Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma

Our plain-English summary of Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma, by B. Terracini, D. Mirabelli, X. Baur, et al (American Journal of Industrial Medicine, 2016).

The study

• Authors: B. Terracini, D. Mirabelli, X. Baur, P. Landrigan, Collegium Ramazzini
• Journal: American Journal of Industrial Medicine
• Published: 2016;59(6):506-7
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this commentary on behalf of the Collegium Ramazzini, an international scientific society of 180 physicians and scientists from 35 countries, the authors addressed a claim used in Italian civil and criminal mesothelioma trials. The Italian asbestos industry and its expert witnesses had argued that, in cases of prolonged exposure, only the earliest periods of asbestos exposure contribute to mesothelioma, and later exposures have no causal role. The authors described the consequences in court. Only firms that employed workers in the early years, often since liquidated, were held liable. Managers in charge during later years of exposure were acquitted. They described a "hard" version of the thesis, a small trigger dose acting in susceptible individuals, presented in a 2005 paper by Chiappino. They also described a "soft" version in a 2012 review by La Vecchia and Boffetta, which they called biased and highly selective. They cited a 2011 systematic review by a working group of the Second Italian Consensus Conference on Pleural Mesothelioma, which concluded that incidence is proportional to cumulative exposure, without setting a time limit after which further exposure adds no risk. They also cited a 2015 review finding that both intensity and duration of exposure determine risk. The Collegium concluded that all exposures, early and late, contribute to risk. It rejected the contrary claim as false and scientifically unfounded, and warned that its acceptance could lead to unjust denial of compensation and hinder prevention.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This is a commentary, not a study, and it reports no new data. Four authors wrote it on behalf of the Collegium Ramazzini, an international scientific society. It answered an argument used by the defense in Italian asbestos trials: that when a worker was exposed for a long time, only the earliest exposure caused mesothelioma and later exposure played no causal role. The authors wrote that, as a result, in a number of trials only the firms that owned factories in the early years were held liable, and no compensation was awarded when those firms had been liquidated. The authors stated that a 2012 review supporting the argument had little scientific merit. They cited a 2011 Italian systematic review, which concluded there was convincing evidence that mesothelioma incidence is proportional to cumulative asbestos exposure. That review found the same increase in exposure was more effective early in a prolonged exposure, but it set no time limit after which more exposure stopped adding risk. A 2015 review found that both intensity and duration of exposure were determinants of risk. The Collegium concluded that all exposures, early as well as late, contribute to risk. Two authors disclosed having given expert testimony.

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: Commentary (position statement) on behalf of the Collegium Ramazzini; no original data
• Who was studied: No study population. The commentary addresses mesothelioma cases brought before Italian courts as possible occupational diseases.
• Exposure: Occupational asbestos exposure, especially prolonged exposure, and how cumulative exposure relates to risk. No specific fiber types are named.
• Main results:
  • The authors described the defense argument in Italian trials: in cases of prolonged asbestos exposure, only the earliest periods of exposure contribute to mesothelioma, and later exposures have no causal role.
  • The authors stated that in a number of trials only the firms that owned factories during the early years of exposure were considered liable, and no compensation was awarded when those companies had been liquidated.
  • The authors judged that a 2012 review by La Vecchia and Boffetta supporting this argument had little scientific merit and was based on a biased and highly selective review of the literature.
  • The commentary reports that a 2011 systematic review by an Italian consensus conference working group concluded that there is convincing evidence that mesothelioma incidence is proportional to cumulative asbestos exposure.
  • According to the commentary, that working group noted that the same increase in exposure was more effective when it occurred early during a prolonged exposure.
  • According to the commentary, the working group's report did not mention any time limit beyond which further exposure would cause no further increase in mesothelioma risk.
  • The commentary reports that a 2015 review of epidemiological studies found that both the intensity and the duration of asbestos exposure are determinants of mesothelioma risk.
  • Disclosure: Dr. Terracini has provided relevant expert testimony in Italian courts.
  • Disclosure: Dr. Mirabelli has provided expert testimony for the Office of the Public Prosecutor in a criminal trial for asbestos-related deaths.
• The authors' conclusion: The Collegium Ramazzini concluded that the risk of malignant mesothelioma is related to cumulative asbestos exposure, with all exposures, early as well as late, contributing to risk. It rejected as false and scientifically unfounded the claim that only the earliest periods of a prolonged exposure contribute.

Topics

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

Medical terms in this study, explained in our Lexicon: Causation, Mesothelioma, Collegium Ramazzini, Expert Witness, Asbestos Exposure, Systematic Review, Pleural Mesothelioma, Cumulative Exposure.

Related studies

• Comments on the causation of malignant mesothelioma: rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma — (2016)
• Re: Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma — B. Terracini, D. Mirabelli, et al. (2016)
• Comments on the Causation of Malignant Mesothelioma: Rebutting the False Concept That Recent Exposures to Asbestos Do Not Contribute to Causation of Mesothelioma — P.J. Landrigan, Collegium Ramazzini (2016)
• Comments on the causation of malignant mesothelioma: rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma — C. Ramazzini (2016)
• Re: Terracini et al. Comments on the causation of malignant mesothelioma: Rebutting the false concept that recent exposures to asbestos do not contribute to causation of mesothelioma. Am J Ind Med 2016;59:506-507 — P. Boffetta (2016)
• 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)

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