Introduction In Italy, asbestos has been extensively used from 1946 until the 1992 ban. Production and import peaked in 1976–1980 but continued at high levels until 1989. Using data of the malignant mesothelioma (MM) registry of the Lombardy Region, the most populated (currently 10 million people, one sixth of the Italian population) and industrialised Italian region, we analysed time patterns in the period 2000–2012 and made incidence projections for the period 2013–2029.

Methods We selected all incident cases of MM (pleura, peritoneum, pericardium, and tunica vaginalis testis) with first diagnosis between 2000 and 2012. We fitted categorical Poisson age-cohort models using 5-year categories for age at diagnosis and birth cohort. The gender-specific age and cohort regression coefficients were then applied to future estimates (intermediate scenarios) of population denominators to calculate projections of the numbers of MM cases in the period 2013- 2029. Statistical analyses were performed with Stata 13.

Results In 2000–2012 we recorded 4,435 MM cases (2,846 men, 1,589 women). Occupational asbestos exposure was more frequent in men (74%) than in women (38%). The average number of MM cases per year was still increasing (+2.6% in men, +3.3% in women). We forecast a peak of 416 cases (266 men, 150 women) in 2019 and 6,809 cases (4,379 men, 2,430 women) in the period 2013-2029, for a total of 11,244 MM cases (7,225 men, 4,019 women) in 30 years.

Conclusions This study documented a high MM burden in Lombardy (one fourth of all Italian cases) in both genders, reflecting extensive asbestos exposure in the past. The decrease of MM occurrence in our Region is expected to start in 2020. Documenting mesothelioma occurrence may help to increase awareness of dangers of asbestos exposure in countries that still use it but where its health effects are still overlooked.