Global burden and future direction of malignant mesothelioma

Malignant mesothelioma is a rare but fatal form of cancer which is difficult to diagnose. It is causally linked to asbestos exposure, i.e., a known asbestos-related disease (ARD), with a latency period of 30-40+ years. The World Health Organization (WHO) has recognized that the burden of ARDs, typically mesothelioma, is rising. However, the global burden of mesothelioma is unclear, and even more so, of its future direction. The WHO mortality database contains data on mesothelioma deaths by country, calendar year and sex and age-groups. Since the introduction of the disease category of “malignant mesothelioma” in 1993 with the 10th revision of the International Classification of Diseases (ICD-10), mesothelioma death figure have become available for analyses. As of January 2011, 83 countries reported 92,000+ mesothelioma deaths, with crude and age-adjusted mortality rates (AAMR) at 6.2 and 4.9 per million population, respectively. The mean age at death was 70 years and the male-to-female ratio was 3.6 to 1. Most importantly, AAMR increased at a rate of 5.4%/year, which should be due to a combination of real increase and improved recognition. We speculate, albeit qualitatively, that this rise will likely continue and even enhance for the immediate decades ahead due to the historical pattern of asbestos use.