High incidence of mesothelioma in an English city without heavy industrial use of asbestos

Our plain-English summary of High incidence of mesothelioma in an English city without heavy industrial use of asbestos, by W.T. Hamilton, A.P. Round, D.J. Sharp, et al (Journal of Public Health, 2004).

The study

• Authors: W.T. Hamilton, A.P. Round, D.J. Sharp, T.J. Peters
• Journal: Journal of Public Health
• Published: 2004;26(1):77-8
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Mesothelioma rates are increasing in the industrialized world, related to occupational asbestos exposure. The highest rates have been reported from areas with specific industries such as shipbuilding or mining. Lower rates have been reported from areas without such industries. We studied an area without heavy industry to examine if such a pattern occurred in England.

Methods: We studied the population of Exeter Primary Care Trust, Devon, United Kingdom, with a population of 131,849. Exeter has no mining, shipbuilding or other heavy industry. All lung cancers and mesotheliomas were identified from the local cancer registry, supplemented by searches at all primary care practices. The cancer diagnoses were checked by inspection of histology or primary care records. Occupational data were extracted from the primary care records.

Results: The searches revealed 291 lung cancers, 283 of which had either histological proof or strong clinical evidence for the diagnosis. Twenty-two (8 per cent) of these were pleural mesotheliomas, 17 of these occurring in men. The incidence rate of mesothelioma in men over 40 years was 12.1 per 100,000 per year (95 per cent confidence intervals 7.0-19.3), one of the highest reported rates in the world.

Conclusion: The mesothelioma epidemic will extend to areas without local heavy industrial exposure.

In plain English

This short report examined mesothelioma in Exeter, England, a city without heavy industrial asbestos use. The area, Exeter Primary Care Trust, had 131,849 residents in mid-2000. The authors searched the hospital cancer register and primary care practice records for lung cancers and mesotheliomas diagnosed between January 1998 and September 2002 in people aged 40 or more. They checked each diagnosis against histology or primary care records. Of 283 primary lung cancers, 22 (8 per cent) were pleural mesotheliomas, 17 of them in men. The rate in men aged 40 and over was 12.1 per 100,000 a year (95 per cent confidence interval 7.0 to 19.3). Occupation was recorded for 14 of the 22. Nine had occupational asbestos exposure recorded; four had naval service, which the authors called possible exposure. Five were recorded as having none. The authors concluded that the mesothelioma epidemic will affect areas without major industrial asbestos exposure. They noted that the study was small and covered one area, and that their thorough methods and nearness to Plymouth's naval dockyard may explain some of the high rate.

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: Short report: population-based count of mesothelioma cases and incidence rate in one area, using a hospital cancer register and primary care records
• Who was studied: Residents of Exeter Primary Care Trust, Devon, United Kingdom (population 131,849 in mid-2000). The study counted new lung and pleural cancers in patients aged 40 or more between January 1998 and September 2002.
• Exposure: Residence in an area without heavy industrial asbestos use. Occupational asbestos exposure was taken from primary care records where recorded. Fiber types are not reported.
• Main results:
  • Of 283 primary lung cancers, 22 (8 per cent) were pleural mesotheliomas, 21 of them with histological proof.
  • 17 of the 22 mesotheliomas occurred in males, with a median (interquartile range) age of 68 (62 to 79) years.
  • The mesothelioma rate in males aged 40 and over was 12.1 per 100,000 (95 per cent CI 7.0 to 19.3).
  • For comparison, the male rate for those aged 20 or more was 6.9 per 100,000 (95 per cent CI 4.0 to 11.0), and for the whole male population 5.2 per 100,000 (95 per cent CI 3.0 to 8.3).
  • Occupation was recorded for 14 of the 22 mesothelioma patients. Nine had occupational asbestos exposure recorded (listed as four with naval service, three in manual jobs, and two with the source unrecorded), and five had specific mention of no occupational exposure. In the discussion the authors describe the naval service cases as possible exposure.
• The authors' conclusion: The authors concluded that the mesothelioma epidemic will affect areas without major industrial exposure to asbestos.
• Limitations the authors state:
  • The high rate may reflect the thoroughness of the methods, since studies based on cancer registry data or death certification under-report incidence.
  • The study was relatively small and involved a single area, which is reflected in the wide confidence interval.
  • Occupational data were limited.
  • Four patients had possible asbestos exposure during naval service, so some of the high rate may reflect Exeter's proximity to Plymouth.

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: Mesothelioma, Asbestos Exposure, Lung Cancer, Cancer Registry, Histology, Pleural Mesothelioma, Incidence, confidence interval.

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