Mesothelioma incidence modeling and forecasting

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1 Mesothelioma incidence modeling and forecasting 214 Casualty Loss Reserve Seminar Jorge Gallardo-Garcia, PhD

2 Draft--Preliminary work product Mesothelioma incidence has remained relatively constant in the last several years 3,5 2 3, 2,5 2, 1,5 SEER 1, 5

3 Draft--Preliminary work product However, the typical incidence models have predicted a declining asbestos-related diagnoses 3,5 3 3, 2,5 2, 1,5 Nicholson/KPMG-style 1, 5

4 4 There has been ample literature attempting to estimate the future number of mesotheliomas in the US population Higginson (198) Enterline (1981) Peto et al (1981) Nicholson et al (1981, 1982) Walker et al (1983) Lilienfeld et al (1988) KPMG (1992) Stallard (21) Stallard et al (24) Though these models had different approaches for estimating the future mesothelioma incidence and resulted in different levels of future counts, all had a common assumption: Either all mesotheliomas are asbestos related or all mesotheliomas were generated by the same process

5 Draft--Preliminary work product Models that assume that all mesothelioma is caused by asbestos do not fit the data well 3,5 5 3, 2,5 2, 1,5 1, SEER Nicholson/KPMG-style 5

6 6 Scientific literature has studied whether asbestos is the only cause of mesothelioma Studies have estimated that a significant portion of mesothelioma diagnoses are not related to asbestos exposure above background levels Pleural mesothelioma: 2%-5% male and 7%-8% female Peritoneal mesothelioma: 7%-85% male and female See, for instance Attanoos, R. L. and Timothy C. Allen (214), Advances in surgical pathology, Lippincott Williams & Wilkins Carbone, M. et al (212), Malignant Mesothelioma: Facts, Myths and Hypotheses, Journal of Cellular Physiology, 227(1) Moolgavkar, S. H. et al (29), Pleural and peritoneal mesotheliomas in SEER: age effects and temporal trends, , Cancer Causes Control, 2

7 7 In fact, there may be several different factors that contribute to mesothelioma incidence other than any asbestos products exposure Naturally-occurring asbestos in the environment Non-asbestos fibers and/or chemicals Fibrous Zeolite (Erionite) Fluoro-edenite Refractory ceramic fibers Carbon nanotubes Other organic fibers Radiation Spontaneous or idiopathic Genetics SV4 virus in vaccines

8 8 Therefore, a model that tries to estimate the number of mesotheliomas in the population should account for its potential sources The Bates White incidence model considers that mesothelioma diagnoses can be cause by Exposure to asbestos-containing products Other sources, collectively referred to as background The model jointly estimates a Nicholson/KPMG-style occupational-based model A model of cancer generation in the general population based on age, gender, and population size The estimation routine uses the scientific observation that most female mesothelioma diagnoses are not related to exposure to asbestos products

9 Draft--Preliminary work product Bates White s statistical model can explain the difference between the typical models and the data 3,5 9 3, 2,5 2, 1,5 1, SEER Related to asbestos products exposure Other causes Total incidence 5

10 Draft--Preliminary work product Theoretically, the asbestos litigation focus should be only on diagnoses caused by asbestos products exposure and in how the exposure occurred 3,5 1 3, 2,5 2, Related to asbestos products exposure (total) Construction industries Shipyard industries Other industries and occupations 1,5 1, 5

11 Number of claims Draft--Preliminary work product Focusing on the asbestos litigation: historically, U.S. mesothelioma tort filings by quarter were driven by epidemiology Filing quarter Source: Bates White claimant database

12 Number of claims 12 Non-malignant filings were driven by economics: mass recruitment led to a surge that subsequently collapsed 2, 15, 1, 5, Source: Bates White claimant database Filing quarter

13 Number of claims 13 And lung and other cancer tort filings basically followed the non-malignant claims as their surge was mostly a byproduct of mass recruitment 1, Lung Cancer Other Cancer Source: Bates White claimant database Filing quarter

14 How will a higher proportion of mesothelioma diagnoses unrelated to asbestos products exposure affect asbestos litigation? 14 How will causation in mesothelioma cases play a role in future trials? How will the way in which mesothelioma claims are pursued by plaintiff firms and defended be affected? How will the asbestos litigation system react to a growing portion of mesothelioma diagnoses with tenuous or no linkage to asbestos-containing products exposure? How will this issue affect the number of mesothelioma claims filed, the number of claims settled, and settlement amounts in the tort system?

15 Mesothelioma incidence modeling and forecasting 214 Casualty Loss Reserve Seminar Jorge Gallardo-Garcia, PhD

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