Factors affecting the mesothelioma detection rate within national and international epidemiological studies: insights from Scottish linked cancer registry-mortality data

Our plain-English summary of Factors affecting the mesothelioma detection rate within national and international epidemiological studies: insights from Scottish linked cancer registry-mortality data, by D.R. Camidge, D.L. Stockton, M. Bain (British Journal of Cancer, 2006).

The study

• Authors: D.R. Camidge, D.L. Stockton, M. Bain
• Journal: British Journal of Cancer
• Published: 2006;95(5):649-52
• Cited by: 25 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

ICD-9 code 163 (malignant neoplasm of pleura) listed as underlying cause of death detected only 40% of Scottish mesothelioma cases (all body sites) from the cancer registry in 1981-1999. This is lower than both the previously published 55% figure, derived from UK mesothelioma register data 1986-1991, which is based on any mention of mesothelioma on death certificates, cross-referenced to cancer registry data, and the 44% figure derived from Scottish mortality data 1981-1999, which captured any mention of mesothelioma on the death certificate. Detection from cancer registry data increased to 75% under ICD-10 in Scotland, confirming earlier predictions of the benefit of ICD-10's more specific mesothelioma codes. Including the accidental poisoning codes E866.4 (ICD-9) and X49 (ICD-10), covering poisoning by 'unspecified' and 'other' causes, which appear to have been used as coding surrogates for mesothelioma when asbestos exposure was explicitly mentioned in deaths suggestive of a mesothelioma, and which are recorded as the underlying cause of death in 4-7% of mesotheliomas, may improve the mesothelioma detection rate in future epidemiological studies.

In plain English

This study used Scottish national records that link cancer registry entries to death records to see how the deaths of mesothelioma patients were coded. The authors examined the underlying cause-of-death codes for 2740 people listed on the cancer registry with mesothelioma (all body sites) who died between 1981 and 2003. Under the older ICD-9 system (1981 to 1999), only 861 of 2133 deaths (40%) were coded as malignant neoplasm of pleura (code 163), the code most studies use to count mesothelioma. Another 22% were coded as lung cancer and 19% as cancer of unspecified site. When Scottish death records that captured any mention of mesothelioma were used instead, the figure was 44%. Under ICD-10 (2000 to 2003), 75% (455 of 607) of deaths carried the new mesothelioma-specific codes. Accidental poisoning codes made up 4% to 7% of these deaths. The General Register Office for Scotland reported that these codes were mainly used for mesothelioma when asbestos exposure was mentioned. The authors concluded that counting these poisoning codes may improve mesothelioma detection in future studies. They looked only at underlying cause-of-death codes.

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: Record-linkage study comparing cancer registry data with death records (cause-of-death coding analysis)
• Who was studied: 2740 mesothelioma patients (all body sites) listed on the Scottish cancer registry who died between 1981 and 2003: 2133 who died 1981 to 1999 (ICD-9) and 607 who died 2000 to 2003 (ICD-10)
• Exposure: No exposure was measured. The study examined death-certificate coding. The authors report that accidental poisoning codes were used as a stand-in for mesothelioma when asbestos exposure was explicitly mentioned.
• Main results:
  • 1981 to 1999 (ICD-9): 861 of 2133 cancer-registry mesothelioma deaths (40%) had malignant pleural tumour (code 163) as the underlying cause of death
  • 1981 to 1999: 475 (22%) of these deaths were coded as malignant neoplasm of bronchus and lung, and 399 (19%) as malignant neoplasm of unspecified site
  • The detection rate was 40% using Scottish cancer registry data and 44% using Scottish mortality data that captured any text mention of mesothelioma on the death certificate (1981 to 1999)
  • 1981 to 1999: 83% (829 of 997) of Scottish deaths coded 163 as underlying cause were registered as mesotheliomas on the cancer registry
  • 2000 to 2003 (ICD-10): 75% (455 of 607) of cancer-registry mesothelioma deaths were accounted for by the mesothelioma-specific C45 codes
  • Use of lung cancer codes fell from 22% to 4%, and use of unspecified-site codes fell from 18% to 1%, from ICD-9 to ICD-10
  • 2000 to 2002: 95% (379 of 399) of ICD-10 C45 deaths were registered as mesotheliomas on the cancer registry
  • Accidental poisoning codes (E866.4 in ICD-9, X49 in ICD-10) were the underlying cause in 4% to 7% of mesothelioma deaths. 81% (79 of 97) of deaths coded E866.4 in 1981 to 1999 were listed as mesotheliomas in the cancer registry.
• The authors' conclusion: The authors concluded that ICD-10 improved detection, as earlier predicted. They also concluded that including the accidental poisoning codes E866.4 and X49 may improve the mesothelioma detection rate in future epidemiological studies.
• Limitations the authors state:
  • Only codes used for the underlying cause of death were examined
  • The record-linkage method is estimated to be 98% accurate
  • Before about 1997, five separate Scottish cancer registries worked in slightly different ways
  • Some mesotheliomas listed on death certificates will still be missed, and some non-mesothelioma codes will be accurate because not all mesothelioma patients die from their mesothelioma

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cancer Registry, Neoplasm, Pleura, Death Certificate, Asbestos Exposure.

Related studies

• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM) — A. Binazzi, D. Di Marzio, et al. (2021)
• Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data — G.A. Abel, S.C. Mendonca, et al. (2017)
• Occupational illnesses within two national data sets — J.P. Leigh, T.R. Miller (1998)
• Analysis of mesothelioma cases and National Cancer Registry data to assess asbestos exposure in India — R. Singh, A.L. Frank (2024)
• US mesothelioma patterns 1973-2002: indicators of change and insights into background rates — M.J. Teta, P.J. Mink, et al. (2008)

Browse more research in British Journal of Cancer, or return to medical research.