title: Incidence of malignant mesothelioma in Germany 2009-2013.
abstract: The malignant mesothelioma is a rare malignancy and mainly caused by occupational exposure to asbestos. German cancer registries are providing a national database to investigate temporal and regional patterns of mesothelioma incidence. These may be of interest for healthcare planning and for surveillance programs aiming at the formerly exposed workforce.
  
  
  
  We analyzed population-based incidence data of malignant mesothelioma by site, type, sex, age, as well as district and state of patient's residence. Age-standardized incidence rates (AIRs40+) were calculated according to the European standard population truncated to the age of 40 years and older. We present rates at national, state, and district level and trends of incidence of northern states of Germany.
  
  
  
  In total, 7,547 malignant mesotheliomas were reported to German cancer registries diagnosed between 2009 and 2013-90% located to the pleura. On average, 1,198 men and 312 women were affected each year. We estimated AIR40+ of 4.77 in 100,000 German men and 0.98 in 100,000 German women. Regional clusters were predominantly located to the seaports of West Germany. The highest regional AIR40+ was 20 per 100,000 men. Corresponding rates in northeast Germany were between 2 and 4 per 100,000 men.
  
  
  
  Regional clusters of high incidence indicate districts with former shipyards and steel industry, but predominantly in the western part of Germany. The West-to-East difference corresponds to patterns of mortality. Twenty years after banning asbestos in Germany, Bremen and Hamburg are presenting the highest mesothelioma incidence but show steadily decreasing trends.
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany. lehnert@ipa-dguv.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Lehnert
authors.affiliation: German Centre for Cancer Registry Data (ZfKD) at Robert Koch-Institute, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kraywinkel
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Heinze
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wiethege
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Johnen
authors.affiliation: German Centre for Cancer Registry Data (ZfKD) at Robert Koch-Institute, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Fiebig
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brüning
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Taeger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000633:toxicity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D012042:Registries
chemical_list: D001194:Asbestos
keywords: Asbestos; Germany; Incidence; Mesothelioma