Asbestos Exposures, Mesothelioma Incidence and Mortality, and Awareness by General Practitioners in the Molise Region, Central Italy

Our plain-English summary of Asbestos Exposures, Mesothelioma Incidence and Mortality, and Awareness by General Practitioners in the Molise Region, Central Italy, by G. Ripabelli, M. Tamburro, D. Di Tella, et al (Journal of Occupational and Environmental Medicine, 2018).

The study

• Authors: G. Ripabelli, M. Tamburro, D. Di Tella, F. Carrozza, M.L. Sammarco
• Journal: Journal of Occupational and Environmental Medicine
• Published: 2018;60(2):e90-e97
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: The aim of this study was to evaluate environmental asbestos sources, mesothelioma incidence and mortality, and awareness on asbestos-related diseases (ARDs) by general practitioners (GPs) in Molise Region.

Methods: The contaminated sites in three towns were identified by census; mesothelioma incidence (2000 to 2012) and mortality (2003 to 2013) was achieved from local registries; GPs were interviewed on practiced population's exposures and ARDs diagnosis.

Results: About 54.3% of visited sites were contaminated (71.2% by friable asbestos) and 38.8% was extremely damaged. Over above time-periods, 32 mesothelioma cases (62.5% males, 25% in people aged 70 to 75 years) and 27 deaths (90% males, 69 ± 10 years, 70.4% pleural mesothelioma) have been reported. A total of 122 GPs were interviewed who had diagnosed 40 mesothelioma and 28 asbestosis cases.

Conclusion: There is the need of remediation/removal interventions for contaminated sites and of strategies to increase GPs awareness on asbestos risks for better patients' management.

In plain English

This study from the Molise Region of central Italy drew on three sources. In 2016, environmental agency technicians surveyed 256 sites in Campobasso, Isernia and Termoli. In those three towns, 42%, 69.2% and 41% of sites were contaminated with asbestos, and friable asbestos was present at 97%, 70.4% and 37.5% of the contaminated sites. The regional Cancer Registry recorded 32 malignant mesothelioma cases from 2000 to 2012, 20 (62.5%) in males, a mean annual incidence of 0.84 per 100,000 inhabitants. In the Lower Molise area alone, 27 deaths from malignant mesothelioma were recorded from 2003 to 2013, 19 (70.4%) of them pleural. Of 137 general practitioners (GPs) contacted, 122 answered a telephone questionnaire. Forty had diagnosed asbestos-related disease, together reporting 28 asbestosis and 40 pleural mesothelioma cases. Seventy-five (61.5%) said they had no information on their patients' possible environmental asbestos exposure. The authors concluded that contaminated sites need remediation or removal and that GPs' awareness of asbestos risks should be increased. They noted that death data covered only one area and that individual patients' exposures were not known.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive regional study combining a census of asbestos-contaminated sites, cancer and mortality registry data, and a telephone questionnaire survey of general practitioners
• Who was studied: 256 sites surveyed in 2016 in Campobasso (81), Isernia (117) and Termoli (58). Malignant mesothelioma cases in the Molise regional Cancer Registry, 2000 to 2012. Mesothelioma deaths in the Lower Molise area, 2003 to 2013. 122 general practitioners interviewed between October 2016 and February 2017.
• Exposure: Environmental asbestos at residential, farm, artisanal, industrial and public sites, recorded as friable or compact and by damage status (more or less than 10% damage on visual inspection). Individual patients' exposures were not measured.
• Main results:
  • Campobasso town: 42% of visited sites were contaminated, and 97% of the contaminated sites had friable asbestos
  • Isernia town: 69.2% of sites were contaminated, and friable asbestos was found at 70.4% of the contaminated sites
  • Termoli: 41% of sites were contaminated, and 37.5% of the contaminated sites contained friable asbestos
  • The type of asbestos at contaminated sites was not reported for 25 sites (Campobasso)
  • Molise Region, 2000 to 2012: 32 malignant mesothelioma cases in the regional Cancer Registry, 20 (62.5%) in males
  • Mean annual incidence of malignant mesothelioma in Molise was 0.84 cases per 100,000 inhabitants
  • 8 of the 32 cases (25%) were in people aged 70 to 75 years
  • 84.4% of the mesothelioma cases occurred in the province of Campobasso
  • Lower Molise area, 2003 to 2013: 27 deaths from malignant mesothelioma, which was 0.22% of 12,234 deaths from all causes
  • Of the 27 mesothelioma deaths in Lower Molise, 24 were in males. Mean age at death was 69 years, plus or minus 10 years.
  • Of the 27 deaths, 19 (70.4%) were from pleural mesothelioma, 3 (11.1%) from peritoneal mesothelioma and 5 (18.5%) from unspecified mesothelioma
  • 137 of 268 registered GPs were contacted, and 122 agreed to take part
  • 75 of the 122 GPs (61.5%) said they had no information on their patients' potential environmental asbestos exposure
  • 40 of the 122 GPs (33%) had direct experience diagnosing asbestos-related disease. Differences between areas were not statistically significant.
  • Of the 68 asbestos-related disease cases the GPs had diagnosed, the GPs identified 47 (69%) as related to the patient's occupation
  • GPs had diagnosed 28 asbestosis cases. 26 of these (93%) were concluded to be related to work carried out abroad.
  • 30 GPs (25%) had diagnosed 40 malignant mesothelioma cases, all pleural
  • No GP had diagnosed or suspected pleural plaques or cancers of the lung, larynx or ovary
• The authors' conclusion: The authors concluded that contaminated sites need remediation or removal and that strategies are needed to increase GPs' awareness of asbestos risks for better management of patients. They also stated that pleural malignant mesothelioma was the most prevalent disease detected in the region.
• Limitations the authors state:
  • No specific data on the population exposed to asbestos, and no information on each patient's residential address or occupational or environmental exposures
  • It was not established whether mesothelioma patients had exposures outside the Molise Region
  • Mortality data covered only the Lower Molise area, limiting comparison with national data
  • Possible bias in the GP survey, because GPs who had managed cases may have been more likely to respond
  • Cases reported by GPs were mapped by the GP's office address, not the patient's home address
  • Registry incidence data lacked information on the anatomical site of the mesotheliomas

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Friable, Pleural Mesothelioma.

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