Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis"

Our plain-English summary of Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis", by A. Marinaccio, D. Consonni, C. Mensi, et al (Scandinavian Journal of Work, Environment & Health, 2021).

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: 2021;47(1):87-89
• Type of article: Letter, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This is a letter in which the authors replied to criticism by Mezei and colleagues of their earlier case-control study of malignant mesothelioma of the pericardium and of the tunica vaginalis testis (TVT). That study used 138 cases collected by the Italian national mesothelioma registry (ReNaM) from 1993 to 2015, compared with controls taken from two existing studies. The authors acknowledged that cases and controls were not fully matched in time and place. Following the critics' suggestion, they ran further analyses restricted to regions with controls and grouped by age and year of birth. For occupational asbestos exposure, the odds ratio for pericardial mesothelioma was 9.16 among women (95% CI 0.56 to 150) and 5.63 among men (95% CI 1.02 to 31.0). For TVT mesothelioma it was 7.70 (95% CI 2.89 to 20.5). A second modelling approach gave similar figures. Among the 70 occupationally exposed cases, construction was the most frequently reported industry of exposure. The authors concluded that the additional analyses confirmed the association between asbestos exposure and pericardial and TVT mesothelioma, supporting a causal role of asbestos for all mesotheliomas.

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: Letter to the editor (authors' reply to a critique), reporting additional sensitivity analyses of the authors' earlier registry-based case-control study
• Who was studied: 138 cases of pericardial and tunica vaginalis testis mesothelioma from the Italian national mesothelioma registry (ReNaM), 1993 to 2015, nationwide. Controls came from a population-based study on pleural mesothelioma (MISEM) and a hospital-based study on cholangiocarcinoma (CARA).
• Exposure: Occupational asbestos exposure, assessed by questionnaire and classified as definite, probable or possible. Definite and probable were combined in the analyses. No fiber types are named.
• Main results:
  • Conditional models using risk sets of age and year of birth, restricted to regions with controls and adjusted for region. Pericardial mesothelioma: OR 9.16 among women (95% CI 0.56 to 150) and OR 5.63 among men (95% CI 1.02 to 31.0). TVT mesothelioma: OR 7.70 (95% CI 2.89 to 20.5).
  • With risk sets of age and year of birth as a covariate, the results were similar. Pericardial mesothelioma: OR 9.17 among women (95% CI 0.56 to 150) and OR 5.76 among men (95% CI 1.07 to 31.0). TVT mesothelioma: OR 9.86 (95% CI 3.46 to 28.1).
  • In analyses restricted to certain areas, odds ratios were larger than in whole-country analyses. The authors interpreted this as bias towards the null.
  • Restricting to definite occupational exposure and using each control set separately gave elevated odds ratios for TVT and pericardial mesothelioma among men. The odds ratio could not be calculated for women.
  • There were 70 occupationally exposed cases: 25 pericardial and 45 TVT.
  • Industries of exposure (cases may have more than one), given as pericardial and TVT counts respectively: construction 22 exposures (7 and 15); steel mills and other metal working (4 and 11); textile (2 and 3); agriculture (2 and 5).
• The authors' conclusion: The authors concluded that the additional analyses confirmed the association between asbestos exposure and pericardial and TVT mesothelioma, supporting the causal role of asbestos for all mesotheliomas.
• Limitations the authors state:
  • Cases and controls were only incompletely matched in time and place.
  • The response rate among population controls in the MISEM study was low (48.4%).
  • Analyses by occupation were limited because most specific jobs were uncommon.

Topics

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

Medical terms in this study, explained in our Lexicon: Case-Control Study, Malignant Mesothelioma, Pericardium, Tunica Vaginalis.

Related studies

• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2021)
• Response to the "Letter to the Editor" by Gabor Mezei et al., Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register" — L. Vimercati, D. Cavone, et al. (2019)
• Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018 — S. Stella, D. Consonni, et al. (2023)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)
• 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)

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