Cancer incidence in Priolo, Sicily: a spatial approach for estimation of industrial air pollution impact

Our plain-English summary of Cancer incidence in Priolo, Sicily: a spatial approach for estimation of industrial air pollution impact, by L. Fazzo, M. Carere, F. Tisano, et al (Geospatial Health, 2016).

The study

• Authors: L. Fazzo, M. Carere, F. Tisano, C. Bruno, A. Cernigliaro, M.R. Cicero, P. Comba, M.L. Contrino, M. De Santis, F. Falleni, V. Ingallinella, A. Madeddu, I. Marcello, C. Regalbuto, G. Sciacca, M.E. Soggiu, A. Zona
• Journal: Geospatial Health
• Published: 2016;11(1):320
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The territory around the industrial Sicilian area of Priolo, Italy, has been defined as a contaminated site (CS) of national priority for remediation because of diffuse environmental contamination caused by large industrial settlements. The present study investigates the spatial distribution of cancer into the CS territory (period 1999-2006). Different geographical methods used for the evaluation of the impact of industrial air pollutants were adopted. Using the database of Syracuse Province Cancer Registry, gender-specific standardised incidence ratios were calculated for 35 tumour sites for the CS overall and for each municipality included in the CS. A cluster analysis for 17 selected neoplasms was performed at micro-geographical level. The identification of the priority index contaminants (PICs) present in environmental matrices and a review of their carcinogenicity have been performed and applied in the interpretation of the findings. The area has a higher cancer incidence with respect to the provincial population, in particular excess is registered among both genders of lung, bladder and breast cancers as well as skin melanoma and pleural mesothelioma and there is an a priori evidence of association with the exposure to PICs. The study highlights the need to provide different approaches in CSs where several exposure pathways might be relevant for the population. The presence of potential sources of asbestos exposure deserves specific concern.

In plain English

This study looked at cancer rates from 1999 to 2006 among people living in the Priolo contaminated site in south-eastern Sicily. The site is a stretch of coast with refineries, petrochemical plants, a cement plant, landfills and a former asbestos-cement plant (Eternit). Using the Syracuse Province Cancer Registry, the authors compared cancer incidence in the site's four municipalities (Augusta, Melilli, Priolo and Syracuse) with the rest of the province. They also searched for clusters of cases in small census areas and reviewed which local pollutants have been linked to which cancers. Pleural mesothelioma occurred more often than expected in men (38 cases, standardised incidence ratio 2.23, 95% confidence interval 1.58-3.06) and in women (9 cases, 2.21, 1.01-4.19). The authors singled this out because occupational asbestos exposure had been documented at the former asbestos-cement plant in Syracuse and in refineries, chemical industries and shipbuilding in Augusta. Lung, bladder and breast cancer and skin melanoma were also in excess in both sexes. The authors noted that they had no information on individual jobs, lifestyle or socioeconomic conditions, so other factors could not be ruled out.

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: Geographical (ecological) study of cancer incidence: standardised incidence ratios compared with the rest of the province, plus cluster analysis at census-tract level and a review of contaminants' carcinogenicity
• Who was studied: Residents of the Priolo contaminated site (municipalities of Augusta, Melilli, Priolo and Syracuse, Sicily, Italy) diagnosed with cancer 1999-2006. The reference was the Syracuse Province population, with residents of the study area excluded. 2552 cases (1808 men, 744 women) in the selected cancer sites.
• Exposure: Residence in an industrial contaminated site (refineries, petrochemical plants, a cement plant, a former asbestos-cement plant, landfills), with a focus on industrial air pollution. Asbestos fiber types are not named. Occupational asbestos exposure was documented at the former asbestos-cement plant in Syracuse and in refineries, chemical industries and shipbuilding and repair in Augusta.
• Main results:
  • Pleural mesothelioma in the whole contaminated site: men 38 observed cases, SIR 2.23 (95% CI 1.58-3.06); women 9 observed cases, SIR 2.21 (95% CI 1.01-4.19).
  • Pleural mesothelioma by municipality, Augusta: men 14 cases, SIR 4.21 (95% CI 2.30-7.06); women 4 cases, SIR 5.12 (95% CI 1.39-13.00). Syracuse: men 17 cases, SIR 1.46 (95% CI 0.85-2.34); women 4 cases, SIR 1.40 (95% CI 0.38-3.58). The authors described increases in both genders in the overall area and in all municipalities except Melilli, and linked them to documented occupational asbestos exposure.
  • In the whole site, all malignant neoplasms, lung cancer, urinary bladder cancer and cutaneous melanoma were above expected numbers in both men and women. All malignant neoplasms: men SIR 1.20 (95% CI 1.16-1.24), women SIR 1.14 (95% CI 1.10-1.18). Lung: men 609 cases, SIR 1.23 (95% CI 1.13-1.33); women 109 cases, SIR 1.23 (95% CI 1.01-1.48).
  • Breast cancer was increased in both genders in the whole site. Men: 13 cases, SIR 2.00 (95% CI 1.06-3.42). Women: 814 cases, SIR 1.15 (95% CI 1.07-1.23).
  • Cluster analysis found significant clusters of lung cancer in both genders in Syracuse, and among women in Augusta in the analysis excluding Syracuse.
• The authors' conclusion: The authors concluded that the population of the Priolo contaminated site has a worse health status than the Province of Syracuse as a whole, and that environmental exposure might play a role. They wrote that the excess of pleural mesothelioma in both sexes deserves specific concern because of the presence of potential asbestos sources.
• Limitations the authors state:
  • The study mainly addressed inhalation of industrial pollutants. Other pathways such as diet and occupation could not be properly handled by the spatial methods used.
  • There was no information on individual occupational and environmental exposures, lifestyle or socioeconomic conditions, so the role of other factors cannot be ruled out.
  • Statistical power was low in Priolo and Melilli because of their small populations.
  • There was no information on some highly toxic micropollutants in atmospheric particulate matter.

Topics

Medical terms in this study, explained in our Lexicon: Cancer Registry, Standardized Incidence Ratio (SIR), Neoplasm, Pleural Mesothelioma, Asbestos Exposure.

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