Mesothelioma is a less common tumour with a poor prognosis. Since the 1970s, many western countries, including the UK, have observed an increasing incidence of this cancer, particularly among men.1 The link to earlier occupational exposure to asbestos, often through mining, shipbuilding or the manufacture of asbestos textiles, cement and insulation is now well established. The average latency period before the development and presentation of disease is over 30 years, and may be as long as 60 years.2 Although many countries have now banned the industrial use of asbestos, this long latency period means that new cases will continue to appear for some time. Early predictions of a peak in European mortality for the first two decades of the 21st century were based on modelling using deaths observed in cohorts of men born in the mid twentieth century.3 Some countries, including Sweden and Norway, have since reported a levelling off in the incidence rates for men, suggesting that the peak in these countries has already been reached.4 Analysis of more recent mortality data from France, Germany and Italy also suggested that the mortality peak in these countries will occur in the current decade rather than the next.5 In Great Britain, where asbestos use continued later than many other countries, the peak is anticipated to occur later between 2011 and 2115.6 Between 1981 and 2000, North East England and South East England were the areas with the highest standardised mortality ratios.7 Asbestos related mortality in Northern Ireland is already showing a decline, with most of these deaths occurring around the shipbuilding industry areas in the Belfast estuary.8
Although public health action has undoubtedly prevented many new cases of mesothelioma, the treatment options for patients once they have developed the disease are limited. The median survival after diagnosis is less than 12 months. Surgery (extrapleural pneumonectomy) combined with postoperative radiotherapy and chemotherapy may have a role in selected patients presenting with early stage disease.9 However, for many patients the main needs will be for an accurate diagnosis, information about the condition, advice on legal implications and for high quality palliative care to help control the symptoms of pain and breathlessness, and provide family support.10 Formal evidence based national guidance on the services these patients can expect or their effectiveness has not yet been developed.
The area of South East England served by the Thames Cancer Registry includes an area of high mesothelioma incidence related to previous shipbuilding (Medway in Kent), and several others where asbestos was used previously in factories (Newham, Tower Hamlets, Barking and Dagenham, Havering and Redbridge in London, and Dartford and Gravesham in Kent). Although the number of women developing mesothelioma is five times lower than for men, factory work in these areas exposed women to asbestos, and women in South East England are among those with the highest risk in the UK.