Hotspots of malignant pleural mesothelioma in Western Europe

Our plain-English summary of Hotspots of malignant pleural mesothelioma in Western Europe, by V. Nuyts, T. Nawrot, B. Nemery, et al (Translational Lung Cancer Research, 2018).

The study

• Authors: V. Nuyts, T. Nawrot, B. Nemery, K. Nackaerts
• Journal: Translational Lung Cancer Research
• Published: 2018;7(5):516-519
• Type of article: Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma, a highly invasive tumour, has been epidemiologically linked to an occupational or environmental exposure to asbestos. Although asbestos has been widely used in diverse industrial applications and in construction, some industrial sectors have been affected much more than others. The objective of this review was to describe the existence of clusters of malignant pleural mesothelioma in Western European countries, based on epidemiological studies published between 2000 and 2015. MEDLINE (PubMed) and Embase were searched for relevant studies on spatial clustering of mesothelioma in Western European countries. Eventually, 16 different studies published between 2000 and 2015 were selected for a comprehensive analysis. Relevant studies on spatial clustering of mesothelioma were found for Belgium, the Netherlands, the United Kingdom, Germany, France, Spain, Italy and Denmark. Clustering of pleural mesothelioma was found mainly around shipyards (16 studies) and asbestos cement industries (10 studies). Although malignant pleural mesothelioma may be found throughout Western Europe, the present study indicates specific areas with higher past and also probable future incidence.

In plain English

This article is a review. The authors searched MEDLINE (PubMed) and Embase for studies published from 2000 to 2015 on geographic clusters ("hotspots") of malignant pleural mesothelioma in Western Europe. They excluded studies dealing only with peritoneal or pericardial mesothelioma. Sixteen studies were selected, covering Italy (6), the United Kingdom (3), Spain (2), and Belgium, the Netherlands, Germany, France and Denmark (1 each). The authors used them to draw a map of hotspots. Most clusters were reported close to shipyards (16 studies) and asbestos-cement industries (10 studies). Depending on the study, other clusters were explained by nearby industries such as the petrochemical industry (6 studies), iron and steel industries (4 studies), and railway construction and asbestos textile manufacturing (3 studies each). One hotspot, in Biancavilla, Italy, was attributed to natural exposure from a stone quarry contaminated by fluoro-edenite fibres. The authors did not pool the data because the studies used different comparison rates and methods. They noted that a missing hotspot on the map does not mean there was none. They concluded that they expect this pattern to continue and that continued vigilance is needed.

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 (literature search and compilation of published studies on geographic clusters, with a map of reported hotspots)
• Who was studied: 16 studies published between 1 January 2000 and 31 December 2015 on the geographic distribution of malignant pleural mesothelioma in Western European countries: Italy (6), United Kingdom (3), Spain (2), and Belgium, the Netherlands, Germany, France and Denmark (1 each). A Europe-wide study was also used. Studies only on peritoneal or pericardial mesothelioma were excluded.
• Exposure: Asbestos sources described in the reviewed studies as lying near mesothelioma hotspots, mainly shipyards and asbestos-cement industries. Natural fluoro-edenite fibres from a stone quarry were reported in Biancavilla, Italy.
• Main results:
  • Across the reviewed studies, most malignant pleural mesothelioma clusters occurred close to shipyards (16 studies) and known asbestos-cement industries (10 studies).
  • Depending on the study, other clusters were explained by nearness to railway construction companies (3 studies), asbestos textile manufacturing companies (3 studies), iron and steel industries (4 studies), petrochemical industry (6 studies), asbestos-using industries (4 studies), industrialized areas (2 studies), hazardous dumping sites (1 study), a military defence station (1 study), an electrical power plant (1 study) and furniture industries (1 study).
  • One hotspot, in Biancavilla (Italy), reported in 4 studies, was attributed to natural asbestos exposure from a stone quarry contaminated by fluoro-edenite fibres.
  • In the Europe-wide study by Montanaro et al. that the authors reviewed, the highest truncated age-standardized mesothelioma rates for men were in Scotland (8.8 per 100,000), England (8 per 100,000) and the Netherlands (7.4 per 100,000).
• The authors' conclusion: The authors concluded that most clusters occurred near asbestos-cement industries and shipyards, that they believe this spatial distribution will continue to be observed, and that continuous vigilance for mesothelioma hotspots is required in the next decades.
• Limitations the authors state:
  • The authors did not pool or meta-analyse the data, because expected numbers were calculated per country and the statistical methods to identify clusters differed between studies. The map therefore shows areas of high incidence within their own country, and the clusters are not equal in intensity.
  • The absence of a hotspot on the map does not necessarily mean there was no cluster. It may only mean that clusters were not investigated, or not published in accessible journals.
  • Mesothelioma cases may be underestimated because not all patients were registered. For example, in France, incidence data were recorded for only 26 of 96 districts.
  • Mesotheliomas also occur outside high-incidence areas, because asbestos use was widespread and exposed people may have moved away from hotspots.
  • Where the reviewed publications did not describe a specific asbestos source, the authors did not search further.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Environmental Exposure, Mesothelioma, Asbestos-Cement.

Related studies

• Accumulation of radium in ferruginous protein bodies formed in lung tissue: association of resulting radiation hotspots with malignant mesothelioma and other malignancies — E. Nakamura, A. Makishima, et al. (2009)
• Epidemiology of mesothelioma in the 21st century in Europe and the United States, 40 years after restricted/banned asbestos use — N. Alpert, M. van Gerwen, et al. (2020)
• Asbestos and cancer: An overview of current trends in Europe — M. Albin, C. Magnani, et al. (1999)
• Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends — F. Montanaro, F. Bray, et al. (2003)
• Asbestos: use, bans and disease burden in Europe — T. Kameda, K. Takahashi, et al. (2014)
• Occupational exposure and laryngeal and hypopharyngeal cancer risk in central and eastern Europe — O. Shangina, P. Brennan, et al. (2006)

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