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Gogou E, Hatzoglou C, Siachpazidou D, Zarogiannis SG, Gourgoulianis KI. Asbestos ban policies and mesothelioma mortality in Greece. BMC Public Health 2024; 24:1177. [PMID: 38671450 PMCID: PMC11055379 DOI: 10.1186/s12889-024-18030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Malignant mesothelioma is a rare form of cancer that mostly affects the pleura and has a strong link to asbestos exposure. Greece banned the use of asbestos in 2005, however, the public was already aware of this substance in the 1980s. This research aims to present an overview of Greece's mesothelioma age-standardized mortality rates (ASMR) from 1983 to 2019 by age, gender, and geographic region and to determine whether the actions to ban asbestos impacted these rates. METHODS Data were retrieved by the Hellenic Statistical Authority (HSA) from death certificates that mentioned mesothelioma as the cause of death from 1983 to 2019 with details on the residence, gender, and age. Statistical analysis was performed using PRISM 6.0 software, a two-way ANOVA test, Trend analysis was conducted using Joinpoint Regression Program 5.0 software. The linear and non-linear model was used to calculate the age-standardized rates of annual percentage change (APC) and its 95% confidential interval (95% CI). RESULTS From 1983 to 2019, 850 total mesothelioma deaths were recorded, the majority of whom were males (634). A rate of 74.6% accounts for males and 25.4% for females, and the ratio of Males: Females was 3:1. Males' ASMR and the whole population's ASMR reached their highest levels in 2011 (0.93/100000person-years and 0.53/100000person-years, respectively). To look for potential changes between the first two decades of the 21st century, we compared the mean ASMR of each geographic region in Greece between two different 10-year subperiods (2000-2009 and 2010-2019). Except for Epirus, all regions of Greece had elevated regional ASMRs, particularly in those with the highest asbestos deposits. Notably, the ASMR in Epirus decreased from 0.54/100000person-years (2000-2009) to 0.31/100000person-years (2010-2019). After 2011, the ASMR for men and the general population stabilized. This stability is important since mesothelioma in men is associated with occupational asbestos exposure. The intriguing discovery of a lower ASMR in Epirus emphasizes the need to raise awareness of the condition and implement effective public health measures. CONCLUSIONS In Greece, the annual ASMR for males and the whole population reached its highest level in 2011, which is positive and encouraging and may be a sign that the rate will stabilize during the following years. Moreover, this study showed that the actions made in the 1980s regarding public awareness and surveillance directly impacted the decrease in Epirus rates. Future research, continual awareness, information, and recording are needed to monitor the mesothelioma epidemic. The possible benefit of a mesothelioma registry and the epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, need to be addressed. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Evdoxia Gogou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Chryssi Hatzoglou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Dimitra Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
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Huang J, Chan SC, Pang WS, Chow SH, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Global Incidence, Risk Factors, and Temporal Trends of Mesothelioma: A Population-Based Study. J Thorac Oncol 2023; 18:792-802. [PMID: 36775192 DOI: 10.1016/j.jtho.2023.01.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Mesothelioma is an uncommon type of cancer which has received little attention. This study aims to evaluate the global disease burden; trends of mesothelioma by age, sex, and geographic locations; and its risk factors on the population level. METHODS The Global Cancer Observatory, Cancer Incidence in Five Continents Plus, and Global Burden of Disease were accessed for mesothelioma incidence and its risk factors worldwide. The associations between mesothelioma incidence and asbestos were evaluated for each country by multivariable linear regression analysis by sex and age. Average annual percentage change (AAPC) was calculated using Joinpoint regression to evaluate the epidemiologic trends of mesothelioma. RESULTS The age-standardized rate of mesothelioma was 0.30 per 100,000 persons with Northern Europe reporting the highest incidence rates. The incidence rate of the male population was much higher than that of the females. Countries with higher human development index (β = 0.119, confidence interval [CI]: 0.073-0.166, p < 0.001), gross domestic product per capita (β = 0.133, CI: 0.106-0.161, p < 0.001), and asbestos exposure (β = 0.087, CI: 0.073-0.102, p < 0.001) had higher mesothelioma. The overall trend of mesothelioma incidence was decreasing, although an increase was observed in Bulgaria (AAPC: 5.56, 95% CI: 2.94-8.24, p = 0.001) and Korea (AAPC: 3.24, 95% CI: 0.08-6.49, p = 0.045). CONCLUSIONS There was a substantial declining incidence trend of mesothelioma in the past decade possibly related to the restriction of the use of asbestos in some countries. Meanwhile, the increasing trend in mesothelioma incidence observed in females might be indicative of an increase in environmental exposure to mineral fibers.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Wing Sze Pang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Shui Hang Chow
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- School of Population and Global Health, The University of Melbourne, Victoria, Australia; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | | | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Global Health, School of Public Health, Peking University, Beijing, People's Republic of China.
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Migliore E, Consonni D, Peters S, Vermeulen RCH, Kromhout H, Baldassarre A, Cavone D, Chellini E, Magnani C, Mensi C, Merler E, Musti M, Marinaccio A, Mirabelli D. Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM). Environ Health 2022; 21:60. [PMID: 35717324 PMCID: PMC9206310 DOI: 10.1186/s12940-022-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Italian mesothelioma registry (ReNaM) estimates mesothelioma incidence and addresses its etiology by assessing cases' exposures but cannot provide relative risk estimates. OBJECTIVES i) To estimate pleural mesothelioma relative risk by industry and occupation and by ReNaM categories of asbestos exposure; and ii) to provide quantitative estimates of the exposure-response relationship. METHODS A population-based mesothelioma case-control study was conducted in 2012-2014 in five Italian regions. Cases and age and gender frequency-matched controls were interviewed using a standard ReNaM questionnaire. Experts coded work histories according to international standard classifications of industries/occupations and assigned asbestos exposure according to ReNaM categories. Job codes were further linked to SYN-JEM, a quantitative job-exposure matrix. Cumulative exposure (CE, f/mL-years) was computed by summing individual exposures over lifetime work history. Unconditional logistic regression analyses adjusted by gender, centre and age were fitted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Among men we observed increased risks of mesothelioma in many industries and associated occupations, including: asbestos-cement (OR = 3.43), manufacture of railroad equipment (OR = 8.07), shipbuilding and repairing (OR = 2.34), iron and steel mills (OR = 2.15), and construction (OR = 1.94). ORs by ReNaM exposure categories were as follows: definite/probable occupational exposure (OR = 15.8, men; OR = 8.80, women), possible occupational (OR = 2.82, men; OR = 3.70, women), sharing home with an exposed worker (OR = 2.55, men; OR = 10.3, women), residential (OR = 2.14, men; OR = 3.24, women). Based on SYN-JEM, mesothelioma risk increased by almost 30% per f/mL-year (OR = 1.28, CI 1.16-1.42). CONCLUSIONS Out study involved five regions with historically different types and levels of industrial development, encompassing one third of the Italian population and half of Italian mesothelioma cases. As expected, we found increased pleural mesothelioma risk in the asbestos industry and in trades with large consumption of asbestos materials. Clear associations were found using both qualitative (ReNaM classifications) and quantitative estimates (using SYN-JEM) of past asbestos exposure, with clear evidence of an exposure-response relationship.
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Affiliation(s)
- Enrica Migliore
- Cancer Epidemiology Unit, CPO Piemonte and University of Turin, Turin, Italy.
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy.
