Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years

Our plain-English summary of Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years, by R.T. Lin, Y.Y. Chang, J.D. Wang, et al (Journal of the Formosan Medical Association = Taiwan Yi Zhi, 2019).

The study

• Authors: R.T. Lin, Y.Y. Chang, J.D. Wang, L.J. Lee
• Journal: Journal of the Formosan Medical Association = Taiwan Yi Zhi
• Published: 2019;118(1 Pt 3):463-470
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/purpose: Globally, asbestos-related diseases (ARDs) keep rising over the coming decades. The epidemic of ARDs will be a burden on public health. We aimed to predict the malignant pleural mesothelioma (MPM) incidence in the next 30 years for Taiwan based on historical asbestos consumption.

Methods: We collected annual data on local asbestos consumption during 1939-2015 and sex-specific incidence of pleural cancer as a proxy for MPM during 1979-2013. We applied Poisson log-linear models to predict future MPM numbers under the assumption that latency periods between asbestos exposure and MPM incidence were between 25 and 45 years.

Results: Asbestos consumption reached a peak in the 1980s, with a total of 668 thousand metric tons during 1939-2015. The observed number of MPM incidence increased by 9- and 6-fold in males and females during 1979-2013, with a cumulative number of 907. Given a latency period of 31 years, MPM incidences were expected to peak around 2012-2016 for males and 2016-2020 for females. In 2017-2046, the predicted total number of new MPM might reach 659 cases (95% confidence interval = 579-749); and the male to female ratios ranged from 1.8 to 2.8.

Conclusion: The MPM epidemic in Taiwan will likely peak in 2012-2020 as a result of local asbestos consumption. Approximately 659 new MPM cases in the next 30 years warrant an urgent need to implement a total asbestos ban and put more resources on a comprehensive surveillance, diagnosis, and follow-up health care system for ARDs.

Copyright © 2018. Published by Elsevier B.V.

In plain English

This modeling study estimated how many new cases of malignant pleural mesothelioma (MPM) Taiwan might see over the next 30 years. The authors combined national asbestos consumption data for 1939 to 2015 with Taiwan Cancer Registry counts of pleural cancer for 1979 to 2013. They used pleural cancer as a stand-in for MPM because about 80% of pleural cancers were mesothelioma. Taiwan consumed around 668 thousand metric tons of asbestos, mostly in the 1980s. Registered cases totalled 907, and the number of cases rose 9-fold in males and 6-fold in females over the 35 years. Using Poisson log-linear models, the best fit was a 31-year delay between asbestos use and diagnosis. The models predicted a peak of 44 to 50 cases per year in males during 2012 to 2016, and 15 to 17 cases per year in females during 2016 to 2020. They predicted 659 new cases (95% confidence interval 579 to 749) in 2017 to 2046. The authors said MPM has been under-reported and their estimate is likely an underestimate. They concluded that at least 659 new cases are foreseeable and urged a national monitoring program.

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-level prediction (modeling) study: Poisson log-linear models linking past national asbestos consumption per person to later pleural cancer incidence, with latency periods of 25 to 45 years tested
• Who was studied: The whole resident population of Taiwan. Pleural cancer cases (used as a proxy for MPM) came from the national Taiwan Cancer Registry, 1979 to 2013: 907 cases in total. Before 1995 the registry included only hospitals with more than 50 beds.
• Exposure: National asbestos consumption, defined as imports plus domestic production minus exports, per person per year, 1939 to 2015. The total was around 668 thousand metric tons, consumed largely in the 1980s. Fiber types were not analyzed separately.
• Main results:
  • Observed MPM cases (pleural cancer) rose 9-fold in males and 6-fold in females between 1979 and 2013. In males, cases went from 23 in 1979 to 1983 to 211 in 2009 to 2013. In females, cases went from 14 to 82 over the same periods.
  • In males, the age-adjusted rate was 4-fold higher in 2009 to 2013 (0.28 per 100,000 person-years) than in 1979 to 1983 (0.07 per 100,000 person-years). In females, crude rates rose 5-fold and age-adjusted rates 3-fold between the same periods.
  • The best-fitting models, for both males and females, assumed a latency period of 31 years between asbestos exposure and diagnosis.
  • Predicted peaks were 44 to 50 cases per year for males during 2012 to 2016, and 15 to 17 cases per year for females during 2016 to 2020.
  • For 2017 to 2046, the predicted total was 659 new MPM cases in Taiwan (95% CI 579 to 749), with male-to-female ratios of about 1.8 to 2.8.
  • The authors estimated that 608 of the predicted cases over the next 30 years would be work-related: 433 male and 175 female. This figure rests on assumed population attributable fractions for occupational asbestos exposure of 97% in men and 82.5% in women.
  • Before 1990, observed case numbers were lower than the model estimates, which the authors interpreted as substantial under-reporting. After 2000 the gap narrowed.
• The authors' conclusion: The authors concluded that Taiwan would be expected to experience its MPM epidemic in 2012 to 2020, with at least 659 new cases foreseeable in the next 30 years. They urged the government to set up a comprehensive monitoring program for surveillance, diagnosis and follow-up health care.
• Limitations the authors state:
  • MPM has been under-reported in Taiwan. Historical data on occupational exposure were lacking, and ongoing exposure to asbestos already in place is not captured. For these reasons the authors considered the estimate a conservative underestimate.
  • Registry data covered only 1979 to 2013, which limited the ability to explore the latency period.
  • The authors could not cross-check their estimate with an age-cohort model, because Taiwan has not yet passed the peak of asbestos-related disease.
  • Diagnostic criteria for MPM changed over time, which may have affected the number of cases diagnosed and reported to the registry.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Latency, Asbestos Exposure, confidence interval.

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