Three decades of pleural cancer and mesothelioma registration in Austria where asbestos cement was invented

Our plain-English summary of Three decades of pleural cancer and mesothelioma registration in Austria where asbestos cement was invented, by M. Neuberger, C. Vutuc (International Archives of Occupational and Environmental Health, 2003).

The study

• Authors: M. Neuberger, C. Vutuc
• Journal: International Archives of Occupational and Environmental Health
• Published: 2003;76(2):161-6
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Recently, a new mesothelioma epidemic was predicted from observations made in Western Europe. From early observations in Austria the lower increase in cases of mesothelioma compared with neighbor countries had been related to different uses of asbestos. In order to test this hypothesis, incidence and mortality of pleural cancer [International Classification of Diseases (ICD)-8/9 163] were analyzed for three decades and supplemented by data from a cohort study in the factory that had been the largest consumer of asbestos imported to Austria and from all Austrian occupational diseases registered between 1990 and 2001. In men, mortality rates (based on 15 to 45 deaths/year) were lowest in 1980-1989, but similar in 1970-1979 and 1990-2001. No increase in younger-birth cohorts was detected. Incidence rates (based on 13 to 44 cases/year) increased (36%) non-significantly ( P=0.14). In women, a significant decrease in mortality and incidence rates ( P<0.01) was observed from 1970. Rates from work-related mesothelioma (based on only 0-7 men and 0-4 women/year) must be interpreted with caution. In the cohort of 2,816 asbestos cement workers 26 pleural mesotheliomas were registered from 1990 through mid-1999. Six of these cases (three male and three female) had not been registered as an occupational disease, but all of these cases had been encoded under ICD 163 in mortality statistics. One female cohort member registered as having asbestosis according to the death certificate had died from mesothelioma according to the statistics of occupational diseases. We conclude that no epidemic of mesothelioma due to past asbestos exposure is to be expected in Austria.

In plain English

This short communication tested whether Austria's different uses of asbestos explained its smaller rise in mesothelioma compared with neighboring countries. The authors analyzed pleural cancer deaths (1970 to 2001), cancer registry incidence (to 1999), mesothelioma accepted as work-related (1990 to 2001), and a cohort of 2,816 asbestos cement workers. In men, death rates were lowest in the 1980s, and the overall trend was not statistically significant. Incidence in men rose 36%, also not significantly (P=0.14). No major change was seen in men born after 1950. In women, death rates fell significantly, by 56% (P=0.001, world standard population). Women's incidence was 27% lower overall, but it rose again in the 1990s and the trend was not significant (P=0.49). Work-related mesothelioma counts were small (0 to 7 men and 0 to 4 women yearly). In the cohort, 26 pleural mesotheliomas were registered from 1990 through mid-1999, and six had not been registered as occupational disease. The authors concluded that no mesothelioma epidemic from past asbestos exposure is to be expected in Austria. They also stated that the rate reported as occupational disease is too low.

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: Short communication analyzing national registry trends (pleural cancer mortality and incidence, accepted occupational mesothelioma cases), supplemented by an update of an asbestos cement worker cohort
• Who was studied: The population of Austria. Pleural cancer deaths covered 1970 to 2001, cancer registry incidence ran up to 1999, and mesothelioma cases accepted as work-related by the Austrian Worker's Compensation Board covered 1990 through 2001. The study also included a cohort of 2,816 asbestos cement workers, followed up to mid-1999.
• Exposure: Exposure was not measured for individuals. The cohort worked at the oldest asbestos cement factory in the world. In the discussion, the authors linked most occupational cases in Upper Austria to the use of amphiboles in asbestos cement production from 1948 for about 20 years. They described Austrian asbestos use as predominantly chrysotile.
• Main results:
  • Men, Austria: pleural cancer mortality rates (based on 15 to 45 deaths per year) were lowest in the 1980s but similar in 1970 to 1979 and 1990 to 2001. The overall trend was not significant.
  • Men, Austria: incidence rates (based on 13 to 44 cases per year) increased 36%, which was not statistically significant (P=0.14).
  • Men, Austria: no major change in pleural cancer death risk was seen in men born after 1950.
  • Women, Austria: pleural cancer mortality (based on 16 to 43 deaths per year) changed by -56% (P=0.001) on the world standard population and by -45% (P=0.005) on the 1991 Austrian population.
  • Women, Austria: pleural cancer incidence (based on 6 to 26 cases per year) changed by -27% (P=0.49) on the world standard population and by -18% (P=0.69) on the 1991 Austrian population. Neither change was statistically significant, and rates rose again in the 1990s after earlier lows (world standard: 0.37 per 100,000 in 1970 to 1974, 0.21 in 1975 to 1979, 0.27 in 1995 to 1999).
  • Men, Upper Austria: as in Austria as a whole, the pleural cancer mortality trend was not significant (P=0.48).
  • Asbestos cement worker cohort: of 2,816 workers, 26 pleural mesotheliomas were registered from 1990 through mid-1999. Six of these (three male, three female) had not been registered as an occupational disease, but all six had been coded under ICD 163 in mortality statistics.
  • Asbestos cement worker cohort: one female cohort member recorded as having asbestosis on the death certificate had died from mesothelioma according to occupational disease statistics.
  • Men: pleural mesothelioma registered as occupational was 3.8 per million men in Upper Austria and 2.9 per million men in Austria as a whole.
• The authors' conclusion: The authors concluded that no epidemic of mesothelioma due to past asbestos exposure is to be expected in Austria.
• Limitations the authors state:
  • Rates of work-related mesothelioma rest on small numbers of cases (0 to 7 men and 0 to 4 women per year), so their trends must be interpreted with caution.
  • Birth-cohort rates rest on small numbers, so random variation has to be considered.
  • Death certificates are a less reliable source for primary pleural cancer (mesothelioma) than the cancer register, because cancers that spread to the pleura from elsewhere get mixed in.
  • Data protection laws prevented the authors from checking whether the female cohort case had been coded as mesothelioma in the cancer register.
  • Occupational disease statistics risk underestimation. The authors think the rate of mesothelioma reported as occupational disease is too low.

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, Asbestos-Cement, Cohort Study, Occupational Disease, Incidence, Pleural Mesothelioma, Death Certificate, Asbestos Exposure.

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