Epidemiology
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Incidence Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence is approximately one per 1,000,000. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal. |
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States. Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Risk factors
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer, bronchial carcinoma). The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Exposure
Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams.
By contrast, the
British Government's Health and Safety Executive
(HSE) states formally that any threshold for
mesothelioma must be at a very low level and it
is widely agreed that if any such threshold does
exist at all, then it cannot currently be
quantified. For practical purposes, therefore,
HSE does not assume that any such threshold
exists. People who work with asbestos wear
personal protective equipment to lower their
risk of exposure.
Exposure to asbestos fibres has been recognised
as an occupational health hazard since the early
1900s. Several epidemiological studies have
associated exposure to asbestos with the
development of lesions such as asbestos bodies
in the sputum, pleural plaques, diffuse pleural
thickening, asbestosis, carcinoma of the lung
and larynx, gastrointestinal tumours, and
diffuse mesothelioma of the pleura and
peritoneum.
The documented presence of asbestos fibres in
water supplies and food products has fostered
concerns about the possible impact of long-term
and, as yet, unknown exposure of the general
population to these fibres. Although many
authorities consider brief or transient exposure
to asbestos fibres as inconsequential and an
unlikely risk factor, some epidemiologists claim
that there is no risk threshold. Cases of
mesothelioma have been found in people whose
only exposure was breathing the air through
ventilation systems. Other cases had very
minimal (3 months or less) direct exposure.
Commercial asbestos mining at Wittenoom, Western
Australia, occurred between 1945 and 1966. A
cohort study of miners employed at the mine
reported that while no deaths occurred within
the first 10 years after crocidolite exposure,
85 deaths attributable to mesothelioma had
occurred by 1985. By 1994, 539 reported deaths
due to mesothelioma had been reported in Western
Australia.
Family members and others living with asbestos
workers have an increased risk of developing
mesothelioma, and possibly other asbestos
related diseases. This risk may be the result of
exposure to asbestos dust brought home on the
clothing and hair of asbestos workers. To reduce
the chance of exposing family members to
asbestos fibres, asbestos workers are usually
required to shower and change their clothing
before leaving the workplace.
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