Epidemiology of malignant mesothelioma in Italy: surveillance systems, territorial clusters and occupations involved

Our plain-English summary of Epidemiology of malignant mesothelioma in Italy: surveillance systems, territorial clusters and occupations involved, by A. Marinaccio, A. Binazzi, M. Bonafede, et al (Journal of Thoracic Disease, 2018).

The study

• Authors: A. Marinaccio, A. Binazzi, M. Bonafede, D. Di Marzio, A. Scarselli, Regional Operating Centres
• Journal: Journal of Thoracic Disease
• Published: 2018;10(Suppl 2):S221-S227
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: As a legacy of the large asbestos consumption until the definitive ban in 1992, Italy is currently suffering a severe epidemic of asbestos related diseases. The aim of this paper is to describe the surveillance system for mesothelioma incidence and to provide evidences regarding the occurrence of the disease in Italy and the circumstances of asbestos exposure.

Methods: Italian National Register of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with Regional Operating Centres (CORs) active in each Italian region, identifying incident malignant mesothelioma (MM) cases from health care structures. Occupational history, lifestyle habits and residential history are obtained using a standardised questionnaire, administered by a trained interviewer, to the subject or to the next of kin. Descriptive epidemiological figures, occupations involved in exposures and territorial maps of MM cases have been produced.

Results: At December 2016, ReNaM has collected 27,356 MM cases for the incidence period between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of interviewed cases (14,818). Non-occupational exposure is still relevant with 4.9% and 4.4% of cases for which respectively a familial exposure (due to the cohabitation with an occupational exposed subject) and an environmental exposure (due to the residence near a contaminated site) has been detected.

Discussion: The epidemiological surveillance of MM incident cases, by the means of a national register for estimating the occurrence of the disease and identifying the circumstances of asbestos exposure, is a relevant tool for preventing asbestos exposure, for supporting the effectiveness of insurance system and for estimating reliable epidemiological figures.

In plain English

This paper described Italy's National Register of Malignant Mesotheliomas (ReNaM), a surveillance system with an operating centre in each of Italy's 20 regions, and presented the cases it had collected. Trained interviewers questioned patients or next of kin about work, lifestyle and residence, and the exposure of investigated cases was then classified. By December 2016 the register held 27,356 malignant mesothelioma cases diagnosed from 1993 to 2015; collection of 2015 cases was still incomplete. Of these, 93% arose in the pleura (lining of the lungs) and 6.5% in the peritoneum (lining of the abdomen). Exposure was investigated for 21,387 cases (78.2%). Among those, 14,818 (around 70%) had occupational exposure. In 4.9% the exposure was familial, from living with a worker exposed on the job. In 4.4% it was environmental, from living near a contaminated site. Among the 5,702 women whose exposure was investigated, 895 (15.7%) had familial exposure. The authors noted that mapping cases by municipality of residence at diagnosis can misplace where exposure happened. They concluded that a national register is a relevant tool for preventing asbestos exposure and supporting the insurance system.

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: Descriptive analysis of data from Italy's national mesothelioma surveillance register (ReNaM), which has a regional operating centre in all 20 Italian regions
• Who was studied: 27,356 malignant mesothelioma cases (19,633 men, 7,723 women) diagnosed in Italy from 1993 to 2015 and collected by the register up to December 2016; the 2015 data were incomplete
• Exposure: Asbestos exposure, assessed through a standardised questionnaire given to the patient or next of kin covering occupational history, lifestyle and residential history. For the cases investigated, exposure was classified as occupational (definite, probable or possible), familial, environmental, other non-occupational, unlikely or unknown. Fiber types were not reported for the register cases.
• Main results:
  • Among all collected cases, 93% were pleural and 6.5% were peritoneal (5.3% in men and 9.4% in women). There were 58 pericardial cases and 79 cases of the tunica vaginalis testis.
  • Cases younger than 45 at diagnosis made up less than 2% of the register. The mean age at diagnosis was around 70 years.
  • The ratio of men to women was 2.54 for all cases and 2.64 for pleural cases only.
  • 21,387 cases (78.2% of all cases) were interviewed. Of these, occupational exposure was defined for around 70% (14,818).
  • Among interviewed cases, 4.9% had familial exposure (from living with an occupationally exposed person) and 4.4% had environmental exposure (from living near a contaminated site).
  • Exposure was investigated ('defined') for 15,685 men, 5,702 women and 21,387 cases overall. These figures are the denominators for the percentages by exposure type.
  • Familial exposure was found in 152 of the interviewed men (1.0%), 895 of the 5,702 interviewed women (15.7%) and 1,047 of all interviewed cases (4.9%).
  • Definite occupational exposure was found in 9,300 of the interviewed men (59.3%), 987 of the interviewed women (17.3%) and 10,287 of all interviewed cases (48.1%).
  • Citing an econometric model described in detail in a separate publication, the authors reported estimated costs of 33,000 euros per patient for medical care and 25,000 euros per patient for insurance and compensation. They put productivity loss at around 200,000 euros per patient.
• The authors' conclusion: The authors concluded that national surveillance of mesothelioma cases through a register is a relevant tool for preventing asbestos exposure, supporting the insurance system, producing reliable epidemiological figures and identifying possible sources of contamination still in place.
• Limitations the authors state:
  • Maps used the municipality of residence at diagnosis as a stand-in for where exposure happened. Because people commute, this could misclassify the place of exposure.
  • Interview coverage varied greatly between regions. Some regions, particularly in Southern Italy, had interviews for less than half of detected cases.
  • Case collection for 2015 was not complete.
  • The incidence-rate maps left out Sardegna, Calabria and Molise because their incidence registration was not complete.

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Malignant Mesothelioma, Mesothelioma, Asbestos Exposure, Occupational History, Habit, Occupational Exposure, Non-Occupational Exposure.

Related studies

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• 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)
• Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register — A. Marinaccio, A. Binazzi, et al. (2012)
• The revised staging system for malignant pleural mesothelioma based on surveillance, epidemiology, and end results database — S. Wang, K. Ma, et al. (2017)
• 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)
• Mesothelioma incidence surveillance systems and claims for workers' compensation. Epidemiological evidence and prospects for an integrated framework — A. Marinaccio, A. Scarselli, et al. (2012)

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