US mesothelioma patterns 1973-2002: indicators of change and insights into background rates

Our plain-English summary of US mesothelioma patterns 1973-2002: indicators of change and insights into background rates, by M.J. Teta, P.J. Mink, E. Lau, et al (European Journal of Cancer Prevention, 2008).

The study

• Authors: M.J. Teta, P.J. Mink, E. Lau, B.K. Sceurman, E.D. Foster
• Journal: European Journal of Cancer Prevention
• Published: 2008;17(6):525-34
• Cited by: 115 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma rates are declining toward background levels, although estimates of the background rate have varied. We expanded upon earlier analyses and provided a data-based estimate of the background rate. We analyzed US male and female patterns for five age groups using the National Cancer Institute's Surveillance Epidemiology and End Results registry data from 1973 to 2002. Age-specific and age-adjusted incidence rates per 1 000 000 persons per year, standardized to the 2000 US population, were calculated for total, pleural, and peritoneal mesothelioma. We also calculated rates for persons who attained working age after the US Occupational Safety and Health Administration asbestos exposure limits took effect. Mesothelioma rates observed among young males and females varied little over time. We observed a decline and convergence of recent male and female rates in older age groups, except those who are between the age of 60 and above, for whom the 2002 male rate was approximately five times greater than that of females. As expected, rates were higher in major shipyard areas on the West coast. Rates for persons with little or no opportunity for occupational asbestos exposure were 1.15 (95% confidence interval: 0.90-1.45) for men and 0.94 (95% confidence interval: 0.87-1.24) for women. Mesothelioma is rare in younger age groups, and rates have been relatively stable and similar for both sexes. Rates continue to decline in older age groups, but remain high for males at 60 years or older. Rates among females at older ages suggest an impact of occupational exposure. The background rate for persons below age 50 is approximately one per million, independent of sex. Future data are needed to estimate this rate for older age groups.

In plain English

This study analyzed US mesothelioma cases diagnosed from 1973 to 2002 in the National Cancer Institute's SEER cancer registries. It compared rates by sex, age, year and site: pleural (chest lining) and peritoneal (abdominal lining). Of 6078 cases in nine registries, 83% were pleural. Women had proportionately more peritoneal cases (22%) than men (8%). Under age 40, male and female rates were similar. At 60 and above, the male rate was about six times the female rate. Rates in men 60 and older rose until 1992, then declined, but were 105 per million in 2002. To estimate a background rate, the authors studied people born 1953 to 1972, who reached working age after US asbestos limits took effect and were diagnosed at ages 30 to 49. Rates were 1.15 per million per year for men (95% CI 0.90–1.45) and 0.94 for women (95% CI 0.71–1.21). Men 60 and older in the San Francisco–Oakland shipyard area had higher rates than the other two California registries and eight other registries combined. The authors concluded that the background rate under age 50 is about 1 per million, and that older ages cannot yet be estimated.

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: Descriptive analysis of population cancer registry (SEER) incidence data, with age-specific and age-adjusted rates and rate ratios
• Who was studied: Mesothelioma cases reported to nine US SEER registries in 1973–2002 (6078 cases), plus up to 13 registries for 1992–2002, covering about 10% to 14% of the US population
• Exposure: The study had no individual exposure data. Asbestos exposure was considered indirectly in two ways. People who reached working age after the US OSHA asbestos limits took effect (born 1953–1972) were treated as having little or no occupational exposure. Shipyard regions (San Francisco–Oakland, Seattle) were compared with other regions. No fiber types were analyzed.
• Main results:
  • For 1973–2002 in nine registries, male total mesothelioma rates were about three times female rates at ages 50–59 (19.1 vs 6.0 per million) and about six times at ages 60 and above (92.3 vs 15.5 per million)
  • Rates for men aged 60 and above increased steeply from 1973 to 1992, then declined, but were still 105 per million in 2002
  • For ages 50–59, the female rate converged to 6 per million in 2002, close to the male rate that year
  • Men born 1953–1972 and diagnosed at age 30 or above (1983–2002, 13 registries) had a rate of 1.15 per million per year (95% CI 0.90–1.45), based on 72 cases
  • Women in the same birth-cohort group had a rate of 0.94 per million per year (95% CI 0.71–1.21), based on 58 cases. For both sexes combined the rate was 1.05 per million (95% CI 0.87–1.24).
  • Of all cases in nine registries, 83% were pleural and 11% peritoneal. Women had proportionately more peritoneal mesothelioma (22%) than men (8%).
  • Men aged 60 and above in San Francisco–Oakland (1992–2002) had higher rates than the eight other SEER registries combined: rate ratio 1.5 (95% CI 1.28–1.59). The ratio rose to 1.8 (95% CI 1.51–1.90) when Seattle was excluded. Male San Francisco–Oakland rates were not significantly higher at younger ages.
  • Male and female rates in the Seattle region exceeded all other SEER regions combined, and exceeded San Francisco–Oakland in the two oldest age groups
  • Women aged 60 and above in San Francisco–Oakland had a rate ratio of 1.5 (95% CI 1.14–1.88) compared with the other registries excluding Seattle
• The authors' conclusion: The authors concluded that US mesothelioma rates for adults under 50 with little or no potential for asbestos exposure are about 1 per million. They said the background rate at older ages must await future SEER data.
• Limitations the authors state:
  • The authors could not link changes in rates to specific levels or types of asbestos exposure
  • Sparse numbers in the youngest age groups prevented a formal age-period-cohort analysis
  • The method could not estimate background rates for people over 50, because past exposures in older people cannot be removed

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, Background Rate, Epidemiology, Incidence, Peritoneal Mesothelioma, Asbestos Exposure, confidence interval, Occupational Exposure.

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