Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues

Our plain-English summary of Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues, by A. Marinaccio, A. Binazzi, M. Bonafede, et al (Occupational and Environmental Medicine, 2015).

The study

• Authors: A. Marinaccio, A. Binazzi, M. Bonafede, M. Corfiati, D. Di Marzio, A. Scarselli, M. Verardo, D. Mirabelli, V. Gennaro, C. Mensi, G. Schallemberg, E. Merler, C. Negro, A. Romanelli, E. Chellini, S. Silvestri, M. Cocchioni, C. Pascucci, F. Stracci, V. Ascoli, L. Trafficante, I. Angelillo, M. Musti, D. Cavone, G. Cauzillo, F. Tallarigo, R. Tumino, M. Melis, ReNaM Working Group
• Journal: Occupational and Environmental Medicine
• Published: 2015;72(9):648-55
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160,000 tons/year. The National Register of Mesotheliomas (ReNaM, "Registro Nazionale dei Mesoteliomi" in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure.

Methods: The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases.

Results: Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100,000) for men and 1.45 for women, respectively. Among the 15,845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12,065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily).

Conclusions: Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos.

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In plain English

This study described malignant mesothelioma cases linked to asbestos exposure outside work, using Italy's national mesothelioma register (ReNaM). The register identified 15,845 cases diagnosed from 1993 to 2008, and exposure was investigated for 12,065 of them (76.1%). Of these, 8,367 (69.3%) were classed as occupationally exposed. Another 530 (4.4%) had lived with someone exposed at work, 514 (4.3%) lived near a source of asbestos pollution, and 188 (1.6%) were exposed through hobbies or leisure, 10.2% in total. Among non-occupational cases, women outnumbered men 2.3 to 1, rising to 5.9 to 1 for household exposure. Living near an asbestos-cement plant was the main environmental source. Clusters included Casale Monferrato, Broni and Bari, and Biancavilla in Sicily, where exposure was attributed to fluoroedenite, an amphibole asbestiform mineral contaminating material used locally for construction and road paving. Non-occupational cases were first exposed younger on average (18.5 versus 22.5 years). The authors concluded that asbestos pollution outside the workplace contributes significantly to asbestos-related disease. They noted uneven regional data and that leisure exposure is probably underestimated.

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: Descriptive analysis of cases in a national mesothelioma incidence surveillance register (ReNaM), comparing non-occupationally exposed cases with occupationally exposed cases
• Who was studied: 15,845 malignant mesothelioma cases diagnosed in Italy from 1993 to 2008 and recorded by the national register. Exposure was investigated for 12,065 (76.1%). Regions began contributing in different years, and some regions did not contribute or had incomplete data.
• Exposure: Non-occupational asbestos exposure, coded as familial (living with a person occupationally exposed to asbestos), environmental (living near a source of asbestos pollution without work exposure) or leisure activities. These cases were compared with occupationally exposed cases. Specific fiber types were not reported for the cases, except fluoroedenite in Biancavilla.
• Main results:
  • Standardised incidence rate of pleural mesothelioma in 2008: 3.84 per 100,000 for men and 1.45 per 100,000 for women
  • Exposure was investigated for 12,065 (76.1%) of the 15,845 cases
  • 8,367 cases (69.3% of the 12,065 with exposure assessed) were classified as occupationally exposed
  • Among cases with exposure assessed, 530 (4.4%) had familial exposure, 514 (4.3%) had environmental exposure and 188 (1.6%) were exposed through hobby or leisure activities
  • Non-occupational exposure (familial, environmental or leisure) accounted for 10.2% of mesothelioma cases nationally
  • Female to male ratio among all non-occupationally exposed cases was 2.3 to 1
  • Female to male ratio among cases with only familial exposure was 5.9 to 1
  • Among environmentally exposed cases, residence near asbestos-cement plants was the predominant source
  • Areas of asbestos pollution from asbestos-cement plants were identified at Casale Monferrato, Broni and Bari
  • In Biancavilla (Sicily), environmental exposure was attributed to the local presence of fluoroedenite, an amphibole asbestiform mineral, as a contaminant of material used for construction and road paving
  • Casale Monferrato had 92 cases with environmental exposure, 68 with familial exposure and 4 with leisure-related exposure over the period
  • Mean age at first exposure was 18.5 years for non-occupationally exposed cases versus 22.5 years for occupationally exposed cases (p less than 0.0001 in the text)
  • Median latency (time from start of exposure to diagnosis) was longer overall for non-occupational than for occupational exposure (46 years for occupational)
• The authors' conclusion: The authors concluded that asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases. They suggested a need to prevent such exposures and to discuss compensation rights for mesothelioma caused by non-occupational exposure.
• Limitations the authors state:
  • Regions started collecting data at different times or are not yet participating, which strongly limits evaluation of incidence trends
  • The percentage of patients interviewed varied between regions, from 45% to 95%
  • Asbestos exposure during leisure activities is difficult to identify and probably underestimated
  • The 10% estimate is strongly tied to specific Italian patterns of exposure
  • The study design, competing causes of death and the limited observation period prevent statistical inferences about exposure and age at diagnosis or latency

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: Malignant Mesothelioma, Asbestos Exposure, Epidemiology, Mesothelioma, Incidence, Pleural Mesothelioma, Environmental Exposure, Asbestos-Cement.

Related studies

• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register — A. Marinaccio, A. Binazzi, et al. (2010)
• Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register — A. Marinaccio, A. Binazzi, et al. (2012)
• Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM) — A. Binazzi, D. Di Marzio, et al. (2021)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Non-occupational exposure to asbestos and malignant mesothelioma in the Italian National Registry of Mesotheliomas — D. Mirabelli, D. Cavone, et al. (2010)

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