Update on mesothelioma incidence and forecast of future cases in Belgium

Belgium has been a "historical champion" in asbestos consumption. A total ban was only introduced in 1998. Previous studies showed a steady rise in malignant mesothelioma incidence. We aimed to update Belgian incidence data through 2022 and model future case projections.

We used past asbestos consumption data for Belgium as a proxy for exposure. Data on the yearly incidence of malignant mesothelioma in Belgium were obtained from the Belgian Cancer Registry (2004-2022), Scientific Institute of Public Health (1987-2021), WHO Mortality Database (1969-2004), and Asbestos Fund (2007-2022). We used Distributed Lag Non-Linear Models, to estimate the exposure-lag-response association and forecast future incidence.

Mesothelioma incidence has increased since the 1970s, plateauing in recent years around 300 cases/year (for a total population of 10-11 million). We predict a decline in the coming decades, estimating 246 cases/year in 2030 (95% prediction interval [PI] 217-278) and 116 cases/year in 2040 (95%PI 96-138). Stratifying by age group, we observed a decline in mesothelioma incidence among the few individuals diagnosed at young ages (< 55y and 55-64y), while cases in the 75-84y and > 85y age groups continue to rise. The number of compensated cases was substantially lower than the registered cases, with 84 cases/year (95%CI 67-101) remaining uncompensated.

The restrictions and ban on asbestos use have reduced the risk of mesothelioma for those who began working after the peak period of asbestos use. Nevertheless, the overall mesothelioma incidence in Belgium does not yet show signs of decline. More efforts should be made to improve compensation of mesothelioma patients.