Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends

Our plain-English summary of Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends, by M.J. Soeberg, J. Leigh, N. van Zandwijk (Journal of Toxicology and Environmental Health. Part B, Critical Reviews, 2016).

The study

• Authors: M.J. Soeberg, J. Leigh, N. van Zandwijk
• Journal: Journal of Toxicology and Environmental Health. Part B, Critical Reviews
• Published: 2016;19(5-6):173-189
• Type of article: Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Australia is known to have had the highest per-capita asbestos consumption level of any nation, reaching a peak in the 1970s. Although crocidolite was effectively banned in the late 1960s, and amosite use ceased in the mid 1980s, a complete asbestos ban was not implemented until 2003. This resulted in an epidemic of asbestos-related disease, which has only now reached its peak. Between 1982 and 2011, 13,036 individuals were newly diagnosed with malignant mesothelioma, with 690 diagnosed in 2011. A further 778 cases were identified between 1945 and 1981 from retrospective searches and the first 2 years of the Australian Mesothelioma Program. The age-standardized malignant mesothelioma incidence rate has leveled off in the last 10 years (2.8 per 100,000 in 2011). There has been a marked increase over time in the age-specific incidence rates for individuals aged 75 years or older. Data from the current Australian Mesothelioma Registry on asbestos exposure history in Australia is available for 449 subjects diagnosed between July 1, 2010, and April 1, 2015. This asbestos exposure history data show that 60% (n = 268) of cases had probable or possible occupational asbestos exposure, with trade-based jobs being the most frequent sources of occupational asbestos exposure. In addition, out of the 449 cases, 377 were recorded as having probable or possible nonoccupational asbestos exposure. Continuous vigilance toward changes over time in the settings in which people are exposed to asbestos and in the descriptive epidemiology of malignant mesothelioma is recommended to enable a comprehensive understanding of the current and future impact of asbestos-related diseases in Australia.

In plain English

This paper reviewed published Australian registry data on malignant mesothelioma. Between 1982 and 2011, 13,036 people in Australia were newly diagnosed. The age-standardized incidence rate, using the Australian standard population, was highest in 2003 at 3.2 per 100,000 and was 2.8 per 100,000 in 2011, an apparent plateau. Rates rose steeply in people aged 75 and older. For those 85 or older the rate went from 9.9 per 100,000 in 1997 to 22.4 in 2011. Five-year relative survival changed little (5.5% in 1982–1987, 6.2% in 2006–2010). Of 449 registry cases diagnosed from July 2010 to April 2015 with exposure data, 268 (60%) were assessed as having probable or possible occupational asbestos exposure, most often in trades such as construction. In all, 377 had probable or possible nonoccupational exposure, a figure that includes people also exposed at work. The authors concluded that case numbers and incidence rates had reached a maximum. They cautioned that the 449 cases may not represent all 2,722 registry cases.

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 and descriptive summary of published aggregate data from national cancer and mesothelioma registries (not a new study of individual patients)
• Who was studied: People diagnosed with malignant mesothelioma in Australia. For incidence: 13,036 people newly diagnosed during 1982–2011. For exposure: 449 people on the Australian Mesothelioma Registry diagnosed between July 1, 2010, and April 1, 2015, who completed both the postal questionnaire and the telephone interview, out of 2,722 registry cases.
• Exposure: Asbestos exposure in occupational and nonoccupational settings, including home renovation. It was assessed by postal questionnaire and telephone interview (OccIDEAS) and classed as probable (high, medium or low likelihood), possible, or unlikely above background. The registry exposure data were not broken down by fiber type.
• Main results:
  • All people: the age-standardized incidence rate was highest in 2003 (3.2 per 100,000, Australian standard population). In 2011 the rates were 2.8, 1.9 and 1.6 per 100,000 using the Australian, WHO and Segi World standards.
  • Annual case numbers: 692 new cases in 2011, a 20% increase on 2001 (576). Numbers in 2012 and 2013 were 713 and 676, which the authors read as the maximum having been reached.
  • By age: the rate for people 85 or older doubled from 9.9 per 100,000 in 1997 to 22.4 per 100,000 in 2011. For ages 75–84 it was 22.2 per 100,000 in 2011. For ages 55–64 it peaked at 7 per 100,000 in 1998 and fell to 4 per 100,000 in 2011.
  • By sex: the rate for men was highest in 2003 at 5.9 per 100,000, then stabilized around 5. The rate for women rose from 0.43 per 100,000 in 1990 to 0.98 per 100,000 in 2010.
  • Western Australia had the highest rates but these declined: 5.2 per 100,000 in 1993–1997, 4.7 in 1998–2002 and 4.5 in 2003–2007. The figure caption describes these jurisdiction rates as rates for men.
  • Survival: one-year relative survival was 44.3% in 2006–2010, compared with 36.9% in 1994–1999. Five-year relative survival was 5.5% in 1982–1987 and 6.2% in 2006–2010.
  • Of the 449 registry cases with exposure data, 268 (60%) had probable or possible occupational asbestos exposure, with trade-based jobs the most frequent source.
  • By job (high-probability exposure): construction jobs (carpenter, joiner, builder, bricklayer), 88 people; metal and mechanical trades, 48. All 21 boilermaker and welding cases were assessed as probable exposure with high likelihood.
  • Of the 449 cases, 377 had probable or possible nonoccupational asbestos exposure. This figure includes people also classed as occupationally exposed.
  • 55 of the 449 people reported ever living in a house made mainly of asbestos cement sheeting ("fibro") built between 1947 and 1987.
• The authors' conclusion: The authors concluded that the annual number of malignant mesothelioma cases and the age-standardized incidence rate had reached a maximum, as earlier predicted. They called for continued monitoring of incidence patterns and of the settings in which people are exposed to asbestos.
• Limitations the authors state:
  • The exposure assessment does not account for duration, frequency or intensity of exposure.
  • The 449 cases with exposure data may not be representative of all 2,722 cases on the current registry.
  • The consent process can cause time lags in collecting exposure data.
  • The 2012 and 2013 incidence rates are slightly underestimated because of delays in pathological confirmation.
  • Survival data run only to the end of 2010, so they cannot show whether the chemotherapy drug pemetrexed, widely available from 2008, improved survival.
  • Small case numbers in the Australian Capital Territory and Northern Territory make those rates hard to interpret.

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: Malignant Mesothelioma, Asbestos Exposure, Crocidolite, Amosite, Mesothelioma, Incidence, Epidemiology.

Related studies

• Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009 — M.J. Soeberg, J. Leigh, et al. (2016)
• The incidence of malignant mesothelioma in Australia 1982-1988 — J. Leigh, C.F. Corvalán, et al. (1991)
• Cancer incidence among women and girls environmentally and occupationally exposed to blue asbestos at Wittenoom, Western Australia — A. Reid, J. Heyworth, et al. (2008)
• Malignant mesothelioma in Australia, 1945-2002 — J. Leigh, T. Driscoll (2003)
• Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region — P. Girardi, V. Bressan, et al. (2014)
• Recent trends in incidence rates of pleural mesothelioma in British Columbia — H.I. Morrison, P.R. Band, et al. (1984)

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