Asbestos exposure and differences in occurrence of peritoneal mesothelioma between men and women across countries

Our plain-English summary of Asbestos exposure and differences in occurrence of peritoneal mesothelioma between men and women across countries, by A. Burdorf, B. Järvholm, S. Siesling (Occupational and Environmental Medicine, 2007).

The study

• Authors: A. Burdorf, B. Järvholm, S. Siesling
• Journal: Occupational and Environmental Medicine
• Published: 2007;64(12):839-42
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: In several countries the incidence of peritoneal mesotheliomas among women closely mirrors the pattern among men. The aim was to investigate the role of asbestos exposure in the aetiology of peritoneal mesotheliomas in women and men.

Methods: All cases of peritoneal mesothelioma were selected from the Swedish and Netherlands Cancer Registers for the period 1989-2003. For both countries incidence rates were calculated and stratified by sex. A linear regression analysis was used to analyse the existence of a trend over time.

Results: Among men the incidence rate of peritoneal mesothelioma in the Netherlands (0.60 per 100 000 persons) was consistently higher than in Sweden with an average ratio of 1.8 (range 1.4-2.8). In both countries no trend over time was observed. During the 15-year period in the Netherlands the incidence rate among men was about 3.3-fold higher than among women. In Sweden the incidence rate among women was slightly higher than in men up to 1999, and thereafter about threefold higher among men. This sudden shift was statistically significant and seemed mainly caused by changes in classification of peritoneal tumours.

Conclusion: The absence of a time trend in the incidence rate of peritoneal mesothelioma in the Netherlands and Sweden in the past 15 years may point to a more limited role of occupational exposure to asbestos in the aetiology of peritoneal mesothelioma than for pleural mesothelioma, especially among women. The observed drop around 2000 in annual incidence of peritoneal mesothelioma among Swedish women indicates the presence in the past of a substantial misclassification with other tumours in the peritoneum.

In plain English

This study used national cancer registry data to compare how often peritoneal mesothelioma (mesothelioma of the lining of the abdomen) was diagnosed in men and women in the Netherlands and Sweden from 1989 to 2003. The authors had no information on individual asbestos exposure. They used incidence patterns to consider the role of asbestos. Among men, the average rate was 0.60 per 100 000 in the Netherlands and 0.34 per 100 000 in Sweden, an average Dutch-to-Swedish ratio of 1.8 (range 1.4 to 2.8). Neither country showed a trend over time. In the Netherlands the rate in men was about 3.3 times that in women, and Dutch women with the disease were younger than Dutch men. In Sweden, rates in women were slightly higher than in men until about 1999. They then dropped suddenly, from 3 to 13 cases a year to 0 to 5. The authors attributed this mainly to changes in how peritoneal tumours were classified. They concluded that the lack of a time trend may point to a more limited role of occupational asbestos exposure in peritoneal than in pleural mesothelioma, especially among women. They noted that case numbers were very low.

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: Registry-based study of incidence rates and time trends (descriptive analysis with linear regression)
• Who was studied: All pathologically confirmed cases of malignant peritoneal mesothelioma in the Swedish and Netherlands Cancer Registers, 1989–2003, men and women
• Exposure: No individual asbestos exposure data were collected. Only year of birth, year of diagnosis and sex were retrieved. The role of occupational asbestos exposure was inferred from incidence patterns.
• Main results:
  • Among men, the average incidence rate was 0.60 per 100 000 in the Netherlands and 0.34 per 100 000 in Sweden
  • The rate in Dutch men was consistently higher than in Swedish men, with an average ratio of 1.8 (range 1.4 to 2.8)
  • In both countries no trend over time was observed
  • In the Netherlands, the incidence rate among men was about 3.3-fold higher than among women over the 15-year period
  • Dutch women with peritoneal mesothelioma were statistically significantly younger than Dutch men with the disease (chi-square 6.59, p = 0.04). A similar but not statistically significant pattern was seen in Swedish women.
  • Among Swedish women, annual cases fell from about 1999 onwards, from 3–13 cases per year to 0–5 cases per year. No such change was seen among Swedish men.
  • The sudden shift in Sweden was statistically significant. The authors judged it to be mainly caused by changes in the classification of peritoneal tumours.
• The authors' conclusion: The authors concluded that the absence of a time trend may point to a more limited role of occupational asbestos exposure in peritoneal than in pleural mesothelioma, especially among women. They also concluded that the drop among Swedish women indicates substantial past misclassification with other peritoneal tumours.
• Limitations the authors state:
  • The number of cases was very low, so age comparisons used only three broad age groups
  • Numbers among Swedish women were too small to reach statistical significance for the age comparison
  • A diagnostic shift like Sweden's may also have occurred in other countries, which would hamper comparisons within and across countries

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Peritoneal Mesothelioma, Incidence, Occupational Exposure, Pleural Mesothelioma, Peritoneum.

Related studies

• Gender differences in pleural mesothelioma occurrence in Lombardy and Piedmont, Italy — D. Consonni, E. Migliore, et al. (2019)
• Explaining differences in incidence rates of pleural mesothelioma between Sweden and the Netherlands — A. Burdorf, B. Järvholm, et al. (2005)
• Emerging evidence that the ban on asbestos use is reducing the occurrence of pleural mesothelioma in Sweden — B. Järvholm, A. Burdorf (2015)
• Differences in occupational mortality from pleural cancer, peritoneal cancer, and asbestosis — D. Coggon, H. Inskip, et al. (1995)
• Differences between peritoneal and pleural mesothelioma in Lombardy, Italy — C. Mensi, M. Mendola, et al. (2017)
• DNA fingerprint analysis reveals differences in mutational patterns in experimentally induced rat peritoneal tumors, depending on the type of environmental mutagen — N. Kociok, K. Unfried, et al. (1999)

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