MTE29.01 Advances in Malignant Pleural Mesothelioma

Abstract

More than 30 years have passed since industrialized countries started to strictly regulate the use of asbestos, including, in several of them, introducing a total ban on import of raw material and of asbestos-containing products. The use of the International Classification of Diseases (ICD) to classify deaths from mesothelioma has been a source of concern in the past because, before the 10th version of ICD (ICD-10), no specific code existed for this type of neoplasm, and analyzes based on entities such as ‘pleural cancer’ were subject to misclassification. Since the late 1990s ICD-10 has been used for death certification in many developed countries. We analyzed age-specific mesothelioma mortality rates (all sites), calculated on the basis of the data of the WHO Mortality Database, among men from Canada (2000-2011), USA (1999-2013), Japan (1995-2008), France (2000-2011), Germany (1998-2013), Italy (2003-2012), the Netherlands (1996-2013), Poland (1999-2013), United Kingdom (2001-2013) and Australia (1998-2011), based on ICD-10, to identify temporal patterns following reduction of asbestos exposure. Mortality in the age groups 35-54 and 55-64 decreased throughout the study period in all countries (median decrease, 7.9% per year and 4.1% per year, respectively) except in Poland and (up to 2007) in Japan, two countries which started from lower rates. In the age group 65-74, mortality decreased in the USA and, since 2009, in the Netherlands, was stable in Australia, and increased in other countries (median increase, 3.0% per year). In the age group above age 74, a decrease was apparent only in the USA after 2003 (median increase in the other countries, 3.5% per year). Our analysis, based on consistent mortality data for mesothelioma, provide strong evidence for a decrease in mortality in the young age groups in most high-income countries: these birth cohorts experienced reduced opportunity for exposure to asbestos during their occupational life. In the case of older age groups, whose members had greater opportunity of exposure, in particular to amphiboles, the evidence of a decrease in mortality is present only in a few countries. Overall, these results stress the importance of early-life exposure circumstances to determine mesothelioma risk throughout life.