Malignant pleural mesothelioma: incidence, etiology, diagnosis, treatment, and occupational health

Abstract

Background: The incidence of malignant mesothelioma in Germany is about 20 cases per million persons per year. Its association with asbestos exposure, usually occupational, has been unequivocally demonstrated. Even though the industrial use of asbestos was forbidden many years ago, new cases of mesothelioma continue to appear because of the long latency of the disease (median, 50 years). Its diagnosis and treatment still present a major challenge for ambulatory and in-hospital care and will do so for years to come.

Methods: This article is based on a selective review of the literature, along with data from the German Mesothelioma Register.

Results: 1397 people died of mesothelioma in Germany in 2010. A plateau in the incidence of the disease is predicted between 2015 and 2030. Most mesotheliomas arise from the pleura. The histological subtype and the Karnofsky score are the main prognostic factors. Only limited data are now available to guide treatment with a combination of the available methods (chemotherapy, surgery, radiotherapy). The prognosis is still poor, with a median survival time of only 12 months. Symptom control and the preservation of the patient's quality of life are the main aspects of care for patients with mesothelioma.

Conclusion: The incidence of mesothelioma is not expected to drop in the next few years. The available treatments are chemotherapy, surgery, and radiotherapy. Specialized treatment centers now increasingly provide multimodal therapy for treatment of mesothelioma.

Figure

New cases of mesothelioma classified as occupational disease according to No. 4105 of the Regulation Concerning Occupational Diseases (Berufskrankheitenverordnung, BKV). Source: German Social Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV)