Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis

PurposeMalignant mesothelioma most commonly arises in the pleura and peritoneum but also occurs rarely at other anatomical sites with mesothelial tissue, namely, the pericardium and tunica vaginalis testis (TVT). This review provides a better understanding of the epidemiology of mesothelioma of these extrapleural sites.MethodsWe conducted a systematic review of the epidemiologic and clinical literature on pericardial mesothelioma and mesothelioma of the TVT. We also analyzed U.S. Surveillance, Epidemiology, and End Results cancer registry data to describe incidence patterns of these malignancies.ResultsAn etiologic role of asbestos exposure has been hypothesized for pericardial and TVT mesotheliomas, but no analytical case-control epidemiologic studies exist to test this relationship. A substantial proportion of cases with these malignancies report no known asbestos exposure. In large occupational cohorts with heavy asbestos exposures, no cases of pericardial or TVT mesothelioma have been reported. Trends in the incidence of these malignancies do not match those of pleural mesothelioma, which correspond to historical trends of commercial asbestos use. A male preponderance of pericardial mesothelioma is not evident.ConclusionsIn the absence of analytic epidemiologic studies, the etiologic role of environmental risk factors for mesothelioma of the pericardium and TVT remains elusive.     

National epidemiologic surveillance systems of asbestos-related disease and the exposed workers register

INTRODUCTION: Italy was the main European producer of asbestos for most of the 20th century and raw asbestos imports wee also significant until the 1990's; there was a mean delay of about ten years in the pattern of asbestos consumption in Italy compared with the USA, Australia, UK and Scandinavian countries. METHODS: A national surveillance system (ReNaM) was implemented to identify cases of mesothelioma and investigate the modalities of asbestos exposure. A register of exposed workers and a database of companies presumably involved in the asbestos exposure problem was also developed. ReNaM has a regional structure and an operative centres (COR) have been established in 16 Italian regions. RESULTS: The ReNaM database currently contains more than 5,000 mesothelioma cases and for 3,500 of these exposure modalities have been defined. Cases of pleural mesothelioma represent 93% of the total but there were also 334 cases of peritoneal mesothelioma, 15 of the pericardium and 14 of the tunica vaginalis of the testicle. Cases with ascertained exposure are thus distributed: 67.4% occupational exposure (ascertained, probable, possible), 4.3% domestic, 4.2% environmental and 1.3% hobby-related exposure, totalling 77.2%; 22.8% had unlikely or unknown exposure. The latency period is very long: on average 43.6 years. The register of asbestos-exposed workers contains figures on exposed workers notified to ISPESL up to 2004 and refers to the exposure period 1993-2003. The data registered cover 160 firms and about 700 workers. CONCLUSIONS: A national, coordinated and uniform epidemiological surveillance system of cases of mesothelioma and the definition of asbestos exposure through active research is extremely important in identifying unexpected contaminating sources. The register of asbestos-exposed workers allows risk to be monitored and protection measures to be implemented.     

Mesothelioma in Mongolia: case report

Abstract

Background:

More than 80% of cases of mesothelioma worldwide have a history of asbestos exposure. In Mongolia, workers in coal burning thermal power plants (TPP) have widely utilized asbestos as an insulation material.

Methods:

We describe the case of a 47-year-old woman diagnosed with a malignant pleural mesothelioma. She worked in a TPP in Ulaanbaatar, Mongolia for 28 years.

Results:

A computer tomography (CT) scan showed a circumferential ring around her left lung, and tissues’ samples had a biphasic variant of mesothelioma with epithelioid and sarcomatoid components.

Discussion:

This is the first reported case of mesothelioma in Mongolia. We expect additional cases of mesothelioma, as well as other asbestos related diseases, will be identified in the future. In order to properly track asbestos related diseases in the country, we recommend the creation of an asbestos related disease registry.     

Mesothelioma in Mongolia: case report

Background:

More than 80% of cases of mesothelioma worldwide have a history of asbestos exposure. In Mongolia, workers in coal burning thermal power plants (TPP) have widely utilized asbestos as an insulation material.

