Ferrante et al respond

Our plain-English summary of Ferrante et al respond, by D. Ferrante, D. Mirabelli, S. Silvestri, et al (American Journal of Industrial Medicine, 2020).

The study

• Authors: D. Ferrante, D. Mirabelli, S. Silvestri, D. Azzolina, A. Giovannini, P. Tribaudino, C. Magnani
• Journal: American Journal of Industrial Medicine
• Published: 2020;63(9):836-837
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor. In it, the authors replied to a letter by Schüz and Kromhout about their earlier cohort study of chrysotile asbestos miners in Balangero, Italy, and compared their study with another study of the same mine by Pira et al. Their cohort had 974 subjects, compared with 1056 in Pira et al's study. They recorded 647 deaths from 1946 to 2013. At the critics' request, they reanalysed their data using Pira et al's cumulative exposure categories: less than 100, 100 to 400, and more than 400 fibers per milliliter-year. Across these categories, lung cancer standardized mortality ratios were 0.96 (95% CI 0.50 to 1.69), 1.40 (0.72 to 2.45) and 1.14 (0.65 to 1.85). Compared with the lowest category, mesothelioma rate ratios were 38.6 (3.58 to 416) at 100 to 400 and 20.8 (1.39 to 313) above 400. The authors concluded that an increase was observed for mesothelioma and suggested for lung cancer. They said dose-response trends showed more clearly with data-driven categories (tertiles and the median). They noted that cause-of-death records could not be found for 26 subjects in 1946 to 1964.

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), reporting a reanalysis of their own earlier cohort study using different exposure categories
• Who was studied: Chrysotile asbestos miners of the Balangero mine, Italy (the authors' cohort, compared with the Pira et al cohort of the same mine)
• Exposure: Cumulative asbestos exposure, grouped as less than 100, 100 to 400, and more than 400 fibers per milliliter-year (f/mL-y), and also split at the median
• Main results:
  • The authors' cohort had 974 subjects, compared with 1056 in Pira et al's study
  • The authors' cohort had 74 deaths in 1946 to 1964, for a total of 647 deaths from 1946 to 2013
  • Lung cancer SMRs in the authors' cohort were 0.96 (95% CI 0.50 to 1.69) below 100 f/mL-y, 1.40 (CI 0.72 to 2.45) at 100 to 400, and 1.14 (CI 0.65 to 1.85) above 400
  • Lung cancer rate ratios, adjusted for age, calendar period and latency, were 1.74 (CI 0.66 to 4.54) for 100 to 400 and 1.29 (CI 0.44 to 3.76) for more than 400 f/mL-y, compared with less than 100
  • For lung cancer, the rate ratio for exposures above the median was 1.61 (CI 0.62 to 4.19)
  • Pleural cancer SMRs were 1.62 (CI 0.04 to 9.05), 9.70 (CI 2.00 to 28.3) and 4.26 (CI 0.52 to 15.40) across the less than 100, 100 to 400, and more than 400 f/mL-y categories
  • Mesothelioma rate ratios, adjusted for calendar period and latency, were 38.6 (CI 3.58 to 416) at 100 to 400 and 20.8 (CI 1.39 to 313) at more than 400 f/mL-y, compared with less than 100
  • For mesothelioma, the rate ratio for exposures above the median was 42.8 (CI 3.44 to 532)
  • The median cumulative exposure in the authors' assessment was 107 f/mL-y, close to the first cutoff of 100 used by Pira et al
• The authors' conclusion: The authors concluded that, with the predefined categories, an increase was observed for mesothelioma and suggested for lung cancer, but that dose-response trends are seen more clearly using data-driven categories (tertiles and the median)
• Limitations the authors state:
  • Cause-of-death certification could not be retrieved for 26 subjects for 1946 to 1964
  • Without a case-by-case comparison, the authors could not comment on some differences between their study and Pira et al's
  • The authors stated that Pira et al's cutoffs place almost 50% of their cohort in the baseline category

Topics

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

Related studies

• Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: A cohort study — D. Ferrante, D. Mirabelli, et al. (2020)
• Re Ferrante et al (2020). Mortality and mesothelioma incidence among chrysotile asbestos miners in Balangero, Italy: A cohort study — J. Schüz, H. Kromhout (2020)
• Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy — F. Luberto, D. Ferrante, et al. (2019)
• Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis — A. Reid, N.H. de Klerk, et al. (2014)
• Cancer mortality and incidence of mesothelioma in a cohort of wives of asbestos workers in Casale Monferrato, Italy — D. Ferrante, M. Bertolotti, et al. (2007)
• Gibb et al. respond — H. Gibb, K. Fulcher, et al. (2014)

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