French Mesothelioma Register: Critical Appraisal Of The Registered Data

Our plain-English summary of French Mesothelioma Register: Critical Appraisal Of The Registered Data, by S. Perdrizet, J. Bignon, L. Di Menza, et al (1980).

The study

• Authors: S. Perdrizet, J. Bignon, L. Di Menza, M. Nebut
• Published: Biological Effects Of Mineral Fibres (J.C. Wagner, Editor), Lyon: Iarc Scientific Publications, Volume 30, Pp. 697-701 (1980)
• Type of article: Conference paper
• Our copy: from Johns-Manville's own medical library, J-M no. 002182. The article is still under copyright, so we describe it here rather than post it.

In plain English

This paper assessed the French mesothelioma register, created in 1975, after four years of operation. The authors compared its results with its three aims: measuring how common mesothelioma is nationally, collecting tissue samples to standardize diagnosis, and supporting research into causes. From 1975 to 1978, 124 cases were registered. Reports came almost entirely from pathologists (82 had reported cases), and some areas sent none. In 1977, 31 histologically confirmed cases were declared in France, compared with 300 in the UK. The authors took this to mean the French count was not complete. Since the register began, 699 cases had been reported. A panel of nine pathologists examined tissue from 497 of them and confirmed 305. Of 218 confirmed cases with a detailed questionnaire, 176 people had been exposed to asbestos and 42 had not. The authors cautioned that answers about moderate or low exposure must be interpreted carefully. They concluded that the register could not provide disease-rate data and that it would be reasonable to abandon that aim. They suggested collecting cases that doctors report voluntarily, for research with a precise and limited objective.

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: Evaluation (critical appraisal) of a national disease register's first four years, comparing its results with its stated objectives
• Who was studied: Mesothelioma cases reported to the French mesothelioma register: 161 histologically confirmed cases from 1965-1974 (preliminary phase), 124 cases registered 1975-1978, and 699 cases reported in total since the register was created
• Exposure: Asbestos exposure assessed by detailed questionnaire for 218 confirmed cases (fiber types not specified)
• Main results:
  • Information came almost entirely from pathologists. 82 pathologists had notified cases, and some geographic areas were silent, which the authors attributed to a lack of participation by pathologists.
  • One-third of the cases were concentrated in two cities, Nantes and Le Havre. The authors said this may reflect high risk from shipyards or asbestos textile plants there, but noted that other areas with similar industries (such as Clermont-Ferrand) should have had similar risks.
  • Mortality statistics recorded 464 cases of primary pleural tumours in 1976. The authors said these figures could overestimate or underestimate cases, and that it was impossible to prove whether the errors cancel out.
  • In 1977, 31 histologically confirmed cases were declared in France, against 300 in the UK. The authors concluded from this that the French census was not complete.
  • Of 699 cases reported, histological material was available for 497. A panel of nine pathologists confirmed 305, excluded 79, found the material insufficient in 83, and could not state the diagnosis precisely in 30.
  • For 218 of the 305 confirmed cases, a detailed questionnaire was available: 176 subjects had been exposed to asbestos and 42 had not.
• The authors' conclusion: The authors concluded that the aim of collecting morbidity data could not be achieved because the data were not exhaustive. They said it would be reasonable to abandon the attempt to establish morbidity indices and instead collect spontaneously reported cases, provided the causal (etiological) and fiber-measurement work had a precise and limited objective. They judged that the diagnostic-standardization aim had been attained and that the etiological data could form the basis for well-defined studies.
• Limitations the authors state:
  • Because asbestos dust is so widespread, answers to the questionnaire about moderate or low exposure must be interpreted cautiously in a retrospective study like this.
  • Pathologists may have selected the cases they reported, limiting them to histologically well-defined cases.
  • Completeness of the register would be difficult to prove even if it were complete, and the authors could not evaluate the extent of the mesothelioma problem in France.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

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