Impact of an asbestos cement factory on mesothelioma incidence: global assessment of effects of occupational, familial, and environmental exposure

Our plain-English summary of Impact of an asbestos cement factory on mesothelioma incidence: global assessment of effects of occupational, familial, and environmental exposure, by C. Mensi, L. Riboldi, S. De Matteis, et al (Environment International, 2015).

The study

• Authors: C. Mensi, L. Riboldi, S. De Matteis, P.A. Bertazzi, D. Consonni
• Journal: Environment International
• Published: 2015;74:191-9
• Cited by: 65 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Few studies have examined the incidence of malignant mesothelioma (MM) associated with distinct sources of asbestos exposure (occupational, familial, or environmental). We assessed the impact of asbestos exposure-global and by source-on the incidence of MM in Broni, an Italian town in which an asbestos cement factory once operated (1932-1993). Based on data collected by the Lombardy Mesothelioma Registry, we calculated the number of observed and expected MM cases among workers, their cohabitants, and people living in the area in 2000-2011. We identified 147 MM cases (17.45 expected), 138 pleural and nine peritoneal, attributable to exposure to asbestos from the factory. Thirty-eight cases had past occupational exposure at the factory (2.33 expected), numbering 32 men (26 pleural, six peritoneal) and six women (four pleural, two peritoneal). In the families of the workers, there were 37 MM cases (4.23 expected), numbering five men (all pleural) and 32 women (31 pleural, one peritoneal). Among residents in Broni or in the adjacent/surrounding towns, there were 72 cases of pleural MM (10.89 expected), numbering 23 men and 49 women. The largest MM excess was found in the towns of Broni (48 observed, 3.68 expected) and Stradella (16 observed, 1.85 expected). This study documents the large impact of the asbestos cement factory, with about 130 excess MM cases in a 12-year period. The largest MM burden was among women, from non-occupational exposure. Almost half of the MM cases were attributable to environmental exposure.

Copyright © 2014 Elsevier Ltd. All rights reserved.

In plain English

This study used Lombardy Mesothelioma Registry data to count malignant mesothelioma cases diagnosed in 2000–2011 that were linked to an asbestos cement factory in Broni, Italy. From 1932 to 1993 the factory used chrysotile, crocidolite and small amounts of amosite. The authors compared observed cases with the numbers expected from regional rates in people never exposed to asbestos. There were 147 cases (138 pleural, nine peritoneal) against 17.45 expected. Former factory workers had 38 cases (2.33 expected). People who lived with workers had 37 cases (4.23 expected), 32 of them women. Residents with environmental exposure had 72 pleural cases (10.89 expected). These included 48 among people who had ever lived in Broni (3.68 expected) and 16 in nearby Stradella (1.85 expected). The authors concluded that the factory accounted for about 130 excess cases in 12 years. They found the largest burden fell on women through non-occupational exposure, and almost half the cases were attributable to environmental exposure. They noted that patients who lived outside Lombardy at the time of diagnosis were not included, and that the populations at risk were only roughly estimated.

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: Population-based incidence study using regional mesothelioma registry data, comparing observed cases with cases expected from regional rates in people never exposed to asbestos (standardised incidence ratios)
• Who was studied: Malignant mesothelioma cases first diagnosed between 1 January 2000 and 31 December 2011 and recorded by the Lombardy Mesothelioma Registry. The cases came from three groups: former workers of the Broni factory (workforce estimated at 2741 men and 714 women), people who lived with those workers, and residents of Broni, nine adjacent towns and 17 surrounding towns in the Province of Pavia, Lombardy, northern Italy.
• Exposure: Asbestos from the Fibronit asbestos cement factory in Broni, which made asbestos cement products in 1932–1993 using chrysotile and crocidolite, with small quantities of amosite. Exposure was classed as occupational (worked at the factory), familial (lived with a factory worker), certain environmental (ever lived in Broni), or potential environmental (no reported asbestos exposure, living in adjacent or surrounding towns).
• Main results:
  • Overall, 147 mesothelioma cases (138 pleural, nine peritoneal) were attributed to asbestos from the factory, against 17.45 expected.
  • The absolute excess was greater in women (87 cases, 7.57 expected) than in men (60 cases, 9.88 expected).
  • Factory workers had 38 cases (2.33 expected): 32 men (26 pleural, six peritoneal) and six women (four pleural, two peritoneal).
  • Standardised incidence ratios for occupational exposure (Table 1): men 16.2 (95% CI 11.1–22.9), women 16.7 (95% CI 6.1–36.3), all workers 16.3 (95% CI 11.5–22.4).
  • Workers' family members had 37 cases (4.23 expected): five men (all pleural) and 32 women (31 pleural, one peritoneal).
  • Standardised incidence ratios for familial exposure (Table 1): men 2.0 (95% CI 0.7–4.7; 5 cases, 2.49 expected), women 18.4 (95% CI 12.6–26.0; 32 cases, 1.74 expected).
  • All 72 patients with environmental exposure living in Broni or the nearby towns had pleural mesothelioma (10.89 expected).
  • Among people who had ever lived in Broni there were 48 cases (20 men, 28 women) against 3.68 expected.
  • For environmental exposure in Broni, the standardised incidence ratio was 11.2 in men and 14.8 in women.
  • In the nine towns adjacent to Broni there were 19 pleural cases (3.14 expected). The standardised incidence ratio was 1.3 in men and 10.8 in women.
  • In Stradella there were two cases in men (0.91 expected) and 14 in women (0.94 expected).
  • In the 17 surrounding towns there were five pleural cases (4.07 expected): one in men (2.06 expected) and four in women (2.01 expected). The standardised incidence ratios were 0.5 for men and 2.0 for women, with wide confidence intervals.
• The authors' conclusion: The authors concluded that the factory accounted for about 130 excess mesothelioma cases in a 12-year period. They found the largest burden was among women, from non-occupational exposure, and that almost half the cases were attributable to environmental exposure.
• Limitations the authors state:
  • Patients who lived outside Lombardy at the time of diagnosis were not included.
  • For environmental exposure, the registry could not track people who once lived in the adjacent or surrounding towns but had moved away by diagnosis. The authors said this led to some underestimation of cases and of standardised incidence ratios.
  • The populations at risk, and so the expected numbers of cases for workers, family members and Broni residents, could only be roughly estimated. The authors said they chose a conservative approach that overestimated the expected numbers.
  • In the environmental analysis, the factory workers, most of whom lived in the area, could not be subtracted from the resident population.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos-Cement, Mesothelioma, Environmental Exposure, Asbestos Exposure, Occupational Exposure, Non-Occupational Exposure.

Related studies

• Impact of an asbestos cement factory on mesothelioma incidence in a community in Italy — D. Consonni, S. De Matteis, et al. (2020)
• Estimate of environmental and occupational components in the spatial distribution of malignant mesothelioma incidence in Lombardy (Italy) — D. Catelan, D. Consonni, et al. (2020)
• Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey — A. Senyiğit, C. Babayiğit, et al. (2000)
• Assessment of environmental asbestos exposure in Turkey by bronchoalveolar lavage — P. Dumortier, L. Coplü, et al. (1998)
• Pleural mesothelioma and occupational and non-occupational asbestos exposure: a case-control study with quantitative risk assessment — D. Ferrante, D. Mirabelli, et al. (2016)
• Familial pleural mesothelioma with environmental asbestos exposure: losses of DNA sequences by comparative genomic hybridization (CGH) — G. Serio, A. Scattone, et al. (2004)

Browse more research in Environment International, or return to medical research.