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The North American Experience with Malignant Mesothelioma


In 1890 Biggs reported a case of ‘endothelioma’ of the pleura. This report may have been the first recognised case of malignant mesothelioma in North America. Since then the incidence of mesothelioma in North America and the world has steadily climbed.
Studies of the incidence of mesothelioma in North America have been hampered by a paucity of data. Before 1988, the United States did not even have a specific code for mesothelioma, so many cases were misclassified on death certificates as lung cancers or abdominal cancers. In the United States, the best estimates of mesothelioma incidence are derived from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute.

The SEER database2 includes about 9.5 per cent of the United States population. It covers 10 regional areas, in five states (Connecticut, Iowa, New Mexico, Utah and Hawaii), and five major urban areas – San Francisco–Oakland, New Orleans, Seattle, Atlanta, and Detroit. Although the SEER regions are reasonably representative of the United States population in terms of demographic and epidemiological factors, the programme may not accurately reflect the country as a whole. It includes some shipbuilding areas, but large urban areas where asbestos was used in manufacturing and construction are underrepresented. The database is organised bycase; each case is identified by age, sex, race, date of diagnosis and cancer type. The data for mesothelioma are published only intermittently. However, this database provides the most comprehensive national incidence data available for this disease.

In 1997 Price3 analysed the SEER data for mesothelioma. He divided the data into five-year age groups in each diagnosis year. He found a consistently higher rate of mesothelioma in men than in women. The rate for women remained relatively constant over the years. On the other hand, the rate for men increased until 1992, when it peaked at 1.9 per 100 000 people. Since then the incidence rate in men has been slowly decreasing.

This trend is presumably due to occupational asbestos exposure, which was highest during the years 1930–60. The highest lifetime risk was for the 1925–30 birth cohort – a group that would have been at work in shipyards, manufacturing and construc- tion during the years 1930–60. In recent years in the United States, the incidence has been approximately 2000–3000 cases per year, or 11.4 cases per million men and 2.8 cases per million women.

The mortality rate in people with prolonged heavy exposure to asbestos varies from 2 to 10 per cent in different studies, and the latency period between initial exposure and manifestation of disease is usually 20–50 years. From 1987 to 1996 an average of 520 people died per year in the United States of malignant mesothelioma.
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