400 t), Vietnam (39,400 t), Indonesia (32,300 t), the Republic of Korea (23,800 t), Kyrgyzstan (23,700 t), Japan (23,400 t), and Mexico (20,100 t). Consumption in all other countries was estimated to be less than 15,000 t each in 2003. Sizable consumption increases occurred in Azerbaijan, China, India, Iran, Kazakhstan, Thailand, and Ukraine between 2000 and the end of 2003. Consumption patterns in countries using less than 5,000 t per year were too erratic to ascertain any trends in their use of asbestos.