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susan Peters
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel C H Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Domenica Cavone
- Interdisciplinary Department of Medicine, Section of Occupational Medicine "B. Ramazzini", University of Bari, Bari, Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Florence, Italy
| | - Corrado Magnani
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont and CPO Piemonte, Novara, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enzo Merler
- Occupational Health Unit, Department of Prevention, Padua, Italy
| | - Marina Musti
- Interdisciplinary Department of Medicine, Section of Occupational Medicine "B. Ramazzini", University of Bari, Bari, Italy
| | - Alessandro Marinaccio
- Unit of Occupational and Environmental Epidemiology - Italian Mesothelioma Register, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit, CPO Piemonte and University of Turin, Turin, Italy
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy
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Pulmonary Asbestos Fiber Burden is Related to Patient Survival in Malignant Pleural Mesothelioma. J Thorac Oncol 2022; 17:1032-1041. [DOI: 10.1016/j.jtho.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022]
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Brims F. Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13164194. [PMID: 34439349 PMCID: PMC8391310 DOI: 10.3390/cancers13164194] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/12/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
Mesothelioma is a cancer predominantly of the pleural cavity. There is a clear association of exposure to asbestos with a dose dependent risk of mesothelioma. The incidence of mesothelioma in different countries reflect the historical patterns of commercial asbestos utilisation in the last century and predominant occupational exposures mean that mesothelioma is mostly seen in males. Modern imaging techniques and advances in immunohistochemical staining have contributed to an improved diagnosis of mesothelioma. There have also been recent advances in immune checkpoint inhibition, however, mesothelioma remains very challenging to manage, especially considering its limited response to conventional systemic anticancer therapy and that no cure exists. Palliative interventions and support remain paramount with a median survival of 9-12 months after diagnosis. The epidemiology and diagnosis of mesothelioma has been debated over previous decades, due to a number of factors, such as the long latent period following asbestos exposure and disease occurrence, the different potencies of the various forms of asbestos used commercially, the occurrence of mesothelioma in the peritoneal cavity and its heterogeneous pathological and cytological appearances. This review will describe the contemporary knowledge on the epidemiology of mesothelioma and provide an overview of the best clinical practice including diagnostic approaches and management.
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Affiliation(s)
- Fraser Brims
- Curtin Medical School, Curtin University, Perth, WA 6845, Australia;
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA 6009, Australia
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Parikh K, Hendriks LEL, Bironzo P, Remon J. Immune checkpoint inhibitors a new player in the therapeutic game of mesothelioma: New reality with new challenges. Cancer Treat Rev 2021; 99:102250. [PMID: 34174669 DOI: 10.1016/j.ctrv.2021.102250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/06/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a rare and orphan thoracic malignancy, with a poor prognosis as the majority of patients are diagnosed with unresectable MPM, with no significant improvements in the therapeutic strategy for over a decade. However, the recent approval of immune checkpoint inhibitors (ICI) in treatment-naïve patients with unresectable MPM marks a significant step forward and hope for the treatment of this disease. In this narrative review, we discuss the biological rationale to use ICI in the treatment of MPM. We summarize the current evidence for the efficacy of ICI in MPM and discuss several unresolved challenges regarding the use of ICI in this disease, such as the best upfront immune approach in MPM (ICI versus ICI plus chemotherapy), the optimal sequential treatment strategy according to the first-line treatment, and the potential role of predictive biomarkers.
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Affiliation(s)
- Kaushal Parikh
- Department of Medical Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Paolo Bironzo
- Department of Oncology, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Jordi Remon
- Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain.
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Bo Y, Zhu Y, Tao Y, Li X, Zhai D, Bu Y, Wan Z, Wang L, Wang Y, Yu Z. Association Between Folate and Health Outcomes: An Umbrella Review of Meta-Analyses. Front Public Health 2020; 8:550753. [PMID: 33384976 PMCID: PMC7770110 DOI: 10.3389/fpubh.2020.550753] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background: There is no study that has systematically investigated the breadth and validity of the associations of folate and multiple health outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding associations between folate and multiple health outcomes by using umbrella review of meta-analysis. Methods: We searched the MEDLINE, EMBASE, and Cochrane Library databases from inception to May 20, 2018, to identify potential meta-analyses that examined the association of folate with any health outcome. For each included meta-analysis, we estimated the summary effect size and their 95% confidence interval using the DerSimonian and Laird random-effects model. We used the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) to assess methodological quality and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation working group classification) to assess the quality of evidence for each outcome included in the umbrella review. Results: Overall, 108 articles reporting 133 meta-analyses of observational studies and 154 meta-analyses of randomized controlled trials (RCTs) were included in the study. Among them, 108 unique exposure-outcome-population triplets (referred to as unique meta-analyses hereafter) of RCTs and 87 unique meta-analyses of observational studies were reanalyzed. Beneficial effects of folate were observed in the all-cause mortality rate and in a number of chronic diseases, including several birth/pregnancy outcomes, several cancers, cardiovascular disease and metabolic-related outcomes, neurological conditions, and several other diseases. However, adverse effects of folate were observed for prostate cancer, colorectal adenomatous lesions, asthma or wheezing, and wheezing as an isolated symptom and depression. Conclusions: Current evidence allows for the conclusion that folate is associated with decreased risk of all-cause mortality and a wide range of chronic diseases. However, folate may be associated with an increased risk of prostate cancer. Further research is warranted to improve the certainty of the estimates.
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Affiliation(s)
- Yacong Bo
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjian Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchang Tao
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xue Li
- School of Public Health, Xinxiang Medical University, Xinxiang, China.,Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yongjun Bu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Zhongxiao Wan
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ling Wang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuming Wang
- Department of Administration, Henan University People's Hospital, Zhengzhou, China
| | - Zengli Yu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
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Kolta MF, Khairy MA, El Hinnawy YH. Imaging of asbestos-related lung and pleural diseases as an endemic exposure in Egypt. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00153-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Asbestos refers to a group of naturally occurring silicate minerals which have been traditionally used in building materials and household products. Inhalation of asbestos fibers, however, has been associated with adverse health outcomes, with the disease manifestations principally affecting the thorax. The aim of our study is to detect and evaluate the different radiological patterns of asbestos-related lung and pleural disease and its complications
Results
MDCT examination was able to assess and distinguish asbestosis as well as asbestos-related lung and pleural disease besides detection of any associated complications.
Conclusion
This study demonstrates that while reporting of malignant asbestos-related pleural disease is adequate, there is room for improvement in the reporting of more benign disease.
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Malignant pleural mesothelioma: Treatment patterns and outcomes from the Spanish Lung Cancer Group. Lung Cancer 2020; 147:83-90. [PMID: 32682189 DOI: 10.1016/j.lungcan.2020.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Malignant mesothelioma is a rare but aggressive tumor arising from the pleura, typically associated with exposure to asbestos. The purpose of this investigation was to describe mesothelioma patient characteristics, treatment patterns, and outcomes in Spain. MATERIAL AND METHODS Patients diagnosed with malignant mesothelioma of the pleura were recorded in an anonymous online database (BEMME, Epidemiologic Spanish Malignant Mesothelioma Database) from June 2008 through May 2013. Patient and tumor characteristics at time of diagnosis, as well as subsequent treatments (surgery, radiation, and chemotherapy), were collected. Among patients treated with chemotherapy, we explored type of chemotherapy regimen and outcomes by treatments. RESULTS A total of 560 malignant pleural mesothelioma (MPM) patients were recorded. The median age at diagnosis was 68 years, mainly with epithelioid histology (62 %), and any asbestos exposure was noted in 45 % of patients. Nearly two-thirds of patients (71 %) received chemotherapy, mainly platinum-pemetrexed combination, as part of their treatment. Surgery and radiotherapy were given in 36 % and 17 % of patients, respectively. The median overall survival (OS) in the whole cohort was 13.0 months (95 % confidence interval (CI), 11.1-14.8 months) with 1-year OS of 53.2 % (95 % CI, 48.7-57.7 %). In patients receiving first-line chemotherapy (N = 315), the median OS was 13.4 months (95 % CI, 10.8-16.0 months), reaching 20.2 months (95 % CI, 17.2-23.2 months) for those 68 patients receiving maintenance chemotherapy. Results of multivariate analyses showed significant association of ECOG-performance status, histology and treatment response with improved OS in MPM patients treated with palliative chemotherapy. CONCLUSIONS Despite multimodal therapeutic intervention, survival of patients with mesothelioma in Spain remains poor. Although it did not reach significance in the multivariate analysis, a meaningful additional survival benefit was observed among those patients receiving maintenance chemotherapy.
