Incidence, mortality and survival of pleural mesothelioma in Zurich between 1981 and 2019, Switzerland

Our plain-English summary of Incidence, mortality and survival of pleural mesothelioma in Zurich between 1981 and 2019, Switzerland, by L. Vinci, M. Wanner, N. Karavasiloglou, et al (Journal of Thoracic Disease, 2024).

The study

• Authors: L. Vinci, M. Wanner, N. Karavasiloglou, H. Dressel, F. Barresi, D. Korol, S. Rohrmann
• Journal: Journal of Thoracic Disease
• Published: 2024;16(12):8240-8249
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma is mainly caused by (occupational) asbestos exposure. Since 1990, the import and use of asbestos is prohibited in Switzerland. However, due to the long latency time between exposure and the development of disease, incidence in Switzerland was expected to further increase for years after the ban. The aim of the present study was to analyse incidence, mortality, and survival of patients diagnosed with malignant pleural mesothelioma in the canton of Zurich in Switzerland.

Methods: Population-based cancer registry data and cause of death statistics of the canton of Zurich from 1981 to 2019 were used to calculate age-standardized incidence and mortality rates. Time trends were investigated with joinpoint regression and net survival was computed using the Pohar-Perme method.

Results: In men, the incidence rate increased from 1981 to 2002 {annual percentage change (APC) 4.7 [95% confidence interval (CI): 2.6 to 6.8]} and then decreased until 2019 [APC: -2.3 (95% CI: -4.2 to -0.3)], while in women it increased over the whole period [APC 6.2 (95% CI: -1.3 to 14.4)]. Mortality rates were stable in men and women. Three-year net survival was 9.7% (95% CI: 7.8% to 12.2%) for men and 22.1% (95% CI: 15.3% to 32.1%) for women. Men with stage I or II pleural mesothelioma had a net survival of 25.4% (95% CI: 17.2% to 37.5%) after three years whereas men with stage III or IV experienced a net survival of 7.4% (95% CI: 3.9% to 13.8%) after three years.

Conclusions: Malignant pleural mesothelioma incidence seems to have reached the peak in the canton of Zurich in men, but not yet in women. Mortality rates were stable in men and women, and net survival was poor for both sexes, particularly in men.

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In plain English

This population-based study used cancer registry and cause-of-death data from the canton of Zurich, Switzerland, for 1981 to 2019; Switzerland has banned asbestos import and use since 1990. It included 798 men and 108 women with malignant pleural mesothelioma. In men, the age-standardized incidence rate rose from 1981 to 2002 (annual percentage change 4.7, 95% CI 2.6 to 6.8), then fell until 2019 (-2.3, 95% CI -4.2 to -0.3). In women it rose throughout (6.2, 95% CI -1.3 to 14.4), which the authors noted was not statistically significant. Mortality rates were stable in both sexes. Three-year net survival was 9.7% (95% CI 7.8% to 12.2%) in men and 22.1% (95% CI 15.3% to 32.1%) in women. In men diagnosed 2003 to 2019, it was 25.4% (95% CI 17.2% to 37.5%) for stage I or II and 7.4% (95% CI 3.9% to 13.8%) for stage III or IV. The authors concluded the early ban seems to have been effective, but incidence remains high compared with other countries and survival remains poor. They cautioned that case numbers, especially among women, were small.

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 descriptive study of cancer registry and cause-of-death data, with time-trend (joinpoint regression) and net survival (Pohar-Perme method) analyses, plus a comparison with accident insurance data
• Who was studied: 798 men and 108 women resident in the canton of Zurich, Switzerland, diagnosed with primary malignant pleural mesothelioma between 1981 and 2019. Cases known only from death certificates and peritoneal mesothelioma (75 cases) were excluded.
• Exposure: Asbestos exposure was not measured for individuals. The study was set against Switzerland's ban on asbestos import and use since 1990. Registry case counts were compared with cases recognized by accident insurers as occupational illness (1986 to 2019). No fiber types were reported.
• Main results:
  • Men: the age-standardized incidence rate increased from 1981 to 2002 (APC 4.7, 95% CI 2.6 to 6.8), then decreased until 2019 (APC -2.3, 95% CI -4.2 to -0.3).
  • Women: the incidence rate increased over the whole period (APC 6.2, 95% CI -1.3 to 14.4), at a lower level than in men.
  • The authors stated that the increase in women was not statistically significant.
  • Mortality rates were stable in men and women, with no joinpoints identified.
  • One-year net survival was 51.6% (95% CI 48.1% to 55.4%) for men and 57.8% (95% CI 48.8% to 68.4%) for women. Three-year net survival was 9.7% (95% CI 7.8% to 12.2%) for men and 22.1% (95% CI 15.3% to 32.1%) for women.
  • Men diagnosed 2003 to 2019: three-year net survival was 25.4% (95% CI 17.2% to 37.5%) for stage I or II and 7.4% (95% CI 3.9% to 13.8%) for stage III or IV.
  • Men: cases recognized by accident insurance followed the registry trend at a lower level, but the numbers in the two sources were similar in 2016, 2017 and 2019. Women: insurance-recognized case numbers did not change over time.
• The authors' conclusion: The authors concluded that the early Swiss asbestos ban seems to have been effective, based on these estimates. They found that incidence in men seems to have peaked but not yet in women, that incidence is still high compared with other countries, and that survival remains poor.
• Limitations the authors state:
  • The time trends should be interpreted with caution because the number of cases was small.
  • The number of women was very small, so their results need cautious interpretation, and no subgroup analysis was done for women.
  • Mortality data rely on death certificates that are rarely validated. Until 1994, the death code used (ICD-8) also included other pleural cancers.
  • Stage was not systematically registered before 2003, so the stage analysis covers only 2003 to 2019.
  • Comparability with other studies that used different relative survival methods is limited.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Latency, Cancer Registry, Incidence, confidence interval.

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