Asbestos Disease Registries1 

Compiled by Joe Ladou



Ericson B, Antão VC, Pinheiro GA. Epidemiological surveillance and occupational respiratory diseases [Article in Portuguese]. J Bras Pneumol. 2006;32 Suppl 2:S1-4. Departamento de Medicina Preventiva e Social, Faculdade de Cincia Médicas da Universidade, Universidade Estadual de Campinas, Campinas, SP, Brasil.

For every communicable disease, the construction of a database is fundamental to prioritizing related measures (educational, prevention and control), as well as to the development of public health policies. Although various countries possess reliable systems of epidemiological surveillance, Brazil still lacks an adequate structure for the collection, processing and dissemination of data. We consider it imperative that the health professionals working in this area make a unified effort, as soon as possible, to compile a database that suitably addresses the epidemiology of occupational respiratory diseases.

Kauppinen T, Saalo A, Pukkala E, Virtanen S, Karjalainen A, Vuorela R. Evaluation of a national register on occupational exposure to carcinogens: effectiveness in the prevention of occupational cancer, and cancer risks among the exposed workers. Ann Occup Hyg. 2007 Jul;51(5):463-70. Epub 2007 Jul 11. Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland.

OBJECTIVES: The objective of this study was to evaluate the performance and effectiveness of a register of employees exposed to carcinogens (the ASA Register) which has been in operation in Finland since 1979, and to study cancer risks among the notified workers. METHODS: The impact of ASA at workplaces was studied by questionnaires mailed to 1448 work departments, which were notified to ASA in 1996, and to 1033 departments, which departed ASA in 1991-1996. The mailing was responded by 69% of departments. The cancer incidence of 35,138 workers notified to ASA in 1979-1988 was followed up through the files of the Finnish Cancer Register for the period 1980-2003. RESULTS: Changes eliminating or substantially reducing exposure to carcinogens were reported by 73% of departments notified to ASA in 1996. The ASA notification process had directly prompted measures to reduce exposure (8% of cases) or contributed to them (24% of cases). Estimations based on responses of the workplaces suggested that the ASA registration had decreased exposure of 600 workers year(-1) (out of approximately 15,000 notified workers, which is <1% of the employed in Finland), preventing thereby an unknown number of occupational cancers. Other benefits of ASA included the saving of the treatment costs of prevented cancers, the prevention of other health outcomes of carcinogens, improved safety behaviour of exposed workers and avoidance of human suffering among cancer patients and their families. The labour safety authorities had better possibilities to direct their activities against carcinogen exposure. These benefits should be considered against the annual costs, mainly due to 7-8 person-years of work required by tasks related to ASA. The results of the cancer incidence study among notified workers were based on a relatively short follow-up (on average 19 years). The incidence of mesothelioma was significantly increased in the ASA cohort, probably due to exposure to asbestos. CONCLUSIONS: These results suggest that a national exposure register may stimulate preventive measures at workplaces. Partially based on the results of the present study the Finnish Ministry of Social Affairs and Health continues ASA registration.

Hansen J, Rasmussen TR, Omland Ø, Olsen JH; Danish National Board of Industrial Injuries. Registration of selected cases of occupational cancer (1994-2002) with the Danish National Board of Industrial Injuries. Ugeskr Laeger. 2007 Apr 30;169(18):1674-8. [Article in Danish] Kraeftens Bekaempelse, Institut for Epidemiologisk Kraeftforskning.

INTRODUCTION: Persons in Denmark afflicted by an occupational disease are offered economical compensation and it is the responsibility of the physician to register such cases with the Danish National Board on Industrial Injuries. However, the number of cancers reported to the Board is lower than expected. We evaluated the causes of underreporting for two types of cancer with a major occupational background. MATERIALS AND METHODS: Cases of pleural mesothelioma and adenocarcinoma of the sinonasal cavities diagnosed between 1994 and 2002 were drawn from the Danish Cancer Registry. Patients were searched for in the files of the National Board of Industrial Injuries. For patients not registered, information on employment history since 1964 and job title was collected from the Danish Supplementary Pension Fund and the Central Population Register, and the likelihood of occupational exposure to asbestos and wood dust was evaluated. RESULTS: 695 individuals were registered with pleural mesothelioma and 108 with adenocarcinoma of the sinonasal cavities in the Cancer Registry. Of these, 381 (55%) patients with mesothelioma and 44 (41%) patients with adenocarcinoma were also registered with the National Board of Industrial Injuries. Among the latter, 91% and 87%, respectively were judged by the Board to be occupationally induced. For 3 out of 4 cases not registered with the Board register-based occupational information was available. This information indicated exposure to asbestos by 60% of the men and 3% of the women; the equivalent figures for adenocarcinoma and wood dust were 32% and 0%, respectively. CONCLUSION: We observed a substantial underreporting of pleural mesothelioma and adenocarcinoma of the sinonasal cavities with the National Board of Industrial Injuries. The underreporting seemed to be unchanged since the 1980s. We propose that all cases of mesothelioma and all cases of cancer of the sinonasal cavities not registered with the Board are referred to a department for industrial medicine for etiological evaluation.

Marinaccio A, Binazzi A, Cauzillo G, Cavone D, Zotti RD, Ferrante P, Gennaro V, Gorini G, Menegozzo M, Mensi C, Merler E, Mirabelli D, Montanaro F, Musti M, Pannelli F, Romanelli A, Scarselli A, Tumino R; Italian Mesothelioma Register (ReNaM) Working Group. Analysis of latency time and its determinants in asbestos related malignant mesothelioma cases of the Italian register. Eur J Cancer.2007 Dec;43(18):2722-8. National Institute for Occupational Safety and Prevention (ISPESL), Occupational Medicine Department, Epidemiology Unit, ViaAlessandria 220/E, 00198 Rome, Italy.

