RR876 - Mesothelioma mortality in Great Britain: The revised risk and two-stage clonal expansion models

Asbestos is a known carcinogen that is the cause of the majority of mesothelioma cases worldwide. Various models have been used to describe the increase and likely future pattern of mesothelioma rates seen in many western countries - a legacy of past heavy industrial asbestos use. Following on from previous work (Tan and Warren, 2009), we analysed female mesothelioma mortality using the same risk model that was assumed for males. We also analysed mesothelioma mortality in males in Great Britain using two alternative risk models; the first is based on asbestos import data where the population is categorised into low and high exposure groups, with the calculation of risk based on the cumulative lung burden of the individual; the second is a two-stage clonal expansion model (TSCE), a biologically-based carcinogenesis model that assumes that the development of a malignant cell is the result of two critical and irreversible events, with asbestos lung burden as the measure of dose that enters the dose-response component of the TSCE model. We use Markov Chain Monte Carlo within a Bayesian framework to fit the models presented in this report.

Though considerably uncertain, peak mortality in females is predicted to occur over a decade later than in males, but with a substantially lower annual number of deaths. The updated models provide a reasonable basis for making relatively short-term projections of mesothelioma mortality in Britain. However, longer-term predictions comprise additional uncertainty not captured within the prediction intervals for the annual mortality rates. Taking this into account, 2100 deaths in 2016 represents our current best estimate of the upper limit for the male projections.

This report and the work it describes were funded by the Health and Safety Executive (HSE). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

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Updated 2021-04-23