Methods:

We describe the case of a 47-year-old woman diagnosed with a malignant pleural mesothelioma. She worked in a TPP in Ulaanbaatar, Mongolia for 28 years.

Results:

A computer tomography (CT) scan showed a circumferential ring around her left lung, and tissues’ samples had a biphasic variant of mesothelioma with epithelioid and sarcomatoid components.

Discussion:

This is the first reported case of mesothelioma in Mongolia. We expect additional cases of mesothelioma, as well as other asbestos related diseases, will be identified in the future. In order to properly track asbestos related diseases in the country, we recommend the creation of an asbestos related disease registry.     

A baseline profile of asbestos in the US-affiliated Pacific islands

Abstract

Asbestos is a recognized occupational and environmental hazard in the Asia-Pacific region, yet information regarding asbestos consumption, exposure, and asbestos-related diseases in the US-affiliated Pacific Islands (USAPIs) is scarce, and the situation regarding asbestos in these islands, particularly with regard to disease burden, surveillance, and health care capacity, is not well understood. Searching through scientific and “gray” literature and interviews with local cancer registry personnel and health professionals yielded no published data, only sufficient, indirect evidence of past and ongoing asbestos exposure, documented cases of mesothelioma and asbestosis, and minimal capacity for preventing and recognizing asbestos-related illnesses. Capacity and resource limitations within the USAPIs can impede regional progress in asbestos prevention and highlight the need for an integrated regional approach to address these data and capacity gaps. A regional mechanism to share expertise and resources and facilitate technical assistance to the USAPIs is urgently needed.     

Compensation of malignant mesothelioma as an occupational disease in Lower Normandy, from 1995 to 2002

BackgroundDespite the close relation between occupational exposure to asbestos and malignant mesothelioma, the compensation of this disease is still far from being the rule. The objective of this study is to assess the compensation process of all the cases of occupational mesothelioma recorded by the regional mesothelioma registry between September 1995 and August 2002, and to make suggestions for improvement of the compensation of future cases.MethodsLifetime exposure to asbestos was assessed for each of the 141 mesothelioma cases observed in Lower Normandy during this time period, and 105 cases could be related to a possible, probable, or very probable occupational exposure to this mineral. Data about notification and compensation of these occupational diseases were gathered with the help of all health insurance organisms concerned.ResultsExcept for five cases in which insurance conditions did not allow any compensation, compensation of occupational mesothelioma occurred in 85% of the cases. This high rate was probably the result of the existence of an early asbestos industry in this region, and of the particular awareness of the Norman population about asbestos-related diseases, as well as of the epidemiological follow-up of mesothelioma in Lower Normandy. When notified for compensation, all cases but one were actually compensated, and the lag-time between notification and compensation proved to decrease since 1995, with an average delay reaching 91,1 days in 2002. Patients who did not report their disease were older than those who did, and the lack of knowledge of medical practitioners about compensation procedures seems to be an important matter in this issue.ConclusionIn order to improve the rate of compensation of occupational malignant mesothelioma cases, information about the usual occupational origin of the disease should be delivered systematically to the general practitioner of each patient. This could be done by pathologists, when they diagnose malignant mesothelioma, and/or by medical examiners when sickness benefits are sought, or even by the epidemiological center of death causes (INSERM, CépiDc), for the beneficiaries of patients who died from malignant mesothelioma.     

La ricostruzione dell’esposizione ad amianto in un’azienda tessile di produzione filati cucirini attraverso l’utilizzo di un’insolita fonte informativa