Italy was an important producer of raw asbestos until 1992 (when it was banned) and it is now experiencing severe public health consequences due to large-scale industrial use of asbestos in shipbuilding and repair, asbestos-cement production, railways, buildings, chemicals and many other industrial sectors. Latency of malignant mesothelioma generally shows a large variability and the relationship with the modality of asbestos exposure is still not fully clarified. We present an analysis of latency period among the case list collected by the Italian mesothelioma register (ReNaM) in the period of diagnosis 1993-2001 (2544 malignant mesothelioma (MM) cases with asbestos exposure history). Exposure is assessed retrospectively by interview. Statistical univariate analyses were performed to estimate median and variability measures of latency time by anatomical site, gender and diagnosis period. The role of diagnostic confidence level, the morphology of the tumour and the modalities of asbestos exposure were verified in a regression multivariate model. We found a median latency period of 44.6 years increasing in recent years with a linear trend. Anatomical site, gender and morphology were not relevant for MM latency time whereas a shorter latency period was documented among occupationally exposed subjects (43 years) with respect to environmentally and household exposed ones (48 years).

Marinaccio A, Binazzi A, Cauzillo G, Chellini E, De Zotti R, Gennaro V, Menegozzo M, Mensi C, Merler E, Mirabelli D, Musti M, Pannelli F, Pannelli F, Romanelli A, Scarselli A, Tosi S, Tumino R, Nesti M; Gruppo di lavoro ReNaM. Epidemiological surveillance of malignant mesothelioma cases in Italy: incidence and asbestos exposure figures by the Italian mesothelioma registry (ReNaM)] Epidemiol Prev.2007 Jul-Aug;31(4 Suppl 1):23-6. ISPESL, Dipartimento di medicina del lavoro, Laboratorio di epidemiologia, Roma.

The Study describes the epidemiological surveillance of mesothelioma cases carried out by the Italian mesothelioma register (ReNaM). A Regional Operating Centre (COR) is present in nearly all Italian regions (17 out of 20) and it collects malignant mesothelioma cases and investigate the modalities of asbestos exposure by using a structured questionnaire. The register produces malignant mesothelioma incidence measures and analyses of the modalities of the asbestos exposure. The standardized incidence rate of malignant mesothelioma in 2001 was 2.98 (in 100,000 inhabitants) among men and 0.98 among women; a professional (certain, probable, possible) exposure has been detected in 67.4% of defined cases. In addition to the conventional sectors (shipbuilding, railways repair and demolition, asbestos-cement production), also textile, building, transport, chemical and glass industries, petroleum and sugar refineries, electricity production and distribution plants are getting involved. Despite the absence of some regions completing the national coverage and the non homogeneity in collecting and coding data, the epidemiological surveillance of malignant mesothelioma carried out by ReNaM is an important tool for the scientific knowledge and the prevention of asbestos-related diseases.

Mensi C, Termine L, Canti Z, Rivolta G, Riboldi L, Pesatori AC, Chiappino G. The Lombardy Mesothelioma Register, Regional Operating Centre (ROC) of National Mesothelioma Register: organizative aspects. Epidemiol Prev.2007 Sep-Oct;31(5):283-9. Dipartimento di medicina preventiva, ambientale e del lavoro, Fondazione IRCCS-Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano.

The Lombardy Mesothelioma Register (LMR) collects all incident cases of Malignant Mesothelioma (MM) occurring since January 1, 2000 in residents of the Lombardy Region. For each "possible case" reported to the Registry by Lombardy hospitals, diagnosis is ascertained through examination of clinical records (including histology reports) according to ISPESL Guidelines. For confirmed cases, a standardized questionnaire is administered to the subject or next-of-kin in order to verify the possible sources of asbestos exposure in his/her lifetime. A panel composed of industrial hygienists, occupational health physicians and occupational epidemiologists evaluate asbestos exposure in the workplace and environmental settings. Case ascertainment completeness is routinely verified using other sources such as hospital discharge records and death certificates coded as 163 (ICD IX). In the period 2000-2004, 1563 cases were collected, of whom 887 have been evaluated: the diagnosis was confirmed for 626 (70.6%) 9 out of 887 evaluated cases. The age and gender standardized incidence rate for pleural mesothelioma in the Lombardy Region, in the year 2000 (the only one with completed data), was 2.4 (males 3.7; females 1.4) per 100,000 residents/year The 70.5% of certain and probable MM has an asbestos exposure, in particular the 64.5% of cases has an occupational exposure. The experience gathered over the years by the LMR has allowed to implement an efficient information network among different institutions and health services. In addition practical skills have been gained in processing epidemiological data, a useful tool to address new scientific hypothesis and to plan ad-hoc researches. In our experience the LMR represents a potential resource transferable to the epidemiological surveillance of different occupational tumours (i.e. sinonasal cancers).

Marinaccio A, Branchi C, Massari S, Scarselli A. National epidemiologic surveillance systems of asbestos-related disease and the exposed workers register. Med Lav.2006 May-Jun;97(3):482-7. Epidemiology Unit, Occupational Medicine Department, Italian Institute for Occupational Safety and Prevention (ISPESL).

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.

Bang KM, Pinheiro GA, Wood JM, Syamlal G. Malignant mesothelioma mortality in the United States, 1999-2001. Int J Occup Environ Health. 2006 Jan-Mar;12(1):9-15. Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention,Morgantown,WV 26505, USA.

Malignant mesothelioma is strongly associated with asbestos exposure. This paper describes demographic, geographic, and occupational distributions of mesothelioma mortality in the United States, 1999-2001. The data (n = 7,524) were obtained from the National Center for Health Statistics multiple-cause-of-death records. Mortality rates (per million per year) were age-adjusted to the 2000 U.S. standard population, and proportionate mortality ratios (PMRs) were calculated by occupation and industry, and adjusted for age, sex, and race. The overall age-adjusted mortality rate was 11.52, with males (22.34) showing a sixfold higher rate than females (3.94). Geographic distribution of mesothelioma mortality is predominantly coastal. Occupations with significantly elevated PMRs included plumbers/pipefitters and mechanical engineers. Industries with significantly elevated PMRs included ship and boat building and repairing, and industrial and miscellaneous chemicals. These surveillance findings can be useful in generating hypotheses and developing strategies to prevent mesothelioma.

