Document a4DeJ2ER8LJRwGZOnM0pYz7LN

Segftd J Work Environ Hkalth 1997-23:266--70, w'laaAL MW BE Htorecm comfruw<TTaB mi&com Trends in mesothelioma incidence and occupational mesotheliomas in Finland in 1960--1995 byAmi Karjalainen, MD,1 Eero Pukkala, PhD,* Karin Mattson, MD,1 Lavri Tammilehto, MD,' Harr) l/ainio, MD4 Karjalalnen A. Pukkala E, Mattson K. Tammilehto L, Vainio H. Trends in mesothelioma incidence and occupational mesbtfiijljqinas in Roland in 1960^1 ?|si SS66-^7&:<h: %;* <||;' .;;:.; 0bjMtW8SThe.smdyanaiyzedthe recetUtrendintheircidcnceofTtiesothelioraaLfiTuilandandevaiuatedthe coverages!reporting iv^ife-nslated m^Sothsliom;a.: 'i:-; ~M*'' : a''' :T .,. : ; j . Methods The incidence of mesothelioma in 1960--1995 wus retrieved from the Finnish Cancer Registry, and the! number: of.WbestQsias.ssciatjsci i worterelaied. m?wthelipmas: iwetei takpta= -frewF-ihe Finrijah Register of: Occupational Diseases. Results Hit annual incidence remained relatively stable for Final(.h men. The annual number of eases still increased among men over 65 years of age, butdeefcased slightly arr.cng mcn under 55 years;of age and among; women. About 3S1 annual eases were diagnosed among men and 10--iSanicirig:womeiin tke raid-l:!)90si'nie:re:portmg qf work- retafed mesotheliomas ihvpreVM during die Finnish asbestos program: in V?S7;:-1992. ft tg.93^i995: about- 30 annual cases (ie, about 90% of 611 pleural and 50% of the pentoneal mesoffieliotnas in hitnilwcre repov-ied to be work-related. , Conclusions The increasing trend in the incidence of mesothelioma in Finland has slowed down in the 1990s, and the maximum of asbestos-related cares In the early '2000s will probably be clearly Itas than the 100 annual cases estimated in. the early t990sJfthe deserved wend continues up to 2010, about 40--50 cases among men attd 10"-2Q nmbiig wotiien will then be diagnosed annually. Mogether^iOf-'SOiofth;ese cases: would be related to occupational asbestos exposure. Kay. tflfItlS anlhphyIlite, efirysorilcrocidoiite, incidence,: mesothelioma occupational. :v: -* ;: Mesothelioma is closely related to past exposure teas* bestos, but the etlologic fraction due to asbestos varies between geographic areas. A recent analysis in North America suggested that, for men. 83% of pleural and 58% of peritoneal mesotheliomas and, (or women. 23% of mesotheliomas are: attributable to past exposure to: asbestos (i')i A background incidence of 1--2 cases per million per year without asbestos exposure has been pro posed (2). Generic and exogenous modifiers of the nsbestos-associated risk may exist (3,4). The typical laten cy time, from first exposure to disease is 30----40 years, and the incidence of mesothelioma has rapidly increased during the past few decades in most industrialized coun tries. In some areas the increase seems to have leveledoff m the 1990s (3--S). A mote pessimistic projection has, however, been published for Great Britain (9). In Finland it has been estimated that the: incidence of mese- ihelioma would peak around 20(0 with about 10G annual asbestos-relatedcases in a population of 5: million (10). Asbestos-related diseases have been subject to much public concern, and consequently patients and physi cians are today betteraware of the role of asbestos in the etiology of mesothelioma. Yet, mesothelioma is still un derreported as ran Occupation!: cancer in Sweden and Denmark (t l, 12). In Finland, a nationwide campaign was undertaken to improve the diagnostics of asbestos- related diseases during the asbestos program fn 1987--- 1992(13). :j,;7r:/ ^ ''JfjT -if?- : The objeklves.of:our:study were: to investigate, (i): whether the recent trend in the incidence of mesothelio- 1 Finnish lustitiite of Occupational Health, Helsinki, Finland. 