Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009

Our plain-English summary of Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009, by M.J. Soeberg, N. Creighton, D.C. Currow, et al (Australian and New Zealand Journal of Public Health, 2016).

The study

• Authors: M.J. Soeberg, N. Creighton, D.C. Currow, J.M. Young, N. van Zandwijk
• Journal: Australian and New Zealand Journal of Public Health
• Published: 2016;40(3):255-62
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) and malignant peritoneal mesothelioma (MPeM) are often grouped together in descriptive epidemiological analyses, resulting in limited understanding of epidemiological patterns for these tumour types.

Methods: We studied patterns in the incidence, mortality and survival of people diagnosed with MPM (n=4,076) and MPeM (n=293) in New South Wales (NSW), Australia, 1972-2009. We also calculated 5-year relative survival for people diagnosed 1972-2006 followed up to 2007. We assessed patterns for each tumour type and histological subtype and, where possible, by combination of these categories.

Results: Annual MPM cases steadily increased over time (n=208 in 2009). There was an increasing trend in the MPM age-standardised incidence rate from 1972 up to 1994. This rate increase has levelled off in the past 10 years. Since 1999, 11 cases of MPeM were diagnosed each year, on average. Five-year relative survival remained stable for MPM and MPeM. However, 5-year relative survival in 2002-2006 was substantially higher for people with MPM epithelioid histological subtype (11.7% [95%CI 6.8-18.2%]) compared to all other non-epithelioid histological subtypes (6.9% [95%CI 5.0-9.1%]), a 70% difference. Survival was also greater for women with MPM (13.4% [95%CI 8.5-19.4%]) compared to men (7.0% [95%CI 5.1-9.2%]).

Interpretation: MPM incidence rates have stabilised since the mid-1990s, suggesting that maximum incidence levels have been reached. When more up-to-date data are available, survival estimates should be reanalysed to include people likely to benefit from the wide introduction of combination chemotherapy in 2007, including pemetrexed.

© 2015 Public Health Association of Australia.

In plain English

This study used New South Wales (Australia) Cancer Registry records of people diagnosed with malignant pleural mesothelioma (4,076) or malignant peritoneal mesothelioma (295 in the results, 293 in the abstract) from 1972 to 2009. The study data had no information on each person's asbestos exposure. Yearly pleural cases rose steadily to 208 in 2009; peritoneal cases stayed level (17 in 2009). The age-standardised pleural rate changed little after the mid-1990s: 2.3 per 100,000 in 1996 and 2.6 (95% CI 2.3–3.0) in 2009. The rate for men peaked at 5.7 per 100,000 (95% CI 4.7–6.6) in 1994. Relative survival compares patients with the general population. For people diagnosed 2000 to 2006, five-year relative survival was 8.2% (95% CI 6.4–10.3%) across all cases. Among pleural cases it was 11.7% (6.8–18.2%) for epithelioid subtype versus 6.9% (5.0–9.1%) for all others, including unspecified subtypes, and 11.1% (6.4–17.2%) for women versus 7.2% (5.3–9.5%) for men. The authors concluded that pleural cases increased, especially among older people, while peritoneal mesothelioma remained extremely rare. Survival analysis covered diagnoses up to 2006, before pemetrexed chemotherapy became widely available.

