Abstract
The incidence of malignant pleural mesothelioma is rising in some European countries; migration trends play a role http://ow.ly/YPRr30hAd3T
To the Editor:
We read with interest the article by Ji et al. [1] regarding the epidemiology of malignant pleural mesothelioma (MPM) in Sweden and familial clustering. The data in the study show the incidence of MPM in Sweden peaked in 2000 and has sharply declined since 2005. Data from other countries suggest a more delayed peak [2–4]. The highest annual incidence of MPM in the world has been reported to occur in the UK and Australia [5]. The incidence of MPM was predicted to peak in UK between 2011 and 2015; this was based on the known associated high latency period and the ban in using asbestos-containing products [6]. This variability in incidence trends across Europe can be explained by the different dates of asbestos bans in Europe, but Ireland migration trends also potentially play a role. Data from our institute indicates that the incidence of malignant mesothelioma has been increasing over the last decade (20 new cases diagnosed in 2002–2008 versus 26 cases in 2009–2013, an increase of 30% (95% CI 11.9–54.2%)). These findings are consistent with the statistics from the National Cancer Registry Ireland (figure 1) [7].
The return to Ireland of retirement-age lower socio-economic classes who have previously worked in asbestos-related industries in the UK seems to be one of the factors contributing to this peak in incidence. The number of Irish returning migrants has nearly tripled in the period 2001–2011 compared to 1981–1990, and just over a half came from the UK [8]. In addition, this has also coincided with improved diagnostic and management strategies, including medical thoracoscopy, which in many institutions fall under the purview of pulmonologists. With the demographic changes associated with free movement across Europe, careful evaluation of the epidemiology of a rare disease such as MPM should be taken beyond simply extrapolating data regarding asbestos imports and ban dates.
Footnotes
Conflict of interest: None declared.
- Received November 18, 2017.
- Accepted November 23, 2017.
- Copyright ©ERS 2018