2 Finnish Cancer Registry, Helsinki. Finland. ? HelsinjdUniversity CentrafHoSpital, Helsinki;. Finland- III ' "; 4 jjhterhatjonal; Agency forReseaifoh on Cancer,;[L;,on, Fmnice. . . Sij,: ^: 7 . . : 7J ' Reprint requests.tb: Dr Antti. Kaqalfuhen, Finnish Institute of Occupational Health; Topeliukscnl?a:u 41: A a, FtN-0.0250 Helsinki. Finland. . V rrr.:;.:.' , . I vv'- . : ::M- v 266 K&jalainenafat: ipn in Finland indicates & need to reevaluate previous In addition to the reports forwarded by the labor protec- projections for the early 2QQQ& atld (ii) whether mesothe- don authorities, the Finnish Register of Occupational lioma is still underreported as an occupational cancer in Diseases receives notifications of every new case re- Finland- ported as an occupational disease to the insurance com panies, regardless of the compensation decision. Infoc- ' ... -fefe:;-^1-. '& \IP'III If .;;ma|ionfrom:these2sowrcesiScpmliinedsO:.thkfetiChease. Subjects and methods of permanent work-related disease is recorded only once. The annual number of pleural and peritoneal mesothefiomas reported to'the Finnish Cancer Registry in 1960-- ReSllftS 1995 was calculated for men and women in different age . categories. As the diagnosis of-mesothelioma, is some- . The annual number of mesotheliomas rose steeply in times difficult, the numbers of other primary pleural can- 1975--1990, but it has not, increased in the 1990s (figure cers andtheir histological diagnoses wpie analyzedsepU' 1). So far the highest annual number was recorded it) rately. The numbers of asbestos-aSsociated Work-related 1989, when 57 new cases Were diagnosed (31 for men, mesotheliomas were retrieved from the Finnish Register 26 for women). Formen the annual number of cases rose of Occupational Diseases, The trend in the reporting of from about ? in 1975 to about 30 in 1985 and to about mesothelioma as an occupational disease was analyzed 35 in 1995. For women the annual number of Cases by comparing the annual statistics of the Finnish Regis- increased in 1975--19911, but fell thereafter to about 10. ter of Occupational Diseases and the Finnish Cancer per year, - Registry. The cases were not compared at the individual From 1985--1989 to 1990--1995, the annual number level. As the annua! numbers were low, the 3-year means of mesotheliomas decreased slightly: among: men under are usually given. Age-adjusted incidence rates were ad- 55 years of age but increased clearly among men over justed to the world Staudartipopulaiion. ; Ii Jr' .;/ 'j { 65years of,age (figure 2);: The age-adjusted hicidehce : # All- hospitals,. medical practitioners, :and; institutions;: for men; has remained- relatively .stable since the::mid- witfc hospital beds are obliged to notify the Finnish Can- l9S0s (Figure 3). In 1990--1994 the age-adjusted ihei- per.Registry^ about all; cancer peases that rconie to thfeir ' denes was 10 per million pereon-years for: men and 219 attention. Moreover, the Registry receives information for women. onspecimens with a diagnosis of cancer from pathology The annual number of primary pleural cancers other laboratories and also information oa death; eertiBcajbs. . than mesothelioma teis always been small and did not from Statistics Finland whenever cancer is mentioned. change markedly in 1985--1995. In 1985--1989 there An average of 5: notificati otis per case is received during were about S annua) cases, among men and 4, among the course of the disease. This cancer registration system women, and,' in 1990--1994,9 and 5 annual cases were is virtually complete (14). Reporting of all known or reported, respectively. Most of them were, cases with no suspected occupational diseases to provincial Jabbr pro-: '!| specific histology, but aisp some adenocarcinomas were: tection authorities is compulsory for Finnish physicians. reported for men (table l). . .