Certified causes of death in patients with mesothelioma in South East England

We extracted mesothelioma registrations in the South East of England area between 2000 and 2004 from the Thames Cancer Registry database. We retained for analysis 2200 patients who had died at the time of analysis, after having excluded seven dead cases where the causes of death were not known to the cancer registry. The 2200 deaths were classified hierarchically to identify (1) mesothelioma deaths, (2) deaths certified as lung cancer deaths or (3) deaths from unspecified cancer, and (4) deaths from other causes.87% of the patients had mesothelioma mentioned on the death certificate. 6% had no mention of mesothelioma but included lung cancer as a cause of death. Another 6% had no mention of mesothelioma or lung cancer, but included an unspecified cancer as a cause of death. Lastly, 2% had other causes of death specified on the death certificate.This analysis suggests that official mortality data may underestimate the true occurrence of mesothelioma by around 10%.Mesothelioma is a rare form of cancer that arises from the pleura or, less often, from the peritoneum. The disease is almost always fatal and the median time between diagnosis and death is less than one year [1,2]. Mesothelioma is strongly associated with occupational exposure to asbestos fibres. Industries with high exposure to asbestos in the past included mining, shipyard working and asbestos cement manufacture.The annual numbers of mesothelioma deaths in Great Britain increased 12-fold in the period from 1968 to 2001[3] and an epidemiological model that incorporated the historical use of asbestos suggested that the annual numbers of deaths will continue to rise to a peak at around 1950–2400 deaths per year in 2011–2015.The aim of this analysis was to examine the certified causes of death of patients diagnosed with mesothelioma, and assess the validity of mortality data as a proxy for data on mesothelioma incidence.Initially, we extracted the numbers of mesothelioma cancer registrations and mesothelioma d