Mesothelioma in Australia: a review

Our plain-English summary of Mesothelioma in Australia: a review, by A.B.W. Musk, N. de Klerk, F.J. Brims (The Medical Journal of Australia, 2017).

The study

• Authors: A.B.W. Musk, N. de Klerk, F.J. Brims
• Journal: The Medical Journal of Australia
• Published: 2017;207(10):449-452
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The incidence of malignant mesothelioma in Australia is among the highest in the world as a result of widespread use of asbestos by industry and in construction throughout the 20th century. The risk of developing malignant mesothelioma after asbestos exposure is dose-related; a transient, low dose exposure confers a correspondingly very low risk of disease. Malignant mesothelioma is a heterogeneous disease, partly explaining the limited role of biomarkers in screening and diagnosis. The prognosis remains poor, and early advice on medico-legal compensation and a collaborative team approach to managing malignant mesothelioma are both essential. Chemotherapy can have a modest treatment effect in some people. New therapies, such as immunotherapy, do not yet have a defined role in the treatment of malignant mesothelioma. As treatment options for malignant mesothelioma are limited and no cure is available, there is no established role for early detection or screening of at risk populations. A multidisciplinary approach to caring for patients with malignant mesothelioma and their carers is vital.

In plain English

This article is a narrative review. The authors summarised Australian experience of malignant mesothelioma, covering its epidemiology, diagnosis, prognosis and management. It did not report a new study. Citing the Australian Mesothelioma Registry, they reported 650 new diagnoses notified in 2015, 78% in men and 82% in people over 65. The age-standardised incidence was 23 cases per million, and they judged that incidence has probably now peaked. They linked Western Australia's high rates to crocidolite mining at Wittenoom from 1937 until 1966. They described waves of disease, the most recent involving people exposed to asbestos already in place, including during home renovation. Citing earlier work, they stated that crocidolite is five times as potent as amosite, which is ten times as potent as chrysotile. They said risk rises with dose, with no threshold below which there is no risk, and that transient exposure carries an extremely low risk. They reported median survival of 9 to 12 months for pleural mesothelioma. The authors concluded that mesothelioma is a universally fatal, preventable disease whose incidence is projected to decline in Australia.

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: Narrative review (commissioned, externally peer reviewed) of the Australian experience of malignant mesothelioma; no new data were collected
• Who was studied: No study population. The review drew on published research and Australian Mesothelioma Registry data on mesothelioma in Australia, with a focus on recent advances (2000 to 2017).
• Exposure: Asbestos in Australia: crocidolite (blue asbestos) mined at Wittenoom Gorge, imported amosite (brown asbestos), and chrysotile (white asbestos) contaminated by amphibole varieties. Exposure came from mining and milling, asbestos-cement manufacture, building and insulation work, and asbestos in place, including during home renovation.
• Main results:
  • Citing the Australian Mesothelioma Registry: 650 notifications of newly diagnosed mesothelioma in 2015. Most patients (78%) were men, and 82% were over 65 years of age.
  • The age-standardised incidence rate in Australia in 2015 was 23 cases per million population.
  • The authors judged that numbers of new cases and age-standardised incidence rates have probably now reached their peak in Australia.
  • A recently described third wave of disease includes people exposed to asbestos in place (occupationally, environmentally or domestically), including those renovating homes.
  • Citing earlier work: crocidolite is five times as potent as amosite for causing mesothelioma, and amosite is ten times as potent as chrysotile.
  • Risk depends on fibre type, amount of exposure and time since first exposure, with no threshold below which there is no risk.
  • For people only transiently exposed (for example, a weekend renovating a house), the risk is extremely low (unmeasurable), but it cannot be excluded altogether.
  • Among Wittenoom workers, who had extremely high crocidolite exposure, 10% of deaths have been attributed to mesothelioma.
  • Citing an earlier study: low dose CT screening of an asbestos-exposed Western Australian population for lung cancer found four cases of asymptomatic mesothelioma (0.44% of the cohort) in the first year.
  • Asbestos-related pleural plaque was described as not an independent additional risk for mesothelioma.
  • Median survival is 9 to 12 months for pleural mesothelioma. Patients with peritoneal mesothelioma often die within 6 months of diagnosis.
  • Combination chemotherapy with cisplatin or carboplatin and pemetrexed improved survival in clinical trial patients by about 3 months.
  • In Australia, about 95% of patients with mesothelioma and documented asbestos exposure are compensated.
• The authors' conclusion: The authors concluded that malignant mesothelioma is a universally fatal, preventable disease. They expected its incidence in Australia to decline over coming decades as asbestos exposure continues to fall, and they considered early multidisciplinary management of key importance.
• Limitations the authors state:
  • The authors noted a limit of the available evidence: asbestos remaining in Australian homes is a mixture of fibre types in varying ratios, so general conclusions about the exact nature of ongoing exposure cannot be drawn.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Asbestos Exposure, Biomarker, Prognosis, Chemotherapy, Immunotherapy, Multidisciplinary Team.

Related studies

• Malignant mesothelioma in Australia, 1945-2002 — J. Leigh, T. Driscoll (2003)
• Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009 — M.J. Soeberg, J. Leigh, et al. (2016)
• Epidemiology of malignant mesothelioma in Australia — A.W. Musk, N.H. de Klerk (2004)
• The incidence of malignant mesothelioma in Australia 1982-1988 — J. Leigh, C.F. Corvalán, et al. (1991)
• Malignant mesothelioma in Australia 2015: Current incidence and asbestos exposure trends — M.J. Soeberg, J. Leigh, et al. (2016)
• In Australia, patients and government at odds over mesothelioma treatment costs — V. Burkitt (2007)

Browse more research in The Medical Journal of Australia, or return to medical research.