«Reconstruction of the asbestos exposure in a textile company producing sewing threads through the use of an unusual information source».Background:The Tuscan Regional Operating Center (ROC) of Malignant Mesotheliomas has identified a cluster of 11 cases of malignant mesothelioma occurred in a textile plant manufacturing sewing thread. Using the common research method, the ROC had not previously been able to identify the specific sources of asbestos exposure causing such a large cluster.Objectives:The ROC’s objective was to review all cases of the cluster and to better identify their occupational asbestos exposures.Methods:The cases’ occupational histories of asbestos exposure have been reviewed, using information deriving from the annual reports sent to the Tuscany Region since 1988 by all the asbestos removal companies according to the Law no. 257/1992, article 9, and from interviews to former employees of the plant.Results:The work cycle has been reconstructed and enriched with the new information about the asbestos presence and its uses in the plant. The eleven cases were all reclassified as “certainly occupational exposed” given that the new collected information depicted a widespread asbestos pollution of the workplace during the period of employment of all cases.Conclusions:Using different sources of information, in addition to those traditionally collected through questionnaires, to reconstruct past asbestos exposuresallowed us to clarify the existence of the cluster of mesothelioma cases and the highest level of occupational asbestos exposure was attributed to all cases with consequent activation of the medico-legal procedure.Key words: Asbestos, malignant mesothelioma, occupational exposure, textile, sewing threads     

Asbestos and Peritoneal Mesothelioma among College-educated Men

Abstract

The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case–control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.     

Asbestos related diseases from environmental exposure to crocidolite in Da-yao,China. I. Review of exposure and epidemiological data

Background: Scattered patches of crocidolite, one form of asbestos, were found in the surface soil in the rural county of Da-yao in southwestern China. In 1983, researchers from the West China University of Medical Sciences (WCUMS) discovered that residents of two villages in Da-yao had hyperendemic pleural plaques and excessive numbers of pleural mesotheliomas.

Aims: To review and summarise epidemiological studies, along with other relevant data, and to discuss the potential contribution to environmental risk assessment.

Methods: This report is based on a review of several clinical/epidemiological studies conducted by WCUMS researchers since 1984, which included one cross sectional medical examination survey, one clinical/pathological analysis of 46 cases of mesothelioma, and three retrospective cohort mortality studies. Additional information acquired from reviewing original data first hand during a personal visit along with an interview of medical specialists from Da-yao County Hospital was also incorporated.

Results: The prevalence of pleural plaque was 20% among peasants in Da-yao over 40 years of age in the cross sectional survey. The average number of mesothelioma cases was 6.6 per year in the 1984–95 period and 22 per year in the 1996–99 period, in a population of 68 000. For those mesothelioma cases that were histology confirmed, there were 3.8 cases/year in the first period and 9 cases/year in the second. Of the 2175 peasants in this survey, 16 had asbestosis. Lung cancer deaths were significantly increased in all three cohort studies. The annual mortality rate for mesothelioma was 85 per million, 178 per million, and 365 per million for the three cohort studies, respectively. The higher exposed peasants had a fivefold increased mesothelioma mortality compared to their lower exposed counterparts. There were no cases of mesothelioma in the comparison groups where no crocidolite was known to exist in the environment. In the third cohort study, almost one of five cancer deaths (22%) was from mesothelioma. The ratio of lung cancer to mesothelioma deaths was low for all three studies (1.3, 3.0, and 1.2, respectively).

Conclusions: The observation of numerous mesothelioma cases at Da-yao was a unique finding, due mainly to their lifetime exposure to crocidolite asbestos. The finding of cases dying at a younger age and the relatively high ratio of mesothelioma cases to lung cancer could also be another unique result of lifetime environmental exposure to crocidolite asbestos. Although the commercial use of crocidolite has been officially banned since 1984, the incidence of mesothelioma has continued to show a steady increase, particularly among peasants. Since the latency of mesothelioma is approximately 30–40 years, the ban had little effect in the 1990s. The increased awareness and changes in diagnosis over time may also contribute to the increase. Furthermore, exposure to asbestos stoves and walls continued. The government implemented reduction of these exposures. However, from a public health standpoint, the most important issue is the complete avoidance of further exposure to asbestos.

     

Fiber burden and asbestos-related diseases: an umbrella review

ObjectiveWhat are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects.MethodAn umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument.ResultsWe retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those > 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels < 0.1 f/ml. No reviews provided information on exposure concentrations for pulmonary fibrosis. Currently, there is limited evidence in humans to establish the causal relationship between gastrointestinal cancer and asbestos exposure.ConclusionsBanning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml.     

