There has been recent, and increasing, interest in the human health effects of occupational and non-occupational exposure to airborne asbestos fibres, including the potential risk of malignant mesothelioma occurrence in New Zealand and Australia.1,2 Despite New Zealand and Australia having among the highest age-standardised incidence rates globally, there are few contemporary reports comparing malignant mesothelioma in New Zealand and Australia with data from other countries. For example, the most recent published literature on the epidemiology of malignant mesothelioma in New Zealand was published in 2004.3High-quality global cancer incidence rate data published in 2013 by the International Agency for Research Cancer (IARC)4 can help determine where New Zealand and Australia are placed in terms of the global incidence of malignant mesothelioma. The IARC global cancer incidence data are reported as male and female populations separately. For the purpose of this short communication, we have focused on male age-standardised malignant mesothelioma incidence rates, as men are the population group most affected by malignant mesothelioma due to the primary mode of asbestos exposure being in occupational settings. However, non-occupational asbestos exposures for both men and women are of increasing concern, particularly in Australia.5,6MethodsWe extracted data from the 10th volume of the Cancer Incidence in Five Continents report published by IARC.7 We extracted age-standardised incidence rates per 100,000 during 2003-2007, along with their standard errors, for malignant mesothelioma using the code C45 from the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Rates were standardised using the Segi World Population age group distribution. Malignant mesothelioma is a relatively rare malignancy with age-standardised incidence rates in many countries, often not exceeding 1.0 per 100,000 person-years. We focused on geographic regions where malignant mesothelioma incidence rates were reported by IARC to be 1.0 per 100,000 or above. These regions were North America, Europe, and Oceania including Australia and New Zealand. A national incidence rate estimate was provided for New Zealand. Age-standardised incidence rate estimates for Australia were presented for each of the 8 population-based cancer registries. However, a national figure was not provided.ResultsCountries where the male age-standardised malignant mesothelioma incidence rate during 2003-2007 was 2.0 per 100,000 or above were Australia (all jurisdictions), Belgium, England, France (1 out of 11 jurisdictions reported), Germany (4 out of 9 jurisdictions reported), Italy (8 out of 33 jurisdictions reported), New Zealand, The Netherlands, Northern Ireland, Scotland, Switzerland (3 out of 9 jurisdictions reported), and Wales (Figure 1). New Zealands age-standardised malignant mesothelioma incidence rate during 2003-207 was 2.6 per 100,000 (95% CI 2.3, 2.9). A median average calculation of Australias sub-national male age-standardised malignant mesothelioma incidence rates during 2003-2007 equates to 2.8 per 100,000. These values for New Zealand and Australia are below the age-standardised incidence rates for Scotland (4.0 per 100,000), England (3.6 per 100,000) and The Netherlands and Northern Ireland (both at 3.0 per 100,000).Figure 1: Male age-standardised malignant mesothelioma incidence rates per 100,000 using the Segi world standard population with 95% confidence limits, 2003-2007, for countries in the North American (clear bars), European (dotted bars), and Oceanic regions (striped bars) where the incidence rate is above 1.0 per 100,000 or more. Data excludes the following countries where incidence was below 1.0 per 100,000: Austria, Belarus, Bulgaria, Czech Republic, Estonia, Iceland, Latvia, Lithuania, Poland, Portugal, Russian Federation, Serbia, Slovakia, Spain, Ukraine, USA (Hawaii). Data extracted from the IARC report Cancer Incidence in Five Continents, Vol X, Forman et al, 2013. We calculated the highest 25 male age-standardised malignant mesothelioma incidence rates reported by IARC during 2003-2007 (Table 1). Incidence in Western Australia (4.5 per 100,000) is third in this ranked listed. However, the next highest Australian jurisdiction is Queensland (3.1 per 100,000) tenth in the ranking. New Zealand was ranked in 21st place. From these data, we can confidently conclude that there is large international variation in malignant mesothelioma rates.Table 1: Twenty-five highest male age-standardised malignant mesothelioma incidence rates per 100,000 person-years, 2003-2007, using global incidence data for the Northern American, European and Oceanic regions published by the International Agency for Research on Cancer (IARC). New Zealand and Australian data in bold. Data extracted from the IARC report Cancer Incidence in Five Continents, Vol X, Foreman et al, 2013. Geographic region Region, country and cancer registry name Age-standardised incidence rate per 100,000 Lower and upper 95% confidence limits European Germany, Bremen 6.0 (5.1, 6.8) European Italy, Genoa 5.6 (4.8, 6.4) Oceanic Australia, Western Australia 4.5 (4.0, 5.0) European