Malignant Pleural Mesothelioma Epidemiology in the United States From 2000 to 2016

Our plain-English summary of Malignant Pleural Mesothelioma Epidemiology in the United States From 2000 to 2016, by A. Thomas, S. Karakattu, J. Cagle, et al (Curēus, 2021).

The study

• Authors: A. Thomas, S. Karakattu, J. Cagle, G. Hoskere
• Journal: Curēus
• Published: 2021;13(4):e14605
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction Pleural mesothelioma constitutes about 80% of all mesotheliomas. The peak incidence of malignant mesothelioma estimated using the cancer registries was in early 1990 to 2000 in the United States. The disease is primarily associated with asbestos exposure. The latency period between asbestos exposure and the development of malignant pleural mesothelioma (MPM) can range anywhere from 15 to 60 years. Asbestos exposure was peaked during the industrial revolution and World War II due to military and shipyard exposures. It is often difficult for the pathologist to distinguish different histological subtypes; due to the disease's rarity and the inadequate tissue sample obtained. There is no available data on the difference in epidemiology of different subtypes of MPM. Surveillance Epidemiology and End Results (SEER), cancer incidence data include population-based registries covering approximately 34.6% of the U.S. population. Here in our study, we analyze malignant pleural mesothelioma epidemiology in the United States, emphasizing different histological subtypes. Methods SEER data from 2000 to 2016 was used in our study. The primary site of cancer is selected as pleura, and malignant behavior only is selected as the filter. Data were analyzed using the SEER stat program. Overall epidemiology of MPM and epidemiology of epithelioid, fibrous, and biphasic histological subtypes were analyzed separately. We used annual percentage change (APC) to evaluate the trend in the epidemiology of MPM. Results summary A total of 11,857 cases of MPM were included in the primary cohort from the SEER 18 registry from 2000 to 2016. The total prevalence of MPM was highest in 2009 and was lowest in 2016. The APC in MPM incidence during this period is -2.0. After removing 5,989 cases with non-specified histology during the same period, the APC for each histological type is -0.7 for fibrous type, 1.8 for epithelioid type, and 2.9 for biphasic type. Out of 17 regional registries included in the study, the greatest statistically significant change in APC was seen in the Hawaiian registry -4.1. In contrast, the lowest statistically significant difference was seen in Seattle (Puget Sound) registry -1.7. The APC in the incidence of MPM among males during the study period was -2.4 while that of females was -0.9. The Iowa registry showed a statistically significant increase in APC of the epithelioid malignant mesothelioma with a statistically insignificant reduction in the overall MPM APC. Conclusion The overall incidence of MPM in the United States is declining, while the data showed an increase in the incidence of epithelioid and biphasic histological subtypes. The authors believe that these conflicting results can be attributed to improved histological diagnosis and improved biopsy techniques.

Copyright © 2021, Thomas et al.

In plain English

This study used U.S. Surveillance, Epidemiology, and End Results (SEER) cancer registry records, which cover about 34.6% of the U.S. population, to study trends in malignant pleural mesothelioma (MPM) from 2000 to 2016. It did not measure anyone's asbestos exposure. The authors included 11,857 cases. Overall incidence fell, with an annual percentage change (APC) of -2.0 (95% confidence interval -2.4 to -1.5). After 5,989 cases with unspecified tissue type were removed, the epithelioid type rose (APC 1.8, interval 1.2 to 2.3) and the biphasic type rose (APC 2.9, interval 0.8 to 5.1). The fibrous type changed by -0.7, with an interval of -3.1 to 1.7, which spans both a fall and a rise. Incidence fell more in males (APC -2.4, interval -3 to -1.8) than in females (APC -0.9, interval -1.5 to -0.2). Epithelioid MPM rose significantly in people aged 70 to 84. The authors attributed the rise in specific subtypes to better tissue diagnosis and biopsy techniques. They noted that registry data can carry selection and reporting bias, and that data were missing from Pennsylvania, Florida and Texas.

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: Retrospective analysis of population-based cancer registry data (SEER), using annual percentage change to describe trends
• Who was studied: 11,857 cases of malignant pleural mesothelioma recorded in the 18 SEER regional registries in the United States from 2000 to 2016. The registries cover about 34.6% of the U.S. population. Cases of age zero or unknown age were excluded.
• Exposure: None measured. The study looked at calendar-year trends in diagnosed cases by histological subtype (epithelioid, fibrous, biphasic), sex, race, age group and region. Asbestos is discussed only as background.
• Main results:
  • Overall MPM incidence: APC -2.0, 95% CI -2.4 to -1.5
  • After removing 5,989 cases with non-specified histology, the APC was -0.7 [-3.1, 1.7] for the fibrous type, 1.8 [1.2, 2.3] for the epithelioid type, and 2.9 [0.8, 5.1] for the biphasic type
  • APC in MPM incidence was -2.4 [-3, -1.8] among males and -0.9 [-1.5, -0.2] among females
  • Among the regional registries, the largest statistically significant change was in Hawaii (-4.1 [-7.6, -0.4]) and the smallest was in Seattle (Puget Sound) (-1.7 [-2.7, -0.6])
  • Overall MPM showed a statistically significant decrease in every age group from 45 to 85. Epithelioid MPM decreased significantly at ages 50-54 and 55-59 and increased significantly at ages 70-74, 75-79 and 80-84.
  • Blacks, whites and Asian/Pacific Islanders showed a statistically significant decrease in overall MPM. Whites showed a statistically significant increase for epithelioid and biphasic MPM.
  • Newly diagnosed MPM cases numbered 499 in 2000 and 247 in 2016. Epithelioid cases numbered 163 in 2000 and 296 in 2016 (appendix Table 1).
  • The Iowa registry showed a statistically significant increase in epithelioid MPM, with a statistically insignificant reduction in overall MPM
• The authors' conclusion: The authors concluded that overall MPM incidence in the United States is declining while epithelioid and biphasic subtypes increased. They believed these conflicting results can be attributed to improved histological diagnosis and improved biopsy techniques, including video-assisted thoracoscopy. They also concluded that incidence declined more in males than in females, although it remains higher in males.
• Limitations the authors state:
  • The study is limited by the basic characteristics of the registry itself
  • The study is retrospective, and there is no information on whether the tissue diagnosis was made in an expert center
  • Conclusions about histological types drawn from registry data may be wrong because of selection bias and reporting bias
  • No data from some states with high MPM incidence, such as Pennsylvania, Florida and Texas

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epidemiology, Mesothelioma, Asbestos Exposure, Latency, Shipyard Exposure, Histological Subtype, SEER.

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