Incidence of mesothelioma In the United States
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 database 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 by case; 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 Price 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 construction during the years 1930–60. In recent years in the United States, the incidence has beenapproximately 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 asbestosvaries 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. Data from the United States Department of Health and Human Services show that states with the highest incidence of mesothelioma are all coastal or Great Lakes States. Florida has displaced New York as the State with the highest number of deaths per year from mesothelioma. In 1996, 78 people died of mesothelioma in Florida. The states with the highest age-adjusted mortality rates were Washington and Oregon, probably due tothe presence of shipyards. The most frequently recorded occupation on death certificates of people with mesothelioma in the United States was homemaker (10.6 per cent of all deaths), followed by managers and administrators, plumbers, pipefitters and steamfitters,production supervisors, labourers, electricians, farmers, carpenters and machinists. The most common industry was construction, followed by ship building and railroads. Other areas with significant mesothelioma incidence were schools and government.
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 database 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 by case; 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 Price 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 construction during the years 1930–60. In recent years in the United States, the incidence has beenapproximately 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 asbestosvaries 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. Data from the United States Department of Health and Human Services show that states with the highest incidence of mesothelioma are all coastal or Great Lakes States. Florida has displaced New York as the State with the highest number of deaths per year from mesothelioma. In 1996, 78 people died of mesothelioma in Florida. The states with the highest age-adjusted mortality rates were Washington and Oregon, probably due tothe presence of shipyards. The most frequently recorded occupation on death certificates of people with mesothelioma in the United States was homemaker (10.6 per cent of all deaths), followed by managers and administrators, plumbers, pipefitters and steamfitters,production supervisors, labourers, electricians, farmers, carpenters and machinists. The most common industry was construction, followed by ship building and railroads. Other areas with significant mesothelioma incidence were schools and government.