<... Figure 1. tisE:ofasb*6tos: and th8 annual number oi mesotheliomas (3-year movino averagei in Finland iSBOr^-l 985- . . : - ;1 SciehdJ Work Environ hagltfi 1997, vo<2& no 4 ; 267 itespitolioma tit'Finland 196&-J995 rTnfftf# 2. Annual nuflibets of rpesoBiallomas tn'mah lit Finland by ape gr6U)S fn 13SQ--1995. ' : Flgurf Si.: Age-adjusted Incidence cf : (jftsbtftftlinma In Finland (3iyaar mMinG: average}; " ;l:|: ; ; Table 1. Primary pleural cancers recorded in the Flnnlsft Cancer :fteglstfjl in 199(b-1994. : . .C .. . OlagmislS . wee; -:J N :f:\ :Wbpb s; .:. .:Mesotlllaitis:::!. 1 , : :f;-iAtbtnoMKlnoma::: . SijtiBmoui-cslTcarclnwna:.: : .; Sarediria ; : ..: ^specified scarcinoma. : . Controversial tiJstotouy Unknowntitstdicsy :5V:: ' ;i|F NeinstoSogy . t54 77 51 ;* to S 0 z 1 - f*v 0 2 1 : : ; 0 0 23 1 m i. 1 84 *0 Zi IV 11 IS Toist 200 100 . 69 100 : to increase in the late 1980$ and still increased in the 1990s (table 2}, About 30 annual cases were reported in 1993--lfSS. During the same, period the number Jof" work-related pleural mesotheliomas in men was 90% of ' that; repoitedrid the. Finnish dancer: Registry ;(tahle:;2). The proportion of reported work-related cases was lower ::fpf:pdrItbfte<tf./T^ mesothVlibmasTn.. women. Discossion Only occasional work-related mesotheliomas were notified to the Finnish Register of Occupational Dis eases before the mid-1980s. The number of cases started The steep ihefease: in ifte-: incidence of mesothelioma .seems :to haw slowed ;down in Finland in the T990s. The annual number of cases is still increasing for men } over <5 years' of age, bm ithas not increased forVpahgef 268 Scaad J Wpm Environ Health I997:. vol23, no A T Karjaiairienot at Table 2. MescthBlfoma cases listed tor Tien anti women In the Finnish Cancer Registry and the Finnish Register cl Occupational Diseases Iir;t%84^1Q9Sand tine jiroportion oi wadrKTelatMi castes H ?:i;l: r-' Perisdoftiirie : : ' " .. yierr : " Finnish Cancer; Finnish Replstei :.:Propqrti0n.o1:: ... .. . Recistjy. . of. Occupational; ' .^ortereietsd ; f:": : Olswses - tases:(E ; - Women Rnn'isH Cancer. Finnish Keglstsr proportion ot ... : Bbalstr^ . afOccupactionsif . work-rotated Diseases:;':: ; cases (*/); 1864--fsa6 . :: :: : :Prltprieutn (Nj .:v: 1967-1989 . Pleura (N).... : Peritpheum (N) .'fj l:590hrJ992 ... : Pteui-a (t4): Peritorieiiiti: (N) 1SS3-h895 V: : :P1a.ura(Nf ::: .... : i*:5" Peritonaiiih (N) : ;. .. Wr { 9 Ik m\M 18 -- 81 ' 4;' ^ n -s'- 2B .; V.71 43 :.r . /; 12 . : - AA / ^ ... 45' .. . 36 7 ;:S:S ' . 29 ^^ 16 : . 88 12; r. . /. 8D .6: ' 30 50 26 2 . : -KVAM ' 1 11 :V 6: a .... ". '. .jr 16v" :.i V : men tty women: The low number bf. report wide training and information campaign was undertaken fied pleural malignancies indicates that the findings are ! to ensure systematic exposure assessment In alj suspected not likely due toehangesin diagnostic accuracy. If the cases of; asbestos-felated. respiratory'. cahcers:!(I7.).:..lf trend observed in 1985-^--1995 continues up to 2010, die :etiolo^c:Tf.actiohs proposed by Spirtas 3$ his col , about 40--50 annual mesotheliomas will then be de- leagues (see the Introduction! are applied to the annual . tcctcd among men and 10-^10 among women. Probably ;;i: mesotheliomas recorded in Finland in the 1990s (35 for altogether AO^-SQ of them tyduld be related to occupa- ( men and 10 15;for women), ahout 30 should be work- Fiona) exposure to asbestos. As the increase slowed down : related. This number equals that of reported cases in .. frohi 1975--198$,' it is-possible' that: it twllsioiydowrrrij? 1993--1995 (table 2). Only asmall fraction of the mes : even further. If soothe iaforetnenlioned estimates for the | otheliomas in women is reported to be work-related. future would be reduced. A decreasing trend should ftrst ] This finding is consistent with the: results of a recent' be observed in the birth cohorts Which entered Worklife |: Finnish study (18). Noneofthe.M wbihenwithmesothe-. : 1 when the most Hazardous exposures had already peaked. ! lioma had occupational exposure to asbestos, whereas The annual numbers:fdr:;men under 55 years of age have .:i . 