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

Our plain-English summary of Epidemiology of mesothelioma in the 21st century in Europe and the United States, 40 years after restricted/banned asbestos use, by N. Alpert, M. van Gerwen, E. Taioli (Translational Lung Cancer Research, 2020).

The study

• Authors: N. Alpert, M. van Gerwen, E. Taioli
• Journal: Translational Lung Cancer Research
• Published: 2020;9(Suppl 1):S28-S38
• Type of article: Review
• Cited by: 127 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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 fibers, as well as of individual genetic susceptibility to asbestos fibers are needed.

2020 Translational Lung Cancer Research. All rights reserved.

In plain English

This review article described asbestos use and mesothelioma rates in the United States and the 53 countries of the World Health Organization European region, using publicly available data. In 1980, per-person asbestos consumption was very high in parts of Europe, for example 9.6 kg for the Russian Federation and Kazakhstan, compared with 1.6 kg in the US. By 2007, US consumption was 0.003 kg per person and most European Union countries were at or near zero, while Kazakhstan remained at 7.0 kg. For 2008 to 2012, age-adjusted mesothelioma incidence per 100,000 people was 0.9 for US males and 0.3 for US females, and 1.7 for European males and 0.4 for European females. US incidence declined, mostly among males, while female rates mostly held steady. European rates rose sharply in the early 2000s and may be leveling off. The authors concluded that asbestos exposure remains a worldwide burden, that legislative action is needed for a complete ban, and that mesothelioma is shifting toward affecting females in substantial numbers. They cautioned that reporting and diagnosis may differ between countries.

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: Review article with descriptive analysis of publicly available data on asbestos consumption, mesothelioma incidence and mesothelioma mortality
• Who was studied: The United States and Europe, defined as the 53 countries of the WHO European region. Incidence data cover 2008–2012. Time trends used registries with continuous data from 1980–2012: SEER-9 in the US, and selected registries in Denmark, France, Germany, Iceland, Israel, Italy, Norway, Switzerland and Scotland.
• Exposure: Country-level asbestos consumption per person in 1980 and 2007, from US Geological Survey reports, set against the national asbestos bans and regulations of each country
• Main results:
  • In 1980, consumption exceeded 5 kg per person in the former Soviet Union (9.6 kg/capita estimated for the Russian Federation and Kazakhstan). US consumption was 1.6 kg/capita.
  • In 2007, US consumption was 0.003 kg/capita and most EU countries had decreased to 0 or nearly 0 kg/capita.
  • In 2007, consumption remained high or very high in several countries, including Kazakhstan at 7.0 kg/capita.
  • For 2008–2012, the world standardized incidence rate per 100,000 was 0.9 for US males and 0.3 for US females, and 1.7 for European males and 0.4 for European females.
  • Incidence per 100,000 was also very high in the Netherlands (2.8 in males, 0.4 in females) and the United Kingdom (3.4 in males, 0.6 in females).
  • For people aged 80 and older, incidence per 100,000 for males was 18.9 in the US and 22.8 in Europe. For females it was 3.0 in the US and 3.4 in Europe.
  • US incidence started to decline from 1980 to 2016, mostly because of a decline among males, while female rates mostly held steady.
  • European rates rose sharply in the early 2000s and may just now be beginning to level off.
  • Females now make up a larger share of people with mesothelioma in the US than in Europe.
  • The ratio of mortality rate to incidence rate exceeded 0.5 in almost all countries with data, and was generally lower for females. In the US it was 0.89 for males and 0.67 for females.
• The authors' conclusion: The authors concluded that asbestos exposure is still a burden worldwide, that legislative action is needed to obtain a complete ban, and that mesothelioma is shifting from a mostly male disease to one that also affects females in substantial numbers. They called for studies on unknown and natural sources of exposure and on genetic susceptibility.
• Limitations the authors state:
  • Comparisons between countries may be affected by differences in reporting, misclassification in diagnosis, or a lack of medical resources to diagnose the disease accurately.
  • Data were limited for the former Soviet Union, the Russian Federation and former Yugoslavia.
  • Because mortality and incidence data came from different sources, some mortality rates exceeded incidence rates. Those ratios were recorded as 1.
  • For some countries, not all years from 2008 to 2012 were available.

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Mesothelioma, Asbestos Exposure, Latency, Environmental Exposure, Incidence.

Related studies

• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare investigation of treatment patterns and overall survival — J.L. Beebe-Dimmer, J.P. Fryzek, et al. (2016)
• Malignant Pleural Mesothelioma Epidemiology in the United States From 2000 to 2016 — A. Thomas, S. Karakattu, et al. (2021)
• Re: "Mesothelioma trends in the United States: an update based on surveillance, epidemiology, and end results program data for 1973 through 2003" — J.H. Lange (2004)
• Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010 — K.M. Bang, J.M. Mazurek, et al. (2014)
• Mortality experience of insulation workers in the United States and Canada, 1943--1976 — I.J. Selikoff, E.C. Hammond, et al. (1979)

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