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Peaks in Incidence for Males: In the US, on the basis of reasonable assumptions reflected in the SEER data and exposure measurements from studies conducted in the 1990s, mesothelioma cases will peak before the year 2000 at approximately 2,300 cases. The number of cases then will decline over the next 50 years to the background level (i.e., the female rate) of approximately 500 cases per year. Equating cases with deaths (mesothelioma is judged to be fatal within 1-2 years following diagnosis), at the peak, the rate of mesothelioma-induced deaths among males would be approximately 19 per million or 0.22% of all male deaths. At the background level, mesothelioma would account for approximately 0.05% of all male deaths.

The timing of 50 years to return to the background level is based on the projection by Price (1997), which may be conservative. The 1960 birth cohort began work in the late 1970s, after many of the federal regulatory programs to limit exposure to asbestos were in place. It is likely that males in the 1960 and subsequent birth cohorts will not have experienced highexposure to asbestos, and, therefore the male incidence should return to the background level more rapidly, in less than 50 years.In the UK, Peto et al. projected a peak of 2,700 deaths in 2020 or, if the underlying data include a 20% diagnostic effect, the peak will be 1,300 deaths in 2010. It is notable that the peak number of mesothelioma deaths in the UK approximates the peak number in the US although the US population is approximately four times larger than the UK population. This comparison suggests that exposure to high levels of airborne asbestos was experienced by a larger segment of the population in the UK than in the US.The difference between the peak year in the UK versus the US (2020 versus 2000) is a reflection of the difference in inferred patterns of exposure. The maximum exposure in the US occurred in manufacturing and construction in the 1930s-1960s. Peto et al. interpreted their results to mean that exposure was greatest in the 1970s than any previous period and suggested that these exposures were common among construction and building-maintenance workers. The 10- to 20-year shift in maximum exposure in the UK versus the US explains the 10- to 20-year shift in the expected peak of mesothelioma-related deaths.

The epidemiology literature on asbestos-related disease historical assessments of exposure generally support the hypothesis that mesothelioma risk is much higher where exposure included amphiboles, specifically fibrous riebeckite ("crocidolite") and grunerite ("amosite"), than when exposure was to chrysotile alone (McDonald & McDonald 1996). Does the mesothelioma trend for males in the US add any further support for this hypothesis of greater potency of amphibole-group minerals? In principle it could, but in practice the answer is no. The increase in male mesothelioma is a consequence of exposure during the 1930 to 1960 time-period, which is heavily influenced by insulator exposures. It is generally acknowledged that these workers principally were exposed to amphibole-group minerals and mixtures of amphiboles and chrysotile (McDonald & McDonald 1996; Selikoff, et al., 1979). The number of mesothelioma cases in the US is projected to peak before the year 2000 (Price, 1997). The exposures responsible for the peak occurred during the 1930s through the 1960s, the period of significant exposure to amphibole and mixed fibers. Following the peak, mesothelioma incidence is projected to decline to background levels over the subsequent 50 years. Exposures that coincide with the decline were experienced beginning in the 1960’s. By the early 1970s, there had been two changes in the characteristics of asbestos exposure. First, building construction became an important activity for asbestos exposure, and the predominant type of asbestos used in building construction in this period was chrysotile. Second, OSHA established exposure limits for asbestos workers and required workers to use respirators where the limits could not otherwise be achieved. The mesothelioma trend, therefore, does not provide clear evidence to support the hypothesis of greater potency of amphibole-group minerals for mesothelioma because the change to predominantly chrysotile exposure coincided with reductions in overall exposure to asbestos.

