Update on mesothelioma incidence and forecast of future cases in Belgium

Our plain-English summary of Update on mesothelioma incidence and forecast of future cases in Belgium, by S. Ronsmans, K. Nackaerts, B. Nemery (BMC Public Health, 2025).

The study

• Authors: S. Ronsmans, K. Nackaerts, B. Nemery
• Journal: BMC Public Health
• Published: 2025;25(1):3870
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Belgium has been a "historical champion" in asbestos consumption. A total ban was only introduced in 1998. Previous studies showed a steady rise in malignant mesothelioma incidence. We aimed to update Belgian incidence data through 2022 and model future case projections.

Methods: We used past asbestos consumption data for Belgium as a proxy for exposure. Data on the yearly incidence of malignant mesothelioma in Belgium were obtained from the Belgian Cancer Registry (2004-2022), Scientific Institute of Public Health (1987-2021), WHO Mortality Database (1969-2004), and Asbestos Fund (2007-2022). We used Distributed Lag Non-Linear Models, to estimate the exposure-lag-response association and forecast future incidence.

Results: Mesothelioma incidence has increased since the 1970s, plateauing in recent years around 300 cases/year (for a total population of 10-11 million). We predict a decline in the coming decades, estimating 246 cases/year in 2030 (95% prediction interval [PI] 217-278) and 116 cases/year in 2040 (95%PI 96-138). Stratifying by age group, we observed a decline in mesothelioma incidence among the few individuals diagnosed at young ages (< 55y and 55-64y), while cases in the 75-84y and > 85y age groups continue to rise. The number of compensated cases was substantially lower than the registered cases, with 84 cases/year (95%CI 67-101) remaining uncompensated.

Conclusions: The restrictions and ban on asbestos use have reduced the risk of mesothelioma for those who began working after the peak period of asbestos use. Nevertheless, the overall mesothelioma incidence in Belgium does not yet show signs of decline. More efforts should be made to improve compensation of mesothelioma patients.

© 2025. The Author(s).

In plain English

This study examined malignant mesothelioma in Belgium, using national asbestos consumption from 1948 as a stand-in for exposure. The authors combined cancer registry cases (2004–2022) with death-certificate data (1969–2003). They raised the death-certificate counts by 19% to correct for undercounting. They then fitted a statistical model linking past consumption to yearly cases and used it to forecast cases up to 2040. Cases rose from the 1970s and levelled off at about 300 a year from about 2015. 2022 had 311 cases, the most yet. Cases diagnosed under age 65 had been declining, while cases at ages 75–84 and over 85 were still rising. The model predicted 246 cases in 2030 (95% prediction interval 217–278) and 116 in 2040 (96–138). From 2009 to 2022, the Asbestos Fund compensated 2,724 cases, against 3,938 registered. That is an average of 87 uncompensated cases a year (95% confidence interval 74–101), or 31% (27–35%), though the abstract gives 84 (67–101). The authors concluded that restrictions and the ban reduced risk for people who began working after peak asbestos use. They called national consumption a crude proxy for exposure.

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: Ecological (population-level) time-series modelling study using a distributed lag non-linear model within a quasi-Poisson regression, with forecasting of future cases
• Who was studied: Yearly mesothelioma cases in the whole Belgian population (around 10 million inhabitants), 1969–2022. Sources were Belgian Cancer Registry incidence for 2004–2022 and corrected death-certificate data (WHO Mortality Database, supplemented by the Belgian Scientific Institute of Public Health) for 1969–2003. Forecasts covered 2023–2040. Compensation data came from the Belgian Asbestos Fund.
• Exposure: National asbestos consumption from 1948, used as a proxy for exposure. It was calculated as import minus re-export, reported combined for Belgium and Luxembourg, and not broken down by fiber type. Consumption peaked in 1972 at about 89,000 tonnes (9.2 kg per capita). For modelling, consumption for 2000–2030 was set to 50 tonnes per year to represent residual exposure.
• Main results:
  • Total mesothelioma incidence in Belgium rose from the 1970s and plateaued at around 300 cases per year from about 2015. No decline was yet discernible in the observed total up to 2022.
  • 2022, the latest year available, had the highest yearly incidence reported so far: 311 cases, or 2.68 cases per 100,000 inhabitants.
  • Among people diagnosed at younger ages (under 55 and 55–64; under 65 overall), incidence had been declining in recent years.
  • The number of cases diagnosed at ages 75–84 and over 85 was seemingly still rising.
  • The model predicted a declining overall incidence: 246 cases per year in 2030 (95% prediction interval 217–278) and 116 cases per year in 2040 (95% prediction interval 96–138).
  • National asbestos consumption that occurred 45–65 years before a given calendar year was associated with the highest risk of mesothelioma.
  • The trend in women was similar to that in men. Women represented 17% to 21% of all mesothelioma cases from 2005 to 2022.
  • For 2009–2022, 2,724 mesothelioma cases were compensated by the Asbestos Fund, compared with 3,938 cases registered in the Belgian Cancer Registry.
  • An average of 87 cases per year (95% CI 74–101) remained uncompensated, or 31% (95% CI 27–35%) of all registered cases. The article's abstract instead gives 84 cases per year (95% CI 67–101).
  • For 2004–2020, death-certificate (WHO) mortality data underestimated Cancer Registry incidence by 19%. A correction factor of 1.19 was therefore applied to the earlier mortality data.
• The authors' conclusion: The authors concluded, together with data from other European countries, that the restrictions and ban on asbestos use have reduced mesothelioma risk for people who began their careers after peak asbestos use. They added that overall incidence in Belgium shows no signs of decline yet.
• Limitations the authors state:
  • National asbestos consumption is a crude proxy for actual exposure. It does not account for the number of exposed workers, exposure intensity, fiber type, or preventive measures.
  • Regional differences within Belgium, such as clusters near asbestos-cement plants and shipyards, could not be considered.
  • Because the data were ecological, individual latency periods could not be determined.
  • Cause of death is less reliably reported in elderly people, which may have led to missed cases. Competing causes of death in the elderly may also affect observed incidence.
  • Incidence data showed a temporary drop in 2020 with several possible explanations, including COVID-19.
  • Before 1998 there was no specific ICD code for mesothelioma. Pleural cancer deaths were used as an imperfect surrogate.

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, Cancer Registry.

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