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Trama A, Proto C, Signorelli D, Garassino MC, Lo Russo G, Ganzinelli M, Prelaj A, Mensi C, Gangemi M, Gennaro V, Chellini E, Caldarella A, Angelillo IF, Ascoli V, Pascucci C, Tagliabue G, Cusimano R, Bella F, Falcini F, Merler E, Masanotti G, Ziino A, Michiara M, Gola G, Storchi C, Mangone L, Vitale MF, Cirilli C, Tumino R, Scuderi T, Fanetti AC, Piffer S, Tiseo M, Gatta G, Botta L. Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study. Thorac Cancer 2020; 11:1661-1669. [PMID: 32364316 PMCID: PMC7262944 DOI: 10.1111/1759-7714.13456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. Centralization of rare cancer in dedicated centers is recommended to ensure expertise, multidisciplinarity and access to innovation. In Italy, expert centers for MPM have not been identified in all regions. We aimed to describe the treatment patterns among MPM patients across different Italian regions and to identify factors associated with the treatment patterns across the regions. Methods We performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003–2008. We included 26 population‐based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department. Results MPM patients mostly received chemotherapy alone (41%) or no cancer‐directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer‐directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department. Conclusions There is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services. Key points
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Affiliation(s)
- Annalisa Trama
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Carolina Mensi
- COR Lombardy, Epidemiology Unit,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Manuela Gangemi
- Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, Turin, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Chellini
- Unit of Occupational & Environmental Epidemiology, Tuscan Occupational Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Adele Caldarella
- Tuscan Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Italo F Angelillo
- Department of Experimental Medicine, COR Campania, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Ascoli
- Department of Radiological Sciences, Oncology and Anatomical Pathology, COR Lazio, University La Sapienza, Rome, Italy
| | - Cristiana Pascucci
- Mesothelioma Marche Registry - COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Giovanna Tagliabue
- Varese Cancer Registry, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesca Bella
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuale, Catania, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Forlì, Italy
| | - Enzo Merler
- COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy
| | - Giuseppe Masanotti
- Sec. Public Health, Department of Experimental Medicine, COR Umbria, University of Perugia, Perugia, Italy
| | | | | | | | - Cinzia Storchi
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Mangone
- Servizio di Epidemiologia, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria F Vitale
- U.O.S.D. Napoli 3 South Cancer Registry, Piazza San Giovanni, Naples, Italy
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Deaprtment, COR Sicily, 'Civic -M.P. Arezzo' Hospital, Ragusa, Italy
| | | | | | - Silvano Piffer
- Trento Cancer Registry, Servizio Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gemma Gatta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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11
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Oddone E, Bollon J, Nava CR, Bugani M, Consonni D, Marinaccio A, Magnani C, Barone-Adesi F. Predictions of Mortality from Pleural Mesothelioma in Italy After the Ban of Asbestos Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E607. [PMID: 31963601 PMCID: PMC7013387 DOI: 10.3390/ijerph17020607] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 12/20/2022]
Abstract
Even if the epidemic of malignant pleural mesothelioma (MPM) is still far from being over worldwide, the health effects of regulations banning asbestos can be evaluated in the countries that implemented them early. Estimates of MPM future burden can be useful to inform and support the implementation of anti-asbestos health policies all around the world. With this aim we described the trends of MPM deaths in Italy (1970-2014) and predicted the future number of cases in both sexes (2015-2039), with consideration of the national asbestos ban that was issued in 1992. The Italian National Statistical Institute (ISTAT) provided MPM mortality figures. Cases ranging from 25 to 89 years of age were included in the analysis. For each five-year period from 1970 to 2014, mortality rates were calculated and age-period-cohort Poisson models were used to predict future burden of MPM cases until 2039. During the period 1970-2014 a total number of 28,907 MPM deaths were observed. MPM deaths increased constantly over the study period, ranging from 1356 cases in 1970-1974 to 5844 cases in 2010-2014. The peak of MPM cases is expected to be reached in the period 2020-2024 (about 7000 cases). The decrease will be slow: about 26,000 MPM cases are expected to occur in Italy during the next 20 years (2020-2039). The MPM epidemic in Italy is far from being concluded despite the national ban implemented in 1992, and the peak is expected in 2020-2024, in both sexes. Our results are consistent with international literature.
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Affiliation(s)
- Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Occupational Medicine Unit (UOOML), ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Jordy Bollon
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (J.B.); (F.B.-A.)
| | - Consuelo Rubina Nava
- Department of Economics and Political Science, University of Aosta Valley, 11100 Aosta, Italy;
| | - Marcella Bugani
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00187 Rome, Italy; (M.B.); (A.M.)
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00187 Rome, Italy; (M.B.); (A.M.)
| | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, and CPO-Piedmont, 28100 Novara, Italy;
| | - Francesco Barone-Adesi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (J.B.); (F.B.-A.)
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12
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Gogou E, Hatzoglou C, Zarogiannis SG, Malli F, Jagirdar RM, Gourgoulianis KI. Mesothelioma Mortality Rates in Greece for the Period 2005-2015 Is Increased Compared to Previous Decades. ACTA ACUST UNITED AC 2019; 55:medicina55080419. [PMID: 31366157 PMCID: PMC6724054 DOI: 10.3390/medicina55080419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 12/13/2022]
Abstract
Background and Objective: To present summary statistics regarding malignant mesothelioma (MM) mortality in Greece during the period 2005–2015 and compare it with previous decades, along with gender, age and geographical area analysis. Materials and Methods: The Hellenic Statistical Authority provided the data, which included all deaths for the period 1983 to 2015 that mentioned MM as the death cause in the corresponding death certificate. MM mortality rates have been calculated with respect to gender, age, and geographical location in Greece. Furthermore, a comparison analysis was made among three eleven consecutive year periods, in order to assess potential changes in the mortality rates. Results: The MM mortality rate has significantly increased during the period 2005–2015 both in males and females compared to earlier decades. The maximum number of MM deaths has shifted to an older age group of 70–80 years during the 2005–2015 period as compared to that of 1983–2004 in both genders. Additionally, MM mortality rates have significantly increased in all geographical areas except for the Epirus Prefecture. Conclusions: Our results demonstrate an increased MM mortality rate in Greece for the decade 2005–2015 as compared to the two previous decades. This increase is possibly due to the fact that the peak in asbestos production and use in Greece was in mid 1990s, while the asbestos ban came in effect in 2005. Based on these findings the MM epidemic in Greece has not yet peaked, therefore it is important to implement screening strategies for early MM detection.
