The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil

Our plain-English summary of The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil, by E. Algranti, C.A. Saito, A.P. Carneiro, et al (Cancer Epidemiology, 2015).

The study

• Authors: E. Algranti, C.A. Saito, A.P. Carneiro, B. Moreira, E.M. Mendonça, M.A. Bussacos
• Journal: Cancer Epidemiology
• Published: 2015;39(5):687-92
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: There are limited data on mesothelioma mortality in industrializing countries, where, at present, most of the asbestos consumption occurs.

Objectives: To analyze temporal trends and to calculate mortality rates from mesothelioma and cancer of the pleura in Brazil from 2000 to 2012 and to estimate future mortality rates.

Methods: We retrieved records of deaths from mesothelioma (ICD-10C45) and cancer of the pleura (ICD-10C38.4) from 2000 to 2012 in adults aged 30 years and over. Crude and age-standardized mortality rates (ASMR) were calculated. Rate ratios of mean crude mortality for selected municipalities were compared to the Brazilian rate. A regression was carried out of the annual number of deaths against asbestos consumption using a Generalized Additive Model (GAM). The best model was chosen to estimate the future burden and peak period of deaths.

Results: There were 929C45 and 1379 C38.4 deaths. The ratio of men to women for C45 was 1.4. A positive trend in C45 numbers was observed in Brazil (p=0.0012), particularly in São Paulo (p=0.0004) where ASMRs presented an increasing linear trend (p=0.0344). Selected municipalities harboring asbestos manipulation presented 3.7-11 fold rate ratios of C45 compared to Brazil. GAM presented best fits for latencies of 34 years or more. It is estimated that the peak incidence of C45 mortality will occur between 2021 and 2026.

Conclusions: The observed ASMRs and the gender ratio close to 1 suggest underreporting. Even so, deaths are increasing and mesothelioma clusters were identified. Compared to industrialized countries Brazil displays a 15-20 year lag in estimated peak mesothelioma mortality which is consistent with the lag of asbestos peak consumption in the country.

Copyright © 2015 Elsevier Ltd. All rights reserved.

In plain English

This study examined Brazilian death records for mesothelioma (ICD-10 code C45) and cancer of the pleura (C38.4) in adults aged 30 and over, 2000 to 2012, and compared them with national asbestos consumption per person since 1961. Records listed 929 mesothelioma deaths and 1379 pleural cancer deaths. For mesothelioma, men outnumbered women by 1.4 to 1. The State of São Paulo had 23.2% of the adult population but 44.6% of mesothelioma deaths. Yearly mesothelioma deaths rose significantly in Brazil and São Paulo. Age-standardized rates rose significantly only in São Paulo. In three São Paulo municipalities with long-established asbestos-cement industries, mesothelioma death rates were 5.2 to 11.0 times the national rate, based on 5 to 18 deaths each. A model linking deaths to consumption at least 34 years earlier fit best. It estimated 1911 mesothelioma deaths (limits 867 to 4242) for 2013 to 2030, peaking around 2021 to 2026. The authors concluded that Brazil lags industrialized countries by some 15 to 20 years. They suggested that low recorded rates partly reflect poor recognition of the disease. They could not check diagnoses or exposures in medical records.