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 data (incidence, mortality and relative survival), with registry records linked to death data
• Who was studied: All people in New South Wales, Australia, diagnosed with malignant pleural mesothelioma (n=4,076) or malignant peritoneal mesothelioma from 1972 to 2009. The article gives the peritoneal count as 295 in its results and 293 in its abstract. Pleural cases were 86% male, 69% over 65 and 67% born in Australia. Survival analysis was limited to adults aged 15 to 99 diagnosed from 1972 to 2006, with follow-up to the end of 2007.
• Exposure: No individual asbestos exposure information was available to the study. It covered all registered mesothelioma cases, whatever their exposure.
• Main results:
  • The yearly number of pleural mesothelioma cases rose steadily. The yearly number of peritoneal cases did not change. In 2009 there were 208 pleural and 17 peritoneal cases.
  • The age-standardised incidence rate for pleural mesothelioma changed little after the mid-1990s: 2.3 per 100,000 in 1996 and 2.6 per 100,000 in 2009 (95% CI 2.3 to 3.0 for 2009).
  • In 2009 the age-standardised pleural mesothelioma rate was 4.8 per 100,000 for men (95% CI 4.1 to 5.5) and 0.8 per 100,000 for women (95% CI 0.5 to 1.0).
  • The highest age-standardised pleural mesothelioma rate for men was 5.7 per 100,000 (95% CI 4.7 to 6.6), in 1994.
  • For pleural mesothelioma in people aged 75 to 84, the age-specific incidence rate rose from 13.1 per 100,000 in 1992 to 1996 to 23.6 per 100,000 in 2007 to 2009.
  • From 1982 to 2008, 3,819 people with pleural or peritoneal mesothelioma were recorded as having died: 3,579 with pleural and 240 with peritoneal mesothelioma.
  • For all mesothelioma cases combined diagnosed 2000 to 2006, five-year relative survival was 8.2% (95% CI 6.4 to 10.3%).
  • For pleural mesothelioma diagnosed 2000 to 2006, five-year relative survival was 11.7% (95% CI 6.8 to 18.2%) for the epithelioid subtype. It was 6.9% (95% CI 5.0 to 9.1%) for all non-epithelioid subtypes, including cases not otherwise specified.
  • For pleural mesothelioma diagnosed 2000 to 2006, five-year relative survival was 11.1% (95% CI 6.4 to 17.2%) for women and 7.2% (95% CI 5.3 to 9.5%) for men.
  • For pleural mesothelioma diagnosed 2000 to 2006, five-year relative survival was 5.6% (95% CI 3.1 to 9.1%) for people aged 75 and older, compared with 22.3% for people aged 15 to 54.
  • Five-year relative survival for all cases changed little between 1972 and 2001. It rose to 9.4% (95% CI 7.2 to 12.0%) for diagnoses in 2002 to 2006.
  • One-year relative survival for pleural mesothelioma was 35.8% (95% CI 33.2 to 38.3%) for diagnoses in 1992 to 2001 and 43.4% (95% CI 40.1 to 46.7%) for 2002 to 2006. The authors described these as small, non-significant improvements.
• The authors' conclusion: The authors concluded that pleural mesothelioma cases increased over time, with greater increases in older age groups. Peritoneal mesothelioma remained extremely rare over the 38 years. Five-year survival after pleural mesothelioma differed by age group, gender and histological subtype.
• Limitations the authors state:
  • No information on individual asbestos exposure history was available to the study.
  • The data were too sparse to interpret rates of change over time.
  • The rise in five-year survival in 2002 to 2006 could be an artefact of how complete the follow-up on deaths was.
  • Survival data ran only to the end of 2006, so the study could not detect any effect of pemetrexed.
  • Rates in the 1970s need caution, because a consistent approach to diagnosis was not in place in Australia until the late 1970s.
  • Most cases had an unspecified histological subtype. It is unclear whether the subtype proportions seen in recent years applied to earlier periods.
  • Explaining the survival differences between groups would need more detailed data on clinical stage and patient performance status.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Pleural Mesothelioma, Histological Subtype, Incidence, Epithelioid, Non-epithelioid, Chemotherapy, Pemetrexed (Alimta).

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• Malignant Peritoneal Mesothelioma: Patterns of Care and Survival in the Netherlands: A Population-Based Study — N.L. de Boer, J.P. van Kooten, et al. (2019)
• Patterns of care for malignant pleural mesothelioma patients compensated by the Dust Diseases Board in New South Wales, Australia — S.C. Kao, S. Clarke, et al. (2013)
• Incidence and survival of peritoneal malignant mesothelioma between 1989 and 2015: A population-based study — N. Le Stang, V. Bouvier, et al. (2019)
• Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales — K. Hannaford-Turner, D. Elder, et al. (2010)

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