The epidemiology and treatment of mesothelioma in South East England 1985-2002

Our plain-English summary of The epidemiology and treatment of mesothelioma in South East England 1985-2002, by V. Mak, E. Davies, V. Putcha, et al (Thorax, 2008).

The study

• Authors: V. Mak, E. Davies, V. Putcha, B. Choodari-Oskooei, H. Møller
• Journal: Thorax
• Published: 2008;63(2):160-6
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To describe trends in the incidence of mesothelioma for men and women in South East England and the geographical variation at the level of primary care trust. To describe treatment patterns by cancer network of residence, and relative survival by cancer network, disease stage and treatment modality.

Methods: 5753 cases were extracted from the Thames Cancer Registry database. We calculated age standardised incidence rates for each year, age specific incidence rates in 10 year age groups, and we used linear regression to compute the average annual percentage change in age standardised incidence. We used Poisson regression to analyse generational trends in incidence.

Results: Men had five times higher incidence of mesothelioma than women. In men, there was an overall 4% increase per year between 1985 and 2002. Over the same period, the overall increase in incidence for women was 5% per year. The incidence was highest in men aged over 70 years, and men aged over 80 years had the highest increase of 8% per year. The incidence rate ratio increased for men born between 1892 and 1942 and started to slow for those born from 1947 onwards. Areas along the Thames and its estuary had the highest incidence. There was some variation by cancer network in the proportion of patients receiving cancer surgery, radiotherapy and chemotherapy. There were no discernable differences in relative survival by cancer network of residence or disease stage but those receiving combined treatment had higher 5 year survival.

Conclusions: Mesothelioma incidence has increased in South East England, particularly for men aged over 70 years. The highest incidence occurs along the Thames and its estuary, reflecting areas of asbestos use in shipbuilding and industry in the past. More research is needed to understand the interrelationships of prognostic factors, treatment choices and survival, and to determine the best care and support for these patients and their families.

In plain English

This study used records from the Thames Cancer Registry, which covered 14.2 million residents of London, Essex, Hertfordshire, Kent, Surrey and Sussex. The authors analysed 5753 cases of mesothelioma diagnosed from 1985 to 2002. 83% of patients were men, and 92% had mesothelioma of the pleura. Incidence was five times higher in men than in women. Age-standardised incidence rose 4% per year in men and 5% per year in women. Men over 80 had the largest yearly rise (7.7%). Compared with men born in 1927, incidence rose sharply for men born from 1892 until 1942, and started decreasing for those born from 1947 onwards. Incidence was highest in areas along the Thames and its estuary. For men, 1-year and 5-year relative survival were 28% and 3%. For women they were 36% and 6%. The authors linked the high-incidence areas to past asbestos use in shipbuilding and industry. They had no information on patients' jobs and could not explore the reasons for the high incidence.

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 study of incidence trends, geographical variation, treatment patterns and relative survival
• Who was studied: 5753 people with mesothelioma diagnosed 1985 to 2002, resident in the area of South East England covered by the Thames Cancer Registry (population 14.2 million). 4767 (83%) were men and 986 (17%) were women. 5287 (92%) had pleural and 213 (4%) had peritoneal mesothelioma. The survival analysis used patients followed up between 1998 and 2002, excluding death-certificate-only cases.
• Exposure: Asbestos exposure was not measured for individual patients. The authors had no information on patients' occupations or migration. They related high-incidence areas to past asbestos use in shipbuilding and industry. No fiber types are named.
• Main results:
  • Men had five times higher incidence of mesothelioma than women.
  • In men, the age-standardised incidence rate rose by 4% per year between 1985 and 2002.
  • In women, incidence rose by 5% per year over the same period. The results section describes it as relatively stable until 1997, with a slight increase thereafter.
  • Men over 80 years had the highest annual increase in incidence (7.7%). Men aged 50 to 59 had an annual increase of 2.2%.
  • Women over 80 years had the highest annual increase among women (13.9%).
  • In men, compared with the 1927 birth cohort, incidence rate ratios increased sharply from the 1892 cohort until 1942. They then increased more slowly and started decreasing from the 1947 birth cohort onwards.
  • Primary care trusts along the Thames and its estuary had the highest incidence. In men and women, the South Essex, Kent and Medway, and North East London cancer networks had higher incidence rates.
  • Among patients diagnosed 1998 to 2002 (438 patients per year on average), 76% had any surgery, 31% had radiotherapy and 18% had chemotherapy. Across the nine networks fully covered by the registry, the proportion receiving cancer surgery ranged from 37% to 61% by network.
  • 14% of patients overall had no treatment recorded, and 24% of patients aged over 80 had no treatment recorded.
  • Relative survival for men was 28% at 1 year and 3% at 5 years. For women it was 36% at 1 year and 6% at 5 years.
  • Survival did not differ between patients from cancer networks with high and low incidence.
  • Men with localised disease had 1-year and 5-year relative survival of 33.1% and 2.9%. Men with non-localised disease had 16.6% and 1.2%. The authors described this as a minimal difference.
  • By treatment, 1-year and 5-year relative survival in men was as follows. Surgery and chemotherapy: 43.7% and 4.3%. Surgery alone: 21.8% and 2.6%. Surgery and radiotherapy: 41.0% and 2.2%. No treatment recorded: 17.8% and 1.8%.
• The authors' conclusion: The authors concluded that mesothelioma incidence increased in South East England, particularly in men aged over 70. They said the highest incidence along the Thames and its estuary reflects past asbestos use in shipbuilding and industry. They concluded that their study provides no further advice on which treatment could improve survival.
• Limitations the authors state:
  • Patients were mapped by where they lived, which is not necessarily where they were exposed.
  • There was no information on patients' migration or occupation, so the reasons for high incidence in some areas could not be explored.
  • Registry data record only treatment given within 6 months of diagnosis, so patients with no treatment recorded may have been treated later.
  • Variation in treatment between networks may partly reflect differences in how treatment details were recorded.
  • Death-certificate-only cases were excluded from the survival analysis. In areas with more such cases, relative survival may be artificially inflated.

Topics

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

Medical terms in this study, explained in our Lexicon: Epidemiology, Mesothelioma, Cancer Registry, Incidence, Chemotherapy.

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• Certified causes of death in patients with mesothelioma in South East England — C. Okello, T. Treasure, et al. (2009)
• Malignant mesothelioma in south east England: clinicopathological experience of 272 cases — D.H. Yates, B. Corrin, et al. (1997)
• Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England — R.A. Damhuis, A. Khakwani, et al. (2015)
• Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years — R.T. Lin, Y.Y. Chang, et al. (2019)
• 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)

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