Malignant pleural mesothelioma: an epidemiological perspective

Our plain-English summary of Malignant pleural mesothelioma: an epidemiological perspective, by B.M. Robinson (Annals of Cardiothoracic Surgery, 2012).

The study

• Author: B.M. Robinson
• Journal: Annals of Cardiothoracic Surgery
• Published: 2012;1(4):491-6
• Cited by: 227 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This paper reviews the aetiology, distribution and projected future incidence of malignant mesothelioma. Asbestos exposure is the most thoroughly established risk factor. Debate continues regarding the relative importance of the different asbestos fibre types and the contribution of Simian virus 40 (SV40). Disease incidence varies markedly within and between countries. The highest annual rates of disease, approximately 30 case per million, are reported in Australia and Great Britain. The risk of disease increases with age and is higher in men. Time from asbestos exposure to disease diagnosis is on average greater than 40 years. Non-occupational asbestos exposures contribute an increasing proportion of disease. With the exception of the United States, incidence continues to increase. In developed countries peak incidence is expected to occur before 2030.

In plain English

This article was a narrative review by a single author of published research on the causes, distribution and expected future numbers of malignant mesothelioma; it collected no new data. The author described asbestos as the most thoroughly established cause, while noting continuing debate over the danger of chrysotile compared with amosite and crocidolite, and over the role of Simian virus 40 (SV40). Studies cited reported average times from first asbestos exposure to diagnosis of 42.8 years in New South Wales, Australia, and 44.6 years in Italy. Registries cited gave age-standardised incidence of 29 per million in both Australia and the United Kingdom, while United States data suggested a plateau and decline since 2000-2005. Cited studies attributed 8.3% of Italian cases in 1993-2001, and up to 30% of current US presentations, to non-occupational exposure. The author concluded that worldwide incidence continues to climb, and reported that current predictions suggest that, except in the United States, peak incidence has not yet been reached.

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: Narrative review (labelled 'Perspective') of published epidemiological studies and registry data; no new data were collected
• Who was studied: Published studies and national registry data on malignant mesothelioma, chiefly from industrialised countries (Australia, United Kingdom, USA, Italy, Japan), plus global WHO mortality data for 1994-2008
• Exposure: Asbestos in general and by fibre type (chrysotile, amosite, crocidolite, tremolite, anthophyllite), occupational and non-occupational exposure; also erionite and Simian virus 40 (SV40) as other proposed factors
• Main results:
  • A cited New South Wales, Australia study reported an average latency of 42.8 years for cases diagnosed 1972 to 2004, with no difference between men and women
  • A cited Italian study reported a mean latency of 44.6 years in 2,544 cases diagnosed 1993 to 2001
  • A cited analysis of the WHO mortality database (1994-2008) found an age-adjusted mesothelioma mortality rate of 4.9 per million, a mean age at death of 70 years and a male to female ratio of 3.6:1
  • National registries in Australia and the United Kingdom gave an age-standardised incidence of 29 per million of population in both countries
  • US SEER incidence data suggested a plateau and then a decline in new mesothelioma cases since 2000-2005
  • A cited analysis by Hodgson and Darnton of seventeen published cohorts calculated a risk ratio of 1:100:500 for chrysotile, amosite and crocidolite respectively; the review notes that others argue chrysotile is not carcinogenic
  • The review reports that the WHO deemed the evidence sufficient to conclude that all types of asbestos cause cancer in humans
  • In a cited 50-year follow-up of 6,908 Wittenoom (Western Australia) employees, mesothelioma death rates were 4.7% in male workers and 3.1% in female workers
  • Cited studies found that non-occupational exposures accounted for 8.3% of cases in Italy (1993-2001) and have been implicated in up to 30% of current presentations in the US
  • The review reports that the role of SV40 in overall human mesothelioma incidence remains unclear
  • Except in the United States, current predictions cited suggest peak incidence has not yet been reached, and that in developed countries it will occur in the second and third decades of the century
• The authors' conclusion: The author concluded that, despite a clear understanding of what causes malignant mesothelioma, worldwide incidence continues to climb, and that long latency and continued asbestos use mean the toll will continue well into the 21st century
• Limitations the authors state:
  • The author notes that mortality data in developed countries may underestimate true mesothelioma incidence because of inaccurate death certification
  • The author notes that future disease from high asbestos consumption in developing countries, particularly in Asia, is difficult to quantify

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Asbestos Exposure, SV40.

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