title: Global magnitude of reported and unreported mesothelioma.
abstract: BACKGROUND
  Little is known about the global magnitude of mesothelioma. In particular, many developing countries, including some with extensive historical use of asbestos, do not report mesothelioma.
  
  
  OBJECTIVE
  We estimated the global magnitude of mesothelioma accounting for reported and unreported cases.
  
  
  METHODS
  For all countries with available data on mesothelioma frequency and asbestos use (n=56), we calculated the 15-year cumulative number of mesotheliomas during 1994-2008 from data available for fewer years and assessed its relationship with levels of cumulative asbestos use during 1920-1970. We used this relationship to predict the number of unreported mesotheliomas in countries for which no information on mesothelioma is available but which have recorded asbestos use (n=33).
  
  
  RESULTS
  Within the group of 56 countries with data on mesothelioma occurrence and asbestos use, the 15-year cumulative number of mesothelioma was approximately 174,300. There was a statistically significant positive linear relation between the log-transformed national cumulative mesothelioma numbers and the log-transformed cumulative asbestos use (adjusted R(2)=0.83, p<0.0001). Extrapolated to the group of 33 countries without reported mesothelioma, a total of approximately 38,900 (95% confidence interval, 36,700-41,100) mesothelioma cases were estimated to have occurred in the 15-year period (1994-2008).
  
  
  CONCLUSIONS
  We estimate conservatively that, globally, one mesothelioma case has been overlooked for every four to five reported cases. Because our estimation is based on asbestos use until 1970, the many countries that increased asbestos use since then should anticipate a higher disease burden in the immediate decades ahead.
authors.affiliation: Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan.
authors.forename: Eun-Kee
authors.initials: EK
authors.lastname: Park
authors.forename: Ken
authors.initials: K
authors.lastname: Takahashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hoshuyama
authors.forename: Tsun-Jen
authors.initials: TJ
authors.lastname: Cheng
authors.forename: Vanya
authors.initials: V
authors.lastname: Delgermaa
authors.forename: Giang Vinh
authors.initials: GV
authors.lastname: Le
authors.forename: Tom
authors.initials: T
authors.lastname: Sorahan
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis / Q000706:statistics & numerical data*; D001194:Asbestos / Q000032:analysis*; D002273:Carcinogens / Q000032:analysis*; D004781:Environmental Exposure / Q000706:statistics & numerical data; D006801:Humans; D008654:Mesothelioma / Q000453:epidemiology*
chemical_list: D002273:Carcinogens; D001194:Asbestos