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Colorectal Cancer Survival by Stage

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					                                        Malignant Pleural Mesothelioma
                                        NCIN Data Briefing
                                                                                                                                                                                                                      KEY MESSAGES:
                                Background                                                                                                                                                                            In the UK mesothelioma is five
                                Pleural mesothelioma is a malignant tumour of the membrane surrounding                                                                                                                times more common in men than in
                                the lung. The majority of pleural mesothelioma are caused by asbestos                                                                                                                 women. The incidence of meso-
                                exposure. Its incidence is increasing even though asbestos is no longer used                                                                                                          thelioma is still increasing, and is
                                in the UK. This is a result of the long latency period (~40yrs) between                                                                                                               expected to peak in about 15
                                exposure and diagnosis. Occupational exposure to asbestos fibres most                                                                                                                 years.
                                commonly occurred in the past in mining, shipbuilding, manufacture of
                                asbestos textiles and cement, plumbing, insulation & building industries,                                                                                                             Survival from mesothelioma is
                                peaked in the 1960s and 1970s.                                                                                                                                                        improving but remains very low and
                                                                                                                                                                                                                      varies by area of diagnosis.
                                Figure 1: One-year relative survival                                                         Figure 3: Age-standardised rates
                                of mesothelioma patients, England,                                                           (per 100,000 European standard
                                2002-2006, by sex and cancer                                                                 population) of mesothelioma,
                                network.                                                                                     England, 2002-2006, by sex and
                                                                                                                             cancer network.                                                                      Survival
                                            Cancer networks                                                                               Cancer networks
                                                                    3 Counties                                                                                   3 Counties
                                                                                                                                                                                                                  Women have a higher relative survival
                                                                        Anglia                                                                                        Anglia                                      than men (Fig. 1). The highest relative
                                                                        Arden                                                                                         Arden
                                                  Avon, Somerset and Wiltshire                                                                  Avon, Somerset and Wiltshire                                      one-year survival in women observed
                                                           Central South Coast
                                                                        Dorset
                                                                                                                                                        Central South Coast
                                                                                                                                                                     Dorset
                                                                                                                                                                                                                  was in Humber & Yorkshire Coast
                                                                 East Midlands
                                                                        Essex
                                                                                                                                                              East Midlands
                                                                                                                                                                      Essex
                                                                                                                                                                                                                  cancer network (CN) (69.6%) and the
                                               Greater Manchester and Cheshire                                                              Greater Manchester and Cheshire                                       lowest in Avon, Somerset & Wiltshire
                                                              Greater Midlands                                                                             Greater Midlands
                                                   Humber and Yorkshire Coast                                                                    Humber and Yorkshire Coast                                       CN (23.5%). The highest relative
                                                             Kent and Medway                                                                               Kent and Medway
                                                 Lancashire and South Cumbria                                                                  Lancashire and South Cumbria
                                                                                                                                                                                                                  survival in men was in Pan
                                                      Merseyside and Cheshire
                                                                 Mount Vernon
                                                                                                                                                    Merseyside and Cheshire
                                                                                                                                                              Mount Vernon
                                                                                                                                                                                                                  Birmingham CN (39.2%) and the
                                                            North East London                                                                             North East London                                       lowest was in Avon, Somerset &
                                                                 North London                                                                                  North London
                                                                   North Trent                                                                                   North Trent                                      Wilshire CN (26.6%). We observed an
                                                              North of England                                                                              North of England
                                                              Pan Birmingham                                                                                Pan Birmingham                                        increase in relative survival with time
                                                                     Peninsula
                                                            South East London
                                                                                                                                                                  Peninsula
                                                                                                                                                          South East London
                                                                                                                                                                                                                  (Fig. 2 and Table 1).
                                                           South West London                                                                             South West London
                                            Surrey, West Sussex and Hampshire
                                                                       Sussex
                                                                                                                                          Surrey, West Sussex and Hampshire
                                                                                                                                                                     Sussex
                                                                                                                                                                                                                  Incidence
                                                                Thames Valley                                                                                 Thames Valley
                                                                 West London                                                                                   West London                                        Men have higher age-standardised
                                                                     Yorkshire

                                                                                                                                   Male       Female
                                                                                                                                                                   Yorkshire
                                                                                                                                                                                                                  incidence rate (per 100,000 European
www.ncin.org.uk/databriefings




                                   Male         Female
                                                                                 0      20      40     60     80                                                               0       2     4     6   8          standard population) ( ASR (E) ) of
                                                                                        Relative survival (%)                                                                               ASR(E)
                                                                                                                                                                                                                  mesothelioma than women. The
                                Figure 2: One-year relative survival                                                         Figure 4: Age-standardised rates                                                     highest incidence rate was among
                                of mesothelioma patient, England,                                                            (per 100,000 European standard                                                       men living in Central South Coast CN
                                1987-2006, by sex and period.                                                                population)  of   mesothelioma,                                                      (7.7 (ASR (E)) (Fig. 3). Looking at the
                                                                                                                             England, 1987-2006, by sex and                                                       incidence by period from 1987 to
                                                                                                                             period.                                                                              2006,    we     observed     a    more
                                   40                                                                                          6                                                                                  pronounced increase in men than in
                                                                                                                                                                                                                  women (Fig. 4).
                                   30
                                                                                                                               4
                                                                                                                                                                                                                  In the cohort dimension, incidence
                                                                                                                                                                                                                  rates     increased in   successive
                                                                                                                   ASR (E)