Camidge DR, Stockton DL, Bain M. Factors affecting the mesothelioma detection rate within national and international epidemiological studies: insights from Scottish linked cancer registry-mortality data. Br J Cancer. 2006 Sep 4;95(5):649-52.Edinburgh Cancer Centre, NameWestern General Hospital, Crewe Road,Edinburgh EH4 2XU, UK.

ICD-9 code 163 (malignant neoplasm of pleura) listed as underlying cause of death detected only 40% of Scottish mesothelioma cases (all body sites) from the cancer registry in 1981-1999. This is lower than both the previously published 55% figure, derived from UK mesothelioma register data 1986-1991, which is based on any mention of mesothelioma on death certificates, cross-referenced to cancer registry data, and the 44% figure derived from Scottish mortality data 1981-1999, which captured any mention of mesothelioma on the death certificate. Detection from cancer registry data increased to 75% under ICD-10 in Scotland, confirming earlier predictions of the benefit of ICD-10's more specific mesothelioma codes. Including the accidental poisoning codes E866.4 (ICD-9) and X49 (ICD-10), covering poisoning by 'unspecified' and 'other' causes, which appear to have been used as coding surrogates for mesothelioma when asbestos exposure was explicitly mentioned in deaths suggestive of a mesothelioma, and which are recorded as the underlying cause of death in 4-7% of mesotheliomas, may improve the mesothelioma detection rate in future epidemiological studies.

Darnton AJ, McElvenny DM, Hodgson JT. Estimating the number of asbestos-related lung cancer deaths in Great Britain from 1980 to 2000. Ann Occup Hyg.2006 Jan;50(1):29-38. Epub 2005 Aug 26. Epidemiology and Medical Statistics Unit, Health and Safety Executive, Magdalen House, Trinity Road, Bootle, Merseyside L20 3QZ, UK.

INTRODUCTION: Inhalation of asbestos fibres is known to cause two main kinds of cancer-mesothelioma and lung cancer. While the vast majority of mesothelioma cases are generally accepted as being caused by asbestos, the proportion of asbestos-related lung cancers is less clear and cannot be determined directly because cases are not clinically distinguishable from those due to other causes. The aim of this study was to estimate the number of asbestos-related lung cancers among males by modelling their relative lung cancer mortality among occupations within Great Britain in terms of smoking habits, mesothelioma mortality (as an index of asbestos exposure) and occupation type (as a proxy for socio-economic factors). METHODS: Proportional mortality ratios for lung cancer and mesothelioma for the 20-year period from 1980 to 2000 (excluding 1981) were calculated for occupational groups. Smoking indicators were developed from three General Household Surveys carried out during the 1980s and 1990s. Poisson regression models were used to estimate the number of asbestos-related lung cancers by estimating the number of lung cancer deaths in each occupation assuming no asbestos exposure and subtracting this from the actual predicted number of lung cancer deaths. RESULTS: The effect of asbestos exposure in predicting lung cancer mortality was weak in comparison to smoking habits and occupation type. The proportion of current smokers in occupational groups and average age at which they started smoking were particularly important factors. Our estimate of the number of asbestos-related lung cancers was between two-thirds and one death for every mesothelioma death: equivalent to between 11 500 and 16 500 deaths during the time period studied. CONCLUSIONS: Asbestos-related lung cancer is likely to have accounted for 2-3% of all lung cancer deaths among males in Great Britain over the last two decades of the 20th century. Asbestos-related lung cancers are likely to remain an important component of the total number of lung cancer deaths in the future as part of the legacy of past asbestos exposures in occupational settings.

McElvenny DM, Darnton AJ, Price MJ, Hodgson JT. Mesothelioma mortality in Great Britain from 1968 to 2001. Occup Med (Lond).2005 Mar;55(2):79-87. Health & Safety Executive--Epidemiology and Medical Statistics Unit,Stanley Precinct, Bootle, Merseyside L20 3QZ, UK.

BACKGROUND: The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. AIMS: To present summary statistics of the British mesothelioma epidemic including summaries by occupation and geographical area. METHODS: Standardized mortality ratios (SMRs) were calculated for local authorities, unitary authorities and counties. Temporal trends in SMRs were also examined. Proportional mortality ratios (PMRs) were calculated using the Southampton (based on the 1980 standard occupational classification) coding scheme. Temporal trends in PMRs were also examined. RESULTS: The annual number of mesothelioma deaths has increased from 153 in 1968 to 1848 in 2001. Current deaths in males account for about 85% of the cases. The areas of West Dunbartonshire (SMR 637), Barrow-in-Furness (593),Plymouth (396) andPortsmouth (388) have the highest SMRs over the period 1981-2000. The occupations with the highest PMRs are metal plate workers (PMR 503), vehicle body builders (526), plumbers and gas fitters (413) and carpenters (388). CONCLUSIONS: These data reinforce earlier findings that geographical areas and occupations associated with high exposure to asbestos in the past continue to drive the mesothelioma epidemic in Great Britain. However, the trends over time suggest a change in the balance of risk away from traditional asbestos exposure industries to industries where one could describe the exposure as secondary, such as plumbers and gas fitters, carpenters, and electricians.

Hodgson JT, McElvenny DM, Darnton AJ, Price MJ, Peto J. The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050.  Br J Cancer.2005 Feb 14;92(3):587-93. Epidemiology and Medical Statistics Unit, Health and Safety Executive, Magdalen House, Trinity Road, Bootle, Merseyside L20 3QZ, UK.

