Mesothelioma Around the World
More International Studies on Mesothelioma and Asbestos Are Needed
Around the world, one instance mesothelioma goes unreported for every four or five reported cases, according to a study published in the January 6, 2011 issue of in Environmental Health Perspectives. The Japanese researchers who authored this study estimated the global 15-year cumulative mortality from mesothelioma between 1994 to 2008 was 213,200.
They could not provide an exact number because of a lack of data collection and, in some cases, accurate diagnosis makes the actual rate of illness unclear. In an attempt to better understand how mesothelioma may affect less-developed nations without the medical knowledge and/or resources to provide accurate diagnoses and reporting, they analyzed what data they could find to look for trends.
Spurred by a Lack of Information
These scientists began their research because of the gross underreporting of mesothelioma in developing countries, including those with extensive asbestos use. Mesothelioma is considered a public health concern because it is difficult to identify, has a bad prognosis, and is on the rise in multiple countries. What information exists concerning the disease is primarily obtained from developed nations that not only have a known history of asbestos use but also have the resources to diagnose asbestos-related diseases. In many countries where mesothelioma may be more common, the lack of knowledge might prevent patients from receiving a diagnosis and/or treatment.
Few Attempts Have Been Made to Study the Global Problem
One of the rare attempts to analyze the problem was a study titled The global burden of disease due to occupational carcinogens, published in 2005 in the American Journal of Industrial Medicine; this paper estimated the cancer led to 43,000 mesothelioma deaths annually. The researchers based this figure on the approximate number of exposed workers and levels of exposure.
The World Health Organization’s (WHO) study on the elimination of asbestos-related diseases published in 2006 accepted this number. However, as the Japanese researchers noted, “there has been no validation or reassessment of this 2005 estimate, possibly because the indices that were used are difficult to access and reproduce. Commonly available statistics should be used to address the shortage of information, which may also improve estimates of the disease burden (level of disease that exists).”
Japanese Researchers Base Their Work on U.S. Statistics
The Japanese authors gathered data about asbestos use from a report by the U.S. Geological Survey (USGS). They defined a country’s total asbestos use as:
- the amount of asbestos a country produces
- plus asbestos imports
- minus asbestos exports
The USGS has published these numbers by country in 10-year intervals from 1920 to 1970, in 5-year intervals from 1970 to 1995, and annually from 1995 to 2007.
Tabulating the Results
In addition to data from the USGS, the researchers looked to the 89 countries with available information on asbestos use and/or mesothelioma case numbers. These countries represented 82.6 percent of the world population in 2000. Of these countries, 56 had available data for both the number of mesothelioma cases and asbestos use, and 33 had no data on the number of mesothelioma cases, but they did have data for asbestos use.
Here’s what the researchers discovered:
- The total asbestos use during 1920–1970 was 51.2 million metric tons among the 56 countries that had data on both the number of mesothelioma cases and asbestos use, and 14.2 million metric tons in the 33 countries having data on asbestos use only.
- The total asbestos use was 65.4 million metric tons across all 89 countries.
- This volume represented 100 percent of the global asbestos use during 1920–1970.
- Total asbestos use was led by the United States, Russia, the United Kingdom, Germany, and Japan.
- The 56 countries with data about the number of mesothelioma cases reported a cumulative total of 92,133 deaths from 1994–2008.
Though more countries provided mesothelioma death information than not, this study makes it clear there is still a knowledge gap that may be holding researchers back as they examine asbestos use and mesothelioma trends outside of the U.S.
An Australian Study Provides Additional Context
In Western Australia, the prognoses of mesothelioma patients have been slowly but steadily improving over the past 5 decades. The increase in treatment resources and the amount spent to treat patients are among factors that have impacted extended survivability.
In a study titled Predicting Survival for Malignant Mesothelioma, published in European Respiratory Journal, a group of Australian scientists examined records of mesothelioma patients contained in the Western Australia Mesothelioma Registry. They analyzed each patient record up to December 2005 to find data about sex, age, date and method of diagnosis, site of the disease, and whether the patient had epithelial, sarcomatoid, or biphasic mesothelioma.
The Consequences of Australia’s Historic Asbestos Use
Australia has several asbestos deposits scattered throughout the country ranging from the crocidolite mine in Wittenoom in Western Australia to the chrysotile mine in Woodsreef in New South Wales. Perhaps due to this abundance, one in three houses built in Australia before 1982 contains asbestos.
Like other developed nations, Australia began to phase out asbestos when the risks became too big to ignore. The mine in Wittenoom was closed in 1966; the one in Woodsreef followed 17 years later in 1983. The substance was officially banned from the country in 2003. However, because asbestos-related diseases like mesothelioma may have a long latency period, Australia is considered one of the worst countries in the world when it comes to asbestos-related diseases. The rate of illness is expected to peak in 2020. In 2018, over 4,000 Australians died from an asbestos-related disease.
Who Has Been Affected?
Though asbestos miners are an obvious demographic of workers who were exposed to asbestos, tens of thousands more worked in manufacturing jobs that used asbestos. Additionally, construction and maintenance workers likely had regular contact with the substance.
Occupational exposure isn’t the only worry, though. A 2016 survey of Australians found that around half of its respondents, both men and women, reported non-occupational exposure (whether in conjunction with occupational exposure or not). This has remained an issue despite the ban on asbestos.
Wittenoom had an active population until recently when the government succeeded in its years-long attempt to shut down the town. Lorraine Thomas, the town’s councilor and owner of its only shop was quoted in a 2004 The Observer article saying testing of airborne particles in the town has shown that levels of asbestos fiber are about the same there as in most urban areas in Australia. Despite her resistance, the government passed a bill to kick out the town’s remaining residents in 2019. Officials have also had to discourage tourists from visiting the old mine and have posted multiple warnings about the asbestos risk.
Demographic Results of the Study
The majority of asbestos-related deaths in Australia are attributed to patients who suffered occupational exposure to asbestos. When analyzing the data for factors that affected survival, the scientists found:
- The older the patient was at diagnosis, the lower their survival rate.
- Males had a 40 percent lower survival rate than females.
- Patients with peritoneal mesothelioma had a 40 percent lower survival rate.
- Patients with sarcomatoid mesothelioma had a worse prognosis than patients with epithelioid or biphasic mesothelioma.
- Survival improvements began in the 1970s and continued through the most recent records studied. The average post-diagnosis survival time increased approximately 301 days between 1960 and 2005.
- Approximately 4 weeks (28 days) of this increase can be attributed to earlier diagnosis.
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