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: Ecological study of national death records: trends analysed by linear regression, and annual deaths modelled against past asbestos consumption with Generalized Additive Models to forecast deaths to 2030
• Who was studied: Deaths with mesothelioma (C45) or cancer of the pleura (C38.4) as the underlying cause among adults aged 30 and over in Brazil, January 2000 to December 2012: 929 C45 and 1379 C38.4 deaths. The study also looked separately at the State of São Paulo and three of its municipalities (Leme, São Caetano do Sul, Osasco).
• Exposure: National apparent asbestos consumption per person (production plus imports minus exports), 1961 to 2012, tested at lags of 29, 34 and 39 years or more. Municipalities were selected because asbestos-cement industries had been settled there for fifty years or more.
• Main results:
  • Mesothelioma (C45) deaths: 548 men and 381 women, a men-to-women ratio of 1.4
  • The State of São Paulo, with 23.2% of Brazil's population aged 30 and over, registered 44.6% of all C45 deaths
  • The annual number of C45 deaths rose significantly over 2000 to 2012 in Brazil (p = 0.0012) and in the State of São Paulo (p = 0.0004)
  • Excluding São Paulo State, the trend in C45 deaths for the rest of Brazil was positive but not statistically significant (p = 0.0563)
  • C45 age-standardized mortality rates ranged from 0.7 to 1.0 per million in Brazil and from 1.0 to 2.1 per million in São Paulo State. The linear upward trend was significant in São Paulo (p = 0.0344) but not for Brazil.
  • For cancer of the pleura (C38.4), the increase in the number of deaths was significant only for Brazil. Age-standardized rates showed no significant trend in either Brazil or São Paulo.
  • Mean crude C45 mortality rate ratios compared with Brazil were 11.0 in Leme (5 deaths), 8.4 in São Caetano do Sul (8 deaths) and 5.2 in Osasco (18 deaths)
  • Pooling the three municipalities, the men-to-women ratio was 4.2 for C45 and 4.0 for C38.4
  • Peritoneal mesothelioma made up 58 (10.6%) of mesothelioma deaths in men and 90 (23.6%) in women. Pleural plus unspecified mesothelioma accounted for 77.1% of cases.
  • Models using asbestos consumption lagged 34 years or more fit best, with R2 of 0.79 for C45, 0.64 for C38.4 and 0.82 for the sum
  • For 2013 to 2030 the model estimated 1911 C45 deaths (lower limit 867, upper limit 4242), peaking around 2021 to 2026. It estimated 2406 C38.4 deaths (2043 to 3325) and 4301 deaths for the two combined (3349 to 5526).
• The authors' conclusion: The authors concluded that mesothelioma mortality in Brazil is increasing, particularly in São Paulo State. They concluded that Brazil lags behind industrialized countries in mesothelioma deaths by some 15 to 20 years, in keeping with its asbestos consumption history.
• Limitations the authors state:
  • The authors could not check confirmation rates for the mesothelioma deaths
  • The authors could not verify asbestos exposure or diagnostic certainty in medical or hospital records
  • Database quality was limited: 14.3% of death certificates had an undefined cause of death in 2000 and 6.7% in 2010, and coverage of deaths varied by region
  • The authors suggested several reasons for the low rates and gender ratios: cases spread unevenly across a large country, poor recognition of mesothelioma by health professionals, limited resources for clinical investigation, and poor quality control of health databases
  • Per capita asbestos consumption does not reflect individual exposure, though the authors considered it a reasonable population-level index
  • The forecast period was longer than the observed time series, which the authors note gives wider intervals than in other prediction studies

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, rate ratio, Mesothelioma Cluster.

Related studies

• Lung Cancer Mortality Trends in a Brazilian City with a Long History of Asbestos Consumption — G.A. Fernandes, E. Algranti, et al. (2019)
• Lung cancer in Brazil — E. Algranti, A.M. Menezes, et al. (2001)
• Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017 — C.A. Saito, M.A. Bussacos, et al. (2022)
• Asbestos and mesothelioma: worldwide trends — L. Kazan-Allen (2005)
• Forecast of Malignant Peritoneal Mesothelioma Mortality in Italy up to 2040 — E. Oddone, J. Bollon, et al. (2020)
• Correction: Saito et al. Sex-Specific Mortality from Asbestos-Related Diseases, Lung and Ovarian Cancer in Municipalities with High Asbestos Consumption, Brazil, 2000-2017. Int. J. Environ. Res. Public Health 2022, 19, 3656 — C.A. Saito, M.A. Bussacos, et al. (2022)

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