Malignant mesothelioma in Japan: analysis of registered autopsy cases

In the Annual of the Pathological Autopsy Cases in Japan, issued by the Japanese Society of Pathology from 1958 to 1996, a total of 1,846 (0.17%) malignant mesothelioma cases (1,287 male, 558 female, 1 unknown) were registered among 1,056,259 autopsy cases. The frequency of mesothelioma (number of cases/total autopsy cases) was 0.10% (461/440,334) for the term 1958-1979, 0.18% (716/390,124) for 1980-1989, and 0.30% (669/225,801) for 1990-1996; the frequency of cases increased significantly over the time periods (p < .0001). Among 1,785 cases for which tumor sites were ascertained, there were 1,213 pleural mesothelioma (68.0%), 431 peritoneal (24.1%), 108 pericardial (6.1%), 6 tunica vaginalis testis (0.3%), and 28 "others" (1.6%). Histological cell type was noted in 598 cases; 245 (41.0%) were epithelial, 168 (28.1%) were biphasic, and 185 (30.9%) were sarcomatous. Seventy-three (0.007%) cases of malignant mesothelioma with asbestosis were found during the entire 39-y period. The frequency of those with asbestosis (number of cases/total autopsy cases) was 0.001% (5/440,334) for the term 1958-1979, 0.006% (27/390,124) for 1980-1989, and 0.018% (41/225,801) for 1990-1996; this increase over time was statistically significant (p < .0001). Researchers expect that cases of asbestos-related mesothelioma will increase in Japan in the future. Tumor sites and histological cell types of mesothelioma with asbestosis did not differ from those in individuals without asbestosis.     

Malignant Mesothelioma in Japan: Analysis of Registered Autopsy Cases

In the Annual of the Pathological Autopsy Cases in Japan, issued by the Japanese Society of Pathology from 1958 to 1996, a total of 1,846 (0.17%) malignant mesothelioma cases (1,287 male, 558 female, 1 unknown) were registered among 1,056,259 autopsy cases. The frequency of mesothelioma (number of cases/total autopsy cases) was 0.10% (461/440,334) for the term 1958-1979, 0.18% (716/390,124) for 1980-1989, and 0.30% (669/225,801) for 1990-1996; the frequency of cases increased significantly over the time periods (p < .0001). Among 1,785 cases for which tumor sites were ascertained, there were 1,213 pleural mesothelioma (68.0%), 431 peritoneal (24.1%), 108 pericardial (6.1%), 6 tunica vaginalis testis (0.3%), and 28 “others” (1.6%). Histological cell type was noted in 598 cases; 245 (41.0%) were epithelial, 168 (28.1%) were biphasic, and 185 (30.9%) were sarcomatous. Seventy-three (0.007%) cases of malignant mesothelioma with asbestosis were found during the entire 39-y period. The frequency of those with asbestosis (number of cases/total autopsy cases) was 0.001% (5/440,334) for the term 1958-1979, 0.006% (27/390,124) for 1980-1989, and 0.018% (41/225,801) for 1990-1996; this increase over time was statistically significant (p < .0001). Researchers expect that cases of asbestos-related mesothelioma will increase in Japan in the future. Tumor sites and histological cell types of mesothelioma with asbestosis did not differ from those in individuals without asbestosis.     

Asbestos: use,bans and disease burden in Europe

Objective

To analyse national data on asbestos use and related diseases in the European Region of the World Health Organization (WHO).

Methods

For each of the 53 countries, per capita asbestos use (kg/capita/year) and age-adjusted mortality rates (deaths/million persons/year) due to mesothelioma and asbestosis were calculated using the databases of the United States Geological Survey and WHO, respectively. Countries were further categorized by ban status: early-ban (ban adopted by 2000, n = 17), late-ban (ban adopted 2001–2013, n = 17), and no-ban (n = 19).