The British mesothelioma register contains all deaths from 1968 to 2001 where mesothelioma was mentioned on the death certificate. These data were used to predict the future burden of mesothelioma mortality in Great Britain. Poisson regression analysis was used to model male mesothelioma deaths from 1968 to 2001 as a function of the rise and fall of asbestos exposure during the 20th century, and hence to predict numbers of male deaths in the years 2002-2050. The annual number of mesothelioma deaths in Great Britain has risen increasingly rapidly from 153 deaths in 1968 to 1848 in 2001 and, using our preferred model, is predicted to peak at around 1950 to 2450 deaths per year between 2011 and 2015. Following this peak, the number of deaths is expected to decline rapidly. The eventual death rate will depend on the background level and any residual asbestos exposure. Between 1968 and 2050, there will have been approximately 90,000 deaths from mesothelioma in Great Britain, 65,000 of which will occur after 2001.

Burdorf A, J\'e4rvholm B, Englund A. Explaining differences in incidence rates of pleural mesothelioma between Sweden and the Netherlands. Int J Cancer.2005 Jan 10;113(2):298-301. Department of Public Health, Erasmus MC, University Medical CenterRotterdam,Rotterdam, PO Box 1738, 3000 DRRotterdam, The Netherlands.

In recent years in several countries a deceleration or leveling off of pleural mesothelioma rates has been observed. The impact of asbestos used was analysed by comparing a country with a relative modest incidence rate of mesothelioma (Sweden) and an early response to asbestos use with a country with one of the highest incidence rates of mesothelioma in Western Europe (The Netherlands). In Sweden the Cancer Register provided information on the annual incidence of pleural mesothelioma, whereas in The Netherlands mortality data were provided by Statistics Netherlands for the period 1969-2001. In The Netherlands among men the incidence rate was consistently higher (1.5-2 times) than in Sweden, whereas among women similar rates were observed. Assuming that none of the female cases was caused by occupational exposure to asbestos, minimum estimates of the etiologic fraction for occupational exposure to asbestos in men would be 82% in Sweden and 92% in The Netherlands. Possible explanations for the consistently higher incidence rates in the Netherlands than in Sweden include differences in exposure levels, the proportion of exposed subjects in the workforce and types of asbestos fibres used. Measures to decrease the exposure to asbestos seem to have decreased the risk of pleural mesothelioma in both countries among age groups below 60 years. This effect will result in a leveling off of the increase in pleural mesothelioma in both countries in the next decade.

Nesti M, Marinaccio A, Chellini E. Malignant mesothelioma in Italy, 1997. Am J Ind Med.2004 Jan;45(1):55-62. Department of Occupational Medicine, Epidemiology unit, ISPESL-National Institute for Occupational Safety and Prevention, Via Alessandria, Rome, Italy.

BACKGROUND: The Italian National Mesothelioma Register (ReNaM) was set up at the Istituto Superiore Prevenzione e Sicurezza Lavoro (ISPESL), inRome, in accordance with Art. 36 of Italian Legislative Decree No. 277 [1991]. METHODS: Five Italian regions,Piedmont,Liguria,Emilia-Romagna,Tuscany, and Apulia, agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data systematically to ISPESL. RESULTS: Four hundred and twenty-nine mesothelioma cases, diagnosed in 1997, are recorded. The standardized annual incidence rate for definite pleural mesothelioma is 1.51 per 100,000 inhabitants (2.26 for males and 0.79 for females). Exposure was defined for 198 mesotheliomas with a histological diagnosis: 125 (63%) refer to occupational exposure, 10 (5%) to environmental exposure, and 5 (2.5%) to household exposure. CONCLUSIONS: Despite the ReNaM's work, many limitations still have to be overcome. Clear-cut information on asbestos exposure is available for a limited number of cases; and differing regional procedures in collecting and evaluating mesotheloma cases exist. At this stage the identification and evaluation of a large number of cases of mesothelioma is a worthwhile result. This epidemiological surveillance, currently being extended to other regions, will enable us to better assess the impact and diffusion of this disease in future, and to monitor more closely the effects of ceasing asbestos use in 1992, and the efficacy of preventive measures since mid '70s.

Neumann V, Rütten A, Scharmach M, Müller KM, Fischer M. Factors influencing long-term survival in mesothelioma patients--results of the German mesothelioma register. Int Arch Occup Environ Health.2004 Apr;77(3):191-9. German Mesothelioma Register, Division of the German Institutions for Statutory Accident Insurance and Prevention (HVGB), Berufsgenossenschaftliche Kliniken Bergmannsheil, Universittsklinik, Brkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

Between 1987 and 2000, the German mesothelioma register recorded a total of 4,455 patients with malignant mesotheliomas. Survival times for 498 (11.2%) patients were available; 155 patients (study group, 3.5% of the total group) survived for more than 2 years and 343 patients (control group, 7.7% of the total group) survived for fewer than 24 months. Male patients were over-represented in both groups, with 13% of women in the study and 4.4% in the control group. The proportion of pleural mesotheliomas was more than 90% in both groups, with peritoneal cases comprising 6.5% in the study group and 3.2% in the control group. Histologically, the epithelioid subtype was represented in 58% of the study group, whereas the biphasic subtype predominated (67.6%) in the control group. Only 7% of tumours were of the sarcomatoid subtype. The average age of patients in the study group was 57.4 years, thus lower than in the control group (62.8 years). Lung dust analysis showed an increased pulmonary asbestos burden in 94% of all patients; significant differences between the study and control group were not observed. In the majority of the total group pleural effusions were the first symptoms. Therapeutic data were available in fewer than 40% of all cases. Surgical interventions were performed, partly in combination with radiation and chemotherapy and as alternative treatments. Significant deviations in survival time dependent on therapy applied could not be proved. By multivariate analysis (Cox proportional hazards regression model) favourable prognostic factors for long-term survival were epithelioid tumour subtype, comparatively young age (<60 years), and female gender ( P<0.05).

