The Australian Mesothelioma Surveillance Program 1979-1985

Our plain-English summary of The Australian Mesothelioma Surveillance Program 1979-1985, by D.A. Ferguson, G. Berry, T. Jelihovsky, et al (The Medical Journal of Australia, 1987).

The study

• Authors: D.A. Ferguson, G. Berry, T. Jelihovsky, S.B. Andreas, A.J. Rogers, S.C. Fung, A. Grimwood, R. Thompson
• Journal: The Medical Journal of Australia
• Published: 1987;147(4):166-72
• Cited by: 47 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000964).

Abstract

The Australian Mesothelioma Surveillance Program was planned in 1977 in order to improve diagnostic criteria, to monitor the incidence of the disease, to develop methods of counting lung fibres, and to explore occupational and other associations of mesothelioma. This paper presents a preliminary analysis of data that were collected between January 1, 1980 and December 31, 1985 on the pathological findings and the work and environmental history of 858 cases of mesothelioma. The annual incidence rate of mesothelioma in Australia was 15 per million population who were aged 20 years and over. This is more than the incidence rate of mesothelioma in any other country for which data are available. However, uncertainty over diagnostic criteria and the degree of ascertainment of cases places doubt on the validity of such comparisons. In 69% of cases, a history of work with or other exposure to asbestos was obtained. Due to the long interval between the first exposure to asbestos and the provisional diagnosis of a mesothelioma (up to 60 years), more than three-quarters of the 456 exposed cases first contacted asbestos in the years of its heavy use between 1930 and 1959. This article analyses cases by the industry and the occupation in which exposure to asbestos first occurred.

In plain English

This paper was a preliminary analysis from the Australian Mesothelioma Surveillance Program, which began as a New South Wales pilot in 1979, attempted to cover all Australia from May 1981, and collected voluntary notifications to the end of 1985. After withdrawals and rejections, 858 cases remained, many not yet reviewed by the pathology panel. The annual incidence was 15 per million people aged 20 and over. Of 726 patients with completed exposure assessments, occupational asbestos exposure was definite in 45%, probable in 7% and possible in 11%. Another 6% had environmental exposure only, and 26% had no exposure history. Among occupationally exposed cases, 73% were diagnosed 30 years or more after first exposure, and 79% of the 456 were first exposed between 1930 and 1959. Crocidolite mining and milling at Wittenoom accounted for 33 notified cases. The authors concluded that the data confirmed a very strong association of mesothelioma with asbestos exposure. They noted that the analysis did not show relative risks and that the data could not be regarded as representative of the true incidence rate.

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: National surveillance program collecting voluntary notifications of mesothelioma cases (preliminary descriptive analysis of a case collection)
• Who was studied: 903 patients (796 men and 107 women) notified in Australia up to December 31, 1985. After 32 cases were withdrawn and 13 were rejected by the Pathology Panel, 858 cases of mesothelioma were considered.
• Exposure: Occupational and environmental asbestos exposure from interview questionnaires, coded by occupational hygienists as definite, probable or possible occupational exposure, or as environmental exposure. Exposures were analysed by the industry and occupation of first exposure. Fibers discussed include crocidolite (Wittenoom), amosite and chrysotile (Baryulgil).
• Main results:
  • Collection began in New South Wales in 1979 as a pilot study. The Program did not attempt to cover all Australia until May 1, 1981.
  • The annual incidence rate of mesothelioma in Australia was 15 per million population aged 20 years and over.
  • Of the 726 patients whose exposure had been assessed, definite occupational exposure was found in 45% (324/726), probable exposure in 7% (49/726) and possible exposure in 11% (83/726).
  • 6% (43/726) had environmental exposure without work exposure, for example domestic use of asbestos cement or living next to an asbestos-cement factory.
  • In 26% (191/726) of cases no history of asbestos exposure was elicited.
  • Of the 342 cases with a definitive diagnosis, 309 had pleural (including pericardial) involvement and 37 had peritoneal (including tunica vaginalis) involvement. Eight were affected in both sites, and the site was not reported in four.
  • Among occupationally exposed subjects, the time from first exposure to diagnosis was 30 years or longer in 73% and 40 years or longer in 41%.
  • 79% of the 456 occupationally exposed subjects first contacted asbestos between 1930 and 1959.
  • Among occupationally exposed cases, 49% (225/456) had been employed in primary asbestos production or manufacturing, and in shipping.
  • Labourers, carpenters, boilermakers and fitters/turners/maintenance engineers made up 49% (222/456) of the occupations with a history of asbestos exposure.
  • About 18 cases a year (12%) were in women, which the authors described as over twice the expected number of incidental (non-occupational) cases.
  • Crocidolite mining and milling at Wittenoom accounted for 33 cases notified between 1980 and 1985, in a population of some 6000 persons.
  • Two subjects were exposed at Baryulgil, a chrysotile mine. They were also exposed to recycled hessian bags that had carried chrysotile, amosite and crocidolite, so the authors stated this does not strengthen any possible association of chrysotile with mesothelioma.
  • The authors estimated that death certificates as a source underestimate the incidence rate of mesothelioma by about 40%.
• The authors' conclusion: The authors concluded that the data confirm the very strong association of mesothelioma with asbestos exposure. They added that the absence of an exposure history in 191 of 726 cases invites enquiry into other environmental causes.
• Limitations the authors state:
  • 516 cases had not yet been reviewed by the Pathology Panel.
  • Numbers of presumptive diagnoses for the two years after 1983 are likely to be incomplete.
  • The Program's data cannot be regarded as representative of the true incidence rate.
  • In about 10% of cases, exposure occurred in multiple industries or occupations, but only the first was analysed. The analysis shows expected associations but not relative risks.
  • It is difficult to be accurate about past exposures.
  • International comparisons are complicated by differences in notification methods and diagnostic criteria.

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: Mesothelioma, Incidence.

Related studies

• Records of the Australian Mesothelioma Surveillance Program have been lost! — M. Hendrickx (2008)
• Comparison of an Australian food-frequency questionnaire with diet records: implications for nutrition surveillance — G.L. Ambrosini, D. Mackerras, et al. (2003)
• Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases — D. Elder, M. Abramson, et al. (2004)
• Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales — K. Hannaford-Turner, D. Elder, et al. (2010)
• Mesothelioma trends in the United States: an update based on Surveillance, Epidemiology, and End Results Program data for 1973 through 2003 — B. Price, A. Ware (2004)
• Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program — S. Metintaş, H.F. Batırel, et al. (2017)

Browse more research in The Medical Journal of Australia, or return to medical research.