Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009

Our plain-English summary of Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009, by M.J. Soeberg, J. Leigh, T. Driscoll, et al (Occupational and Environmental Medicine, 2016).

The study

• Authors: M.J. Soeberg, J. Leigh, T. Driscoll, B. Armstrong, J.M. Young, N. van Zandwijk
• Journal: Occupational and Environmental Medicine
• Published: 2016;73(3):187-94
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Australia is known to have had one of the highest per-capita asbestos consumption rates, yet there are few contemporary reports on malignant mesothelioma trends.

Methods: Data on 10 930 people with malignant pleural mesothelioma (MPM) and 640 people with malignant peritoneal mesothelioma diagnosed in Australia during 1982-2009 were analysed. Observed incidence rate trends were quantified. Incidence rates were projected up to 2030 using observed incident cases during 1982-2012. The relative per-decade change in excess mortality during 1999-2009 was estimated.

Results: During 1982-2009, acceleration in MPM age-standardised incidence rates were highest for women and those aged 75 years and above, with average annual percentage changes of +4.9 (95% CI 3.6 to 6.2) and +7.2 (95% CI 5.4 to 9.0), respectively. Age-standardised incidence rates for men with MPM aged 0-64 years decelerated rapidly during 2003-2009, an average annual percentage change of -5.1% (95% CI -7.6% to -2.5%). Overall, male age-specific MPM incidence rates in the age group of 65-74 year during 2010-2030 are projected to decline with rates projected to increase for older men and women with MPM. There was a statistically significant 16% relative reduction in the excess mortality rate (EMR) up to 5 years postdiagnosis for people diagnosed with malignant pleural and peritoneal mesothelioma combined in 2009 compared with those diagnosed in 1999, an EMR ratio of 0.84 (95% CI 0.77 to 0.92).

Conclusions: Australia's malignant mesothelioma incidence rates appear to have reached maximum levels but with differences over time by age, gender and tumour location. Improvements over time in survival provide a glimpse of hope for this almost invariably fatal disease.

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In plain English

This study used Australian national cancer registry data on malignant pleural and peritoneal mesothelioma. It covered 10 930 people with pleural and 640 with peritoneal mesothelioma diagnosed in 1982–2009, and projected rates to 2030. Over 1982–2009, age-standardised pleural rates rose fastest among women (on average +4.9% a year, 95% CI 3.6% to 6.2%) and people aged 75 and over (+7.2% a year, 95% CI 5.4% to 9.0%). Among people aged 0–64, pleural rates fell by 5.1% a year during 2003–2009 (95% CI −7.6% to −2.5%). Pleural rates for men aged 65–74 appeared to have peaked in 2005–2010, but were projected to rise up to 2020 for men aged 75 and over and women aged 65 and over. Peritoneal rates for men aged 65 and over were projected to peak in 2015–2025. For both types combined, the excess death rate up to five years after diagnosis was 16% lower for people diagnosed in 2009 than in 1999 (ratio 0.84, 95% CI 0.77 to 0.92). The authors concluded that incidence rates appear to have reached maximum levels. The analyses did not assess individual asbestos exposure.

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: Population-based study of national cancer registry data: incidence trends (joinpoint regression), projections to 2030 (age-period-cohort models), and relative survival modelling
• Who was studied: 10 930 people with malignant pleural mesothelioma and 640 with malignant peritoneal mesothelioma diagnosed in Australia 1982–2009 (Australian Cancer Database). Registry cases up to 2012 were added for the projections. The survival analysis covered 6472 adults aged 15–99 diagnosed 1999–2009, followed to 2011.
• Exposure: Individual asbestos exposure was not analysed. The study examined rates of diagnosed mesothelioma against the background of Australia's high asbestos consumption. The authors could not directly test whether the asbestos ban reduced incidence.
• Main results:
  • Pleural mesothelioma, 1982–2009: the average annual percentage change in age-standardised incidence was highest for women (+4.9%, 95% CI 3.6% to 6.2%) and for people aged 75 and over (+7.2%, 95% CI 5.4% to 9.0%).
  • Pleural mesothelioma, people aged 0–64: rates rose 1982–1994 (+4.6% a year), levelled off 1994–2003 (+0.9%) and declined sharply 2003–2009 (−5.1% a year, 95% CI −7.6% to −2.5%).
  • Pleural mesothelioma, people aged 75 and over: rates rose +11.0% a year (95% CI 7.7% to 14.3%) in 1982–1996. They kept rising more slowly, +3.2% a year (95% CI 1.5% to 4.9%), in 1996–2009.
  • Peritoneal mesothelioma, men and women combined, 1982–2009: the average annual percentage change was +2.4% (95% CI 0.9% to 3.9%). The authors describe the peritoneal estimates as less stable.
  • Projections, men with pleural mesothelioma: rates for those aged 65–74 appear to have peaked in 2005–2010. Rates for those aged 75 or more are expected to increase up to 2020 and then decline.
  • Projections, women with pleural mesothelioma aged 65 and over: rates will increase slightly up to 2020.
  • Projections, men with peritoneal mesothelioma aged 65 or more: rates are projected to peak in 2015–2025.
  • Survival up to 5 years after diagnosis, pleural and peritoneal combined, diagnosed 1999–2009: the modelled excess mortality rate ratio per decade was 0.84 (95% CI 0.77 to 0.92). This was a statistically significant 16% reduction for people diagnosed in 2009 compared with 1999.
  • Five-year relative survival changed little over time in any subgroup.
  • Women had 9% less excess mortality than men (EMRR 0.91, 95% CI 0.85 to 0.98).
  • People with non-epithelioid disease had almost twice the excess mortality of people with the epithelioid subtype (EMRR 1.94, 95% CI 1.79 to 2.10).
  • Peritoneal mesothelioma analysed alone: excess mortality was 30% lower for 2009 than 1999 diagnoses (EMRR 0.70, 95% CI 0.48 to 1.03). The authors said a faster improvement than for pleural disease is possible but not established.
• The authors' conclusion: The authors concluded that Australia's malignant mesothelioma incidence rates appear to have reached maximum levels, with differences over time by age, gender and tumour location. They also concluded that improvements in survival give a glimpse of hope.
• Limitations the authors state:
  • Tumour stage at diagnosis was not recorded in the database.
  • Peritoneal mesothelioma data were sparse, so some trend estimates could not be calculated.
  • The study could not directly test whether banning asbestos reduced mesothelioma incidence.
  • The survival model assumed the same per-decade reduction for all ages, genders, subtypes and follow-up periods.
  • The authors could only note that the survival improvement coincided with wider availability of pemetrexed. They could not show it was caused by it.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Malignant Mesothelioma, Pleural Mesothelioma, Incidence.

Related studies

• Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends — M.J. Soeberg, J. Leigh, et al. (2016)
• 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)
• Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009 — M.J. Soeberg, N. Creighton, et al. (2016)
• Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years — R.T. Lin, Y.Y. Chang, et al. (2019)
• Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence — S. Conti, G. Minelli, et al. (2015)

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