Malignant mesothelioma in Italy, 1997

Our plain-English summary of Malignant mesothelioma in Italy, 1997, by M. Nesti, A. Marinaccio, E. Chellini (American Journal of Industrial Medicine, 2004).

The study

• Authors: M. Nesti, A. Marinaccio, E. Chellini
• Journal: American Journal of Industrial Medicine
• Published: 2004;45(1):55-62
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The Italian National Mesothelioma Register (ReNaM) was set up at the Istituto Superiore Prevenzione e Sicurezza Lavoro (ISPESL), in Rome, in accordance with Art. 36 of Italian Legislative Decree No. 277 [1991].

Methods: Five Italian regions, Piedmont, Liguria, Emilia-Romagna, Tuscany, and Apulia, agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data systematically to ISPESL.

Results: Four hundred and twenty-nine mesothelioma cases, diagnosed in 1997, are recorded. The standardized annual incidence rate for definite pleural mesothelioma is 1.51 per 100,000 inhabitants (2.26 for males and 0.79 for females). Exposure was defined for 198 mesotheliomas with a histological diagnosis: 125 (63%) refer to occupational exposure, 10 (5%) to environmental exposure, and 5 (2.5%) to household exposure.

Conclusions: Despite the ReNaM's work, many limitations still have to be overcome. Clear-cut information on asbestos exposure is available for a limited number of cases; and differing regional procedures in collecting and evaluating mesotheloma cases exist. At this stage the identification and evaluation of a large number of cases of mesothelioma is a worthwhile result. This epidemiological surveillance, currently being extended to other regions, will enable us to better assess the impact and diffusion of this disease in future, and to monitor more closely the effects of ceasing asbestos use in 1992, and the efficacy of preventive measures since mid '70s. Am. J. Ind. Med. 45:55-62, 2004.

Copyright 2003 Wiley-Liss, Inc.

In plain English

This article reported results from Italy's National Mesothelioma Register (ReNaM) for five regions: Piedmont, Liguria, Emilia-Romagna, Tuscany and Apulia. Regional centers recorded 429 malignant mesothelioma cases diagnosed in 1997. Of these, 392 were pleural, 34 peritoneal and three pericardial. Counting all levels of diagnostic certainty, the age-standardized annual incidence of pleural mesothelioma was 2.03 per 100,000 inhabitants (3.00 for males, 1.07 for females). For histologically definite pleural cases only, it was 1.51. Median survival was 275 days for pleural mesothelioma (95% confidence interval 241 to 309 days) and 157 days for peritoneal mesothelioma. The authors reported exposure results for 198 cases. Of these, 125 (63%) were classed as occupational (definite, probable or possible), 10 as environmental and 5 as household. For 41, exposure was unknown because information was insufficient or incomplete. The most common sectors were building and construction, metallurgy and steel, shipbuilding, and railway stock. The article did not name asbestos fiber types. The authors stated that exposure information was available for only a limited proportion of cases and that regional procedures differed. They concluded that identifying and evaluating many cases was a worthwhile result at this stage.

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 mesothelioma register (epidemiological surveillance) report of incident cases, with interview-based assessment of asbestos exposure
• Who was studied: 429 malignant mesothelioma cases diagnosed in 1997 in five Italian regions (Piedmont, Liguria, Emilia-Romagna, Tuscany, Apulia), which together cover more than 17 million people; 326 were histologically definite
• Exposure: Asbestos exposure in general (occupational, household, environmental), judged by an industrial hygienist from questionnaire interviews and documents. Occupational exposure was graded definite, probable or possible. No fiber types are named.
• Main results:
  • Of the 429 cases, 392 were pleural (more than 91%), 34 peritoneal (about 8%) and 3 pericardial. The male-to-female ratio for all cases was 2.52:1.
  • Across all five regions and all diagnostic levels, the standardized annual incidence was 2.21 per 100,000 inhabitants for all sites (3.24 males, 1.22 females) and 2.03 for pleural mesothelioma (3.00 males, 1.07 females)
  • For histologically definite pleural mesothelioma (all five regions, both sexes), the standardized incidence rate was 1.51 per 100,000 (Table I)
  • Median survival was 275 days for pleural mesothelioma and 157 days for peritoneal mesothelioma
  • For all 392 pleural mesothelioma cases, the median survival of 275 days had a 95% confidence interval of 241 to 309 days (Table II). No interval is given for the peritoneal median.
  • Among the 198 cases for which the authors reported exposure results, 63% (125 cases) were classed as occupationally exposed (certain, probable or possible)
  • Among the same 198 cases, household exposure was recorded for 5 cases (2.5%) and environmental exposure for 10 cases (5%)
  • Among the same 198 cases, exposure was defined as unknown for 41 cases (20.7%) because information was insufficient and/or incomplete
  • The most common occupational exposures were in building and construction (16%), metallurgy and steel (14%), shipbuilding (13%) and railway stock (9%)
• The authors' conclusion: The authors concluded that, despite many limitations, identifying and evaluating a large number of mesothelioma cases was a worthwhile result at this early stage. They stated that extending surveillance to other regions should allow closer monitoring of the effects of ceasing asbestos use.
• Limitations the authors state:
  • Clear-cut asbestos exposure information was available for only a limited proportion of cases
  • Exposure assessment had not yet started, or was still in progress, for about 54% of cases
  • The five regional centers used similar but not identical procedures, making it difficult to compare data between centers
  • Exposure proportions, overall and by occupational sector, were affected by bias from the interview-based reconstruction of exposure

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Incidence, Pleural Mesothelioma, Occupational Exposure, Environmental Exposure, Asbestos Exposure.

Related studies

• Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register — A. Marinaccio, A. Binazzi, et al. (2010)
• 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)
• 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)
• Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years — R.T. Lin, Y.Y. Chang, et al. (2019)
• The contribution of environmental monitoring in the epidemiological assessment of exogenous risk. The experience of ARPA in the Emilia-Romagna Region of Italy — A. Zavatti, P. Lauriola (1999)
• Incidence and survival trends for malignant pleural and peritoneal mesothelioma, Australia, 1982-2009 — M.J. Soeberg, J. Leigh, et al. (2016)

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