Wingo PA, Jamison PM, Hiatt RA, Weir HK, Gargiullo PM, Hutton M, Lee NC, Hall HI. Building the infrastructure for nationwide cancer surveillance and control--a comparison between the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program (United States). Cancer Causes Control.2003 Mar;14(2):175-93. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,Atlanta, Georgia, USA.

OBJECTIVE: In preparation for jointly publishing official government cancer statistics, the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI) compared incidence rates from NCI's Surveillance Epidemiology and End Results (SEER) Program and CDC's National Program of Cancer Registries (NPCR). METHODS: Data for 1999 covering 78% of the US population were obtained from SEER and selected NPCR registries that met high quality data criteria. Incidence rates (per 100,000 population) were age-adjusted to the 2000 US standard population, and 95% gamma confidence intervals were estimated. RESULTS: NPCR rates for all sites combined were higher than SEER rates (males: NPCR 553.6, SEER 538.7; females: NPCR 420.8, SEER 412.5), but rates for specific cancer sites varied by registry program. Rates for colon cancer (males: NPCR 47.0, SEER 42.7; females: NPCR 36.5, SEER 33.8) and tobacco-related cancers were higher in NPCR than SEER. In contrast, NPCR rates were lower than SEER rates for cancers of the female breast (NPCR 134.0, SEER 135.9), prostate (NPCR 162.0, SEER 170.2), and melanoma as well as for cancers more common among Asians and Pacific Islanders (e.g., stomach cancer). CONCLUSIONS: Rate differences may arise from population differences in socio-demographic characteristics, screening use, health behaviors, exposure to cancer causing agents or registry operations factors.

Leigh J, Driscoll T. Malignant mesothelioma in Australia, 1945-2002. Int J Occup Environ Health. 2003 Jul-Sep;9(3):206-17. Center for Occupational and Environmental Health, Department of Public Health and Community Medicine, University of Sydney, Sydney, NSW, Australia.

Using register data, time trends in mesothelioma incidence in Australia from 1945 to 2002 were calculated. Incidences are reported by age, sex, anatomic site, and state of notification. Associations with occupational and environmental asbestos exposure histories and lifetime risks in different exposure categories were investigated. Lung-fiber content was measured in a subset of cases. Australia had 7,027 cases from 1945 to 2001, with 488 more in January 2002 through June 2003. Incidence rates for Australia per million population > or = 20 years old (1999) were: male 53.3; female 10.2; total 31.8. Rates have continually increased and are the highest reported national rates in the world.Western Australia had the highest rate (1999 total 47.7), but most cases arose from the two most populous eastern states,New South Wales andVictoria. In 88% of cases (male 90%, female 61%), histories of asbestos exposures were obtained. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length/g dry lung were obtained, suggesting unrecognized exposure. Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of settings. The number of cases is expected to be about 18,000 by 2020, with about 11,000 yet to appear.

Gorini G, Silvestri S, Merler E, Chellini E, Cacciarini V, Seniori Costantini AS.Tuscany mesothelioma registry (1988-2000): evaluation of asbestos exposure. Med Lav.2002 Nov-Dec;93(6):507-18. UO Epidemiologia Occupazionale e Ambientale, Centro per lo Studio e la Prevenzione Oncologica (CSPO), Istituto Scientifico della Regione Toscana, Firenze.

BACKGROUND: The Tuscany Mesothelioma Register (ARTMM) records pleural malignant mesothelioma cases ofTuscany residents, diagnosed by histological, cytological, or clinical (radiography or computerized tomography) examinations. The ARTMM began in 1988 and estimates mesothelioma incidence inTuscany and collects information on past asbestos exposure of mesothelioma cases. OBJECTIVES: The aim of this paper was to describe the incidence of pleural mesothelioma cases inTuscany and to analyse their possible past asbestos exposures. METHODS: We considered pleural mesothelioma cases recorded in ARTMM in the period 1988-2000 and interviews collected for these cases. In order to identify past asbestos exposure in the occupational and non-occupational history of patients, interviews were carried out using a standardised questionnaire. RESULTS: In the period 1988-2000, 494 pleural malignant mesothelioma cases were recorded in the ARTMM; 82% were males. In the periods 1988-1993, 1994-1997, 1998-2000 the incidence rates, standardised on the Italian population (per 100,000), were respectively 1.15, 1.57, 2.58 among males; 0.29; 0.27; 0.29 among females. Information on occupational history was collected for 418 mesothelioma patients (85% of recorded cases): 173 mesothelioma cases were directly interviewed; for 245 cases relatives or work colleagues were interviewed. Occupational asbestos exposure was ranked as certain, probable or possible in 72% of the interviewed cases (80% of males; 20% of females). Environmental and non-occupational asbestos exposure was identified in 1% of males, and 3% of females. In 24% of the interviewed cases (15% of males; 74% of females) no known asbestos exposure was identified. Occupational asbestos exposure occurred in maritime activities (shipyards, dock work, merchant and regular Navy), the building industry, railway carriage construction and maintenance, rail transport, textile industries (mainly rag sorting), electricity production, asbestos cement manufacture, chemical, iron and steel industries and in glass manufacturing. InTuscany two areas are distinguished for their well-documented and massive use of asbestos: the coastal areas (Livorno and Massa Carrara) for maritime activities, and the areas ofPistoia andArezzo for railway carriage construction and repair. Mesothelioma incidence rates in these areas are the highest in the whole region. CONCLUSIONS: Further investigation is needed in order to identify unknown asbestos uses and consequent exposure, in particular for females. Uncertainty as regards occurrence of asbestos exposure persists in the textile industries where the mesothelioma epidemics have not yet declined. Research hypotheses are addressed on the re-use of jute bags previously containing asbestos, therefore collection of further information on periods and methods of this recycling activity is essential.

