Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends

Our plain-English summary of Pleural mesothelioma incidence in Europe: evidence of some deceleration in the increasing trends, by F. Montanaro, F. Bray, V. Gennaro, et al (Cancer Causes & Control, 2003).

The study

• Authors: F. Montanaro, F. Bray, V. Gennaro, E. Merler, J.E. Tyczynski, D.M. Parkin, M. Strnad, M. Jechov'a, H.H. Storm, T. Aareleid, T. Hakulinen, M. Velten, H. Lef'evre, A. Danzon, A. Buemi, J.P. Daur'es, F. Ménégoz, N. Raverdy, M. Sauvage, H. Ziegler, H. Comber, E. Paci, M. Vercelli, V. De Lisi, R. Tumino, R. Zanetti, F. Berrino, G. Stanta, F. Langmark, J. Rachtan, R. Mezyk, J. Blaszczyk, P. Ivan, M. Primic-Zakelj, A.C. Martínez, I. Izarzugaza, J. Borràs, C.M. Garcia, I. Garau, N.C. Sánchez, A. Aicua, L. Barlow, J. Torhorst, C. Bouchardy, F. Levi, T. Fisch, N. Probst, O. Visser, M. Quinn, A. Gavin, D. Brewster, M. Mikov, ENCR Working Group
• Journal: Cancer Causes & Control
• Published: 2003;14(8):791-803
• Cited by: 80 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries.

Material And Methods: The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40-74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986-1990 and 1991-1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988-1997) were compared with trends in the previous decade. Fitted rates in younger (40-64) and older adults (65-74) in the most recent period were also compared.

Results: There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings.

Conclusions: While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.

In plain English

This study used European cancer registry data to describe pleural mesothelioma rates and trends among people aged 40 to 74. In the latest five-year period, rates among men ranged from 8.8 per 100,000 in Scotland, 8.0 in England and 7.4 in The Netherlands to below 1 in Estonia and in parts of Spain, Poland and Yugoslavia (Vojvodina) covered by regional registries. Rates in women were much lower. Regional registries in Trieste, Genoa and Rotterdam had the highest rates. Among men, rates rose significantly in about 1978 to 1987 in every country with data except Denmark. In about 1988 to 1997, among country series a significant rise was seen only in England and France (France from selected areas), though the Maastricht and Isere regional registries also rose significantly. Recent increases were generally smaller in men aged 40 to 64 than in those aged 65 to 74. Countries banning asbestos earlier tended to have smaller recent increases, a weak correlation. The authors concluded that rates were still rising but slowing in some countries, and that a decrease may begin sooner than expected.

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 study of population cancer registry incidence data: geographical comparison and time-trend (regression) analysis
• Who was studied: Pleural mesothelioma cases aged 40 to 74 recorded by European national and regional cancer registries. These were registries accepted in Cancer Incidence in Five Continents Volume VII, excluding Malta and Iceland. For some countries (including Italy, Switzerland, France, Germany, Spain, Poland and Yugoslavia) only selected areas were covered. The most recent 5-year period was mostly 1993 to 1997. Trend periods were about 1978 to 1987 and 1988 to 1997.
• Exposure: No individual exposure data. The authors compared each country's recent trend in male mesothelioma rates with the year of its national asbestos ban.
• Main results:
  • Men aged 40 to 74, most recent 5-year period: rates per 100,000 were 8.8 in Scotland, 8.0 in England and 7.4 in The Netherlands. Rates were below 1 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56). The figures for Spain, Poland and Yugoslavia come from selected areas only.
  • The Spain, Poland and Yugoslavia figures cover only the listed registry areas.
  • Among women the country ranking was similar to that of men, but rates were much lower.
  • Male-to-female rate ratios among the national populations ranged from 1.8 in Estonia to 9.0 in The Netherlands.
  • The highest incidence rates were detected in the regional areas of Trieste, Genoa and Rotterdam.
  • Men, 1991–1995 compared with 1986–1990: standardized rate ratios ranged from 0.98 in Norway to 1.35 in England. Only England's difference was significant (95% CI 1.28 to 1.42).
  • Rates among women were also increasing in most populations, except Denmark and Finland.
  • Men, first period (about 1978–1987): the estimated annual percent change rose significantly in all countries with data, except Denmark.
  • Men in England: the estimated annual percent change was 10.2 (95% CI 5.8 to 14.6) in 1978–1987 and 4.7 (95% CI 1.6 to 7.8) in 1988–1997.
  • Men, latest 10 years (about 1988–1997), country series: a significant increase was detected only in England and France. The France series covers selected areas only.
  • Men in the Maastricht (Netherlands) regional registry, 1988–1997: estimated annual percent change 3.1 (95% CI 0.4 to 5.8).
  • Men in the Isere (France) regional registry, 1988–1997: estimated annual percent change 4.8 (95% CI 0.8 to 8.8).
  • Joinpoint analysis found no significant changes in trend, except for England, where a deceleration was detected in 1986.
  • Rates in the selected regional registries were mostly still increasing, except in Rotterdam and Varese.
  • Recent trends in younger men (40–64) were generally smaller than in older men (65–74), in both national and regional registries.
  • There was a positive but weak correlation between recent trend and year of national asbestos ban. Countries that banned asbestos earlier showed more moderate increases.
• The authors' conclusion: The authors concluded that pleural mesothelioma incidence was still increasing in Europe but had begun to decelerate in some countries. They added that a decrease may begin sooner than expected, given asbestos exposure data and the relatively recent bans.
• Limitations the authors state:
  • Random variation in the trends may have affected detection of changes in trend (joinpoints) in registries other than England.
  • Because of the long latency of mesothelioma, no conclusion about the effectiveness of asbestos bans can be drawn for many years.
  • For the low rates seen in Eastern countries, problems with diagnosis or registration of mesothelioma cases could not be ruled out.

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, rate ratio, confidence interval, Mesothelioma, Cancer Registry, Incidence, Asbestos Exposure.

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