Knowledge and awareness of asbestos risk among General Practitioners: Validation of a questionnaire in an area with a high incidence of asbestos-related diseases

Our plain-English summary of Knowledge and awareness of asbestos risk among General Practitioners: Validation of a questionnaire in an area with a high incidence of asbestos-related diseases, by M. Bertolotti, M. Tamburro, A. Salzo, et al (Preventive Medicine Reports, 2025).

The study

• Authors: M. Bertolotti, M. Tamburro, A. Salzo, A. Cassinari, S. Crivellari, C. Bertolina, M. Farotto, C. Adesso, M.A. Di Palma, A. Natale, F. Torregiani, G. Pacileo, A. Maconi, G. Ripabelli
• Journal: Preventive Medicine Reports
• Published: 2025;49:102940
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Given the critical role of general practitioners (GPs) in the early diagnosis and management of asbestos-related diseases (ARDs), and the significant history of asbestos fibres pollution in Alessandria Local Health Authority (ASL AL), this project aimed to assess the knowledge and awareness of asbestos risks, as well as the experience in diagnosing ARDs among GPs working in Alessandria province, Northern Italy.

Methods: A questionnaire was administered to 216 GPs from all ASL AL territorial districts during 26 Territorial Assistance Equipes (EATs) meetings, held from September 2022 to January 2023. It contained 29 questions covering three main areas: 'knowledge and awareness', 'competence and experience', 'sociodemographic characteristics and workload'.

Results: Although GPs were aware of the health hazards of asbestos (94 %) and the increased risk of mesothelioma from asbestos exposure (92.6 %), significant disparities and heterogeneity of knowledge were observed among territorial districts and by comparing Casale Monferrato district with all the others, particularly regarding asbestos exposure routes, reporting of occupational diseases, and mesothelioma latency.

Conclusions: This project provides a comprehensive overview of GPs' knowledge, awareness and experience in managing ARDs, providing indications of customised training requirements. This evaluation could be extended to all areas with a history of previous asbestos exposure and provide a useful tool for policy makers to define and plan strategic actions on asbestos. This work could also be adapted to different realities with a history of environmental pollutant exposure other than asbestos, which pose a risk for the development of several diseases.

© 2024 The Authors.

In plain English

This was a questionnaire survey of general practitioners (GPs) in the Alessandria Local Health Authority area of Northern Italy. The area includes Casale Monferrato, recognised as an asbestos-contaminated National Priority Contaminated Site and the former location of the Eternit asbestos-cement factory. Of 280 GPs in the province, 232 attended 26 team meetings held from September 2022 to January 2023, and 216 completed the 29-question survey. Almost all knew that asbestos is dangerous to health (94%) and that asbestos exposure increases the risk of mesothelioma (92.6%). The median knowledge score was 63%. GPs in the Casale Monferrato district scored higher (median 72%, with 42.6% at the optimal level). Only 56% recognised domestic exposure, meaning living with someone exposed at work, as a way of being exposed. 46.8% did not give the correct average mesothelioma latency of over 25 years. Only 4.6% had a high awareness score. 74% felt their training was not sufficient to answer patients' questions, and 74.6% had submitted no occupational disease reports related to asbestos exposure in the last 5 years. The authors concluded that GPs need topic-specific update courses on recognising asbestos-related diseases and on reporting occupational diseases.

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: Cross-sectional questionnaire survey of general practitioners, using a questionnaire first revised and tested in a pilot phase
• Who was studied: General practitioners in the Alessandria Local Health Authority (ASL AL), Alessandria province, Northern Italy. Of 280 GPs in the province, 232 attended the team (EAT) meetings and 216 completed the questionnaire, September 2022 to January 2023. 56.5% were male, median age 60 years. A pilot version was given to 17 GPs from Molise and ASL AL in June to July 2022.
• Exposure: Not a study of people exposed to asbestos. It measured GPs' knowledge and awareness of asbestos risks and asbestos-related diseases, and their experience with them, using 29 questions. GPs in Casale Monferrato district (an asbestos National Priority Contaminated Site, former location of the Eternit asbestos-cement factory) were compared with GPs in the other districts. No specific fiber types were studied.
• Main results:
  • 94% of the 216 GPs knew asbestos is dangerous to human health.
  • 92.6% of the 216 GPs knew that asbestos exposure increases the risk of mesothelioma.
  • Across all 216 GPs, the median knowledge score was 63% (IQR 51 to 72). 59.3% had a good level of knowledge and 18% an optimal level.
  • GPs in Casale Monferrato district (n = 47) had a higher median knowledge score of 72% (IQR 60 to 78), and 42.6% reached an optimal level. The difference from the other districts was statistically significant (p < 0.001).
  • Only 56% of all GPs recognised domestic exposure (living with someone professionally exposed to asbestos) as a mode of exposure. The figures were 87.5% for environmental exposure and 95.4% for occupational exposure.
  • About half of all GPs correctly identified the online procedure for reporting a worker's asbestosis diagnosis to INAIL (50.5%). In Casale Monferrato, 78.7% answered correctly.
  • 46.8% of GPs did not give the correct average latency period for mesothelioma, which is over 25 years.
  • The median awareness score was 54% (IQR 46 to 62), and only 4.6% of GPs had a high level of awareness. Awareness levels did not differ significantly between districts, or between Casale Monferrato and the other districts.
  • 74% of GPs did not feel their current scientific and professional training on asbestos-related diseases was sufficient to answer patients' questions on occupational diseases and workplace accidents.
  • 81.9% of GPs considered Continuing Medical Education on asbestos and asbestos-related diseases inadequate.
  • Only 5.6% of GPs reported attending Continuing Medical Education courses that covered asbestos-related diseases in the past 12 months.
  • 69.9% of GPs reported they had not evaluated cases of asbestos-related disease in the previous year.
  • Asked how many occupational disease reports related to asbestos exposure they had submitted in the last 5 years, 161 of the 216 GPs (74.6%) had submitted none.
  • On the same question, 38.3% of GPs in Casale Monferrato had submitted reports in the period, compared with 20.7% in the other districts (p = 0.005).
  • Knowledge was higher among younger GPs (p < 0.001).
• The authors' conclusion: The authors concluded that GPs need topic-specific update courses to improve their knowledge of recognising the symptoms of asbestos-related diseases, guiding patients toward early diagnosis, and notifying occupational diseases. They suggested extending the assessment to all areas with a history of asbestos exposure, and adapting the questionnaire for areas affected by other environmental pollutants.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Casale Monferrato, Occupational Disease, Latency.

Related studies

• Awareness, knowledge and training gaps regarding asbestos among General Practitioners: a pilot study — G. Ripabelli, A. Salzo, et al. (2021)
• Asbestos Exposures, Mesothelioma Incidence and Mortality, and Awareness by General Practitioners in the Molise Region, Central Italy — G. Ripabelli, M. Tamburro, et al. (2018)
• Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire — Ó. Arrieta, C. Núñez-Valencia, et al. (2012)
• Prospective study of asbestos-related diseases incidence cases in primary health care in an area of Barcelona province — M. Rosell-Murphy, R. Abós-Herràndiz, et al. (2010)
• Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England — G. Lyratzopoulos, R.D. Neal, et al. (2012)
• Polymorphisms in DNA repair genes as risk factors for asbestos-related malignant mesothelioma in a general population study — I. Dianzani, L. Gibello, et al. (2006)

Browse return to medical research.