Global Magnitude of Unreported Mesothelioma

Case reports of mesothelioma and other asbestos-related diseases are readily available in the United States through the data of government organizations such as the Center for Disease Control and the National Cancer Institute. The documentation of naturally occurring asbestos as well as products and materials that potentially contain asbestos is on-going and reported to the public in detail. This is the case for many western countries that have successfully banned the mining and manufacturing of asbestos because of its severely harmful health effects. Despite the carcinogenic nature of asbestos, many developing countries still use the mineral because of its low cost, durability, and array of possible applications. There are an astounding amount of countries that do not report mesothelioma diagnoses or mortality rates.

A recent study by Environmental Health Perspectives (EHP) attempts to tackle this issue head-on, calculating the estimated extent of mesothelioma worldwide with both reported and unreported cases. Mesothelioma attorneys at Pintas & Mullins Law Firm emphasize the importance of obtaining correct documentation for this cancer to aid in the development of better detection methods, treatments options, and ultimately, a cure.

Cases of malignant mesothelioma are on the increase, and present a major global health concern. Few attempts have been made to quantify the global incidence of mesothelioma. One study of the total burden of occupational carcinogens reported 43,000 mesothelioma deaths/year, based on an estimated proportion of exposed workers and levels of exposure, combined with absolute risk measures. This number, endorsed by the World Health Organization (WHO), is widely quoted to guide preventive activities. However, there has been no validation or reassessment of this 2005 estimate, possibly because the indices that were used are difficult to access and reproduce.

In the EHP study, they employed cumulative indicators of asbestos use and number of mesothelioma cases, hypothesizing that recent national burden of mesothelioma is a consequence of historical cumulative use of asbestos. This relationship was then applied to countries that lack relevant health data. The cumulative numbers of all types of mesothelioma were obtained from the WHO Mortality Database and tallied by country.
Globally, 89 countries had available information on frequency of mesothelioma and/or use of asbestos at the national level. These countries represented 82.6% of the global population in the year 2000. Of these countries, 56 had data for both mesothelioma frequency and asbestos use, and 33 had no mesothelioma frequency data but had data for asbestos use.

It is unlikely that mesothelioma is absent in countries that have used asbestos but do not report mesothelioma frequency. Based on available data of 56 countries, we observed that recent cumulative mortality of mesothelioma is closely related to historical cumulative use of asbestos. Further extrapolation of this relation to the 33 countries with no available data for mesothelioma suggested that one mesothelioma case is unreported for every four to five cases reported worldwide (38,900 unreported vs. 174,300 reported).

Accounting for the reported and unreported numbers, we estimated the global burden of mesothelioma to be 213,200 (15-year cumulative mortality during 1994-2008). This is equivalent to an annual average of approximately 14,200 cases. These estimates are larger than the estimated 10,000 mesothelioma deaths proposed by consensus for only the developed regions in the world. There are, however, obvious limitations in the methods in the present study, as well as potential sources of errors in the information applied.

It is plausible that unreported cases are substantial in countries with high cumulative use of asbestos, including asbestos-producing countries such as Russia, Kazakhstan, China, and India. Underdiagnosis and/or underreporting may have occurred in these countries because of lack of awareness, knowledge, and resources. It is also possible that, even if mesothelioma cases are diagnosed domestically, frequency numbers are not actively disclosed to the international community because of the increasing number of countries adopting bans on asbestos use on grounds of public health. Some countries with vested interest in maintaining the production and trade of asbestos may be poorly motivated to acknowledge related diseases. For example, Russia is known for not recognizing asbestosis.

Developed countries should share experience and technology to enable developing countries to promote accurate diagnosis, reporting, and management of asbestos-related diseases, including mesothelioma. Moreover, political will is essential to ensure that asbestos use ceases globally. Mesothelioma lawyers at Pintas & Mullins Law Firm highlight the immediate risk to public health caused by global asbestos consumption. If you were exposed to the toxic mineral and consequently developed an illness, contact an asbestos attorney immediately to discuss your legal claim.