Association of pulmonary tumors with asbestosis in Piedmont and Lombardy

Our plain-English summary of Association of pulmonary tumors with asbestosis in Piedmont and Lombardy, by E.C. Vigliani, G. Mottura, P. Maranzana (Annals of the New York Academy of Sciences, 1965).

The study

• Authors: E.C. Vigliani, G. Mottura, P. Maranzana
• Journal: Annals of the New York Academy of Sciences
• Published: 1965;132(1):558-74
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002513).

Abstract

In Piedmont and Lombardy, there are at present about 4,000 asbestos workers employed in mining, and in textile and asbestos products factories. From 1943 to 1964, 879 cases of asbestosis were certified in the above regions: 830 cases in Piedmont and 49 in Lombardy. Of these, 172 died and 707 are still alive. The ultimate cause of death of the 172 subjects who died was in 15 cases carcinoma of the lung and in three cases mesothelioma of the pleura. One lung carcinoma and two pleural mesotheliomas were found among the 707 living subjects.

The incidence of death from thoracic malignancy among subjects with asbestosis has been compared with that found among workers with silicosis. Among 172 fatal cases of asbestosis, 15 carcinomas of the lung and three mesotheliomas of the pleura were found, that is 10.5 per cent of all cases. No case of mesothelioma and 25 cases of carcinoma of the lung, that is 1.8 per cent, were found among 1,459 fatal cases of silicosis. Carcinoma of the lung therefore accounts for death in subjects with asbestosis five times more frequently than in subjects with silicosis.

The rate of death from carcinoma of the lung and from mesothelioma has been studied in 24,700 necropsies performed on people over 40 years of age in Turin, Milan and Pavia. In Turin and Milan, carcinoma of the lung accounts roughly for 4 per cent of the necropsies (5.3 per cent of men and 1.8 per cent of women) ; this is half the rate found among all subjects with asbestosis and one-fourth the rate among those who came to post-mortem.

Mesotheliomas, either pleural or peritoneal, were found in 76 out of a total of 24,700 necropsies (0.3 per cent) of subjects over 40 years of age. Three cases of mesothelioma (all pleural) were found among the 172 fatal cases of asbestosis. Altogether, six cases of mesothelioma of the pleura occurred in people occupationally exposed to asbestos dust ; three of them had worked with crocidolite and amosite besides chrysotile. In 10 cases of mesothelioma, not occupationally exposed to asbestos dust, where a lung specimen was available for study, no asbestos bodies were found.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

The authors reviewed Italian compensation records for all 879 workers certified with asbestosis in Piedmont and Lombardy from 1943 to September 1964. Of these, 172 had died and 707 were alive. The study areas included a chrysotile mine, asbestos textile and products factories, and an asbestos-cement factory. For comparison, the authors reviewed 1,459 deaths among certified silicosis cases in the provinces of Turin and Milan. They also reviewed 24,700 hospital necropsy records of people over 40 in Turin, Milan and Pavia. Among the 172 asbestosis deaths, 15 (8.7 per cent) were from lung cancer and 3 were from pleural mesothelioma. Among silicosis deaths, lung cancer accounted for 1.8 per cent overall and 2.8 per cent of those without tuberculosis. Lung cancer made up roughly 4 per cent of necropsies in Turin and Milan, and mesothelioma 0.3 per cent of all necropsies. Six pleural mesotheliomas, three certain and three probable, occurred in occupationally exposed people. Three of them had worked at a factory using crocidolite alongside amosite and chrysotile. The authors concluded that lung cancer deaths were at least three times more frequent than in silicosis. They noted that they could not calculate true incidence.

