title: High incidence of mesothelioma in an English city without heavy industrial use of asbestos.
abstract: BACKGROUND
  Mesothelioma rates are increasing in the industrialized world, related to occupational asbestos exposure. The highest rates have been reported from areas with specific industries such as shipbuilding or mining. Lower rates have been reported from areas without such industries. We studied an area without heavy industry to examine if such a pattern occurred in England.
  
  
  METHODS
  We studied the population of Exeter Primary Care Trust, Devon, United Kingdom, with a population of 131,849. Exeter has no mining, shipbuilding or other heavy industry. All lung cancers and mesotheliomas were identified from the local cancer registry, supplemented by searches at all primary care practices. The cancer diagnoses were checked by inspection of histology or primary care records. Occupational data were extracted from the primary care records.
  
  
  RESULTS
  The searches revealed 291 lung cancers, 283 of which had either histological proof or strong clinical evidence for the diagnosis. Twenty-two (8 per cent) of these were pleural mesotheliomas, 17 of these occurring in men. The incidence rate of mesothelioma in men over 40 years was 12.1 per 100,000 per year (95 per cent confidence intervals 7.0-19.3), one of the highest reported rates in the world.
  
  
  CONCLUSIONS
  The mesothelioma epidemic will extend to areas without local heavy industrial exposure.
authors.affiliation: Division of Primary Health Care, University of Bristol. w.hamilton@bristol.ac.uk
authors.forename: William T
authors.initials: WT
authors.lastname: Hamilton
authors.forename: Alison P
authors.initials: AP
authors.lastname: Round
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Sharp
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D001194:Asbestos / Q000633:toxicity; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007221:Industry; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries
chemical_list: D001194:Asbestos