Roggli VL, Sharma A, Butnor KJ, Sporn T, Vollmer RT. Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases. Ultrastruct Pathol.2002 Mar-Apr;26(2):55-65. Department of Pathology,Durham Veterans Administration and Duke University Medical Center,North Carolina 27710, USA.

Asbestos exposure is indisputably associated with development of mesothelioma. However, relatively few studies have evaluated the type of occupational exposure in correlation with asbestos fiber content and type. This study reports findings in 1445 cases of mesothelioma with known exposure history; 268 of these also had fiber burden analysis. The 1445 cases of mesothelioma were subclassified into 23 predominant occupational or exposure categories. Asbestos body counts per gram of wet lung tissue were determined by light microscopy. Asbestos fiber content and type were determined by scanning electron microscopy and energy dispersive x-ray analysis. Results were compared with a control group of 19 lung tissue samples. Ninety-four percent of the cases occurred among 19 exposure categories. Median asbestos body counts and levels of commercial and noncommercial amphibole fibers showed elevated levels for each of these 19 categories. Chrysotile fibers were detectable in 36 of 268 cases. All but 2 of these also had above-background levels of commercial amphiboles. When compared to commercial amphiboles, the median values for noncommercial amphibole fibers were higher in 4 of the 19 exposure groups. Most mesotheliomas in the United States fall into a limited number of exposure categories. Although a predominant occupation was ascertained for each of these cases, there was a substantial overlap in exposure types. All but 1 of the occupational categories analyzed had above-background levels of commercial amphiboles. Commercial amphiboles are responsible for most of the mesothelioma cases observed in the United States.

Burdorf A, Dahhan M, Swuste P. Occupational characteristics of cases with asbestos-related diseases in The Netherlands. Ann Occup Hyg.2003 Aug;47(6):485-92.Erasmus MC, University Medical CenterRotterdam, Department of Public Health, The Netherlands.

OBJECTIVE: To describe the occupational background of cases with an asbestos-related disease and to present overall mesothelioma risks across industries with historical exposure to asbestos. METHODS: For the period 1990-2000, cases were collected from records held by two law firms. Information on jobs held, previous employers, activities performed and specific products used were obtained from patients themselves or next of kin. Branches of industry and occupations were coded and the likelihood of asbestos exposure was assessed. For each branch of industry, the overall risk of mesothelioma was calculated from the ratio of the observed number of mesothelioma cases and the cumulative population-at-risk in the period 1947-1960. In order to compare mesothelioma risks across different industries, risk ratios were calculated for the primary asbestos industry and asbestos user industries relative to all other branches of industry. RESULTS: In total, 710 mesotheliomas and 86 asbestosis cases were available. The average latency period was approximately 40 yr and the average duration of exposure was 22 yr. Ship building and maintenance contributed the largest number of cases (27%), followed by the construction industry (14%), the insulation industry (12%), and the navy and army, primarily related to ship building and maintenance (5%). In the insulation industry, the overall risk of mesothelioma was 5 out of 100 workers, and in the ship building industry, 1 out of 100 workers. The construction industry had an overall risk comparable with many other asbestos-using industries (7 per 10,000 workers), but due to its size claimed many mesothelioma cases. CONCLUSION: The majority of cases with asbestos-related diseases had experienced their first asbestos exposure prior to 1960. For cases with first asbestos exposure after 1960, a shift was observed from the primary asbestos industry towards asbestos-using industries, such as construction, petroleum refining, and train building and maintenance. Due to the long latency period, asbestos exposure from 1960 to 1980 will cause a considerable number of mesothelioma cases in the next two decades.

Leigh J, Davidson P, Hendrie L, Berry D. Malignant mesothelioma in Australia, 1945-2000. Am J Ind Med.2002 Mar;41(3):188-201. Center for Occupational and Environmental Health, Department of Public Health and Community Medicine, University of Sydney, Sydney, NSW, Australia.

BACKGROUND: Australia has maintained a total national malignant mesothelioma case register since 1980. There has been a marked increase in the incidence of mesothelioma in the last 20 years. Currently 450-600 cases are notified annually in a population of 20 million. While the history of the Wittenoom (StateWestern Australia) crocidolite mine and its aftermath is well known, these cases comprise only 5% of the total. This study describes the incidence of mesothelioma in Australia from 1945 to 2000. METHODS: Using register data, time trends in mesothelioma incidence were calculated. Analyses of incidence are reported by age, sex, anatomical site, and state of notification. Associations with occupational and environmental asbestos exposure histories are described. Lung fiber content measurements were made on a subset of cases. RESULTS: Australia has had 6,329 cases of mesothelioma from 1 January 1945 to 31 December 2000. (A further 620 cases were notified in the period from 1 January 2001 to 31 October 2001.) Annual incidence rates for Australia per million population > or = 20 years (1997) were: male, 59.8; female, 10.9; total, 35.4. Incidence rates have been continually increasing and are the highest reported national rates in the world. WhileWestern Australia has the highest rate (1997 total rate, 52.8), most cases arise from the two most populous eastern states,New South Wales andVictoria. In 88% (male 90%, female 61%) of cases, a history of asbestos exposure was obtained. Exposures occurred in a wide variety of occupational and environmental circumstances. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length per gm dry lung were obtained, suggesting unrecognized exposure. CONCLUSIONS: Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of occupational and environmental settings. The number of cases in total is expected to be about 18,000 by 2020, with about 11,000 yet to appear.

Marsh GM, Gula MJ, Youk AO, Buchanich JM, Churg A, Colby TV. Historical cohort study of US man-made vitreous fiber production workers: II. Mortality from mesothelioma. J Occup Environ Med.2001 Sep;43(9):757-66. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.