                                   20
                                                                                                                                                                                                                  generations up to the 1945 cohort,
                                   10
                                                                                                                               2
                                                                                                                                                                                                                  where the estimated incidence rate
                                                                                                                                                                                                                  was 9.5 in males and 1.9 in females
                                   0                                                                                           0                                                                                  (Fig. 5).
                                        1990                     1995                   2000                   2005                1989                   1994                    1999                     2004
                                                                Period (mid-year of group)                                                                 Period (mid-year of group)
                                                                      Male           Female                                                                        Male            Female




                                We predict that the incidence rate in men will increase until about 2022, and that the rate will decrease during the
                                2020s, 2030s and 2040s (Fig. 6). Among women we predict that the incidence rate will increase gradually until
                                reaching a maximum in 2027 and then to remain relatively stable thereafter.

                                        D                                                                                                                                                                          was 9.5 in males and 1.9 in females
                                                                                                                                                                                                                  (Fig. 5).          October 2010
                                Table 1: One-year relative survival (%) of mesothelioma male and female patients in
                                England, from 1987 to 2006.
                                                               Male                                                                Female
                                Period        No. cohort    Cumulative       Relative                  No. cohort               Cumulative                      Relative
                                                              deaths       survival (%)                                           deaths                      survival (%)
                                1987-1991        3145             2391               24.9                    611                       430                           30.4
                                1992-1996        4348             3212               27.2                    769                       550                           29.4
                                1997-2001        5962             4260               29.8                   1129                       761                           33.7
                                2002-2006        7011             4761               33.7                   1447                       895                           39.6
                                Methods
                                                                                          Figure 5: Age-standardised rates (per 100,000 European standard
                                We extracted data on patients diagnosed with              population) of mesothelioma, South East England, 1875-1965, by
                                mesothelioma (ICD-10 C45) living in England               sex and cohort of birth.
                                between 2002 and 2006 from the National
                                Cancer Information Service (NCIS). We                       10
                                                                                                     Male      Female

                                extracted ASR (E) and one-year relative                      9
                                survival (%) in cancer networks, by sex. We                  8

                                displayed these rates and proportions in bar                 7

                                charts.                                                      6
                                                                                 ASR(E)




                                                                                             5
                                We also analysed ASR (E) and one-year                        4
                                relative survival (%) on patients diagnosed                  3
                                between 1987 and 2006 in which we                            2

                                combined single years of diagnosis into five-                1

                                year periods. These periods were represented                 0
                                                                                                 1875 1880 1885 1890 1895 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965
                                by their mid-points.                                                                                      Cohort of birth (mid-year of group)

                                We also extracted data on patients diagnosed
                                between 1960 and 2007 from the Thames
                                Cancer Registry. A Poisson regression age-
                                cohort model was used to estimate the age                 Figure 6: Observed (thick lines) and predicted (dashed lines) age-
                                specific rates in the cohort dimension and                standardised rates (per 100,000 European standard population) of
                                Possion regression age-period model was                   mesothelioma, South East England, 1947-2057, by sex and period.
                                used to estimate the age-specific rates in past
                                and future periods. These rates were then                           Observed      Projected
                                used to obtain ASR (E) for each of the birth                10
                                                                                                     Male          Male
                                                                                            9        Female        Female
                                cohorts and for each period of diagnosis.                   8
                                                                                            7

                                Summary                                                     6
                                                                                 ASR(E)




                                                                                            5
                                                                                            4
                                There is significant variation in mesothelioma
                                                                                            3
www.ncin.org.uk/databriefings




                                survival rates across England, but there has                2
                                                                                            1
                                been an important increase in relative survival             0
                                rate over the study period. The most likely                      1947 1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007 2012 2017 2022 2027 2032 2037 2042 2047 2052 2057
                                explanation for this improvement would seem                                                                   Period (mid-year of group)

                                to be lead time and earlier diagnosis, though
                                this is worthy of further investigation.
                                          FIND OUT MORE:
                                          Thames Cancer Registry
                                          Thames Cancer Registry is the lead Cancer Registry for lung cancer and mesothelioma
                                          http://www.tcr.org.uk
                                          Other useful resources within the NCIN partnership:
                                          Cancer Research UK CancerStats – Key facts and detailed statistics for health professionals
                                          http://info.cancerresearchuk.org/cancerstats/

                                          The NCIN is a UK-wide initiative, working closely with cancer services in England, Scotland,
                                          Wales and Northern Ireland, and the National Cancer Research Institute (NCRI), to drive
                                          improvements in standards of cancer care and clinical outcomes by improving and using the
                                          information it collects for analysis, publication and research. In England, the NCIN is part of the
                                          National Cancer Programme.

                                      D
                                                                                                                                                                                      October 2010