Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks

Our plain-English summary of Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks, by A. Marinaccio, D. Consonni, C. Mensi, et al (Scandinavian Journal of Work, Environment & Health, 2020).

The study

• Authors: A. Marinaccio, D. Consonni, C. Mensi, D. Mirabelli, E. Migliore, C. Magnani, D. Di Marzio, V. Gennaro, G. Mazzoleni, P. Girardi, C. Negro, A. Romanelli, E. Chellini, I. Grappasonni, G. Madeo, E. Romeo, V. Ascoli, F. Carrozza, I.F. Angelillo, D. Cavone, R. Tumino, M. Melis, S. Curti, G. Brandi, S. Mattioli, S. Iavicoli, ReNaM Working Group
• Journal: Scandinavian Journal of Work, Environment & Health
• Published: 2020;46(6):609-617
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives The purposes of this study are to describe the epidemiology of pericardial and tunica vaginalis testis mesothelioma and assess the role of asbestos exposure for these rare diseases. Methods Based on incident pericardial and tunica vaginalis testis mesothelioma cases collected from the Italian national mesothelioma registry (ReNaM) in the period 1993-2015, incidence rates, survival median period and prognostic factors have been evaluated. A case-control study has been performed to analyze the association with asbestos exposure (occupational and non-occupational) for these diseases. Results Between 1993 and 2015, 58 pericardial (20 women and 38 men) and 80 tunica vaginalis testis mesothelioma cases have been registered with a mean annual standardized (world standard population as reference) incidence rates of 0.049 (per million) in men and 0.023 in women for the pericardial site, and 0.095 for tunica vaginalis testis mesothelioma. Occupational exposure to asbestos was significantly associated with the risk of the diseases [odds ratio (OR) 3.68, 95% confidence interval (CI) 1.85-7.31 and OR 3.42, 95% CI 1.93-6.04 in pericardial and tunica vaginalis testis mesothelioma, respectively]. The median survival was 2.5 months for pericardial and 33.0 months for tunica vaginalis testis mesotheliomas. Age was the main predictive factor for survival for both anatomical sites. Conclusions For the first time in an analytical study, asbestos exposure was associated with pericardial and tunica vaginalis testis mesothelioma risk, supporting the causal role of asbestos for all anatomical sites. The extreme rarity of the diseases, the poor survival and the prognostic role of age have been confirmed based on population and nationwide mesothelioma registry data.

In plain English

This study used Italy's national mesothelioma registry to examine two very rare mesotheliomas: of the heart lining (pericardial) and of the testis lining (tunica vaginalis testis). From 1993 to 2015 it recorded 58 pericardial (38 men, 20 women) and 80 testicular cases. World-standardized yearly incidence per million was 0.049 in men and 0.023 in women for pericardial, and 0.095 for testicular mesothelioma. Median survival was 2.5 months (pericardial) and 33.0 months (testicular), and older patients fared worse. A case-control analysis compared 45 pericardial cases with 929 controls and 68 testicular cases with 593 male controls. Occupational asbestos exposure was associated with higher odds of pericardial (OR 3.68, 95% CI 1.85–7.31) and testicular mesothelioma (OR 3.42, 95% CI 1.93–6.04). For pericardial mesothelioma, the OR was 5.52 (95% CI 2.14–14.2) in men and 1.99 (95% CI 0.60–6.63) in women. The authors concluded this supports a causal role of asbestos at all sites. They noted that controls came from later years than many cases and from only six regions. Exposure was assessed only qualitatively, so fiber types could not be separated.

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: Registry-based analysis of incidence and survival, plus a case-control study of asbestos exposure
• Who was studied: The registry part covered pericardial and tunica vaginalis testis mesothelioma cases in the Italian national mesothelioma registry, 1993–2015 (58 pericardial, 80 testicular). The case-control part included 45 pericardial cases (28 men, 17 women) and 68 testicular cases. Controls came from two earlier Italian studies, one population-based study on pleural mesothelioma and one hospital-based study on cholangiocarcinoma. All 929 controls (593 men, 336 women) were used for pericardial mesothelioma, and the 593 male controls for testicular mesothelioma.
• Exposure: Lifetime asbestos exposure was assessed with a standardized questionnaire. It was classed as occupational (definite, probable, possible) or non-occupational (familial, environmental, leisure-related) and compared against 'unlikely' exposure. Fiber types were not analyzed separately.
• Main results:
  • Registry counts, 1993–2015: 58 pericardial mesothelioma cases (38 men, 20 women) and 80 tunica vaginalis testis cases
  • Pericardial mesothelioma, mean yearly incidence standardized to the world population: 0.049 per million in men and 0.023 per million in women
  • Tunica vaginalis testis mesothelioma: mean yearly incidence of 0.095 (per million)
  • Median survival was 2.5 months for pericardial mesothelioma
  • Median survival was 33.0 months for tunica vaginalis testis mesothelioma
  • Pericardial mesothelioma patients aged 75 and over had a hazard of death of 3.52 (95% CI 1.45–8.51) compared with patients under 65. Younger patients with testicular mesothelioma also had a better prognosis.
  • Among the 113 cases with an exposure assessment, 70 (61.9%) had occupational asbestos exposure (definite, probable or possible)
  • Pericardial mesothelioma, men and women combined (45 cases, 929 controls): occupational asbestos exposure, OR 3.68 (95% CI 1.85–7.31)
  • Pericardial mesothelioma, occupational exposure by sex: men OR 5.52 (95% CI 2.14–14.2); women OR 1.99 (95% CI 0.60–6.63)
  • Tunica vaginalis testis mesothelioma (68 cases, 593 male controls): occupational asbestos exposure, OR 3.42 (95% CI 1.93–6.04)
  • Any asbestos exposure (occupational or non-occupational): OR 1.79 (95% CI 0.95–3.34) for pericardial and OR 2.25 (95% CI 1.30–3.90) for testicular mesothelioma
  • Only two pericardial cases had non-occupational exposure, so the risk estimates for that exposure were statistically unstable
  • Analyses by economic sector of exposure did not show specific risks
• The authors' conclusion: The authors concluded that, for the first time in an analytical epidemiological study, asbestos exposure was associated with pericardial and tunica vaginalis testis mesothelioma risk. They saw this as support for the causal role of asbestos for mesothelioma at all anatomical sites.
• Limitations the authors state:
  • Controls came from earlier studies carried out in later years than many of the cases (cases 1993–2015). The authors give the control studies as 2012–2015, although the methods report one control set interviewed in 2014–2016.
  • Controls came only from six regions (Apulia, Lombardy, Piedmont, Tuscany, Veneto, Emilia-Romagna), which are among the most industrialized in Italy
  • Exposure assessment was qualitative
  • The share of cases with collected exposure histories varied from 45% to 95% across regions
  • Regional registry centers started at different times, which could have biased the study
  • Possible over-reporting of cases, as with specialized registries in general
  • Different asbestos fiber types could not be analyzed separately. Exposure was reconstructed qualitatively, and chrysotile and amphiboles were used together in many Italian workplaces.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pericardial, Tunica Vaginalis, Malignant Mesothelioma, Case-Control Study, Epidemiology, Mesothelioma, Incidence.

Related studies

• Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis" — A. Marinaccio, D. Consonni, et al. (2021)
• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM) — A. Binazzi, D. Di Marzio, et al. (2021)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register — A. Marinaccio, A. Binazzi, et al. (2010)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)

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