Findings

Between 1920–2012, the highest per capita asbestos use was found in the no-ban group. After 2000, early-ban and late-ban groups reduced their asbestos use levels to less than or equal to 0.1 kg/capita/year, respectively, while the no-ban group maintained a very high use at 2.2 kg/capita/year. Between 1994 and 2010, the European Region registered 106 180 deaths from mesothelioma and asbestosis, accounting for 60% of such deaths worldwide. In the early-ban and late-ban groups, 16/17 and 15/17 countries, respectively, reported mesothelioma data to WHO, while only 6/19 countries in the no-ban group reported such data. The age-adjusted mortality rates for mesothelioma for the early-ban, late-ban and no-ban groups were 9.4, 3.7 and 3.2 deaths/million persons/year, respectively. Asbestosis rates for the groups were 0.8, 0.9 and 1.5 deaths/million persons/year, respectively.

Conclusion

Within the European Region, the early-ban countries reported most of the current asbestos-related deaths. However, this might shift to the no-ban countries, since the disease burden will likely increase in these countries due the heavy use of asbestos.     

Environmental exposure to asbestos and risk of pleural mesothelioma: review and meta-analysis

A number of epidemiological studies have addressed the risk of pleural mesothelioma from environmental (household and neighborhood) exposure to asbestos, but no overall risk estimate is available. We reviewed the epidemiological studies on risk of pleural mesothelioma and household or neighborhood exposure to asbestos. We identified eight relevant studies; most were conducted in populations with relatively high exposure levels. We combined the risk estimates in a meta-analysis based on the random-effects model. The relative risks (RRs) of pleural mesothelioma for household exposure ranged between 4.0 and 23.7, and the summary risk estimate was 8.1 (95% confidence interval [CI]: 5.3–12). For neighborhood exposure, RRs ranged between 5.1 and 9.3 (with a single RR of 0.2) and the summary estimate was 7.0 (95% CI: 4.7–11). This review suggests a substantial increase in risk of pleural mesothelioma following high environmental exposure to asbestos; however, the available data are insufficient to estimate the magnitude of the excess risk at the levels of environmental exposure commonly encountered by the general population in industrial countries.     

An updated review on asbestos and related diseases in China

Abstract

Background: Asbestos is an industrial mineral that can cause diseases such as asbestosis, lung cancer, and mesothelioma. Asbestos consumption in China has increased steadily since the 1960s and is currently at half a million tonnes per year. Work conditions in the asbestos-related industries are poor and exposure levels frequently exceed the occupational exposure limit.

Objective: To provide an updated overview on asbestos production and consumption in China and discuss what is known about the resulting burden of asbestos-related diseases.

Findings: China is the world's top chrysotile consumer and second largest producer. Over a million people may be occupationally exposed, yet reliable disease statistics are unavailable and the national burden of asbestos-related disease (ARD) is not well known. Nevertheless, ARD prevalence, incidence, and mortality are expected to be high and will increase for many decades due to the volume of asbestos consumed historically, and a long latency period.

Conclusions: Government policies to prevent ARD have been implemented but more actions are necessary to ensure compliance and ultimately, the complete elimination of asbestos to prevent a heavy future disease burden.     

Asbestos related diseases in Italy: an integrated approach to identify unexpected professional or environmental exposure risks at municipal level

PURPOSE: Past intensive use of asbestos has implied severe public health consequences. Spatial distribution of deaths from malignant mesothelioma and of compensated cases for asbestos related diseases in Italy were compared to identify unexpected sources of asbestos exposure. METHODS: Mortality for malignant mesothelioma at municipal level and geographical clusters of compensated cases for asbestos related diseases, as proxy of industrial asbestos exposure, were identified in the period 1988-2001. RESULTS: Municipalities with at least four mesothelioma deaths and a statistically significant mortality excess were 148; and 53 out of them had no compensated case for asbestos-related diseases. Finally 22 of these lay outside of any aforementioned cluster, thus suggestive of a possible unrecognized exposure. CONCLUSIONS: Availability long-term national figures and the different etiology of asbestos related diseases are the key features of this exercise that was applied to Italy, but can be replicated wherever registration systems of diseases related to long term exposure to asbestos are available.     

Recent Mortality from Pleural Mesothelioma,Historical Patterns of Asbestos Use,and Adoption of Bans: A Global Assessment

Background

In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.

Objectives

This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships.

Methods

For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.

Results

Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970–1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R² value of 0.47 (p < 0.0001).

Conclusions

The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.