Malignant mesothelioma: global incidence and relationship with asbestos

Our plain-English summary of Malignant mesothelioma: global incidence and relationship with asbestos, by C. Bianchi, T. Bianchi (Industrial Health, 2007).

The study

• Authors: C. Bianchi, T. Bianchi
• Journal: Industrial Health
• Published: 2007;45(3):379-87
• Type of article: Review
• Cited by: 198 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma incidence varies markedly from one country to another. The highest annual crude incidence rates (about 30 cases per million) are observed in Australia, Belgium, and Great Britain. A lot of data indicate a relationship between mesothelioma and asbestos. The hot areas for mesothelioma exactly correspond to the sites of industries with high asbestos use, such as shipbuilding and asbestos-cement industry. However, in many countries with high asbestos consumption, mesothelioma incidence is low. The reasons for this fact are not clear. The latency periods elapsing between first exposure to asbestos and development of mesothelioma are mostly longer than 40 yr. An inverse relationship exists between intensity of asbestos exposure and length of the latency period. Mesothelioma generally develops after long-time exposures to asbestos. Some recent studies show that the risk increases with the duration of exposure. Possible co-factors in the pathogenesis of asbestos-related mesothelioma include genetic predisposition, diets poor in fruit and vegetables, viruses, immune impairment, recurrent serosal inflammation. The study of co-morbidity in mesothelioma could give an insight into the pathogenesis of the tumor. While a levelling-off in mesothelioma incidence has been registered in some countries, a worsening of the epidemic is predictable in large parts of the world.

In plain English

This was a review article by two authors from a cancer research center in Monfalcone, Italy. It gathered registry data, mortality data and researchers' estimates on mesothelioma incidence worldwide and on its relationship with asbestos. The highest estimated annual crude incidence rates, around 30 cases per million, were for Australia, Belgium and Great Britain. Cited studies linked areas of high mesothelioma rates to shipyards and asbestos-cement factories. Some places with heavy asbestos exposure or use, such as Thailand, reported few cases, and the authors said the reasons were not clear. In cited case series from Italy and the UK, mean latency periods were about 48 to 49 years, and insulation workers had shorter latency. Cited studies suggested that risk rose with duration of employment, though not consistently. The authors also discussed possible co-factors, including genetic predisposition, diet, the SV40 virus, immune impairment and recurrent inflammation. They concluded that data are lacking for very large parts of the world and that countries that have banned asbestos remain a small minority.

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 article (narrative review of published incidence and mortality data and other studies)
• Who was studied: Published mesothelioma incidence and mortality data, registry figures and researchers' estimates from countries around the world, summarized in a table of estimated incidence for selected countries
• Exposure: Asbestos exposure in general, including shipbuilding, the asbestos-cement industry and other occupations. The review noted disagreement over the role of amphiboles versus chrysotile.
• Main results:
  • Australia, Belgium and Great Britain had the highest reported or estimated incidence, with annual crude incidence rates around 30 cases per million
  • Among men in Italy, the provinces with the highest standardized mortality rates from pleural malignant tumors (4 to 12 per 100,000) were where the largest shipyards and the largest asbestos-cement factory were located
  • In the Bazhenovskoye area, Russian Federation, where past exposure was very heavy, eight mesothelioma cases were diagnosed in a 23-year period (1981 to 2003)
  • In Thailand, which ranked second in the world for per capita asbestos consumption in 1996, mesothelioma and asbestos-related disease in general were practically unknown
  • In 400 pleural mesotheliomas from the Trieste-Monfalcone area, Northeastern Italy, latency periods ranged from 14 to 75 years (mean 48.8, median 51)
  • In 301 mesotheliomas of the pleura and peritoneum in workers from the Devonport Naval Dockyards, UK, the mean latency period was 48.5 years
  • In the Trieste-Monfalcone series, insulation workers had relatively short latency periods (range 28 to 32 years, mean 29.6, median 29.0)
  • In the Trieste-Monfalcone series, 75% of patients had been exposed for 20 years or more and 91% for 5 years or more
  • In a cited study of workers in an asbestos-cement industry in Norway, the standardized incidence ratio for mesothelioma was 34.8 with 5 to 9 years of employment, 51.3 with 10 to 14 years, and 84.1 with more than 15 years
  • In a cited study of Norwegian insulation workers, there was an apparent reduction of risk with 20 or more years of employment
  • In a cited cohort of asbestos textile workers in the Province of Turin, Italy, standardized mortality rates rose with duration of employment for peritoneal cancer but not for pleural cancer
  • In a cited study, benign pleural disease appeared to increase the risk of peritoneal mesothelioma, but not of pleural mesothelioma, beyond the risk attributable to severity of asbestos exposure
  • In Japan, 911 mesothelioma deaths were registered in 2005, according to a personal communication
• The authors' conclusion: The authors concluded that data on mesothelioma incidence and mortality are not available for very large parts of the world, which they called a serious obstacle to knowledge, and that countries banning asbestos are growing but remain a small minority
• Limitations the authors state:
  • For a large part of the world, incidence data are not available or are insufficient
  • Data sources differ between countries, so not all available data are equally reliable
  • It is uncertain whether US SEER data, covering about 15% of the population, reflect the whole country
  • In the more recent Australian Mesothelioma Register report, occupational data were missing for nearly 50% of registered cases

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Incidence, Asbestos-Cement, Latency, Asbestos Exposure, Inflammation.

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