51% ofthe 37 men bad definite orprobable occupational decreased slightly in the 199t)s. This observation isbased, : -jj exposure: . -F'... . . : h however, on a rather small annual number of cases. ' Fy ' The age^adjusted incidence of mesothelioma in men . There ate 2 probable explahations for the apparent :j. in Finland is in die lower range among industrialized . plateamnjg oTthe mesothelioma trend. The steepness of : countries: Tins low incidence is probably partly due to the increase in T975--1985 waspaitly artificial andcaused the 'fact that Fitiland, vvhile' curieritly . a highlyvindtls-. by improvement in (he diagnostics of mesothelioma. The :' trlalized society: was hot :as. industrialtzed .as most other increase in the incidence had probably started already j western societies in the 1950s and 1960s. Abthopbyllite earlier. It is also probable that the occurrence of the most , asbestos was quarried anti widely used Jri Firtland, and hazardous exposures did not increase as much as did the i die mesothelioma risk of anthophylliteasbestos seems to total use of asbestos in the 1960s. Crocidolius spraying f "be relatively low (19). This fact may also have con decreased in Finland in the late 1960s and early 1970s j. tributed ta the. low incidence of mesothelioma in Em and was banned in 1976. Most Of the increase in the use j land. Exposure to croci (Elite during shipyard wolk seems of asbestos in the 1960s concerned asbestos Cement - to be very common ambhg Finnish ntesothdlipma pa products and other chrysotile-coptainihg and less friable j tients, although many patients have had mixed exposure . asbestos products. The mesothelioma risk associated;with to various types of asbestos (20). Genetic: factors also chrysodie asbestos is still controversial, but it is lower | seem to play a role for mesothelioma (3), Becent studies thanthat caused by crocidolite (2,15,16), ; iit the United States and Great Britain found UNA se- . While the increasingl trend::in the total incidence: of j qoences specific fori Simian virus; 40 (SVdD) in the iiia- hiesotheiioiha seem* (0 feayeiloweddowih;, the: Opening j jority of mesothelioma tissue specimens from asbestos- of occupational mesotheliomas clearly improved during j exposed persons, but not in lthe controTsamplCsEi 21).; .the?.national asbestos program in 1987--1992. During J The significance of these fiMings remains to be settled the program a guidebook was published,, ajid a nation-:. ! :Scend J Work Environ Hoa/fi T&97, vo/ 23, no 4 269 MS;SBtiieli<^jKR^ar& i9S0^WS^ ;.: ;:; ; MesotheliomS is Considered to be a good indicator of ; I thstirend of therfeptdeimc;ofa$b^ commonly used estimate for the number of asbestosrelated lung cancers is 2 times the number of asbestos- ! 9. Bate J, Hodgson JT, Matthews EE. Junes JR. Continuing in ' crease in tnesc^theiiptna niprtaiity m hritein. Izitieet 1995;345:. 535--9. 10. Huuskonen MS, Kaqalainen A, Koskiaen K, Tossavaiiten A. . related mesotheliomas.: This estimate would yield about j Ff [D.iagtfdMA nr,dl: sofveilliiice pf::a$btOi-i:elatetl:: diseases!? 60 asbestos'-related lung cttncets in meniandiesi than 10:: Suomep Ltaksril 1993;48:S88--43, ' inWomen aunualfyin fte-.1990s,.while^aboutdOO annua!; I t; And^3son.}B. Tordrt aa^; un^cice^ daises. wfire. reported. in >1 ^3~i;99$C2|).: :7hei::l4|h: jupg::: cancer:mesothe!ioinst ratio in the occupational disease statistics may be partly attributed to the carcinogenic properties of Finnish anthophyffite asbestos 19, 24}. f: fF ;; ^Fr'Fl^ all:I Uvr.Dan# Skov.TjXyhge.E. Und^ndjpOjrting .pf dCcuimticnal' : ;caiieprs in:DeiUnarlt S.gaiidJ Work Environ:Health' 1996^2!: : , -- f;ff'-: f:;;'J.F ; t Trt conclusion the jncreasing; trendii the incideilec of ; : 13- HuusKanen JUS. KoskinenF, T(^vaiec.A::Ktth'aJainn A mesothelioma has slowed in Fmland:.:This development indicates that the numberof asbestos-related mesothelio mas in 2010 will probably be less than the 100 annual cases estimated in the early t99fls. The reporting of oc cupational mesothelioma has reached u Jugh level in the RinnfrJP, RantanejiJ.KnnijhJnidrute of Qccupationalttealth asbestos program 1987--92. Am J bid Med 199528:123-- 42. 