Health surveillance for former asbestos exposed worker: a specific programme developed in an Italian region

Our plain-English summary of Health surveillance for former asbestos exposed worker: a specific programme developed in an Italian region, by E. Chellini, F. Battisti, A. Cristaudo, et al (Journal of Thoracic Disease, 2018).

The study

• Authors: E. Chellini, F. Battisti, A. Cristaudo, P. Sartorelli, P. Calà
• Journal: Journal of Thoracic Disease
• Published: 2018;10(Suppl 2):S383-S389
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-related diseases usually have a long latency since first exposure and this legitimates a health surveillance programme addressed to asbestos workers after the cessation of their occupational exposure. After a brief history of health surveillance initiatives performed in Italy as well as in other countries, we describe a regional programme for former asbestos-exposed workers, focusing on organizational features. A regional group of experts defined its operational and economical aspects. The Regional Council supported the whole programme, making it free of charge for all subjects who fulfil the predefined enrolment criteria (being resident in the region, being younger than 80 years old with cessation of occupational asbestos exposure within the last 30 years). The programme activities are classified in two levels: a first level for a basic health evaluation and a second level for in-depth analyses. In order to guarantee an homogeneous delivery in the whole region, the programme has to be performed by public health services with a quality control of activities. The involvement of specific public health services and the cooperation of social stakeholders are expected to play a major role in overcoming still open critical issues, such as the lack of programme existence awareness and adhesion, the correct stratification of subjects for the follow-up, and the real homogeneous delivery of the health surveillance in whole region.

In plain English

This perspective article describes a programme and reports no research results. The authors described a public health surveillance programme for former asbestos workers in Tuscany, Italy, started in April 2017 with regional funds. It was free for Tuscan residents under 80 whose work exposure to asbestos had ended within the last 30 years and was certified by a public occupational health physician, and who were retired or worked at a different plant from where they were exposed. A first phase included a medical history, an ILO-read chest radiograph, spirometry, and questionnaires on chronic bronchitis and breathlessness. A second phase, used only when needed, included CT scans to evaluate pleural plaques and lung tissue abnormalities. Low-dose CT lung cancer screening was not included. The authors estimated that almost 5,600 former workers met the criteria. They reported 1,330 taken in charge in earlier local initiatives and 3,619 more identified. The authors concluded that training, monitoring and stakeholder cooperation might help with open problems: limited awareness of the programme, grouping people by exposure level for follow-up, and achieving consistent delivery across the region.

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: Perspective article describing the clinical and organisational features of a regional health surveillance programme (no study data)
• Who was studied: Former asbestos-exposed workers in Tuscany, Italy, eligible for the programme. They must be residents of Tuscany and under 80. Their occupational asbestos exposure must have ceased within the last 30 years and be certified by a public occupational health physician. They must be retired or working at a different plant from where they were exposed.
• Exposure: Past occupational asbestos exposure in general; no fiber types, specific products or doses are named
• Main results:
  • The programme started in April 2017 after the regional council deliberated and supplied specific funds
  • The enrolment criteria include having stopped occupational asbestos exposure within the last 30 years
  • The protocol has two sequential phases: a basic health evaluation and an in-depth health evaluation
  • The first phase includes a chest radiograph interpreted under the ILO classification of pneumoconiosis, along with spirometry and questionnaires
  • In the second phase, CT is used to evaluate pleural plaques and parenchymal (lung tissue) abnormalities
  • The protocol does not include low-dose CT lung cancer screening
  • Follow-up intervals are set by exposure and disease. Healthy subjects with medium-high former exposure are seen every 3 years and those with low exposure every 5 years. Subjects with a non-malignant asbestos-related disease are seen every year.
  • The authors estimated that almost 5,600 former exposed asbestos workers fit the enrolment criteria and will be involved
  • At the time of writing, 1,330 former exposed workers had been taken in charge during earlier local initiatives, and 3,619 further subjects had been identified
  • Planners expected (an estimate, not an observed result) that one-fourth of subjects would need an in-depth clinical study, and half of those a 1-year follow-up
  • The authors stated the programme is not a true screening programme
• The authors' conclusion: The authors concluded that a specific public health surveillance programme, including training and monitoring activities and the cooperation of professional and social stakeholders, might help overcome open problems: lack of awareness of the service, correct stratification of subjects for follow-up, and homogeneous delivery across the region
• Limitations the authors state:
  • Not everyone who could benefit from the service may know about it
  • Grouping subjects by the intensity of their past exposure is still under discussion. Intensity is hard to estimate after the fact, especially when workplaces are not well known or have closed.
  • Delivering the surveillance homogeneously across the whole region remains an open question

Topics

Medical terms in this study, explained in our Lexicon: Latency, Occupational Exposure, Asbestos Exposure.

Related studies

• Feasibility of a screening programme for lung cancer in former asbestos workers — G. Mastrangelo, M.N. Ballarin, et al. (2008)
• 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)
• Compensation of pleural mesothelioma in France: data from the French National Mesothelioma Surveillance Programme — S. Chamming's, B. Clin, et al. (2013)
• Health survey of former workers in a Norwegian coke plant: Part. 1. Estimation of historical exposures — P.R. Romundstad, A. Rønneberg, et al. (1998)
• Perceptions of health hazards in the narratives of Italian migrant workers at an Australian asbestos mine (1943-1966) — F. Cappelletto, E. Merler (2003)
• Cancer incidence in a cohort of asbestos-exposed workers undergoing health surveillance — F. Barbiero, T. Zanin, et al. (2018)

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