Mesothelioma Diagnosis

Mesothelioma is closely related to exposure to asbestos, and mesothelioma mortality can be taken as an index of past exposure to asbestos in the population. We analysed mesothelioma mortality since 1968 to assess the current state of the mesothelioma epidemic, and to predict its future course.

Rates of mesothelioma in men formed a clear pattern defined by age and date of birth. Rates rose steeply with age showing a very similar pattern in all five-year birth cohorts. By date of birth, rates increased from mid-1893 to mid-1948, and then fell. Relative to the 1943-48 cohort, the risk for the 1948-53 cohort is 0.79 and for the 1953-58 cohort 0. 48.

Despite these falls, if the age profile of rates for these cohorts follows the pattern of past cohorts, their predicted lifetime mesothelioma risks will be 1.3%, 1.0%, and 0.6%. Combining projections for all cohorts results in a peak of annual male mesothelioma deaths in about the year 2020 of between 2700 and 3300 deaths.

If diagnostic trend is responsible for a 20% growth in recorded cases every 5 years-an extreme but arguable case-and if this trend has now ceased, the peak of annual male deaths will be reduced to 1300, reached around the year 2010. Analysis of occupations recorded on death certificates indicate that building workers, especially plumbers and gas fitters, carpenters and electricians are the largest high-risk group.

These data indicate that mesothelioma deaths will continue to increase for at least 15 and more likely 25 years. For the worst affected cohorts-men born in the 1940s-mesothelioma may account for around 1% of all deaths. Asbestos exposure at work in construction and building maintenance will account for a large proportion of these deaths, and it is important that such workers should be aware of the risks and take appropriate precautions.

Introduction Mesothelioma is almost always fatal; most patients affected die within a year of diagnosis. The majority of cases are pleural in origin, although peritoneal tumours are equally common in some groups of workers exposed to amosite (brown) asbestos. The risk is negligible up to 10 years after first asbestos exposure and very low up to 15 years, but increases thereafter as the third or higher power of time since first exposure n 1

The association of mesothelioma with asbestos was first noted in 1960 n 2, and since 1968, the UK Health and Safety Executive has maintained a register of deaths in England, Wales, and Scotland for which mesothelioma is mentioned on the death certificate in three Annual deaths increased from 154 in 1968 to 1009 in 1991, and increases have also occurred in other countries in four.

The increase in rates in individuals above the age of 60 is the expected continuation of trends observed over the past 20 years, reflecting asbestos exposure when those now aged over 60 began their working lives in the early 1950s and earlier. However, there is a continuing increase in the death rate among men now aged under 50, most of whom began work in the mid 1960s or later. The increase suggests that asbestos exposure was greater around 1970 than in any previous period, and that mesothelioma rates will continue to increase as this generation ages.

Mesothelioma |