As part of our ongoing mortality surveillance program for the US man-made vitreous fiber (MMVF) industry, we examined mortality from malignant mesothelioma using data from our 1989 follow-up of 3478 rock/slag wool workers and our 1992 follow-up of 32,110 fiberglass workers. A manual search of death certificates for 1011 rock/slag wool workers and 9060 fiberglass workers revealed only 10 death certificates with any mention of the word "mesothelioma." A subsequent review of medical records and pathology specimens for 3 of the 10 workers deemed two deaths as definitely not due to mesothelioma and one as having a 50% chance of being caused by mesothelioma. Two other deaths, for which only medical records were available, were given less than a 50% chance of being due to mesothelioma. Eight of the 10 decedents had potential occupational asbestos exposure inside or outside the MMVF industry. We also estimated the mortality risk from malignant mesothelioma in the cohort using two cause-of-death categorizations that included both malignant and benign coding rubrics. Using the more comprehensive scheme, we observed overall deficits in deaths among the total cohort and fiberglass workers and an overall excess among rock/slag wool workers. The excess in respiratory system cancer is largely a reflection of elevated lung cancer risks that we attributed mainly to confounding by smoking, to exposures outside the MMVF industry to agents such as asbestos, or to one or more of the several co-exposures present in many of the study plants (including asbestos). The second scheme, which focused on pleural mesothelioma in time periods when specific malignant mesothelioma coding rubrics were available, classified only one cohort death as being caused by malignant mesothelioma, compared with 2.19 expected deaths (local county comparison). We conclude that the overall mortality risk from malignant mesothelioma does not seem to be elevated in the US MMVF cohort.

Jemal A, Grauman D, Devesa S. Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94. Am J Ind Med.2000 May;37(5):512-21. Division of Cancer Epidemiology and Genetics, National Cancer Institute,Bethesda,Maryland, Maryland 20892-7244, USA.

BACKGROUND: Lung cancer mortality rates among white males in the United States were observed to be elevated during 1950-69 in counties with shipbuilding industries during World War II; risk was found to be associated with asbestos exposure. We evaluated the geographic patterns in more recent years, 1970-94, for whites and compared them with the 1950-69 patterns. METHODS: We calculated age-adjusted rates and estimated rate ratios between comparison groups. RESULTS: Rates generally were higher in shipyard counties than in all nonshipyard counties and in coastal nonshipyard counties for both sexes and time periods. Rates increased markedly from 1950-69 to 1970-94 in all groups, with the changes more pronounced in females than males. Pleural mesothelioma mortality rates were also significantly higher in shipyard counties than coastal nonshipyard counties in all regions among males but not among females. CONCLUSIONS: The more pronounced changes in lung cancer mortality rates among females in shipyard counties may be attributed to the combined effects of low asbestos exposures and changes in smoking behavior. Am. J. Ind. Med. 37:512-521, 2000. Published 2000 Wiley-Liss, Inc.

Yeung P, Rogers A, Johnson A. Distribution of mesothelioma cases in different occupational groups and industries in Australia, 1979-1995. Appl Occup Environ Hyg.1999 Nov;14(11):759-67. Alan Rogers OH&S Pty Ltd, Clovelly, Australia.

Australia was a producer and user of asbestos and has one of the highest national incidences of mesothelioma in the world. The incidence is still rising and expected to do so for another 10-20 years. A study was conducted in 1996 to examine the past and current incidence rates of mesothelioma in a number of industries and occupations as the basis for predicting future outcomes. Occupational histories of a total of 3758 mesothelioma cases collected by two sequential national schemes--the Australian Mesothelioma Surveillance Program (1979-1985) and Australian Mesothelioma Register (1986-1995)--were reviewed and coded by the authors. The building industry contributed the largest number of cases nationwide followed by shipbuilding and repair, asbestos cement production, crocidolite mining and milling, railway locomotive construction and repair, coal-fired power stations, and other engineering operations. The mean latency between initial occupational asbestos exposure and diagnosis of the disease was 37.4 years (range = 4-66 years) for cases notified between 1979 and 1985, and 41.4 years (range = 6-84 years) for those between 1986 and 1995. Trends for each industry group have been changing considerably in the past 16 years, with the traditional primary asbestos industry cases from crocidolite mining and milling now on the decline and cases from asbestos cement production having plateaued. In contrast, more recently, more cases were observed from the asbestos user industries such as the building industry, and from occupations such as plumbers, carpenters, machinists, and car mechanics. These increases might be a reflection of the longer latency effects of the intermittent and less severe exposures in these larger occupational groups.

Iscovich J, Fischbein A, Witt-Kushner J, Ginsberg G, Richter E, Tulchinsky T. Malignant mesothelioma in Israel, 1961-1992. Int J Occup Environ Health. 1999 Jul-Sep;5(3):157-63. The International Fertility Institute, 142 Achuza Street, Ra'anana, 43300, Israel.

The authors monitored time trends in the incidences and distributions of malignant mesotheliomas during 1961-92 in 223 Israeli persons, including 21 men from a cohort of 3,057 asbestos-cement workers (83,122 person-years). The annual incidence rates of malignant mesotheliomas in Jewish men ranged between 2.5 per million in 1961-82 and 4.6 per million in 1985-92. The male-to-female incidence ratio rose from 1.2 in the 1960s to 2.9 during 1985-92, as a result of increases in risk among Israeli-born males. Females accounted for 37.6% of all cases, after exclusion of the cohort of asbestos workers. Of the 223 cases, 202 (91%) had no indication of direct occupational exposure to asbestos. In Jewish females, the incidence of malignant mesotheliomas did not increase after 1961. The mean age at diagnosis in all cases was lowest in the Israeli-born (53.0 years). High levels of asbestos exposure in the 1970s and the relatively early age of onset of the disease indicate that exposure began at a younger age in Israel than in European countries. Asbestos manufacture and use peaked in Israel during the mid-1970s, so the maximum impact of these trends has yet to be seen.

Cocco P, Dosemeci M. Peritoneal cancer and occupational exposure to asbestos: results from the application of a job-exposure matrix. Am J Ind Med.1999 Jan;35(1):9-14. Occupational Studies Section, National Cancer Institute, Bethesda,MD 20892, USA.