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Affiliation(s)
- Evdoxia Gogou
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece.
| | - Chrissi Hatzoglou
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
| | - Foteini Malli
- Anatomy and Physiology Lab, Nursing Department, University of Thessaly, 41500 Larissa, Greece
| | - Rajesh M Jagirdar
- Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece
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13
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Abstract
Since 1973 the International Agency for Research on Cancer has classified asbestos as a certain carcinogen, but today it is still used in several countries. To date, mesothelioma risk is certainly linked not only to occupational exposures but also to environmental exposures. The incidence and mortality are increasing worldwide, especially in developing countries where asbestos is still often used without adequate measures for worker safety. The epidemiological surveillance systems of related asbestos diseases are instruments of public health adopted internationally. The experience and the operating methodology of the Italian mesothelioma registry and the data produced from 1996 to 2015 highlight how in countries where the asbestos ban has been active for over 20 years the risk of asbestos remains present, especially in the construction sector as well as for the environmental exposures of the resident population near companies that used asbestos in their production cycle. Worldwide, it is necessary to introduce the ban on the extraction, processing, and marketing of asbestos as claimed by the international scientific community.
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14
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Ospina D, Villegas VE, Rodríguez-Leguizamón G, Rondón-Lagos M. Analyzing biological and molecular characteristics and genomic damage induced by exposure to asbestos. Cancer Manag Res 2019; 11:4997-5012. [PMID: 31239765 PMCID: PMC6556979 DOI: 10.2147/cmar.s205723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/19/2019] [Indexed: 12/24/2022] Open
Abstract
Asbestos is one of the most important occupational carcinogens. Currently, about 125 million people worldwide are exposed to asbestos in the workplace. According to global estimates, at least 107,000 people die each year from lung cancer, mesothelioma, and asbestosis as a result of occupational exposure to asbestos. The high pathogenicity of this material is currently known, being associated with the development of pulmonary diseases, of which lung cancer is the main cause of death due to exposure to this mineral. Pulmonary diseases related to asbestos are a common clinical problem and a major health concern worldwide. Extensive research has identified many important pathogenic mechanisms; however, the precise molecular mechanisms involved, and the generated genomic damage that lead to the development of these diseases, are not completely understood. The modes of action that underlie this type of disease seem to differ depending on the type of fiber, lung clearance, and genetics. This evidences the need to increase our knowledge about these effects on human health. This review focuses on the characteristics of asbestos and the cellular and genomic damage generated in humans via exposure.
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Affiliation(s)
- Diana Ospina
- Biology Program, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogotá 111221,Colombia
| | - Victoria Eugenia Villegas
- Biology Program, Faculty of Natural Sciences and Mathematics, Universidad del Rosario, Bogotá 111221,Colombia
| | - Giovanni Rodríguez-Leguizamón
- Hospital Universitario Mayor Méderi - Universidad del Rosario. School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, 111221, Colombia
| | - Milena Rondón-Lagos
- School of Biological Sciences, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150003, Colombia
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15
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Laaksonen S, Ilonen I, Kuosma E, Sutinen E, Wolff H, Vehmas T, Husgafvel-Pursiainen K, Salo JA, Koli K, Räsänen J, Myllärniemi M. Malignant pleural mesothelioma in Finland: regional and gender variation. Acta Oncol 2019; 58:38-44. [PMID: 30375909 DOI: 10.1080/0284186x.2018.1532599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare occupational cancer with a poor prognosis. Even with a multimodality treatment approach, the treatment outcomes remain unsatisfactory. The use of asbestos has been banned in most developed countries, but MPM continues to be a significant occupational disease also in these countries. Aim of this study is to identify modern epidemiology and assess equality in care. METHODS Our study cohort consists of 1010 patients diagnosed with MPM in Finland during 2000-2012. The data were collected from the Finnish Cancer Registry, the National Workers' Compensation Center Registry and the National Registry of Causes of Death, Statistics Finland. RESULTS Women were diagnosed a mean of 4.5 years later than males (p = .001), but survival did not differ (overall median survival 9.7 months). A workers' compensation claim was more common in males (OR 11.0 [95% CI 7.5-16.2]) and in regions with a major asbestos industry (OR 1.7 [95% CI 1.3-2.2]). One-year and three-year survivals did not differ regionally. Patients without chemotherapy treatment had an inferior survival (RR 1.8 [95% CI 1.5-2.0]). The initial survival benefit gained with pemetrexed was diluted at 51 months. CONCLUSIONS MPM is a disease with a poor prognosis, although chemotherapy appears to improve survival time. Significant gender and regional variation exists among patients, with notable differences in diagnostic and treatment practices. Long-term outcomes with pemetrexed remain indeterminate. IMPACT Emphasize centralized consult services for the diagnosis, treatment and support that patients receive for MPM, facilitating equal outcomes and compensation.
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Affiliation(s)
- Sanna Laaksonen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Ilonen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Eeva Kuosma
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eva Sutinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Henrik Wolff
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tapio Vehmas
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Jarmo A. Salo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Katri Koli
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marjukka Myllärniemi
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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16
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Nuyts V, Nawrot T, Nemery B, Nackaerts K. Hotspots of malignant pleural mesothelioma in Western Europe. Transl Lung Cancer Res 2018; 7:516-519. [PMID: 30450289 DOI: 10.21037/tlcr.2018.10.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant pleural mesothelioma, a highly invasive tumour, has been epidemiologically linked to an occupational or environmental exposure to asbestos. Although asbestos has been widely used in diverse industrial applications and in construction, some industrial sectors have been affected much more than others. The objective of this review was to describe the existence of clusters of malignant pleural mesothelioma in Western European countries, based on epidemiological studies published between 2000 and 2015. MEDLINE (PubMed) and Embase were searched for relevant studies on spatial clustering of mesothelioma in Western European countries. Eventually, 16 different studies published between 2000 and 2015 were selected for a comprehensive analysis. Relevant studies on spatial clustering of mesothelioma were found for Belgium, the Netherlands, the United Kingdom, Germany, France, Spain, Italy and Denmark. Clustering of pleural mesothelioma was found mainly around shipyards (16 studies) and asbestos cement industries (10 studies). Although malignant pleural mesothelioma may be found throughout Western Europe, the present study indicates specific areas with higher past and also probable future incidence.