Switzerland, Graubunden and Glarus 4.0 (2.7, 5.3) European Germany, Hamburg 3.7 (3.3, 4.1) European Scotland (national registry) 3.7 (3.5, 4.0) European Italy, Friuli-Venezia Giulia 3.6 (3.1, 4.1) European England (national registry) 3.6 (3.5, 3.7) European Italy, Lombardy, South 3.1 (2.3, 3.9) Oceanic Australia, Queensland 3.1 (2.8, 3.4) European The Netherlands 3.0 (2.9, 3.1) European Northern Ireland (national registry) 3.0 (2.6, 3.4) Oceanic Australia, New South Wales 3.0 (2.8, 3.2) Oceanic Australia, South Australia 3.0 (2.6, 3.4) European Switzerland, St Gall-Appenzell 2.7 (2.0, 3.4) European Wales (national registry) 2.7 (2.4, 3.0) European Italy, Lecco 2.6 (1.8, 3.4) European Switzerland, Zurich 2.6 (2.2, 3.1) Oceanic Australia, Australian Capital Territory 2.6 (1.6, 3.6) Oceanic Australia, Tasmania 2.6 (1.9, 3.3) Oceanic New Zealand (national registry) 2.6 (2.3, 2.9) European France, Loire-Atlantique 2.5 (2.1, 3.0) Oceanic Australia, Victoria 2.5 (2.3, 2.7) European Germany, Schleswig-Holstein 2.4 (2.1, 2.7) European Italy, Reggio Emilia 2.4 (1.7, 3.1) DiscussionNew Zealand and Australia are one of a number of high-income countries with elevated incidence of malignant mesothelioma. This is a direct result from exposure to airborne asbestos fibres in occupational settings. It is difficult to determine the total asbestos consumed in New Zealand over time, including both the import of raw asbestos, as well as the import and use of asbestos-containing products. Kjellstrom and Smartt have reported that the import of crude (raw) asbestos into New Zealand peaked in 1974 at 12,500 tonnes (4 kg per capita), followed by a steep decline. No crude asbestos was imported into New Zealand after 1991.8 The use of materials containing chrysotile asbestos is not yet banned in New Zealand, and import of such material is not strictly regulated.2 Australias asbestos consumption peaked during 1970-1979 at around 700,000 metric tonnes9 with a complete asbestos ban in place by 2003. Australias malignant mesothelioma peak incidence is estimated around 2010.10 Little is understood about the peak of malignant mesothelioma in New Zealand; further research is warranted in this area. In both New Zealand and Australia, occupational and non-occupational exposure to airborne asbestos fibres will continue to pose challenges to the public health community both in terms of undertaking epidemiological research to understand who is most at risk of asbestos exposure, as well as the communication of health risks associated with asbestos exposure in the built environment.

There has been recent, and increasing, interest in the human health effects of occupational and non-occupational exposure to airborne asbestos fibres, including the potential risk of malignant mesothelioma occurrence in New Zealand and Australia.1,2 Despite New Zealand and Australia having among the highest age-standardised incidence rates globally, there are few contemporary reports comparing malignant mesothelioma in New Zealand and Australia with data from other countries. For example, the most recent published literature on the epidemiology of malignant mesothelioma in New Zealand was published in 2004.3High-quality global cancer incidence rate data published in 2013 by the International Agency for Research Cancer (IARC)4 can help determine where New Zealand and Australia are placed in terms of the global incidence of malignant mesothelioma. The IARC global cancer incidence data are reported as male and female populations separately. For the purpose of this short communication, we have focused on male age-standardised malignant mesothelioma incidence rates, as men are the population group most affected by malignant mesothelioma due to the primary mode of asbestos exposure being in occupational settings. However, non-occupational asbestos exposures for both men and women are of increasing concern, particularly in Australia.5,6MethodsWe extracted data from the 10th volume of the Cancer Incidence in Five Continents report published by IARC.7 We extracted age-standardised incidence rates per 100,000 during 2003-2007, along with their standard errors, for malignant mesothelioma using the code C45 from the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Rates were standardised using the Segi World Population age group distribution. Malignant mesothelioma is a relatively rare malignancy with age-standardised incidence rates in many countries, often not exceeding 1.0 per 100,000 person-years. We focused on geographic regions where malignant mesothelioma incidence rates were reported by IARC to be 1.0 per 100,000 or above. These regions were North America, Europe, and Oceania including Australia and New Zealand. A national incidence rate estimate was provided for New Zealand. Age-standardised incidence rate estimates for Australia were presented for each of the 8 population-based cancer registries. However, a national figure was not provided.ResultsCountries where the male age-standardised malignant mesothelioma incidence rate during 2003-2007 was 2.0 per 100,000 or above were Australia (all jurisdictions), Belgium, England, France (1 out of 11 