Pleural mesothelioma: a descriptive analysis based on a case-control study and mortality data in Ile de France, 1987-1990

Our plain-English summary of Pleural mesothelioma: a descriptive analysis based on a case-control study and mortality data in Ile de France, 1987-1990, by Y. Iwatsubo, J.C. Pairon, C. Archambault de Beaune, et al (American Journal of Industrial Medicine, 1994).

The study

• Authors: Y. Iwatsubo, J.C. Pairon, C. Archambault de Beaune, S. Chamming's, J. Bignon, P. Brochard
• Journal: American Journal of Industrial Medicine
• Published: 1994;26(1):77-88
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Incidence rates of pleural mesothelioma in Ile de France were examined for the period 1987-1990, on the basis of information collected in a case-control study. This study was designed to include all new cases of pleural mesothelioma occurring in the region. On the other hand, mortality rates from pleural malignancies in the same region were examined on the basis of death certificates recorded by INSERM for the same period. A large difference was found between the two types of data. Average annual incidence rates were 7.5 per million among men and 1.6 per million among women. Average annual mortality rates due to primary pleural malignancies were 25.2 per million in males and 8.9 per million in females. This study confirms discordances between incidence and mortality data for pleural malignancies already reported in several countries. However, contrasting with some previous reports, the annual mortality rate from pleural malignancies was higher than the incidence rate of mesothelioma in this study. This emphasizes the usefulness of a specific investigation to explain such discordances, prior to comparison of data from one country to another.

In plain English

This French study compared pleural mesothelioma cases with deaths from pleural malignancies in Ile de France for 1987 to 1990. The cases came from a hospital-based case-control study that enrolled living patients with a tissue diagnosis. It counted 163 people (127 men, 36 women), including 22 whose slides the French Mesothelioma Panel had not yet reviewed. The deaths were those certified as definite or presumed primary pleural malignancy, a broader category than mesothelioma: 435 in men and 237 in women. Average yearly age-adjusted incidence of mesothelioma was 7.5 per million in men and 1.6 in women. The matching death rates from pleural malignancy were 25.2 and 8.9 per million. The authors called deaths five times the cases, though their counts (672 against 163) give about four. The authors said cases may have been missed outside hospitals, without tissue diagnosis, or among those who died before interview. They said death figures may be inflated because the disease code has no specific mesothelioma category. They concluded that, unlike some earlier reports, mortality exceeded incidence. Asbestos exposure was not analyzed in this report.

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: Descriptive analysis comparing pleural mesothelioma incidence from a hospital-based case-control study with mortality from pleural malignancies on death certificates
• Who was studied: Pleural mesothelioma cases registered in Ile de France (Paris and six adjacent departments, about 10 million inhabitants) from January 1, 1987 to December 31, 1990. 174 people were interviewed and 163 were counted as mesothelioma (127 men, 36 women). The study also examined deaths in the same area and period coded as malignant neoplasm of pleura, stated or presumed to be primary (ICD category 163).
• Exposure: Not analyzed in this report. Occupational and environmental information was collected by questionnaire for a later case-control report.
• Main results:
  • 163 patients were considered mesothelioma for the incidence analysis: 118 definite, 23 possible, and 22 not yet assessed by the French Mesothelioma Panel. Of 152 cases submitted to the Panel, 11 (7.2%) were judged definitely not mesothelioma.
  • Among the 118 definite mesotheliomas, 103 (87.3%) were epithelial type.
  • Average annual age-adjusted incidence of pleural mesothelioma was 7.5 per million among men and 1.6 per million among women.
  • In men, incidence rose with age. The 65-74 age group averaged 39.8 per million per year.
  • Death certificates attributed 435 deaths in men and 237 deaths in women to definite or presumed primary pleural malignancy over the 4 years. This is a broader category than mesothelioma.
  • The average annual age-adjusted mortality rate from pleural malignancies was 25.2 per million in men and 8.9 per million in women.
  • The authors described deaths from pleural malignancy on death certificates as five times the number of cases in the incidence study. Their reported counts (672 deaths, 163 cases) give a ratio of about four.
• The authors' conclusion: The authors concluded that, in contrast with some previous reports, the annual mortality rate from pleural malignancies was higher than the incidence rate of mesothelioma in this study.
• Limitations the authors state:
  • Counting the 22 unconfirmed cases and the 23 possible cases may have included some cases overdiagnosed as mesothelioma.
  • Restricting inclusion to hospital cases with histological confirmation could have caused underregistration. Cases followed outside hospitals, or diagnosed only by clinical, radiological or cytological criteria, were not included.
  • Only patients alive at interview were included, so cases who died before interview were not counted in the incidence rates.
  • The disease classification has no specific code for mesothelioma, which could overestimate mortality. This could happen through inclusion of other primary pleural tumors and of metastases from unidentified adenocarcinomas.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Case-Control Study, Incidence, Death Certificate, Mesothelioma.

Related studies

• Occupations and industries in France at high risk for pleural mesothelioma: A population-based case-control study (1998-2002) — P. Rolland, C. Gramond, et al. (2010)
• Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme — S. Chamming's, B. Clin, et al. (2013)
• Choice of rating method for assessing occupational asbestos exposure: study for compensation purposes in France — C. Gramond, P. Rolland, et al. (2012)
• Estimation of the incidence of pleural mesothelioma according to death certificates in France — Y. Iwatsubo, M. Matrat, et al. (2002)
• Pleural mesothelioma: dose-response relation at low levels of asbestos exposure in a French population-based case-control study — Y. Iwatsubo, J.C. Pairon, et al. (1998)
• Estimation of the past and future burden of mortality from mesothelioma in France — A.G. Ilg, J. Bignon, et al. (1998)

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