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Affiliation(s)
- Valerie Nuyts
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Tim Nawrot
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium.,Centre for Environmental Sciences, University of Hasselt, Hasselt, Belgium
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Respiratory Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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17
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Assessing the completeness and correctness of the registration of malignant mesothelioma in Belgium. Lung Cancer 2018; 122:38-43. [DOI: 10.1016/j.lungcan.2018.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/19/2018] [Accepted: 05/20/2018] [Indexed: 11/21/2022]
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18
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Time trends and spatial patterns in the mesothelioma incidence in Slovenia, 1961–2014. Eur J Cancer Prev 2017; 26 Joining forces for better cancer registration in Europe:S191-S196. [DOI: 10.1097/cej.0000000000000384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Liu B, van Gerwen M, Bonassi S, Taioli E. Epidemiology of Environmental Exposure and Malignant Mesothelioma. J Thorac Oncol 2017; 12:1031-1045. [DOI: 10.1016/j.jtho.2017.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 01/11/2023]
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20
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[Asbestos, an epidemic that still needs to be controlled]. GACETA SANITARIA 2017; 31:365-367. [PMID: 28595991 DOI: 10.1016/j.gaceta.2017.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/21/2022]
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21
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Soeberg MJ, Creighton N, Currow DC, Young JM, van Zandwijk N. Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009. Aust N Z J Public Health 2015; 40:255-62. [DOI: 10.1111/1753-6405.12503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/01/2015] [Accepted: 10/01/2015] [Indexed: 01/04/2023] Open
Affiliation(s)
- Matthew J. Soeberg
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical School; University of Sydney; New South Wales
- Asbestos Diseases Research Institute; University of Sydney; New South Wales
| | | | | | - Jane M. Young
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, Sydney Medical School; University of Sydney; New South Wales
| | - Nico van Zandwijk
- Asbestos Diseases Research Institute; University of Sydney; New South Wales
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22
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Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region. Cancer Epidemiol 2014; 38:496-503. [DOI: 10.1016/j.canep.2014.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/31/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
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23
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DePew ZS, Verma A, Wigle D, Mullon JJ, Nichols FC, Maldonado F. Nonspecific pleuritis: optimal duration of follow-up. Ann Thorac Surg 2014; 97:1867-71. [PMID: 24681036 DOI: 10.1016/j.athoracsur.2014.01.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nonspecific pleuritis (NSP) is a frequent diagnosis after parietal pleural biopsy, but the clinical significance of this finding and need for further follow-up have not been firmly established. Previous reports suggest that 5% to 25% of patients with NSP are subsequently diagnosed with pleural malignancy. METHODS Our pathology database was queried for patients with histologic evidence of NSP from January 01, 2001, to December 31, 2012 (n = 413). Patients with less than 1 year of follow-up after biopsy, diagnosis of empyema, tuberculous pleuritis, active systemic connective tissue disease or vasculitis, or active malignancy were excluded (n = 327). The remaining patients were included and their medical records were reviewed. RESULTS Eighty-six patients were included. Mean follow up was 1,824 ± 1,032 days (range, 409 to 4,599 days). Three of the 86 patients with NSP (3.5%) were subsequently diagnosed with pleural malignancy. All 3 patients were found to have mesothelioma with a mean time from biopsies to diagnosis of 205 ± 126 days (range, 64 to 306 days). Twenty-two of 86 patients (25.5%) had a possible identifiable cause of pleural inflammation (benign disease). After exclusion of these 22 patients, the incidence of malignancy was 3 of 64 (4.7%). CONCLUSIONS The incidence of subsequent pleural malignancy (mesothelioma) among patients found to have NSP based on pleural biopsy was 3.5%. Occult mesothelioma in patients with NSP will most likely be diagnosed within 1 year of the initial pleural biopsy; therefore, these patients should be followed for a minimum of 1 year to allow for timely detection of occult pleural malignancy.
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Affiliation(s)
- Zachary S DePew
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Akash Verma
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dennis Wigle
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - John J Mullon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Francis C Nichols
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
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24
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Schonfeld SJ, McCormack V, Rutherford MJ, Schüz J. Regional variations in German mesothelioma mortality rates: 2000–2010. Cancer Causes Control 2014; 25:615-24. [DOI: 10.1007/s10552-014-0368-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/14/2014] [Indexed: 02/03/2023]
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25
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Van den Borre L, Deboosere P. Asbestos in Belgium: an underestimated health risk. The evolution of mesothelioma mortality rates (1969-2009). INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2014; 20:134-40. [PMID: 24999848 PMCID: PMC4090878 DOI: 10.1179/2049396714y.0000000058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Although Belgium was once a major international manufacturer of asbestos products, asbestos-related diseases in the country have remained scarcely researched. Objectives: The aim of this study is to provide a descriptive analysis of Belgian mesothelioma mortality rates in order to improve the understanding of asbestos health hazards from an international perspective. Methods: Temporal and geographical analyses were performed on cause-specific mortality data (1969–2009) using quantitative demographic measures. Results were compared to recent findings on global mesothelioma deaths. Results: Belgium has one of the highest mesothelioma mortality rates in the world, following the UK, Australia, and Italy. With a progressive increase of male mesothelioma deaths in the mid-1980s, large differences in mortality rates between sexes are apparent. Mesothelioma deaths are primarily concentrated in geographic areas with proximity to former asbestos industries. Conclusions: Asbestos mortality in Belgium has been underestimated for decades. Our findings suggest that the location of asbestos industries is correlated with rates of mesothelioma, underlining the need to avert future asbestos exposure by thorough screening of potential contaminated sites and by pursuing a global ban on asbestos.
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Affiliation(s)
- Laura Van den Borre
- Interface Demography, Department of Sociology, Vrije Universiteit, Brussels, Belgium
| | - Patrick Deboosere
- Interface Demography, Department of Sociology, Vrije Universiteit, Brussels, Belgium
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26
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Second Italian Consensus Conference on Malignant Pleural Mesothelioma: State of the art and recommendations. Cancer Treat Rev 2013; 39:328-39. [DOI: 10.1016/j.ctrv.2012.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/08/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
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27
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Vogl TJ, Lindemayr S, Naguib NNN, Gurung J, Nour-Eldin NEA, Zangos S, Mbalisike EC. Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma. Radiology 2012; 266:649-56. [PMID: 23151824 DOI: 10.1148/radiol.12111858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate tumor response by means of volumetric assessment, survival, and changes in patient symptoms after the treatment of unresectable and/or recurrent pleural mesothelioma by using regional nonselective transarterial chemoperfusion as a palliative treatment option. MATERIALS AND METHODS This retrospective study was approved by the hospital ethical committee, and all patients signed an informed consent prior to treatment. Thirty-nine patients (mean age, 64.0 years; 10 women and 29 men) with unresectable pleural mesothelioma were treated with repetitive transarterial chemoperfusion between March 2007 and March 2010, with a mean of 2.9 sessions per patient at 4-week intervals. Transarterial chemoperfusion was performed by using mitomycin C, cisplatin, and gemcitabine. Computed tomography findings and patient symptoms were evaluated. Tumor response was evaluated by using Response Evaluation Criteria in Solid Tumors guidelines, and survival was assessed with the Kaplan-Meier method. The change in volume for the partial-response group was tested by using the Wilcoxon signed-rank test. RESULTS In 36% of treated tumors (14 of 39), partial response was achieved, and tumor volume decreased from a mean value ± standard deviation of 839.6 mL ± 590.3 (range, 3.9-1972.2 mL) to 137 mL ± 399.8 (range, 0.88-1131.4; P = .00012). In 49% of tumors (19 of 39), stable disease was noted. In 15% of tumors (six of 39), progressive disease was seen. Mean specific growth rate of the tumor was 0.00158% per day. The mean survival time was 14.2 months (range, 2.1-33.1 months) from the start of treatment. For patients with tumors that responded to treatment, mean survival time was 15 months (range, 4.5-33.1 months). Mean time to disease progression was 2.6 months for all tumors, 1.5 months for stable disease, and 1.3 months for progressive disease. CONCLUSION Transarterial chemoperfusion may have the potential to yield positive results and response in the treatment of recurrent and/or unresectable pleural mesothelioma. © RSNA, 2012.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
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28
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Ameille J. Les différentes pathologies pleuropulmonaires liées à l’amiante : définitions, épidémiologie et évolution. Rev Mal Respir 2012; 29:1035-46. [DOI: 10.1016/j.rmr.2012.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/17/2012] [Indexed: 01/09/2023]
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Park EK, Takahashi K, Jiang Y, Movahed M, Kameda T. Elimination of asbestos use and asbestos-related diseases: an unfinished story. Cancer Sci 2012; 103:1751-5. [PMID: 22726320 PMCID: PMC7659290 DOI: 10.1111/j.1349-7006.2012.02366.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 06/19/2012] [Indexed: 11/27/2022] Open
Abstract
Asbestos is a proven human carcinogen. Asbestos-related diseases (ARDs) typically comprise lung cancer, malignant mesothelioma, asbestosis, pleural plaques, thickening and effusion. International organizations, notably the World Health Organization and the International Labour Organization, have repeatedly declared the need to eliminate ARDs, and have called on countries to stop using asbestos. However, the relevant national-level indicators (e.g., incidence/mortality rates and per capita asbestos use, as well as their interrelationships) indicate that ARDs are increasing and asbestos use is continuing in the world. Lessons learned by industrialized countries in terms of policy and science have led to a growing number of countries adopting bans. In contrast, industrializing countries are faced with a myriad of forces prompting them to continue using asbestos. Full-scale international cooperation will thus be needed, with industrialized countries sharing their experiences and technologies to enable industrializing countries to make smooth transitions to banned states and achieve the goal of eliminating ARDs.
