Recent trends in mesothelioma incidence in the United States

Our plain-English summary of Recent trends in mesothelioma incidence in the United States, by R. Spirtas, G.W. Beebe, R.R. Connelly, et al (American Journal of Industrial Medicine, 1986).

The study

• Authors: R. Spirtas, G.W. Beebe, R.R. Connelly, W.E. Wright, J.M. Peters, R.P. Sherwin, B.E. Henderson, A. Stark, B.M. Kovasznay, J.N. Davies
• Journal: American Journal of Industrial Medicine
• Published: 1986;9(5):397-407
• Cited by: 87 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000438).

Abstract

Mesothelioma incidence rates based on data from population-based cancer registries in New York State (exclusive of New York City), Los Angeles County, California, and the SEER Program of the National Cancer Institute were analyzed for trends, using original cancer registry diagnoses. Results indicate a significant increase in incidence during 1973-80 for pleural mesothelioma among white males older than 55 at time of diagnosis but not for other age-race-sex-site subgroups. A histopathologic review of New York State and Los Angeles County cases by two independent pathologists, expert in the diagnosis of mesothelioma, lowered the overall estimates but a significant upward trend remained. The observed trend does not appear to be related to changes in diagnostic practice. The results of a five-member panel of expert pathologists will be published in a separate methodology paper.

In plain English

The authors analyzed mesothelioma cases recorded in cancer registries for Los Angeles County (1972-80), New York State outside New York City (1973-80), and nine National Cancer Institute SEER registries (1973-80). Using the registries' original diagnoses, pleural mesothelioma among white males increased significantly in all three areas, by an average of 13%, 12% and 12% per year respectively. These increases were limited to older white males. None of the trends for pleural mesothelioma among white females was statistically significant, and there were too few cases to measure trends for nonwhites. Two expert pathologists confirmed the diagnosis in 64% (261/405) of Los Angeles and New York cases with adequate slides. Using the reviewed diagnoses lowered the rates, but significant increases remained there for older white males with pleural mesothelioma. After adjustment for other factors, year of diagnosis did not significantly affect the confirmation rate. The authors concluded the trend did not appear to reflect changes in diagnostic practice and was consistent with environmental or occupational exposure 25 to 40 years earlier. The reviewing pathologists were not given occupation or exposure information.

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 cancer registry incidence study with trend analysis (log-linear regression) and a two-stage expert pathology review of registry cases
• Who was studied: Malignant pleural and peritoneal mesothelioma cases recorded in the Los Angeles County cancer registry (1972-80), the New York State Cancer Registry excluding New York City (1973-80), and nine SEER registries (Connecticut, Hawaii, Iowa, New Mexico, Utah, Atlanta, Detroit, San Francisco, Seattle; 1973-80), covering about ten percent of the U.S. population
• Exposure: The study analyzed registry-diagnosed cases, and the article does not report individual exposure data. The reviewing pathologists were given no information on occupation or exposure.
• Main results:
  • Pleural mesothelioma among white males, 1973-80, based on original registry diagnoses: average annual increases of 13% (Los Angeles County), 12% (New York State) and 12% (SEER). The trend was significant at p less than .01 in each data set.
  • The increases were confined to older white males. SEER showed significant increases only among white males above age 65. In New York State the increase began at age 55. In Los Angeles County the only significant increase was in the 65-74 age group.
  • None of the trends for pleural mesothelioma among white females was statistically significant. There were insufficient data to measure trends for nonwhites, for peritoneal mesothelioma in Los Angeles County and New York State, and for white females in Los Angeles County.
  • Pathology review of Los Angeles County and New York State cases: slides were obtained for 428 of 567 cases, and 405 were adequate. The referee pathologists confirmed 64% (261/405).
  • After adjustment for other factors, year of diagnosis had a nonsignificant effect on the confirmation rate.
  • Among female peritoneal cases, the expert pathologists judged the majority (22/30) to be misdiagnosed, usually as female genital cancers.
  • Using rates based on the second pathology review lowered overall incidence estimates. Significant increases over time remained for older white male pleural cases in Los Angeles County and New York State.
• The authors' conclusion: The authors concluded that the specificity of the increase by sex, tumor site and age argues against any appreciable change in diagnostic practice. They also concluded that the increase among white males over 55 is consistent with a cohort effect due to environmental or occupational exposure 25 to 40 years earlier.
• Limitations the authors state:
  • False negative diagnoses could not be measured, and some cases had inadequate pathology material for review.
  • SEER data may overestimate national incidence, although they may correctly reflect the changing incidence.
  • Evaluation of trends by histologic subgroup was inconclusive because of too few cases.

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: Mesothelioma, Incidence, SEER, Cancer Registry, Pleural Mesothelioma.

Related studies

• Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005 — B. Price, A. Ware (2009)
• Response to Letter to the Editor Regarding "Ambient Asbestos Fiber Concentrations and Long-Term Trends in Pleural Mesothelioma Incidence Between Urban and Rural Areas in the United States (1973-2012)" by Finkelstein — K.A. Keeton, M.E. Glynn, et al. (2018)
• Letter Concerning: Glynn ME, Keeton KA, Gaffney SH, Sahmel J. Ambient Asbestos Fiber Concentrations and Long-Term Trends in Pleural Mesothelioma Incidence Between Urban and Rural Areas in the United States (1973-2012). Risk Analysis 2018;38(3):454-471 — M.M. Finkelstein (2018)
• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003-2008 — S.J. Henley, T.C. Larson, et al. (2013)
• Mesothelioma in the United States. Incidence in the 1970's — M.W. Hinds (1978)

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