Malignant mesothelioma in Rome, Italy 1980-1995. A retrospective study of 79 patients

Our plain-English summary of Malignant mesothelioma in Rome, Italy 1980-1995. A retrospective study of 79 patients, by V. Ascoli, C.C. Scalzo, F. Facciolo, et al (Tumori, 1996).

The study

• Authors: V. Ascoli, C.C. Scalzo, F. Facciolo, M. Martelli, L. Manente, P. Comba, C. Bruno, F. Nardi
• Journal: Tumori
• Published: 1996;82(6):526-32
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim And Background: To evaluate the characteristics of a case-series of 79 malignant mesothelioma patients collected from the main teaching hospital of Rome, Italy, and other local clinics of Latium Region and to assess the role of asbestos exposure, since previous studies on the occurrence of the disease in this area were lacking.

Methods: The study included cytohistologically diagnosed malignant mesothelioma (71 pleural, 7 peritoneal, and 1 testicular tunica vaginalis) detected or referred for consultation during the period 1980-1995. Information regarding occupational and/or nonoccupational exposures was derived from clinical records and interviews, when available.

Results: Patients were resident in Rome and other towns of Latium; a few were from other parts of central and southern Italy. Exposure to asbestos was assessed for 45.5% of patients, another 45.5% had unknown exposure, and for the remaining 9% such information was lacking. Occupational exposure occurred in 53% of men for whom information was available and nonoccupational exposure occurred in 20% of women. The study identified two clusters of cases from an asbestos-cement plant and a facility where asbestos was ubiquitous. Furthermore, most exposed subjects reported occupations in the construction industry, which is particularly active in the Latium Region; others were railroad workers, naval mechanics and navy personnel, bakers, explosive workers and car mechanics. A few patients reported indoor exposure to asbestos at home and/or in the workplace.

Conclusions: The study confirmed that mesothelioma risk is present in several job titles of the construction industry, and it is no longer confined to workers employed in the manufacture or application of asbestos products. The occurrence of malignant mesothelioma in patients with unexpected occupational and nonoccupational exposures indicates the need for further investigation on previously underestimated exposures.

In plain English

This retrospective, hospital-based study reviewed 79 malignant mesothelioma patients detected or referred for consultation from 1980 to 1995; two were first diagnosed elsewhere in 1979. Most came from Rome's Policlinico Umberto I Hospital; the rest were referred from other hospitals in Rome and the Latium Region. There were 54 men and 25 women. Tumors arose in the pleura in 71, peritoneum in 7, and tunica vaginalis testis in 1. Exposure was judged from clinical records and, where possible, patient or relative interviews. The authors classed 45.5% as certainly or probably exposed to asbestos and 45.5% as having unknown exposure. Occupational exposure was ascertained in 12 and considered probable in 19 of 54 men (31 in all); nonoccupational exposure was identified in 5 of 25 women. Construction workers formed the largest probable-exposure group. Cases clustered at an asbestos-cement plant and a Colleferro facility where asbestos was everywhere. The authors concluded that mesothelioma risk is no longer confined to workers making or applying asbestos products. They stated the series cannot estimate the true rate of disease in Latium.

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: Retrospective, hospital-based case series (pathology review with retrospective exposure assessment)
• Who was studied: 79 patients with diffuse malignant mesothelioma detected or referred for consultation at the Department of Pathology, Policlinico Umberto I Hospital, Rome, during 1980-1995. The methods give the diagnosis period as January 1980 to September 1995, but two included women had their primary diagnosis made elsewhere in 1979. There were 54 men and 25 women, aged 22 to 87 where age was known. 53 cases came from the hospital's files and 26 were referred from other hospitals of Rome and the Latium Region. 61 lived in the Latium Region (38 in Rome) and 14 lived elsewhere, mostly in southern Italy.
• Exposure: Asbestos exposure was estimated retrospectively from clinical records (79 cases) and from interviews with the patient (36) or next-of-kin (10). In 10 cases, occupational physicians corroborated the information. Exposure was graded as ascertained occupational, probable occupational, domestic paraoccupational, environmental (buildings insulated with asbestos), or unknown. Settings included an asbestos-cement plant, the SNIA chemical and mechanical facility, construction, naval and railroad work, bakers' ovens, and buildings with sprayed amosite insulation.
• Main results:
  • Of the 79 tumors, 71 arose from the pleura, 7 from the peritoneum and 1 from the tunica vaginalis testis.
  • The tumors were epithelial in 58 (73%) patients, biphasic in 15 (19%) and sarcomatoid in 6 (8%).
  • 67 cases were classified as definite mesothelioma and 12 as probable.
  • Across all 79 patients, 45.5% were certainly or probably exposed to asbestos and 45.5% had unknown exposure. For 9%, it could not be determined whether exposure had occurred because information was lacking.
  • Occupational asbestos exposure, ascertained or probable, occurred in 57% of men (31 of 54). Of these, 12 were ascertained and 19 probable.
  • Nonoccupational exposure to asbestos was identified in 20% of women (5 of 25). Three were housewives whose husbands had asbestos exposure, and two had indoor environmental exposure.
  • Among patients with probable occupational exposure, construction workers (masons, painters and carpenters) were the largest category.
  • Two clusters were identified. Three patients with ascertained exposure came from the SNIA facility in Colleferro, where asbestos was ubiquitous. Two asbestos-cement workers came from the Cemamit plant in Ferentino.
  • One woman, an office worker, had worked in a skyscraper insulated with amosite, mainly applied by spraying. One housewife was married to a worker at the National Printing House, where crumbly sprayed amosite insulation was ubiquitous.
  • 36 patients had unknown exposure. Their main occupations included clerks, professionals, teachers, an aircraft pilot, retired people and 9 housewives.
  • 15 cases (19%) were diagnosed in 1980-1989 and 64 (81%) in 1990-1995. The authors attributed this rise to accumulated experience and improved techniques.
  • In 36 patients (45.5%) the diagnosis was made from limited sampling (fluid cytology, fine-needle aspiration or closed-needle biopsy). The other 43 needed open surgery.
• The authors' conclusion: The authors concluded that their study confirms that mesothelioma risk is no longer confined to workers in the manufacture or application of asbestos products. They wrote that cases with unexpected occupational and nonoccupational exposures, and the high proportion of women, suggest a need to investigate hidden or underestimated sources of asbestos exposure.
• Limitations the authors state:
  • The case series is not suitable for estimating the true incidence rate of mesothelioma in the Latium Region.
  • Exposure information relied on hospital records, only partially supplemented by interviews.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Tunica Vaginalis, Occupational Exposure, Asbestos-Cement, Mesothelioma.

Related studies

• Malignant mesothelioma in Rome and Latium region, 1993-2001 — V. Ascoli, S. Belli, et al. (2003)
• Asbestos containing materials in schools of Rome and surrounding area (Italy) — A. Campopiano, A. Cannizzaro, et al. (2021)
• Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023 — F. Giacomino, F. Marinelli, et al. (2024)
• Mineral particles in the lungs of subjects resident in the Rome area and not occupationally exposed to mineral dust — L. Paoletti, D. Batisti, et al. (1987)
• A one-generation cluster of malignant mesothelioma within a family reveals exposure to asbestos-contaminated jute bags in Naples, Italy — V. Ascoli, C. Carnovale-Scalzo, et al. (2003)
• Concomitant malignant mesothelioma of the pleura, peritoneum, and tunica vaginalis testis — V. Ascoli, F. Facciolo, et al. (1996)

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