Annals of Oncology 18: 985–990, 2007
Published online 9 October 2006
Epidemiology of peritoneal mesothelioma: a review
International Agency for Research on Cancer, Lyon, France
Received 4 April 2006; revised 2 August 2006; accepted 18 August 2006
The epidemiology of peritoneal mesothelioma is complicated by possible geographic and temporal variations in
diagnostic practices. The incidence rates in industrialized countries range between 0.5 and three cases per
million in men and between 0.2 and two cases per million in women. Exposure to asbestos is the main known
cause of peritoneal mesothelioma. Results on peritoneal mesothelioma have been reported for 34 cohorts
exposed to asbestos, among which a strong correlation was present between the percentages of deaths from
pleural and peritoneal mesothelioma (correlation coefficient 0.8, P < 0.0001). Studies of workers exposed
only or predominantly to chrysotile asbestos resulted in a lower proportion of total deaths from peritoneal
mesothelioma than studies of workers exposed to amphibole or mixed type of asbestos. Cases of peritoneal
mesothelioma have also been reported following exposure to erionite and Thorotrast, providing further evidence
of common etiological factors with the pleural form of the disease. The role of other suspected risk factors, such
as simian virus 40 infection and genetic predisposition, is unclear at present. Control of asbestos exposure
remains the main approach to prevent peritoneal mesothelioma.
Key words: asbestos, epidemiology, peritoneal mesothelioma, thorotrast
The peritoneum is the second most frequent site of origin of
mesothelioma, after the pleura. In developed countries,
malignant mesothelioma (International Classification of Diseases
for Oncology–Morphology codes 9050–9055) is the most
frequent malignant neoplasm of the peritoneum . Symptoms
of peritoneal mesothelioma are unspecific, the most frequent
beingincreasedabdominal girth,painandweightloss ;usually
diagnosis occurs late. Treatment includes the combination of
debulking surgery and i.p. chemotherapy. Survival remains poor;
in the USA Surveillance, Epidemiology and End Results (SEER)
cancer registry data median survival is 10 months and relative
5-year survival is 16% , however, in selected clinical series
a longer survival (median >50 months) has been reported .
Although asbestos has been known for several decades to cause
peritoneal mesothelioma, in addition to the pleural form of the
disease , no detailed review of the epidemiological features of
this disease has been published recently.
The descriptive epidemiology of peritoneal mesothelioma is
complicated by temporal and geographic variability in
diagnostic criteria. In addition, low sensitivity and low
specificity of the diagnosis are important concerns, since
mesothelioma of the peritoneum can be misdiagnosed as
a neoplasm originating from other abdominal organs, notably
adenocarcinoma from the ovary, and vice versa [5, 6].
Furthermore, sensitivity and specificity of the diagnosis may
vary by place and time, thus complicating geographic and
temporal analyses of the occurrence of the disease. Furthermore,
given the strong association between asbestos and
mesothelioma, knowledge of previous exposure might
influence diagnostic accuracy; if this is the case, a diagnosis
of peritoneal mesothelioma would be more frequently made
for a patient with recognized past asbestos exposure than for
a patient with a similar clinical presentation but without
history of asbestos exposure.
The consequences of these potential biases are difficult to
assess. Although it is likely that occurrence of peritoneal
mesothelioma is underestimated in most populations,
overestimation might occur in circumstances of recognized
asbestos exposure. In general, caution should be used in the
interpretation of the available data on the incidence and
mortality from this disease.
Recent international data on the incidence of peritoneal
mesothelioma are available from Eurocim, a collaboration of
European population-based cancer registries , and from the
SEER program of the United States . Only sparse data are
available from the other countries. Figure 1 reports the most
recent data from selected nationwide European cancer registries
and the SEER registries; at this level of aggregation, age-
standardized incidence rates among men range from 0.5 to
about three cases per million population. However, higher rates
*Correspondence to: Dr P. Boffetta, International Agency for Research on Cancer,
150 Cours Albert Thomas, 69008 Lyon, France. Tel +33-4-72738554;
Fax: +33-4-72738320; E-mail: email@example.com
ª 2006 European Society for Medical Oncology
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