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Affiliation(s)
- Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, Busan, Korea
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Siesling S, van der Zwan JM, Izarzugaza I, Jaal J, Treasure T, Foschi R, Ricardi U, Groen H, Tavilla A, Ardanaz E. Rare thoracic cancers, including peritoneum mesothelioma. Eur J Cancer 2012; 48:949-60. [PMID: 22406029 DOI: 10.1016/j.ejca.2012.02.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/31/2012] [Accepted: 02/13/2012] [Indexed: 01/11/2023]
Abstract
Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.
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Affiliation(s)
- Sabine Siesling
- Department of Registry and Research, Comprehensive Cancer Centre The Netherlands, PO Box 330, 9700 AH Groningen, The Netherlands.
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Burdorf A, Heederik D. Applying quality criteria to exposure in asbestos epidemiology increases the estimated risk. ACTA ACUST UNITED AC 2011; 55:565-8. [PMID: 21742624 DOI: 10.1093/annhyg/mer042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mesothelioma deaths due to environmental exposure to asbestos in The Netherlands led to parliamentary concern that exposure guidelines were not strict enough. The Health Council of the Netherlands was asked for advice. Its report has recently been published. The question of quality of the exposure estimates was studied more systematically than in previous asbestos meta-analyses. Five criteria of quality of exposure information were applied, and cohort studies that failed to meet these were excluded. For lung cancer, this decreased the number of cohorts included from 19 to 3 and increased the risk estimate 3- to 6-fold, with the requirements for good historical data on exposure and job history having the largest effects. It also suggested that the apparent differences in lung cancer potency between amphiboles and chrysotile may be produced by lower quality studies. A similar pattern was seen for mesothelioma. As a result, the Health Council has proposed that the occupational exposure limit be reduced from 10 000 fibres m(-3) (all types) to 250 f m(-3) (amphiboles), 1300 f m(-3) (mixed fibres), and 2000 f m(-3) (chrysotile). The process illustrates the importance of evaluating quality of exposure in epidemiology since poor quality of exposure data will lead to underestimated risk.
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Affiliation(s)
- Alex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.
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Delgermaa V, Takahashi K, Park EK, Le GV, Hara T, Sorahan T. Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ 2011; 89:716-24, 724A-724C. [PMID: 22084509 DOI: 10.2471/blt.11.086678] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 05/17/2011] [Accepted: 05/17/2011] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To carry out a descriptive analysis of mesothelioma deaths reported worldwide between 1994 and 2008. METHODS We extracted data on mesothelioma deaths reported to the World Health Organization mortality database since 1994, when the disease was first recorded. We also sought information from other English-language sources. Crude and age-adjusted mortality rates were calculated and mortality trends were assessed from the annual percentage change in the age-adjusted mortality rate. FINDINGS In total, 92,253 mesothelioma deaths were reported by 83 countries. Crude and age-adjusted mortality rates were 6.2 and 4.9 per million population, respectively. The age-adjusted mortality rate increased by 5.37% per year and consequently more than doubled during the study period. The mean age at death was 70 years and the male-to-female ratio was 3.6:1. The disease distribution by anatomical site was: pleura, 41.3%; peritoneum, 4.5%; pericardium, 0.3%; and unspecified sites, 43.1%. The geographical distribution of deaths was skewed towards high-income countries: the United States of America reported the highest number, while over 50% of all deaths occurred in Europe. In contrast, less than 12% occurred in middle- and low-income countries. The overall trend in the age-adjusted mortality rate was increasing in Europe and Japan but decreasing in the United States. CONCLUSION The number of mesothelioma deaths reported and the number of countries reporting deaths increased during the study period, probably due to better disease recognition and an increase in incidence. The different time trends observed between countries may be an early indication that the disease burden is slowly shifting towards those that have used asbestos more recently.
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Affiliation(s)
- Vanya Delgermaa
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu City, Fukuoka Prefecture 807-8555, Japan
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Baumann F, Maurizot P, Mangeas M, Ambrosi JP, Douwes J, Robineau B. Pleural mesothelioma in New Caledonia: associations with environmental risk factors. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:695-700. [PMID: 21193386 PMCID: PMC3094423 DOI: 10.1289/ehp.1002862] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 12/29/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND High incidences of malignant mesothelioma (MM) have been observed in New Caledonia. Previous work has shown an association between MM and soil containing serpentinite. OBJECTIVES We studied the spatial and temporal variation of MM and its association with environmental factors. METHODS We investigated the 109 MM cases recorded in the Cancer Registry of New Caledonia between 1984 and 2008 and performed spatial, temporal, and space-time cluster analyses. We conducted an ecological analysis involving 100 tribes over a large area including those with the highest incidence rates. Associations with environmental factors were assessed using logistic and Poisson regression analyses. RESULTS The highest incidence was observed in the Houaïlou area with a world age-standardized rate of 128.7 per 100,000 person-years [95% confidence interval (CI), 70.41-137.84]. A significant spatial cluster grouped 18 tribes (31 observed cases vs. 8 expected cases; p = 0.001), but no significant temporal clusters were identified. The ecological analyses identified serpentinite on roads as the greatest environmental risk factor (odds ratio = 495.0; 95% CI, 46.2-4679.7; multivariate incidence rate ratio = 13.0; 95% CI, 10.2-16.6). The risk increased with serpentinite surface, proximity to serpentinite quarries and distance to the peridotite massif. The association with serpentines was stronger than with amphiboles. Living on a slope and close to dense vegetation appeared protective. The use of whitewash, previously suggested to be a risk factor, was not associated with MM incidence. CONCLUSIONS Presence of serpentinite on roads is a major environmental risk factor for mesothelioma in New Caledonia.
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Affiliation(s)
- Francine Baumann
- Université de la Nouvelle-Calédonie, Equipe de Recherche en Informatique et Mathématiques, Noumea, New Caledonia.
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Metz-Flamant C, Samson E, Caër-Lorho S, Acker A, Laurier D. Solid cancer mortality associated with chronic external radiation exposure at the French atomic energy commission and nuclear fuel company. Radiat Res 2011; 176:115-27. [PMID: 21476856 DOI: 10.1667/rr2528.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Studies of nuclear workers make it possible to directly quantify the risks associated with ionizing radiation exposure at low doses and low dose rates. Studies of the CEA (Commissariat à l'Energie Atomique) and AREVA Nuclear Cycle (AREVA NC) cohort, currently the most informative such group in France, describe the long-term risk to nuclear workers associated with external exposure. Our aim is to assess the risk of mortality from solid cancers among CEA and AREVA NC nuclear workers and its association with external radiation exposure. Standardized mortality ratios (SMRs) were calculated and internal Poisson regressions were conducted, controlling for the main confounding factors [sex, attained age, calendar period, company and socioeconomic status (SES)]. During the period 1968-2004, there were 2,035 solid cancers among the 36,769 CEA-AREVA NC workers. Cumulative external radiation exposure was assessed for the period 1950-2004, and the mean cumulative dose was 12.1 mSv. Mortality rates for all causes and all solid cancers were both significantly lower in this cohort than in the general population. A significant excess of deaths from pleural cancer, not associated with cumulative external dose, was observed, probably due to past asbestos exposure. We observed a significant excess of melanoma, also unassociated with dose. Although cumulative external dose was not associated with mortality from all solid cancers, the central estimated excess relative risk (ERR) per Sv of 0.46 for solid cancer mortality was higher than the 0.26 calculated for male Hiroshima and Nagasaki A-bomb survivors 50 years or older and exposed at the age of 30 years or older. The modification of our results after stratification for SES demonstrates the importance of this characteristic in occupational studies, because it makes it possible to take class-based lifestyle differences into account, at least partly. These results show the great potential of a further joint international study of nuclear workers, which should improve knowledge about the risks associated with chronic low doses and provide useful risk estimates for radiation protection.
