title: Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020.
abstract: BACKGROUND
  A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011-2015 and 2016-2020 in Spain.
  
  
  METHODS
  Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions.
  
  
  RESULTS
  Pleural cancer deaths increased across the study period, rising from 491 in 1976-1980 to 1,249 in 2006-2010. Predictions for the five-year period 2016-2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality.
  
  
  CONCLUSIONS
  The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040.
authors.affiliation: Environmental and Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5 28029, Madrid, Spain. glabente@isciii.es.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: López-Abente
authors.forename: Montserrat
authors.initials: M
authors.lastname: García-Gómez
authors.forename: Alfredo
authors.initials: A
authors.lastname: Menéndez-Navarro
authors.forename: Pablo
authors.initials: P
authors.lastname: Fernández-Navarro
authors.forename: Rebeca
authors.initials: R
authors.lastname: Ramis
authors.forename: Javier
authors.initials: J
authors.lastname: García-Pérez
authors.forename: Marta
authors.initials: M
authors.lastname: Cervantes
authors.forename: Eva
authors.initials: E
authors.lastname: Ferreras
authors.forename: María
authors.initials: M
authors.lastname: Jiménez-Muñoz
authors.forename: Roberto
authors.initials: R
authors.lastname: Pastor-Barriuso
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000266:history / Q000401:mortality*; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001194:Asbestos