Mesothelioma Lawsuit: In Canada several large epidemiological studies have provided data for estimates of the incidence of mesothelioma. Morrison and colleagues in 1984® looked at all cases of pleural mesothelioma diagnosed in British Columbia from 1973 through 1980 and reported to the National Cancer Incidence Reporting System (NCIRS) of Statistics Canada. They identified 64 cases (54 men and 10 women). Almost all cases were clustered in Cowichan Valley, Capital and Greater Vancouver counties. They noted an overall increasing incidence with age. Among men, but not women, they found an increasing incidencc over time, and correlated this with a relatively high level of shipbuilding and ship repair activity in Vancouver and Victoria thirty to forty years before the study. Similar increased rates of mesothelioma have been observed in shipbuilding centers in the United States and Great Britain. The authors also compared the incidence of mesothelioma obtained from NCIRS data to that obtained by looking at death records. They found that only 60 percent of the cases were identified by looking at mortality data – so death records are therefore a poor substitute for incidence records, since mesothelioma is often not recorded as the cause of death.
In 1985 Churg and colleagues surveyed all pathologists in British Columbia, in an attempt to identify all cases of mesothelioma diagnosed in 1982. Occupational histories were obtained when possible, the pathology slides were reviewed, and when tissue was available the lung was analysed for asbestos content. They identified 19 cases (17 men and 2 women) of confirmed mesothelioma; obtained occupational histories for 16, and analysed lung tissue fibre content in 7. The calculated incidence per year based on their data was 17 cases per million men and 1.9 cases per million women over age 15. Compared with data from 1966-1975, this was a marked increase in the incidence rate for men, but no obvious increase for women — similar to the observations by Price in the United States. Fourteen of fifteen men had a history of occupational asbestos exposure, mostly in shipyards, or in construction or insulation work. In the six men whose lung tissue was analysed, the pulmonary content of chrysotile asbestos was within the range of the general population, but the values for amosite and crocidolite were elevated on average 300-fold compared to a reference population. No commercial amphibole was found in the lungs of the one woman analysed. They concluded that the cases in women may not have been associated with asbestos, and may represent the background nonasbestos associated mesothelioma rate in the general population.
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Since the end of 1967, all pathologists in Canada (over 400) have been surveyed periodically to identify all cases of fatal mesothelioma diagnosed at autopsy or biopsy. In 1972 the survey was extended for one year to all pathologists (almost 7000) throughout the United States.8 On each occasion, nearly all responded. The investigators visited the pathologists and collected material for panel review. They selected a control from the same pathology file with metastatic lung disease from a primary tumor outside the chest, matched for date, sex and age. They also interviewed relatives to obtain detailed residential and occupation histories. As of 1972, there were 344 male cases of mesothelioma; 188 cases compared with 78 controls Tell into one of five defined exposure groups. Insulation work showed the highest relative risk at 46.1. Asbestos production and manufacture was next at 6.1. Occupational exposure to asbestos was recorded in only two of 162 female cases, and in no controls. In eight cases and two controls, exposure had been in the home, likely from the clothing of an asbestos worker.
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However, the issue was far from settled. In a national survey of mesothelioma in Canada from I960 to 1968, McDonald and colleagues11 found a history of asbestos contact in a relatively small proportion of cases – mostly in insulation and allied trades rather than in the asbestos-producing industry. They surveyed pathologists across the country to find all cases of mesothelioma after 1959. They found 165 cases (111 pleural, 47 peritoneal, 3 both and 4 pericardial). Updates in subsequent years showed a slightly increased association with asbestos exposure, but still lower than expected. When pathologists reviewed the cases12 the diagnosis was confirmed in only about 50 per cent or the cases, among whom the incidence of asbestos exposure was also higher. A follow-up analysis added a chrysotile mining industry cohort and two small groups of employees in gas mask factories to the survey data. They found 254 fatal cases of mesothelioma (181 men, 73 women) in Quebec from 1960 to 1978. They were able to obtain occupational and residential histories for the majority, and found that only about 40 per cent of the male cases and 5.4 per cent of the female cases were attributable to occupational asbestos exposure (asbestos manufacture, production, insulation, heating trades, shipyards, and construction). Six people probably had household exposure. The intervals between first employment and death from mesothelioma were longer for miners and millers than for manufacturing workers. All the miners and millers had pleural mesothelioma, while the factor)’ workers included 8 with peritoneal mesothelioma. The incidence did not clearly increase over this time period.
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