Letter to the Editor: Largely Unchanged Annual Incidence and Overall Survival of Pleural Mesothelioma in the USA
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LETTER TO THE EDITOR
Letter to the Editor: Largely Unchanged Annual Incidence and Overall Survival of Pleural Mesothelioma in the USA Daniel J. Lauer III1 • Kenneth A. Mundt2 • William J. Thompson2 • Elizabeth A. Best1
Accepted: 21 July 2020 Socie´te´ Internationale de Chirurgie 2020
We read with great interest the analysis of pleural mesothelioma by Keshava et al. [1]. One of the stated objectives of this study was to ‘‘evaluate trends in the incidence of malignant pleural mesothelioma… in the modern era’’ acknowledging the long-standing hypothesis that ‘‘a decrease in peak asbestos exposure after the 1970s would translate into a peak incidence of mesothelioma in the early 2000s followed by a subsequent decline’’ [1]. Using data from the National Cancer Database (NCDB), the investigators estimated the US case counts from 2004 to 2014 (range 1783–2031), concluding that ‘‘the annual incidence of mesothelioma has not declined this century and remains stable,’’ and ‘‘there is little to suggest that the decrease in industrial use [of asbestos] over the past several decades has translated into a decreased incidence of pleural mesothelioma’’ [1]. While this research question is important, the approach and methods employed are not well suited for addressing it. Simply comparing annual case counts in a population that has grown each year from 2004 to 2014 is problematic unless the population remains the same size and maintains the same age distribution. With a growing population, a stable cancer rate would generate larger numbers of cases each year. Furthermore, as with many other cancers, pleural mesothelioma risk increases sharply with age [2]. Since the age-specific population growth over these years disproportionately has been greater among the ‘‘baby boomers’’—entering age categories at which mesothelioma
& Daniel J. Lauer III [email protected]
is greatest—one might expect additional increases in case counts, even if the age-specific rates remain stable. Therefore, without a good understanding of the changes occurring in the base population, case counts will not provide a true representation of the rates at which mesothelioma is occurring in the USA, and may be misleading. The epidemiological literature also demonstrates different trends in mesothelioma incidence rates by sex. Henley et al. [3] reported that during 2003 to 2008, ‘‘the number of cases diagnosed each year remained level, whereas rates decreased among men and were stable among women.’’ Annual age- and sex-specific mesothelioma data from the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program corroborate this. A peak incidence rate in 1992 of 2.48 per 100,000 is seen among men, followed by a consistent decline [4], likely reflecting declining levels of occupational exposure to amphibole asbestos beginning in the 1970’s. Among women, age-adjusted mesothelioma incidence rates have remained stable, likely reflecting background rates of mesothelioma, given a much lower probability of historical occupational a
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