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: Preliminary retrospective review of compensation records of certified asbestosis cases (living and dead), compared with deaths among certified silicosis cases and with hospital necropsy records
• Who was studied: 879 certified asbestosis cases (830 in Piedmont, 49 in Lombardy), 1943 to September 1964. 172 died (121 men, 51 women) and 707 were alive. Comparison groups were 1,459 deaths among certified silicosis cases in the provinces of Turin and Milan, and 24,700 necropsies of people over 40 in Turin, Milan and Pavia (1944 to 1963). A 'certified case' was a person whose compensation claim was accepted, with loss of working capacity assessed at more than 20 per cent.
• Exposure: Occupational asbestos exposure in the Province of Turin (a chrysotile mine at Balangero and asbestos products and textile factories), the Province of Alessandria (a large asbestos-cement factory), and Lombardy (small mines and asbestos products factories). One textile factory used crocidolite besides amosite and chrysotile.
• Main results:
  • Among the 172 dead asbestosis cases, the cause of death was lung cancer in 15 and pleural mesothelioma in 3
  • Among the 707 living asbestosis cases, one lung cancer and two pleural mesotheliomas were found
  • Severe asbestosis itself (with cardiorespiratory insufficiency) accounted for about 40 per cent of the deaths among the asbestosis cases
  • Lung cancer caused 8.7 per cent of deaths among asbestosis cases (15 of 172), compared with 2.8 per cent among silicosis cases without tuberculosis
  • Among males, lung cancer death rates were 11.6 per cent for asbestosis and 2.7 per cent for silicosis without tuberculosis
  • Among all 1,459 silicosis deaths, 25 were from lung cancer (1.8 per cent), and no mesothelioma was found
  • The authors stated that the three-year difference in mean age at death between the asbestosis and silicosis groups could not account for the difference in lung cancer deaths
  • In necropsies of people over 40 in Turin and Milan, lung cancer accounted for roughly 4 per cent (5.3 per cent of men, 1.8 per cent of women)
  • Among asbestosis cases who had a necropsy, lung cancer accounted for 14.5 per cent
  • Among 24,700 necropsies of people over 40 in Turin, Milan and Pavia, 76 mesotheliomas were found: 59 pleural, 12 peritoneal and 5 pericardial
  • Turin had about twice the rate of mesothelioma at necropsy that Milan had, while lung cancer rates did not differ between the two cities
  • Among Turin necropsy mesothelioma cases, the homes of 20 showed no concentration near the district with asbestos plants
  • Relatives of 18 Turin necropsy mesothelioma cases were asked about asbestos work. Only one said yes: a woman who had worked 6 months in an asbestos textile factory 30 years before death.
  • Lung specimens from 10 mesothelioma cases (8 from Turin, 2 from Milan) showed no asbestos bodies. In one case, fragments of a fibrous mineral, presumably asbestos, were seen.
  • Three certain and three probable cases of pleural mesothelioma were found in people with occupational exposure to asbestos; four had died and two were alive
  • Three of the six mesothelioma cases had worked in the only asbestos factory where crocidolite was usually used, besides amosite and chrysotile
  • Of 90 asbestosis deaths from known causes other than severe asbestosis, 7 (7.7 per cent) were from stomach or colon cancer. The authors said their figures did not show a very high rate of gastrointestinal cancer deaths.
  • The authors judged that their findings showed pleural mesothelioma is not too rare in Italy among people with asbestosis
• The authors' conclusion: The authors concluded that occupational asbestos exposure in Piedmont and Lombardy results in a rate of death from lung cancer at least three times higher than in silicosis
• Limitations the authors state:
  • Age- and year-specific death rates for the worker cohort were not available, so comparison with the general population was difficult
  • Few asbestosis cases had necropsies, so the comparison with autopsy series must be interpreted with caution
  • Only a small percentage of hospital deaths underwent necropsy, so the necropsy material was selected in favor of interesting or rare diseases
  • Diagnostic criteria may have differed between pathologists in the three cities over 20 years
  • About half the cases labelled as mesothelioma did not exactly fit the classical pattern, making the true mesothelioma death rate hard to judge
  • The results do not allow calculation of the actual incidence of lung cancer among asbestos workers
  • Lung slides were available for only a small share of mesothelioma cases, and the part of the lung sampled was unknown
  • Cause of death remained unknown in 13 of the asbestosis deaths
  • The data do not allow any conclusion about mesothelioma and crocidolite exposure
  • Insulation workers were not included in the study

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Balangero mine, Balangero, about 20 km north of Turin, Piedmont

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Carcinoma, Mesothelioma, Pleura, Pleural Mesothelioma, Silicosis, Crocidolite, Amosite, Chrysotile.

Related studies

• Gender differences in pleural mesothelioma occurrence in Lombardy and Piedmont, Italy — D. Consonni, E. Migliore, et al. (2019)
• TruCutR needle biopsy in asbestosis and silicosis: correlation of histological changes with radiographic changes and pulmonary function in 41 patients — P. Tukiainen, E. Taskinen, et al. (1978)
• Asbestosis and silicosis — G.R. Wagner (1997)
• Mortality of Talc Miners and Millers From Val Chisone, Northern Italy: An Updated Cohort Study — E. Pira, M. Coggiola, et al. (2017)
• Costs of asbestosis and silicosis hospitalization in Italy (2001-2018) : Costs of asbestosis and silicosis hospitalization — P. Ferrante (2021)
• Serum oncoproteins and growth factors in asbestosis and silicosis patients — P.W. Brandt-Rauf, S. Smith, et al. (1992)

Browse more research in Annals of the New York Academy of Sciences, or return to medical research.