Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008
Vanya Delgermaa a, Ken Takahashi a, Eun-Kee Park a, Giang Vinh Le a, Toshiyuki Hara a & Tom Sorahan b
a. 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. b. Institute of Occupational and Environmental Medicine, University of Birmingham, Edgbaston, England.
Correspondence to Ken Takahashi (e-mail: firstname.lastname@example.org).
(Submitted: 30 January 2011 – Revised version received: 17 May 2011 – Accepted: 17 May 2011 – Published online: 13 June 2011.)
Bulletin of the World Health Organization 2011;89:716-724C. doi: 10.2471/BLT.11.086678
Malignant mesothelioma is a rare but fatal form of cancer which is difficult to diagnose. The disease is causally linked to asbestos exposure with an etiological fraction of 80% or more.1,2 It has been reported that the incidence is much higher in men than women.3 The latency period for mesothelioma after initial exposure to asbestos is typically longer than 30 years and the median survival time after diagnosis is 9–12 months.3 The World Health Organization (WHO) has recognized that asbestos is one of the most important occupational carcinogens and that the burden of asbestos-related disease is rising. Consequently, WHO has declared that asbestos-related diseases should be eliminated throughout the world.4
The global mesothelioma burden is unclear. Driscoll et al. estimated that as many as 43 000 people worldwide die from the disease each year.5 It has also been estimated that there are around 10 000 mesothelioma cases annually in Australia, Japan, North America and western Europe combined.1 In addition, Park et al. suggested that one mesothelioma case may be overlooked for every four to five recorded.6 Reports of an increase in the incidence of mesothelioma have been published in a wide range of countries.7–11 However, to date there is no established global baseline that can be used to evaluate trends in disease occurrence.
Since 1994, data on mesothelioma deaths have been included in the WHO mortality database, which records deaths in WHO Member States in each calendar year. Data are specified by disease category, gender and 5-year age intervals and are integrated across countries using a common format.12 Data comparability improved with the introduction of the International Classification of Diseases (ICD),13 though the category “malignant mesothelioma” was included only in 1993 with the 10th revision (ICD-10).14 However, as acknowledged by WHO, accuracy in diagnosing causes of death varies among countries.13 By 30 January 2011, mesothelioma death figures were available for a 15-year period. The aim of this study was to improve the understanding and management of malignant mesothelioma by carrying out a descriptive analysis of global data available on deaths caused by the disease.