Health impact of exposure to asbestos in polluted area of Southern Italy

Our plain-English summary of Health impact of exposure to asbestos in polluted area of Southern Italy, by L. Vimercati, D. Cavone, F. Mansi, et al (Journal of Preventive Medicine and Hygiene, 2019).

The study

• Authors: L. Vimercati, D. Cavone, F. Mansi, E.S.S. Cannone, L. DE Maria, A. Caputi, M.C. Delfino, G. Serio
• Journal: Journal of Preventive Medicine and Hygiene
• Published: 2019;60(4):E407-E418
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The three main sources of asbestos pollution in the city of Bari, Puglia, the former Fibronit asbestos factory, the Torre Quetta beach, the former Rossani barracks and the history of their reclamation are described. The results of cohort studies on factory workers and case-control studies on asbestos exposure to the resident population and the onset of mesothelioma are also reported. Finally, the data of the regional register of mesothelioma related to residents in the city of Bari and four new cases with environmental exposure due to the former Rossani barracks are presented.

©2019 Pacini Editore SRL, Pisa, Italy.

In plain English

This article reviews published studies on asbestos and health in Bari, southern Italy. The authors searched the medical literature and described three pollution sources: the former Fibronit asbestos cement factory (mostly chrysotile, with crocidolite and amosite), Torre Quetta beach, where factory waste was dumped, and the former Rossani military barracks. In one reviewed follow-up of 414 male former Fibronit workers, lung tumor deaths gave an SMR of 201 (95% CI 146-276), with much higher ratios for pleural and peritoneal tumors and asbestosis. A reviewed case-control study of mesothelioma cases without occupational exposure reported a relative risk of 5.29 (95% CI 1.18-23.74) for living within 500 meters of the plant. Regional register data counted 367 mesothelioma cases among Bari residents in 1993-2015. Exposure was reconstructed for 255 of them, and 26% were reported as environmental, though the article does not clearly say which total that share refers to. The register also identified four new cases linked to the barracks. The authors concluded that the factory and barracks are correlated with increased mesothelioma risk among residents. They noted that Fibronit fiber measurements exist only from the 1970s.

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: Review of published epidemiological studies (cohort, case-control and case reports) found through a MEDLINE/PubMed search and hand-searching, plus regional mesothelioma register data. The journal labels it an original article, but the text calls itself a review.
• Who was studied: Studies of former Fibronit asbestos cement workers and of residents of the Bari municipality, Apulia, southern Italy. The medical conditions of interest were pleural and peritoneal mesothelioma.
• Exposure: Occupational and environmental exposure from three sources: the former Fibronit asbestos cement factory (operating 1933 to 1985, using chrysotile 80%, crocidolite 15% and amosite 5%), asbestos waste at Torre Quetta beach, and asbestos roofs and chimneys at the former Rossani military barracks.
• Main results:
  • SENTIERI project (reviewed), Bari-Fibronit polluted site, 1995-2002: men had 49 pleural cancer deaths, SMR 199 (90% CI 155-253). Women had 17, SMR 192 (90% CI 122-287).
  • SENTIERI-ReNaM (reviewed), 2000-2011: 123 malignant mesothelioma cases (88 men, 35 women) were recorded among residents of the polluted site. SIR was 271 (90% CI 228-323) in men and 322 (90% CI 244-426) in women.
  • Fibronit cohort of 417 male workers (reviewed): average latency for pleural mesothelioma was about 42 years (minimum 26, maximum 52).
  • Fibronit cohort follow-up of 414 male former workers to 31 December 2012 (reviewed), with 232 deaths. Lung tumors had an SMR of 201 (95% CI 146-276). Pleural tumors were printed as 4.033 (2.541-6.401), peritoneal tumors 2.945 (1.404-6.177) and asbestosis 13.268 (9.481-18.570), on a scale where 100 equals expected.
  • Geographical study of 64 mesothelioma cases among Bari residents, 1980-2001 (reviewed): within about 1 km of the factory, the estimated risk was 2.38 times the normal level.
  • Case-control study of 48 non-occupational mesothelioma cases and 273 controls, 1993-2003 (reviewed): the relative risk within 500 meters of the plant was 5.29 (95% CI 1.18-23.74). For the 1,500-2,000 m band, the odds ratio was 2.31 (95% CI 0.88-6.06), which was not statistically significant.
  • Lung fiber study of five mesothelioma cases with no occupational exposure who lived near Fibronit (reviewed): lung fiber loads ranged from 110,000 to 2,300,000 fibers per gram of dry lung. A linear relationship with cumulative exposure indices was observed.
  • Apulia regional register (COR Apulia), 1993-2015: 367 mesothelioma cases among Bari residents. Exposure was reconstructed for 70% (255). Of the reconstructed cases, 58% had occupational exposure and 3% family/domestic or leisure exposure. Separately, 26% of 'the cases among the residents' were reported with environmental exposure; the article does not clearly state whether that share is of all 367 or of the 255 reconstructed cases.
  • Four new malignant mesothelioma cases (one peritoneal, three pleural) were identified from the regional registry and attributed to environmental exposure from the Rossani military barracks.
• The authors' conclusion: The authors concluded that the presence of the asbestos cement factory and the military barracks in the urban area is correlated with increased risk of malignant mesothelioma in the resident population.
• Limitations the authors state:
  • Fibronit fiber concentration measurements were available only for the 1970s.
  • Meteorological data for the periods of interest were not available, so wind data from 1961-1990 were used instead.
  • In the Fibronit cohort follow-up, no information was available on workers who left before the February 1972 baseline.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Environmental Exposure.

Related studies

• Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy — L. Vimercati, D. Cavone, et al. (2019)
• Topsoil and urban dust pollution and toxicity in Taranto (southern Italy) industrial area and in a residential district — M. Trifuoggi, G. Pagano, et al. (2018)
• Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation — L. Vimercati, D. Cavone, et al. (2018)
• 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)
• 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)
• Managing asbestos in Italy: twenty years after the ban — S. Silvestri (2012)

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