jurisdictions reported), Germany (4 out of 9 jurisdictions reported), Italy (8 out of 33 jurisdictions reported), New Zealand, The Netherlands, Northern Ireland, Scotland, Switzerland (3 out of 9 jurisdictions reported), and Wales (Figure 1). New Zealands age-standardised malignant mesothelioma incidence rate during 2003-207 was 2.6 per 100,000 (95% CI 2.3, 2.9). A median average calculation of Australias sub-national male age-standardised malignant mesothelioma incidence rates during 2003-2007 equates to 2.8 per 100,000. These values for New Zealand and Australia are below the age-standardised incidence rates for Scotland (4.0 per 100,000), England (3.6 per 100,000) and The Netherlands and Northern Ireland (both at 3.0 per 100,000).Figure 1: Male age-standardised malignant mesothelioma incidence rates per 100,000 using the Segi world standard population with 95% confidence limits, 2003-2007, for countries in the North American (clear bars), European (dotted bars), and Oceanic regions (striped bars) where the incidence rate is above 1.0 per 100,000 or more. Data excludes the following countries where incidence was below 1.0 per 100,000: Austria, Belarus, Bulgaria, Czech Republic, Estonia, Iceland, Latvia, Lithuania, Poland, Portugal, Russian Federation, Serbia, Slovakia, Spain, Ukraine, USA (Hawaii). Data extracted from the IARC report Cancer Incidence in Five Continents, Vol X, Forman et al, 2013. We calculated the highest 25 male age-standardised malignant mesothelioma incidence rates reported by IARC during 2003-2007 (Table 1). Incidence in Western Australia (4.5 per 100,000) is third in this ranked listed. However, the next highest Australian jurisdiction is Queensland (3.1 per 100,000) tenth in the ranking. New Zealand was ranked in 21st place. From these data, we can confidently conclude that there is large international variation in malignant mesothelioma rates.Table 1: Twenty-five highest male age-standardised malignant mesothelioma incidence rates per 100,000 person-years, 2003-2007, using global incidence data for the Northern American, European and Oceanic regions published by the International Agency for Research on Cancer (IARC). New Zealand and Australian data in bold. Data extracted from the IARC report Cancer Incidence in Five Continents, Vol X, Foreman et al, 2013. Geographic region Region, country and cancer registry name Age-standardised incidence rate per 100,000 Lower and upper 95% confidence limits European Germany, Bremen 6.0 (5.1, 6.8) European Italy, Genoa 5.6 (4.8, 6.4) Oceanic Australia, Western Australia 4.5 (4.0, 5.0) European Switzerland, Graubunden and Glarus 4.0 (2.7, 5.3) European Germany, Hamburg 3.7 (3.3, 4.1) European Scotland (national registry) 3.7 (3.5, 4.0) European Italy, Friuli-Venezia Giulia 3.6 (3.1, 4.1) European England (national registry) 3.6 (3.5, 3.7) European Italy, Lombardy, South 3.1 (2.3, 3.9) Oceanic Australia, Queensland 3.1 (2.8, 3.4) European The Netherlands 3.0 (2.9, 3.1) European Northern Ireland (national registry) 3.0 (2.6, 3.4) Oceanic Australia, New South Wales 3.0 (2.8, 3.2) Oceanic Australia, South Australia 3.0 (2.6, 3.4) European Switzerland, St Gall-Appenzell 2.7 (2.0, 3.4) European Wales (national registry) 2.7 (2.4, 3.0) European Italy, Lecco 2.6 (1.8, 3.4) European Switzerland, Zurich 2.6 (2.2, 3.1) Oceanic Australia, Australian Capital Territory 2.6 (1.6, 3.6) Oceanic Australia, Tasmania 2.6 (1.9, 3.3) Oceanic New Zealand (national registry) 2.6 (2.3, 2.9) European France, Loire-Atlantique 2.5 (2.1, 3.0) Oceanic Australia, Victoria 2.5 (2.3, 2.7) European Germany, Schleswig-Holstein 2.4 (2.1, 2.7) European Italy, Reggio Emilia 2.4 (1.7, 3.1) DiscussionNew Zealand and Australia are one of a number of high-income countries with elevated incidence of malignant mesothelioma. This is a direct result from exposure to airborne asbestos fibres in occupational settings. It is difficult to determine the total asbestos consumed in New Zealand over time, including both the import of raw asbestos, as well as the import and use of asbestos-containing products. Kjellstrom and Smartt have reported that the import of crude (raw) asbestos into New Zealand peaked in 1974 at 12,500 tonnes (4 kg per capita), followed by a steep decline. No crude asbestos was imported into New Zealand after 1991.8 The use of materials containing chrysotile asbestos is not yet banned in New Zealand, and import of such material is not strictly regulated.2 Australias asbestos consumption peaked during 1970-1979 at around 700,000 metric tonnes9 with a complete asbestos ban in place by 2003. Australias malignant mesothelioma peak incidence is estimated around 2010.10 Little is understood about the peak of malignant mesothelioma in New Zealand; further research is warranted in this area. In both New Zealand and Australia, occupational and non-occupational exposure to airborne asbestos fibres will continue to pose challenges to the public health community both in terms of undertaking epidemiological research to understand who is most at risk of asbestos exposure, as well as the communication of health risks associated with asbestos exposure in the built environment.