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Affiliation(s)
- C Metz-Flamant
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), DRPH,SRBE,LEPID, Fontenay-aux-Roses, France.
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Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, de Vuyst P, Dienemann H, Galateau-Salle F, Hennequin C, Hillerdal G, Le Pe'choux C, Mutti L, Pairon JC, Stahel R, van Houtte P, van Meerbeeck J, Waller D, Weder W. [Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 13:C23-45. [PMID: 20976998 PMCID: PMC6134413 DOI: 10.3779/j.issn.1009-3419.2010.10.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
恶性胸膜间皮瘤(malignant pleural mesothelioma, MPM)是一种罕见肿瘤,但发病率正逐渐上升,且预后较差。2008年,欧洲呼吸学会(European Respiratory Society, ERS)和欧洲胸外科医师学会(European Society of Thoracic Surgeons, ESTS)特别工作组召集各方专家计划制定MPM诊治经验及更新指南。 为了使MPM得到及时准确的诊断,专家推荐对患者实施胸腔镜检查,有手术禁忌和胸腔粘连的病例除外。约10%的病例采用标准染色方法无法获得满意的结果。因此我们推荐在胸膜活检的基础上,采用特异性免疫组化标志物。由于目前缺乏一个统一的、切实有效的分期系统,我们推荐应用最新的TNM分期,并且提出三个阶段的治疗前评估。在MPM的治疗中,患者的体力状态评分和组织亚型是目前唯一的、具有重要临床价值的预后因素。在临床试验中,应对其它潜在因素进行初步探讨并予以报道。MPM对化疗高度耐受,仅有少数患者可接受根治性手术。本文对新的治疗方法和策略进行了综述。 目前由于最佳综合治疗的资料有限,适合采用多种方案联合治疗策略的患者应被纳入专业机构的前瞻性试验中。
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Affiliation(s)
- A Scherpereel
- Dept of Pulmonary and Thoracic Oncology,Hospital Calmette CHRU of Lille 59037 Lille Cedex, France.
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Metz-Flamant C, Guseva Canu I, Laurier D. Malignant pleural mesothelioma risk among nuclear workers: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2011; 31:9-23. [PMID: 21346295 DOI: 10.1088/0952-4746/31/1/r01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Exposure to ionising radiation has been suggested as a causal risk factor for malignant pleural mesothelioma (MPM). Studies of patients treated by radiotherapy for primary cancers have suggested that radiation contributes to the development of secondary MPM. Here we examined the risk to nuclear workers of MPM related to exposure to low doses of occupational radiation at low dose rates. All results concerning MPM risk in published studies of nuclear workers were examined for their association with radiation exposure and potential confounders. We found 19 relevant studies. Elevated risks of pleural cancer were reported in most (15/17) of these studies. Eight reported risks higher for radiation monitored workers than for other workers. However, of 12 studies that looked at associations with ionising radiation, only one reported a significant dose-risk association. Asbestos was an important confounder in most studies. We conclude that studies of nuclear workers have not detected an association between ionising radiation exposure and MPM. Further investigations should improve the consideration of asbestos exposure at the same time as they address the risk of MPM related to occupational exposure of nuclear workers to low doses of ionising radiation at low dose rates.
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Affiliation(s)
- C Metz-Flamant
- Laboratory of Epidemiology, Institute of Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
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37
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Ugolini D, Neri M, Casilli C, Ceppi M, Canessa PA, Ivaldi GP, Paganuzzi M, Bonassi S. A bibliometric analysis of scientific production in mesothelioma research. Lung Cancer 2010; 70:129-35. [DOI: 10.1016/j.lungcan.2010.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 12/23/2009] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
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Menvielle G, Soerjomataram I, de Vries E, Engholm G, Barendregt JJ, Coebergh JW, Kunst AE. Scenarios of future lung cancer incidence by educational level: Modelling study in Denmark. Eur J Cancer 2010; 46:2625-32. [DOI: 10.1016/j.ejca.2010.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 06/14/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
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Munkholm-Larsen S, Cao CQ, Yan TD. Malignant peritoneal mesothelioma. World J Gastrointest Surg 2009; 1:38-48. [PMID: 21160794 PMCID: PMC2999110 DOI: 10.4240/wjgs.v1.i1.38] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 07/27/2009] [Accepted: 08/04/2009] [Indexed: 02/06/2023] Open
Abstract
Malignant mesothelioma is a highly aggressive neoplasm. The incidence of malignant mesothelioma is increasing worldwide. Diffuse malignant peritoneal mesothelioma (DMPM) represents one-fourth of all mesotheliomas. Association of asbestos exposure with DMPM has been observed, especially in males. The great majority of patients present with abdominal pain and distension, caused by accumulation of tumors and ascitic fluid. In the past, DMPM was considered a pre-terminal condition; therefore attracted little attention. Patients invariably died from their disease within a year. Recently, several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy. This remarkable improvement in survival has prompted new search into the medical science related to DMPM, a disease previously ignored as uninteresting. This review article focuses on the key advances in the epidemiology, diagnosis, staging, treatments and prognosis of DMPM that have occurred in the past decade.
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Affiliation(s)
- Stine Munkholm-Larsen
- Stine Munkholm-Larsen, Christopher Q Cao, Tristan D Yan, University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney 2050, Australia
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Abstract
The objective of this study was to examine the epidemiological data that confirm the risks of pleural mesothelioma, lung cancer, and other respiratory damage associated with nonoccupational exposure to asbestos, in circumstances where exposure levels are usually lower than those found in the workplace: domestic and paraoccupational exposure to asbestos-containing material among people living with asbestos workers or near asbestos mines and manufacturing plants, environmental exposure from naturally occurring asbestos in soil, and nonoccupational exposure to asbestos-containing material in buildings. Studies concerning natural asbestos in the environment show that the exposure that begins at birth does not seem to affect the duration of the latency period, but the studies do not show whether early exposure increases susceptibility; they do not suggest that susceptibility differs according to sex. Solid evidence shows an increased risk of mesothelioma among people whose exposure comes from a paraoccupational or domestic source. The risk of mesothelioma associated with exposure as result of living near an industrial asbestos source (mines, mills, asbestos processing plants) is clearly confirmed. No solid epidemiological data currently justify any judgment about the health effects associated with passive exposure in buildings containing asbestos. Most of the studies on nonoccupational sources reported mainly amphibole exposure, but it cannot be ruled out that environmental exposure to chrysotile may also cause cancer. Nonoccupational exposure to asbestos may explain approximately 20% of the mesotheliomas in industrialized countries, but it is does not seem possible to estimate the number of lung cancers caused by these circumstances of exposure.
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Affiliation(s)
- Marcel Goldberg
- INSERM Unité 687, Hôpital Paul Brousse, 94807 Villejuif Cedex, France.
