Geographic study of mortality due to mesothelioma in Peru and its evolution

Our plain-English summary of Geographic study of mortality due to mesothelioma in Peru and its evolution, by J.S. Torres-Roman, V. Gomez-Rubio, L. Sanchez-Trujillo, et al (Cancer Epidemiology, 2020).

The study

• Authors: J.S. Torres-Roman, V. Gomez-Rubio, L. Sanchez-Trujillo, E. Delgado-Rosas, F. Puche-Vergara, J.M. Sanz-Anquela, M.A. Ortega
• Journal: Cancer Epidemiology
• Published: 2020;68:101791
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Peru has a public health problem because of asbestos imports. We analyzed the mortality trends for mesothelioma in Peru and its provinces from 2005 to 2014 and estimated their relationship with the amount of asbestos imported previously.

Methods: We computed age-standardized mortality rates (ASMRs) per 100,000 population (direct method and SEGI world standard population reference), and the standardized mortality ratio (SMR). The relationship between the amount of asbestos imported annually along the period 1965-2010 and the number of mesothelioma deaths per year from 2005 to 2014 was estimated by log-linear Poisson regression models and Pearson correlation calculations.

Results: After correcting the number of deaths, Peru registered 428 cases (or 430 when corrected cases are rounded by sex) between 2005 and 2014. The highest ASMRs were in Arequipa and Callao (range: 0.40-0.41/100,000 population), followed by Huancavelica (0.36/100,000 population). This translates into approximately one death per each 68-111 of asbestos tons imported. The latency period for the higher level of positive correlation found was 8 years (r = 0.8). Male female sex ratio was lower in provinces such as Junin and Hunacavelica with geological asbestos risk.

Conclusions: Two patterns of mesothelioma risk have been detected, occupational and environmental. During the 2002-2006 years, Peru increased the asbestos use. If crocidolite imports were also increased, this could be behind the 8 years latency period detected. Peru should boost strategies towards the total ban of all forms of asbestos.

Copyright © 2020 Elsevier Ltd. All rights reserved.

In plain English

The authors used Peru's Ministry of Health death registry to count mesothelioma deaths (ICD-10 code C45) in Peru's 25 provinces from 2005 to 2014. They corrected the counts for underreporting and compared them with the tons of asbestos Peru imported from 1965 onward. After correction there were 428 deaths (430 when rounded by sex: 242 men, 188 women). Yearly age-standardized death rates ranged from 0.15 to 0.32 per 100,000 in men and from 0.09 to 0.24 in women. The highest provincial rates were in Arequipa (0.41), Callao (0.40) and Huancavelica (0.36). Deaths lined up most closely with imports from 8 years earlier, at about one death per 68 to 111 tons. The authors said it was uncertain whether this short latency was real. In Ica, Junin and San Martin, more deaths were recorded among women than men; provincial rates by sex were not calculated. The authors concluded that occupational and environmental patterns of risk were detected and that Peru should move toward banning all forms of asbestos. They named a poor-quality death registry and few deaths as limitations.

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: Geographic (population-level) mortality study using national death registry data, with Poisson regression and Pearson correlation linking yearly deaths to earlier asbestos import tonnage
• Who was studied: Deaths coded as mesothelioma (ICD-10 C45) in the Peru Ministry of Health (MINSA) death registry, 2005 to 2014, across Peru's 25 administrative provinces; 254 registered deaths, 428 after correction for underreporting
• Exposure: Tons of asbestos imported by Peru, 1965 to 2014, from customs and other sources (cumulative 221,448 tons). Crocidolite was recorded separately only from 2008. Individual exposures were not studied.
• Main results:
  • After correction, 430 mesothelioma deaths in Peru from 2005 to 2014 (242 men, 188 women); 428 in the province totals
  • Yearly age-standardized mortality rates ranged from 0.15 to 0.32 per 100,000 in men and from 0.09 to 0.24 per 100,000 in women
  • The highest provincial rates for 2005 to 2014 (both sexes) were in Arequipa and Callao, 0.40 to 0.41 per 100,000
  • Huancavelica followed, at 0.36 per 100,000
  • Four provinces had no mesothelioma deaths reported
  • The Poisson model fitted best for an 8-year gap between imports and deaths (R2 = 0.88); the highest Pearson correlation was also at 8 years
  • With the 8-year gap, there was one corrected death for every 68 to 111 tons of asbestos imported
  • The male-to-female ratio of uncorrected recorded deaths was below 1 in Ica (0.50), Junin (0.75) and San Martin (0.25). These ratios are based on death counts. Provincial mortality rates were not calculated separately by sex.
• The authors' conclusion: The authors concluded that two patterns of mesothelioma risk, occupational and environmental, were detected. They suggested that rising imports in 2002 to 2006, possibly including crocidolite, could lie behind the 8-year latency, and said Peru should pursue a total ban on all forms of asbestos.
• Limitations the authors state:
  • Peru lacks a high-quality national death registry; unregistered deaths reach up to 78 % in Loreto province (the authors corrected for this by province and year)
  • The number of mesothelioma deaths was low; only 14 of the 25 provinces had 3 or more deaths over the period
  • It is uncertain whether the 8-year latency is real or reflects the low number of reported deaths
  • The amount of crocidolite imported before 2008 is unknown

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, standardized mortality ratio (SMR), Latency, Crocidolite.

Related studies

• Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009 — M.J. Soeberg, J. Leigh, et al. (2016)
• Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020 — G. López-Abente, M. García-Gómez, et al. (2013)
• 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)
• Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 — Australian Institute of Health and Welfare (2013)
• Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study — N.L. de Boer, J.P. van Kooten, et al. (2019)
• The Role of Adjuvant Radiotherapy in the Treatment of Pleural Mesothelioma — G.D. Lewis, S.M. Dalwadi, et al. (2019)

Browse more research in Cancer Epidemiology, or return to medical research.