Absence of evidence for a significant background incidence of diffuse malignant mesothelioma apart from asbestos exposure

Our plain-English summary of Absence of evidence for a significant background incidence of diffuse malignant mesothelioma apart from asbestos exposure, by E.J. Mark, T. Yokoi (Annals of the New York Academy of Sciences, 1991).

The study

• Authors: E.J. Mark, T. Yokoi
• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:196-204
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004492).

Abstract

The incidence of diffuse malignant mesothelioma is rising. Physicians can diagnose a disease only when they know that it exists, so one explanation for the rise in incidence is more widespread appreciation of the clinical and pathological features of the disease. Modern pathology has ascribed specific requirements for the diagnosis of diffuse malignant mesothelioma. A priori one cannot assume that these requirements have increased the likelihood of the diagnosis because the requirements also can serve to exclude the diagnosis depending on the findings. Most cases of diffuse malignant mesothelioma are suspected by macroscopic and routine microscopic techniques that have been available since the last part of the nineteenth century. Although single reported instances of some pulmonary diseases have survived from the nineteenth century, pathologists did not identify enough cases to convincingly establish the existence of diffuse malignant mesothelioma of the pleura as an entity until the 1930s or 1940s. One must conclude that the background level of diffuse malignant mesothelioma in Europe and in the United States prior to 1930 was extremely low. No case was detected at the Massachusetts General Hospital until 1946.

In plain English

The authors, pathologists in Boston and Nagoya, Japan, asked whether diffuse malignant mesothelioma occurred at a 'background' level apart from asbestos. They reviewed the autopsy records of Massachusetts General Hospital from 1946 back to 1896, when its recorded autopsies began, and the early medical literature on chest tumors. The hospital had performed more than 47,000 autopsies since 1896. The authors found no malignant mesothelioma before a 1946 case in a 37-year-old Swedish asbestos worker. After 1946, approximately 100 autopsies at the hospital showed diffuse malignant mesothelioma of the pleura. The early literature held only scattered possible cases. A thirty-volume German pathology reference work from the 1920s and 1930s could not say definitively whether the disease existed. The authors concluded that the background level of the disease in Europe and the United States before 1930 was extremely low, and that current cases at their hospital were not attributable to any significant local background level. They noted that their hospital's experience was not likely to represent a worldwide pattern. They also noted that their reading assumed referral and autopsy patterns did not change around 1940.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of hospital autopsy files, combined with a review of early published medical literature on chest tumors
• Who was studied: Autopsy records of Massachusetts General Hospital, Boston, reviewed from 1946 back to the first recorded autopsy in 1896. More than 47,000 autopsies had been performed there over 95 years. The authors also reviewed pathology literature from the late nineteenth and early twentieth centuries.
• Exposure: No exposure was measured. The question was whether diffuse malignant mesothelioma existed before and apart from commercial asbestos use. The authors noted that many local people had been exposed to asbestos in shipyards. No fiber types were named.
• Main results:
  • No malignant mesothelioma was found in the hospital's autopsy files before the 1946 index case.
  • The first case at the hospital, in 1946, was a 37-year-old Swedish asbestos worker. At autopsy the diagnosis was mesothelioma of pleura and pericardium.
  • A 1941 chest tumor was labelled as possibly a 'mesothelial sarcoma of the pleura'. The authors judged that it probably represented a malignant localized fibrous tumor, not a diffuse mesothelioma.
  • After 1946, approximately 100 autopsies at the hospital disclosed diffuse malignant mesothelioma of the pleura.
  • Over the 95-year period, all recorded diffuse malignant mesotheliomas of the pleura occurred in the last 45 years and none in the first 50 years.
  • A 1930 report of five primary pleural tumors from Mount Sinai Hospital in New York was the only article cited in the published 1946 case record. It included only one diffuse tumor consistent with diffuse malignant mesothelioma. The other cases were three localized fibrous tumors and a giant lipoma.
  • Among early reports, the authors identified a probable desmoplastic diffuse malignant mesothelioma in a 71-year-old man autopsied at Boston City Hospital in 1928.
  • In the German Handbuch of pathology from the 1920s and 1930s, any pre-1930 cases were so sporadic that its authors could not state definitively whether the disease existed.
  • The authors interpreted the hospital findings to mean that current cases there were not attributable to any significant local background level of the disease.
• The authors' conclusion: The authors concluded that the background level of diffuse malignant mesothelioma in Europe and the United States before 1930 was extremely low.
• Limitations the authors state:
  • The hospital's large and increasing number of mesothelioma patients is not likely to represent a uniform worldwide phenomenon.
  • The interpretation assumes that patterns of patient referral and reasons for autopsy did not differ before and after about 1940.
  • Early reports usually lacked photomicrographs, so identifying past cases depended on written descriptions.
  • Changing diagnostic tests could either increase or decrease how often the diagnosis is made.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Pathology, Pleura.

Related studies

• Background incidence of mesothelioma: animal and human evidence — E.B. Ilgren, J.C. Wagner (1991)
• Asbestos-Related Disorders in Germany: Background, Politics, Incidence, Diagnostics and Compensation — X. Baur (2018)
• Acne inversa complicated by squamous cell carcinoma in association with diffuse malignant peritoneal mesothelioma arising in the absence of predisposing factors: a case report — V. Barresi, E. Vitarelli, et al. (2008)
• Diffuse malignant pleural mesothelioma in an urban hospital: clinical spectrum and trend in incidence over time — K.E. Shepherd, L.C. Oliver, et al. (1989)
• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)
• Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends — F. Montanaro, F. Bray, et al. (2003)

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