14. Teppo:L Pttkkula R, heluonciitM^lSata quality and quality control of apopulatfntt-bnsedlcOTCer registry;: experience in:,:: F F*Maad.ActaOn^ :l990s:;lt will be. an important social:chaQerigs:to.:;maW":; 15. ^ Sjayher: LT; Dankovic DA. Lenicn;.RA.:acup|do>J9l:.<5tpt^: tain this high level of reporting as asbestos-related mes otheliomas will not disappear' for many decades. . s|: sure toehrysotiie asbestos and cancer risk: ..a review', of the v\ j wnpidhold hypothesis. Am jtpiibJiC Health; i996:Sd: 179^-86.: . 161 AVorid Health Orgaflizatiori (WHO!.. Sayironmeptal; health " . critcda on chiyswife asbestos. Geneva:: inteniatlpitai: Prognuh 1 r : on.Chmicnl:;?afety, WHO; In.press. .' J ;l;f .; Acknowledgments i:i7.: Katielsirteti'A, HauskoneaMS, KoskineiiSi K, Kala:: t. Rv TqssiiviUhenA1 Ke.uJikcs)'OyU).ja.f(iesbtei:op.man msunatfi- We thank Professor Lyly Teppo from the Famish Cancer Registry for his valuable comments. . . widdii^npstjikka fCuldewoh for exposure: asslsine.nt and .; evaluation in die,.diagnostics of asbestps-related lung catlcer "^^' imd:is(fMffieljo9ajifiebpijid:;HsnbiJi'In^ittite.of:Gffciip!Bip.iiT ". at Health, 1992- English summary, . IS. Tuoml T, Miiu^tp.tien tyfSi Vinurnq NltTbssav^ncn-Av Ttto- tnUehto L, Mattson K, at &1. Relative risk of tnesatfielionia - I Menaces I " ::: associated with differentlovels ofexposute to asbestos: Scatid: J Work Environ Health 1991,17:404--8, 19. Meunnati LO. Pukkola E, Hskataa M. Cancer incidence 1. Spirts* R, Heinemann EF, Bernstein Lr Beebe M. JSeebn RJ. .: ktndug afithopMhte^bMttB quatry.workera in Finland. Of- .. ' . Staric: Av:et:.al.Flalignwir meiapiheUaritu: attribuioblk risRFf: :; . cupEnvirpn Med l994;51:42:l--5. asbestos exposure. Oecup Environ Med i994;51;804--11. 20. TuotniT.EboMS nnrjetalslh the lungs of tncsOtbeliooia pa- ' 2. McDon^d:JC,McDpnaaAD,piie epideitiiotogy()fntesothe-; tienH; ebmjpiiison between data u SSd, TEM: and personal . :. iiomain histqricalt'ontext; EuriRespirJ l996;.9:1932--42::.. interview information. AmJtbdMcd 1992:21:155--62. 3. Hirvonen A, Sassftoslci ST.Linnainmaa K, Koskinen K, Hus-. 21. v:Garbonp:Mi Rass.HFRiziK.P, MminCtti :MR, t>i .Muzio M, ' : gafVel-Purstairtefi K;. MelttomK, *L ifflotbatwueiSaMit*. : j {erase ahd n-acetyltranifeWeibnotylws pd asbestes-associ- ued putebiiary diMWeR. 3NCU9^^;.1#S3^,:; ,1 . Mew Dfti etj uJ.: Simian vims 46-iii:e:.DNA:seqnen:ces lk ::..iturnanplenraIrnothelioma, G>ncDgeue i994:9:73f--90-::: 22. isiricktet :HD'i Coedett JI; Hetiilag M, TtaVis WD, Vi'>UIams::L 4. . Peppte:C, Jasoni S, Hav&bt :H, Wyiifotd-lbotnosi D. Gfcbs ' AE.jftebkiii CS. et at. Siipian virus 40 and pleural: aiespdreii&-:: AR. . Si mlflu .:virs$40:lafge T antigen (SV40TLAJ) primer : nta: in htiniaiis. Cancer Epidemiol: Biurnarker! Prev 19965: specific DNA tanpUfieainn in human; pleural mesothelioma -: tissue.:Ttot:i996;Sl::jb7f-f: vF . " FF :"V\ '4 473--5. 23. Karjalaihen;AvVasamaM, SaveliiA, Jolanki.Ri'KauppihcfiX 3. Damhuis RAM. Plantcydt HT; Mesothelioma [letted- Lancet F ::AmJB4ttitauifit 1995 {Occuptdbnal efikases :1995ji Helsiitjd: } i995;345'.l2J3--4, Pinoish InsUtule ol Occupational Health, 1996. 6,:::De:VQs Irvine H. Mesothelicnu'Fctterj. Lancet 1993:345: ;: 1233. :;?,j 24. : Kartaluinen A. Aonita 5, Vanhalo E, Vainiu. H. Asbestos : exposure and the risk oflung cancer in a general urban popu- ..': 7. Pyi.ce B. AiuJysisjDf cunciittients in United Slates inestiheli- ialon. Scam) 1 Work EnvironHeaidi 1994^(k243--JO. oma incidence. Am Jf Epidemiol 1997; W5:2J J--5. 8. Anonymous. ASbMipsflinked cancer: rites up less than pre dicted. JNCl 1992^14^60-4. ^Received fee pubiicatl.<Mt::4 Fftbruar)'; 1997 |ff:' %[ ft 270:.:.: Scand J lVoi* EnvironHdSlth 1$$7, vot23- W 4 T