Is the ratio of pleural mesothelioma mortality to pleural cancer mortality approximately unity for Italy? Considerations from the oldest regional mesothelioma register in Italy

Our plain-English summary of Is the ratio of pleural mesothelioma mortality to pleural cancer mortality approximately unity for Italy? Considerations from the oldest regional mesothelioma register in Italy, by G. Gorini, E. Merler, E. Chellini, et al (British Journal of Cancer, 2002).

The study

• Authors: G. Gorini, E. Merler, E. Chellini, E. Crocetti, A.S. Costantini
• Journal: British Journal of Cancer
• Published: 2002;86(12):1970-1
• Type of article: Comment, Letter
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

doi:10.1038/sj.bjc.6600363 www.bjcancer.com © (2002) Cancer Research UK

In plain English

This letter to the editor responded to a 1999 article by Peto and colleagues. That article assumed that, among men in Western European countries other than Britain, pleural mesothelioma deaths were about equal (a 1:1 ratio) to deaths recorded as pleural cancer (ICD 163). The authors tested this for men in Tuscany, an Italian region of about 3.5 million people, from 1994 to 1999. They compared the regional mesothelioma and mortality registers. The mesothelioma register recorded 228 male pleural mesothelioma cases, and 188 of these men had died by 31 December 1999. The mortality register recorded 256 male pleural cancer deaths. Of the 188 mesothelioma deaths, 154 (82%) were coded as pleural cancer on the death certificate. Only 154 of the 256 pleural cancer deaths (60%) appeared in the mesothelioma register, giving a ratio of 0.73 to 1. Of 22 such unmatched deaths in Florence and Prato provinces, 11 were recorded in the regional cancer register as lung cancer. The authors concluded that the low ratio was above all due to poor-quality death certificates coded as pleural cancer.

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: Letter to the editor responding to Peto et al (1999). That article based its estimates on the male ratio of pleural mesothelioma mortality to pleural cancer mortality, and assumed this ratio was 1:1 for Western European countries other than Britain. The authors calculated this ratio by linking regional register data for Tuscany.
• Who was studied: Male residents of Tuscany, Italy (a region of about 3.5 million inhabitants), 1994 to 1999, as recorded in the Tuscan mesothelioma register and the Tuscan mortality register. A subgroup check used the Tuscan Cancer Register for residents of Florence and Prato provinces.
• Exposure: Not studied. The letter concerns how pleural mesothelioma deaths were coded on death certificates. It reports no asbestos exposure, fiber types, products or jobs.
• Main results:
  • The Tuscan Mesothelioma Register recorded 228 male pleural mesothelioma cases in 1994 to 1999.
  • By 31 December 1999, 188 of the 228 male cases had died and 40 were alive.
  • In the same period, the Tuscan Mortality Register recorded 256 male pleural cancer (ICD 163) deaths.
  • Of the 188 male mesothelioma deaths in the register, 154 (82%) were correctly coded as pleural cancer on the death certificate.
  • The remaining male mesothelioma deaths were coded as lung cancer (9.0%), peritoneal or retroperitoneal cancer (2.1%), other or unspecified cancers (2.7%), or non-malignant causes (4.3%).
  • Of all 256 male deaths coded ICD 163 (pleural cancer), 154 (60%) were also recorded in the mesothelioma register.
  • For males in Tuscany in 1994 to 1999, the ratio of pleural malignant mesothelioma mortality to pleural cancer mortality was 0.73 to 1 (0.60 divided by 0.82).
  • For comparison, the authors cited ratios from earlier studies, not this one: 1.62 to 1 in Britain (Peto, 1999) and 0.93 to 1 in France (Brochard et al, 1995).
  • There were 22 pleural cancer death certificates of Florence or Prato residents that were not in the mesothelioma register. Of these, 3 were not in the Tuscan Cancer Register, 11 were recorded there as lung cancer and 3 as other cancers.
  • The other 5 of those 22 cases (23%) were recorded as pleural cancer without a histological diagnosis and without the word 'mesothelioma' in any medical report.
• The authors' conclusion: The authors concluded that the low ratio for Tuscany was above all due to the poor quality of death certificates coded ICD 163. They added that this accuracy is not likely high for all of Italy, and that a national mesothelioma register will in future allow the ratio to be calculated more widely.
• Limitations the authors state:
  • The proportion of pleural cancer deaths that were mesothelioma cannot be calculated accurately for all of Italy, because reliable mortality and incidence data are lacking.
  • The national mesothelioma register does not yet cover all of Italy, so the ratio could only be calculated for Tuscany.

Topics

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

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

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