BACKGROUND: Because of the rarity of peritoneal mesothelioma, occupational risks associated with it have seldom been studied, particularly among women. In this respect, death certificates databases may provide numbers large enough for analysis, although the International Classification of Diseases, 9th revision (ICD-9) does not single out mesothelioma from the rest of peritoneal cancers. The aim of this paper is twofold: to explore occupational risks of peritoneal cancer among men and women, and to test the performance of a job-exposure matrix in detecting its association with asbestos exposure using the occupation and industry reported in the death certificate. METHODS: From a large database containing information on the 1984-1992 death certificates of 24 U.S. states, we identified 657 deaths from peritoneal cancer and 6,570 controls who died from non-malignant diseases, 1:10 matched by region, gender, race, and 5-year age group. RESULTS: Occupations at risk included insulators among men, and machine operators among women. Among men, we found a significant increase in risk associated with employment in manufacturing industries, such as industrial and miscellaneous chemicals; miscellaneous non-metallic mineral and stone products; construction and material handling machines; and electrical machinery, equipment, and supplies; as well as in services to dwellings and other buildings. Industries at increased risk among women included elementary and secondary schools; miscellaneous retail stores; and publishing and printing. Our job-exposure matrix classified 17 male cases and 3 controls in the high probability category of exposure to asbestos (OR = 61.6). Among men, risk of peritoneal cancer increased significantly by probability and intensity of exposure to asbestos. No such pattern was observed among women. The job-exposure matrix did not classify any female subjects in the high probability or intensity of asbestos exposure. DISCUSSION: This study provides evidence that death certificate data and job-exposure matrices are useful tools to observe well-established associations, such as the one existing between peritoneal cancer and asbestos exposure among men, in spite of crude information, disease misclassification, and occupational misclassification. These factors are more likely to preclude meaningful results among women.

Kang SK, Burnett CA, Freund E, Walker J, Lalich N, Sestito J. Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures. Am J Ind Med.1997 Jun;31(6):713-8. Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health, Cincinnati,Ohio, USA.

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

Peto J, Hodgson JT, Matthews FE, Jones JR. Continuing increase in mesothelioma mortality in Britain. Lancet.1995 Mar 4;345(8949):535-9. Section of Epidemiology, Institute of Cancer Research,Belmont, Surrey, UK.

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. We found that 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.

Cicioni C, London SJ, Garabrant DH, Bernstein L, Phillips K, Peters JM. Occupational asbestos exposure and mesothelioma risk in Los Angeles County: application of an occupational hazard survey job-exposure matrix. Am J Ind Med.1991;20(3):371-9. Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles 90033-9987.

We evaluated the newly available National Institute for Occupational Safety and Health (NIOSH) National Occupational Hazard Survey (NOHS) job exposure matrix (JEM) by considering mesothelioma risk from asbestos exposure. We applied this system (NOHS-JEM) to the Los Angeles County Cancer Surveillance Program (CSP) to see how many cancer cases could be assigned asbestos exposure and how asbestos exposure affected mesothelioma risk. Using the same CSP data, our "experts" classified asbestos exposure simply by occupation and industry. Both exposure classifications were divided into low and high; the NOHS-JEM by the number of exposed people per couplet, and ours by judgements of intensity. Odds ratios (OR) for mesothelioma risk for low and high asbestos exposure for the NOHS-JEM were 2.0 (95% C.I. 1.2-3.4) and 2.5 (95% C.I. 1.2-4.8). For ours, corresponding risks were 1.6 (95% C.I. 1.1-2.4) and 6.3 (95% C.I. 2.5-15.1). Our system was able to assign more cases to couplets then the NOHS-JEM (35,895 to 22,369). Three limitations of the NOHS-JEM were that many occupation-industry couplets were not classified at all, many couplets associated with past asbestos exposure (before the 1972-1974 NOHS survey) were not classified as asbestos exposure, and no assessment of intensity was made. These limitations may apply to other exposures and should be carefully considered before the NOHS-JEM is applied to other case-control studies.

Enterline PE, Henderson VL. Geographic patterns for pleural mesothelioma deaths in the United States, 1968-81. J Natl Cancer Inst.1987 Jul;79(1):31-7.

Deaths and death rates for mesothelioma of the pleura are presented by age, sex, and geographic area for the United States for the years 1968-81. Death rates increased with age and in every age group were roughly three times higher for males than for females. Over the period 1968-81, death rates increased for males aged 65 years or more, whereas death rates in other age-sex groupings remained fairly constant or declined slightly. It is known that asbestos is highly related to mesothelioma, and the increase in death rates among older males could be due to asbestos. Conversely, the fact that death rates in younger males and in females have not been increasing suggests some kind of background level not strongly related to the use of asbestos. When the geographic distribution of death rates was examined by state, there was considerable geographic variation with some clustering. High death rates for males appeared for the Northeastern States and along the Pacific Coast, and for Illinois, Florida, Wyoming, and Colorado. Females shared this geographic pattern to some extent. When death rates were examined by county, a relationship was seen between pleural mesothelioma deaths among males and the presence of asbestos products plants and shipbuilding facilities. Excessive death rates in some counties and states did not appear to be related to asbestos exposure. Although the similarity in geographic patterns of mortality for males and females suggests a common etiology, the trends in mortality suggest different etiologies. There may be important causes of pleural mesothelioma yet to be identified.

Ferguson DA, Berry G, Jelihovsky T, Andreas SB, Rogers AJ, Fung SC, Grimwood A, Thompson R. The Australian Mesothelioma Surveillance Program 1979-1985. Med J Aust.1987 Aug 17;147(4):166-72. National Occupational Health and Safety Commission, Sydney, NSW.

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.


1Discussion paper for a series of meetings in Brazil, June 2008.



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