Prediction of Mesothelioma Incidence from Asbestos

Consumption, A Comparative Study

Domyung PaekSeoul National University

Korean Situation

• Asbestos industry started operation from 1960’s.

• Yet mesothelioma incidence stays low around 1-2/million, with male to female ratio of 1.6.

• Concerns over what to expect (any increase?), where to expect (asbestos industry locations?) and whom to expect (any specific job or task?)

Asbestos Mining and Import, Korea

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

0

20000

40000

60000

80000

100000

120000

Mining Import

Phases of Change

EXPANSIOEXPANSIONN

FALLFALLPLATEAPLATEAUU

Industrial Industrial Safety and Safety and Health Act of Health Act of Korea, 1981Korea, 1981

First First Mesothelioma Mesothelioma Case in Korea, Case in Korea, 19941994

0

1

2

3

4

5

6

7

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Asbestos- related Cancers in Korea

Lung Cancer, Comp Lung Cancer, Not-CompMesothelioma, Comp Mesothelioma, Not-Comp

Korean Situation

• However, with very scanty data about mesothelioma incidence, future prediction is in murky state.

• Need to predict future scenarios based on inter-country comparative study.

Asbestos and Mesothelioma

• Usually studied in occupational settings, especially of mining and manufacturing sectors.

• However, much bigger problems are found in end-user industries such as construction and ship-building

• Per-capita consumption of asbestos can be a fair indicator of asbestos exposure extent in end-user industries

Asbestos and Mesothelioma

• The relationship can be studies in two directions– Spatial variation• Between jobs or departments• Between companies or industries• Between different countries

– Temporal variation• Between different periods • Between countries of different phases

Asbestos and Mesothelioma

• An example of spatial variation study– Per-capita asbestos consumption versus

mesothelioma incidence of different countries

Ecological association between asbestos-related diseasesand historical asbestos consumption: an international

analysisRo-Ting Lin, Ken Takahashi, Antti Karjalainen, Tsutomu Hoshuyama, Donald Wilson, Takashi

Kameda, Chang-Chuan Chan, Chi-Pang Wen, Sugio Furuya, Toshiaki Higashi, Lung-Chang Chien, Megu Ohtaki

Lancet 2007; 369: 844–49

Asbestos and Mesothelioma

• How about temporal variation study?

• Usually future predictions based on age-cohort models without asbestos inputs

• As yet, no relationship study between changes of asbestos consumption and mesothelioma incidence

Temporal Variation Study

• Analysis of cumulative per-capita asbestos exposure over certain age period versus mesothelioma incidence after certain age of a given birth cohort– When and how long is the best age period

of asbestos exposure to explain the changing mesothelioma incidence of different birth cohorts?

– How strong is the dose-response of mesothelioma incidence for a given cumulative asbestos exposure?

Temporal Variation Study

• Studies from Japan and Netherlands

Temporal Variation Study

• Per-capita asbestos consumption– Imported asbestos/population size

• Mesothelioma incidence risk of different birth cohorts of 5-10 year periods from 1910-1960– Age/period/cohort model analysis of

mesothelioma incidence data of each country

Analysis

• Mesothelioma rate ratio for a specific cohort was calculated based on age-sex specific mesothelioma mortality in certain period, i.e. age-cohort.

• Exposure during specific age (period) based on per-capita asbestos consumption was regressed against mesothelioma rate ratio.

RR(cohort I) =

∑ ( Per-capita asbestos consumption(i period)

* (40- age(i period))2 )

Analysis of exposure age period

• Period of from 15 – 25 years old

Analysis of temporal change

• Exposures of relatively young age period (15-25 years old) showed the best fit of the data

• After the exposure, takes about 30 years to show the elevation of the risk

• After the exposure, takes about 50 years to reach the peak of the risk

Prediction of PeakSpurt of asbestos industry

Peak of asbestos industry

Spurt of meso incidence

Ban of asbestos use

Peak of meso incidence

Netherlan

ds

1950’s

1965’ 1990’ 1991 2017

Japan 1960’s

1975’ 2000’ 2005 2030

Korea 1970’s

1990’ 2010’ 2009 2045(?)