The reductions in exposure were and continue to be significant. Cumulative lifetime exposure, the measure of exposure used to assess the risk of asbestos-related disease, typically was hundreds of fiber-years per cubic centimeter of air (f-yrs/cm3) for workers during the 1930s to the 1960s. For example, an estimate for exposures by insulation worker is 4-12 f/cm3 (as a time-weighted average) for 25 years (Selikoff et al., 1979; USEPA, 1986). These estimates translate into cumulative exposure ranging from 100 to 300 f-yrs/cm3. Beginning in the late 1970s, annual average daily exposure for workers conducting activities involving asbestos would have been a fraction of one f/cm3. To compare levels of exposure for the 1930s to 1960s versus the 1970s and forward, note that 100 to 1000 working years would be required in the latter time-period to accumulate the levels of exposures experienced during the former period.

The annual number of mesothelioma cases among males in the US is near its peak and has been projected to decline to a background level of approximately 500 cases per year. The historical increase in mesothelioma cases was a consequence of exposures to high levels of airborne amphiboles and mixed-fiber asbestos during the 1930s through the 1960s among insulators and building trades working near insulation activities. The subsequent decline may be due, in part, to a change in exposure, predominantly to chrysotile asbestos, but another very important factor is the significant reduction in exposure levels among workers over the past 25 years. In the UK, the mesothelioma pattern is similar to the pattern in the US, but is shifted 20 years into the future. The peak is projected for the year 2020, and is attributed to maximum exposure of construction workers to asbestiform amphibole in the 1970s, 20 years later than maximum exposures in the US.Although the trends are similar and can be explained, in part, by increases and reductions in levels of exposure, the types of exposures that are responsible for the mesothelioma peaks are different. It is surprising, considering the US experience, that maximum exposures in the UK occurred in the construction industry as late as the 1970s. Projections based on modeling of UKata from 1968 through 1991 are falling short of the actual number of cases. The historical data were revised in 1997 and, beginning in 1986, reflect more cases than were used to develop the models and projections. These revised data, if reanalyzed, could indicate an earlier peak in the number of cases, which may be closer to the pattern in the US.In the US, general awareness of the numbers of workers with asbestos-related diseases as a consequence of high-level historical exposures, government regulations, and government guidance programs have led to dramatic reductions in exposure. US regulations and guidance aimed at limiting exposure to asbestos do not account for differences in the potencies of amphibole-group minerals and chrysotile asbestos. Nevertheless, typical levels of exposure currently appear to be low enough to render the risk of mesothelioma and other asbestos-related diseases negligible. On the basis of an analysis of US trends of incidence of asbestos-related disease and exposure data collected in the US, exposure levels in the US are projected to remain low in the future. Under these circumstances, differentiating amphibole-group minerals exposures from exposures to chrysotile would have no practical significance in terms of risk managemenCorn M, McArthur B, Dellarco M (1994). Asbestos exposure of building maintenance personnel. Appl. Occup. Environ. Hyg. 9(11),845-852.

Dupre JS, Mustard JF, Uffen RJ (1984). Report of The Royal Commission on Matters of Health and Safety Arising from the Use of Asbestos in Ontario. Ontario: Ontario Ministry of the Attorney General, 1984.

HEI (1991). "Asbestos in Public and Commercial Buildings: A Literature Review and Synthesis of Current Knowledge," Health Effects Institute - Asbestos Research, Cambridge Massachusetts.Hutchings S, Jones JR, Hodgson JT (1995). Asbestos-related diseases, Chapter 9 in Occupational Health Decennial supplement, Edited by Francis Drever, Health and Safety Executive, 1995.McDonald JC (1985). Health Implications of Environmental Exposure to Asbestos. Environmental Health Perspectives 1985; 62:319-328.McDonald JC, McDonald AD (1996). The epidemiology of mesothelioma in historical context, Eur Respir J., 1996,9,1932-1942.

Mlynarek S, Corn M, Blake C (1996). Asbestos exposure of building maintenance personnel. Regulatory Toxicology and Pharmacology, 1996.Mossman BT, Bignon J, Corn M, Seaton A, Gee JBL (1990). Asbestos: Scientific Developments and Implications for Public Policy, Science 247:294-301.

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