Asbestos-related mesothelioma in Monfalcone, Italy

Our plain-English summary of Asbestos-related mesothelioma in Monfalcone, Italy, by C. Bianchi, A. Brollo, L. Ramani, et al (American Journal of Industrial Medicine, 1993).

The study

• Authors: C. Bianchi, A. Brollo, L. Ramani, C. Zuch
• Journal: American Journal of Industrial Medicine
• Published: 1993;24(2):149-60
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The Monfalcone area, in northeastern Italy, is a small industrial territory (population about 60,000), with a large shipyard. Between October 1979 and April 1992, ninety-two malignant mesotheliomas were diagnosed at the Monfalcone Hospital. The series included 84 men and 8 women, aged 42 to 89 years (median age 68 years). There were 89 pleural and 3 peritoneal tumors. Seventy patients (69 men and 1 woman) had worked in the shipyards; six were seamen, and four insulators. Five men had been exposed to asbestos in various industries; six women had histories of domestic exposure, and one woman had a history of possible environmental exposure. The latency periods (intervals between first exposure to asbestos and diagnosis of the tumor) ranged from 20 to 65 years (median 52 years). Latency periods among insulators were significantly lower than among shipyard workers, as well as lower than among the other categories (p < 0.01). Lung asbestos bodies were isolated after chemical digestion in 73 cases at necropsy, and in two cases at surgery. In necropsy cases, asbestos body burdens ranged between 100 and 10,000,000 bodies per gram of dried tissue (median 11,000). Pleural plaques were observed at necropsy in 62 out of 73 cases, and in two cases at surgery. In the time period we considered, the annual incidence rates for pleural mesothelioma were very high among male Monfalcone residents, being 189 per 100,000 among people aged 75 years or more. On the basis of occupational data and of objective signs (lung asbestos bodies, pleural plaques), all the cases of the present series but one (that with possible environmental exposure) were considered as asbestos-related. The role of co-factors in the development of asbestos-related mesothelioma is suggested.

In plain English

This report described 92 malignant mesotheliomas diagnosed at the pathology laboratory of Monfalcone Hospital, in a shipbuilding area of northeastern Italy, between October 1979 and April 1992. The patients were 84 men and 8 women, and 89 tumors were pleural and 3 peritoneal. Seventy patients had worked in shipbuilding, six were Navy or merchant marine seamen, four were insulators, five men worked in other industries, and six women had cleaned the work clothes of family members. The article did not have data on which asbestos fiber types were involved. The time from first exposure to diagnosis ranged from 20 to 65 years (median 52) and was significantly shorter in insulators. Of 73 patients examined at autopsy, 62 had pleural plaques. Their lung asbestos body counts ranged from 100 to about 10,000,000 per gram of dried tissue (median 11,000). Among male residents, the crude annual incidence of pleural mesothelioma was 22.0 per 100,000, and 189 per 100,000 at age 75 or older. The authors considered all cases but one to be asbestos-related and suggested that other co-factors may play a role.

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: Hospital-based case series (all mesotheliomas diagnosed at one pathology laboratory), with occupational histories, autopsy markers of exposure, and calculated incidence rates for area residents
• Who was studied: 92 patients with malignant mesothelioma (84 men aged 42 to 87, median 68.0; 8 women aged 48 to 89, median 76.5) diagnosed at Monfalcone Hospital, Italy, from October 1979 to April 1992. In 89 the pleura was the primary site and in 3 the peritoneum. 88 were residents of the Monfalcone area (population about 60,000).
• Exposure: Asbestos exposure by history. Occupational exposure: shipbuilding industry 70 (69 men, 1 woman), Navy and merchant marine 6, insulation 4, textile industry 2, chemical industry (sodium carbonate factory) 1, construction industry 1, paper industry 1. Domestic exposure in 6 women, from cleaning family members' work clothes. Possible environmental exposure in 1 woman. Exposure lasted from one month to 45 years (median 34 years). Fiber types for these cases were not available.
• Main results:
  • Latency (first exposure to diagnosis) ranged from 20 to 65 years, median 52. It was significantly shorter in insulators than in shipyard workers and than in the other categories (p less than 0.01).
  • At autopsy, pleural plaques were seen in 62 of 73 cases.
  • In autopsy cases, lung asbestos bodies ranged from 100 to about 10,000,000 per gram of dried tissue (median 11,000). In two surgical cases the counts were 700,000 and 3,000 per gram.
  • Among male Monfalcone-area residents, the crude annual incidence of pleural mesothelioma was 22.0 per 100,000 (age-standardized to the European population: 20.0). For women the crude rate was 2.1 per 100,000.
  • Among men aged 75 or older, the annual pleural mesothelioma incidence was 189 per 100,000.
  • All 3 peritoneal mesothelioma patients were men: a shipyard joiner, a man exposed during Navy service, and an insulator.
  • Among autopsy cases, 11 patients had had a partial gastrectomy (Billroth II type) for peptic ulcer 10 or more years earlier.
  • All insulators examined at autopsy had pleural plaques and asbestos body counts above 10,000 per gram of dried tissue. Among shipyard workers, 75% had large (moderate to severe) plaques and 59% had counts above 10,000 per gram.
• The authors' conclusion: The authors considered all cases except the one with possible environmental exposure to be asbestos-related. They suggested that factors other than asbestos may play a role, and they expected a further wave of mesotheliomas in the coming decades because heavy exposure also occurred in the 1960s and 1970s.
• Limitations the authors state:
  • In four cases the diagnosis rested only on cytology. Nine other cases with cytology suspicious for mesothelioma had no further investigation and were not included.
  • Data on the types of asbestos in these cases were not available.
  • Occupational histories often came from relatives. In six cases the written work booklet led to corrections of 5 years or more in the date of first exposure that relatives had given.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Malignant Mesothelioma, Insulator, Environmental Exposure, Latency, Asbestos Bodies, Autopsy, Asbestos Body Formation.

Related studies

• Asbestos exposure in the Monfalcone area. A social and pathological study of 100 autopsy cases — C. Bianchi, A. Brollo, et al. (1981)
• Asbestos exposure in a shipyard area, northeastern Italy — C. Bianchi, A. Brollo, et al. (2000)
• Mesothelioma among shipyard workers in Monfalcone, Italy — C. Bianchi, T. Bianchi (2012)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)
• Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence — S. Conti, G. Minelli, et al. (2015)
• Differences between peritoneal and pleural mesothelioma in Lombardy, Italy — C. Mensi, M. Mendola, et al. (2017)

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