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Ahn YS, Kang SK. Asbestos-related occupational cancers compensated under the Industrial Accident Compensation Insurance in Korea. INDUSTRIAL HEALTH 2009; 47:113-122. [PMID: 19367039 DOI: 10.2486/indhealth.47.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Compensation for asbestos-related cancers occurring in occupationally-exposed workers is a global issue; this is also an issue in Korea. To provide basic information regarding compensation for workers exposed to asbestos, 60 cases of asbestos-related occupational lung cancer and mesothelioma that were compensated during 15 yr; from 1993 (the year the first case was compensated) to 2007 by the Korea Labor Welfare Corporation (KLWC) are described. The characteristics of the cases were analyzed using the KLWC electronic data and the epidemiologic investigation data conducted by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety and Health Agency (KOSHA). The KLWC approved compensation for 41 cases of lung cancer and 19 cases of mesothelioma. Males accounted for 91.7% (55 cases) of the approved cases. The most common age group was 50-59 yr (45.0%). The mean duration of asbestos exposure for lung cancer and mesothelioma cases was 19.2 and 16.0 yr, respectively. The mean latency period for lung cancer and mesothelioma cases was 22.1 and 22.6 yr, respectively. The major industries associated with mesothelioma cases were shipbuilding and maintenance (4 cases) and manufacture of asbestos textiles (3 cases). The major industries associated with lung cancer cases were shipbuilding and maintenance (7 cases), construction (6 cases), and manufacture of basic metals (4 cases). The statistics pertaining to asbestos-related occupational cancers in Korea differ from other developed countries in that more cases of mesothelioma were compensated than lung cancer cases. Also, the mean latency period for disease onset was shorter than reported by existing epidemiologic studies; this discrepancy may be related to the short history of occupational asbestos use in Korea. Considering the current Korean use of asbestos, the number of compensated cases in Korea is expected to increase in the future but not as much as developed countries.
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Affiliation(s)
- Yeon-Soon Ahn
- Department of Occupational Medicine, Dongguk University International Hospital, 814 Siksa-dong, Goyang, 410-773, Korea
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Montanaro F, Rosato R, Gangemi M, Roberti S, Ricceri F, Merler E, Gennaro V, Romanelli A, Chellini E, Pascucci C, Musti M, Nicita C, Barbieri PG, Marinaccio A, Magnani C, Mirabelli D. Survival of pleural malignant mesothelioma in Italy: a population-based study. Int J Cancer 2009; 124:201-7. [PMID: 18792097 DOI: 10.1002/ijc.23874] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A median survival time of about 9 months is generally reported among malignant pleural mesothelioma cases. Recently, better results in terms of survival and performance status have been reported in clinical trials that included highly selected patients. We describe the survival of pleural mesothelioma patients and the factors predictive of survival in an unselected, population-based setting. Pleural mesothelioma cases (4,100) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan-Meier) and multivariate (Cox proportional hazards regression) analyses of survival were carried out according to selected individual characteristics, including limited information on treatment in a subset of 578 cases. The median survival time was 9.8 months (95% confidence interval: 9.4-10.1). In multivariate analysis, younger age at diagnosis and epithelioid histotype were associated with significantly reduced hazard ratios. Positive effects of gender (women) and being diagnosed in a hospital with a thoracic surgery unit were of border-line statistical significance. No association with calendar period of diagnosis or asbestos exposure was present. Treatment was not associated with a statistically significant improvement in survival. This is the largest population-based study on survival in patients with pleural mesothelioma to date. Age and morphology were the main prognostic factors. Results regarding the effect of treatment were disappointing but may be useful to assess the future impact, at the population level, of recently introduced therapies.
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Affiliation(s)
- Fabio Montanaro
- Department of Epidemiology and Prevention, Liguria Mesothelioma Registry, National Cancer Research Institute IST, Genoa, Italy
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Nishikawa K, Takahashi K, Karjalainen A, Wen CP, Furuya S, Hoshuyama T, Todoroki M, Kiyomoto Y, Wilson D, Higashi T, Ohtaki M, Pan G, Wagner G. Recent mortality from pleural mesothelioma, historical patterns of asbestos use, and adoption of bans: a global assessment. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1675-80. [PMID: 19079719 PMCID: PMC2599762 DOI: 10.1289/ehp.11272] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 08/14/2008] [Indexed: 05/14/2023]
Abstract
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 R(2) 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.
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Affiliation(s)
- Kunihito Nishikawa
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Ken Takahashi
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | | | - Chi-Pang Wen
- Centre for Health Policy Research and Development, National Health Research Institutes, Taiwan
| | - Sugio Furuya
- Japan Occupational Safety and Health Resource Centre, Tokyo, Japan
| | - Tsutomu Hoshuyama
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Miwako Todoroki
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Yoshifumi Kiyomoto
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Donald Wilson
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Toshiaki Higashi
- Department of Work, Systems, and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Megu Ohtaki
- Department of Environmetrics and Biometrics, Hiroshima University, Hiroshima, Japan
| | - Guowei Pan
- Department of Environmental Epidemiology, Liaoning Provincial Centre for Disease Prevention and Control, Shenyang, People’s Republic of China
| | - Gregory Wagner
- U.S. National Institute for Occupational Safety and Health, Washington, DC, USA
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Linking Expert Judgement and Trends in Occupational Exposure into a Job-Exposure Matrix for Historical Exposure to Asbestos in The Netherlands. ACTA ACUST UNITED AC 2008; 52:397-403. [DOI: 10.1093/annhyg/men030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Larrañaga N, Sarasqueta C, Jesús Michelena M. Incidencia del cáncer en Guipúzcoa (1998-2002) y tendencias desde 1986. GACETA SANITARIA 2008; 22:188-96. [DOI: 10.1157/13123962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lung function predicts survival in a cohort of asbestos cement workers. Int Arch Occup Environ Health 2008; 82:199-207. [PMID: 18408949 DOI: 10.1007/s00420-008-0322-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 03/28/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death. METHODS From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression. RESULTS Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5-1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers. CONCLUSION Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.
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Ferrer J, Martínez C. El diagnóstico de las enfermedades respiratorias causadas por el asbesto. Arch Bronconeumol 2008. [DOI: 10.1157/13119535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ferrer J, Jesús Cruz M. Amianto, factor de riesgo del cáncer de pulmón. Med Clin (Barc) 2008; 130:334-5. [DOI: 10.1157/13117354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Margery J, Ruffié P. [Malignant pleural mesothelioma: interrogations and hopes concerning the expected epidemic]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:354-364. [PMID: 18166941 DOI: 10.1016/s0761-8417(07)78422-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a rare incurable tumor. Interest in MPM has increased in recent years due to a steadily increasing incidence subsequent to the intensive use of asbestosis, the main causal agent, but also due to better awareness in the political and scientific communities faced with a serious public health issue. Our knowledge of MPM has improved regularly in terms of pathologic diagnosis and the mechanisms underlying the mesothelial carcinogenesis. MPM is also the subject of many technological innovations as illustrated by the recent identification of new biological markers, access to metabolic imaging, and clinical research on targeted treatments. Proper management implies the participation of the general population since the implementation of administrative procedures for social indemnities. In 2007, a more aggressive therapeutic approach is becoming common practice with the use of radiotherapy and the emergence of the concept of multimodal care centered on wide pleuropneumonectomy. These advances create real hope for improvement, but also many interrogations since no standard treatment protocol has been clearly identified.
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Affiliation(s)
- J Margery
- Service de Pneumologie, Hôpital d'Instruction des Armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart.
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