The epidemiology of pleural mesothelioma: current concepts and controversies

Our plain-English summary of The epidemiology of pleural mesothelioma: current concepts and controversies, by M. Huncharek (Cancer Investigation, 1989).

The study

• Author: M. Huncharek
• Journal: Cancer Investigation
• Published: 1989;7(1):93-9
• Cited by: 7 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. 000099).

Summary of the article

In this opinion piece (labelled 'Op-Ed'), the author reviewed published data on the epidemiology of pleural mesothelioma and highlighted controversial aspects of its relationship with asbestos. The author reported that incidence had been rising, especially among asbestos-exposed workers. U.S. SEER data for 1973–1978 gave annual age-adjusted rates of 0.9 per 100,000 in white males and 0.3 in white females, and the male rate was increasing by almost 10% per year. Diagnostic uncertainty and the lack of a specific disease code complicated incidence and mortality estimates, and projections of future asbestos-related mesotheliomas ranged from 15,000 to 300,000. The article summarized occupational risks (including mining, manufacturing, insulation, shipbuilding, railroad work and brake repair), household and environmental exposures (including zeolite in Turkish villages), and non-asbestos agents that cause mesothelioma in animals. Unresolved issues discussed were the risk from asbestos in buildings such as schools, where the estimated lifetime risk for students exposed at 0.001 f/ml was 1.7 to 17.3 cases per million, and the risk from maintenance, repair and removal work; host factors such as immune changes and HLA antigens; and the role of chrysotile. The author concluded that it appears prudent to assume all fiber types represent a mesothelioma hazard, that 'secondary' or 'bystander' exposure may be a serious health hazard, and that close surveillance of exposed school populations is necessary.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This op-ed reviewed published research on the epidemiology of pleural mesothelioma and reported no new data. Cited SEER registry data gave annual age-adjusted incidence for 1973-1978 of 0.9 per 100,000 white males and 0.3 per 100,000 white females. With 1979-1980 data added, the male rate was rising by almost 10% per year. The review covered occupational, household and Turkish zeolite exposures. A cited case-control study of U.S. railroad workers found an odds ratio of 7.2 for jobs with potential asbestos exposure. A cited model estimated 1.7 to 17.3 lifetime mesothelioma cases per million students exposed to 0.001 fibers per milliliter for 35 hours a week, 36 weeks a year, for 5 years from age 10. The model's authors said the highest estimate may be an overestimate, and the author noted such predictions apply only to intact or undamaged materials. The review discussed host factors and a suggested potency gradient from crocidolite to chrysotile, which the author noted is not universally accepted. The author concluded it appears prudent to assume all fiber types represent a mesothelioma hazard, and that bystander exposure may represent a serious health hazard.

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: Narrative review (published as an op-ed) of literature on the epidemiology of pleural mesothelioma; no original data
• Who was studied: No study population of its own. The author reviewed published reports on mesothelioma incidence, occupational and nonoccupational risk, building exposures, host factors, and asbestos fiber types.
• Exposure: Asbestos of different fiber types (crocidolite, amosite, chrysotile, anthophylite) in occupational, household, environmental and building settings; also zeolite (described as an asbestiform mineral) in Turkey
• Main results:
  • Cited SEER registry data for 1973-1978 gave annual age-adjusted mesothelioma incidence of 0.9 cases per 100,000 among white males and 0.3 per 100,000 among white females.
  • SEER data for 1979-1980, combined with the 1973-1978 data, showed the male rate increasing by almost 10% per year, while the female rate appeared consistent.
  • In a cited case-control study of U.S. railroad workers, those in jobs with potential asbestos exposure had a significant odds ratio of 7.2. Skilled trades with regular exposure had a statistically significant odds ratio of 21.4. Occupations with intermittent exposure had a nonsignificant odds ratio of 2.3. The author considered these data an underestimate because they relied on death certificates.
  • In a cited 1978 McDonald and McDonald study, mesothelioma occurred 60 times more frequently in a crocidolite-exposed group of factory workers than in Quebec chrysotile miners and millers.
  • Weill and Hughes estimated a lifetime mesothelioma risk of 1.7 to 17.3 cases per million students. The estimate assumed exposure to 0.001 fibers per milliliter for 35 hours per week, 36 weeks per year, for 5 years beginning at age 10. Those authors said the highest estimate may be an overestimate, particularly if school asbestos products contain only chrysotile. The author noted these predictions pertain only to intact or undamaged asbestos materials.
  • Published projections of future asbestos-related mesotheliomas over the next 2-3 decades ranged from 15,000 to 300,000. The author considered such projections unreliable.
  • The suggested gradient in potency from crocidolite to chrysotile was described as not universally accepted. Animal studies were cited showing that all major commercial asbestos types, including chrysotile, can produce mesothelioma.
• The authors' conclusion: The author concluded that it appears prudent to assume all fiber types represent a mesothelioma hazard, and that secondary or bystander asbestos exposure may represent a serious health hazard.
• Limitations the authors state:
  • The author stated that uncertain diagnosis and classification, and the lack of a unique disease code, lead to underreporting and underestimation of mesothelioma incidence.
  • The author stated that data from several other asbestos-using industries are sparse and often anecdotal.
  • The author stated that evidence on pleural mesothelioma risk from environmental exposure is equivocal.

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, Pleural Mesothelioma, SEER, Mesothelioma, Environmental Exposure, Zeolite, Chrysotile.

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