Malignant pleural mesothelioma in Italy

Our plain-English summary of Malignant pleural mesothelioma in Italy, by C. Bianchi, T. Bianchi (Indian Journal of Occupational and Environmental Medicine, 2009).

The study

• Authors: C. Bianchi, T. Bianchi
• Journal: Indian Journal of Occupational and Environmental Medicine
• Published: 2009;13(2):80-3
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study reviews a series of 811 malignant pleural mesothelioma cases, diagnosed at hospitals in Trieste and Monfalcone districts of north eastern Italy, a narrow coastal strip with a population of about three lakh, in the period 1968-2008. The diagnosis was based on histological examination in 801 cases, and cytological findings in 10. Necropsy was performed in 610 cases. Occupational histories were obtained directly from the patients or their relatives through personal or telephone interviews. Routine lung sections were examined for asbestos bodies in 500 cases. In 143 cases asbestos bodies were isolated and counted by chemical digestion of the lung tissue using the Smith-Naylor method. The series included 717 men and 94 women aged between 32 and 93 years (mean 69.2 years). Detailed occupational data was obtained for 732 cases.The majority of patients had marine jobs - shipbuilding (449 cases), maritime trades (56 cases), and port activities (39 cases). The nature of work of other patients included a variety of occupations, with non-shipbuilding industries being the most common. Thirty-four women cleaned the work clothes of family members occupationally exposed and hence had a history of asbestos exposure at home. Most of the patients had their first exposure to asbestos before 1960. The latency period ranged between 13 and 73 years (mean 48.2). Latency period among insulators and dock workers were shorter than other categories. Asbestos bodies were detected on routine lung sections in 343 cases (68.6%). Lung asbestos body burdens after isolation ranged between two to 10 millions bodies per gram of dried tissue. Despite some limitations in the use of asbestos in this area since the 1970s, the incidence of tumor remained high during the last years.

In plain English

This study described a series of 811 cases of malignant pleural mesothelioma diagnosed at hospitals in Trieste (1968-2008) and Monfalcone (October 1979-2008), in north-eastern Italy. Diagnosis was based on tissue examination in 801 cases and cell findings in 10, and was confirmed or made at autopsy in 610. Occupational histories came from interviews with patients or relatives. The series included 717 men and 94 women. Most patients had marine jobs: shipbuilding (449 cases), maritime trades (56) and port activities (39). Thirty-four women had been exposed at home by cleaning the work clothes of exposed family members. Of 587 cases with a known date of first exposure, about 80% were first exposed before 1960. Of 552 cases with a calculated latency (time from first exposure to diagnosis), 77% had latency longer than 40 years. Latency was shorter among insulators and dock workers than in other groups. Asbestos bodies were seen on routine lung sections in 343 of 500 cases examined (68.6%). The authors stated that, despite limits on asbestos use since the 1970s and a 1992 Italian ban, the area's mesothelioma epidemic showed no signs of abatement.

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: Case series: description of pleural mesothelioma cases diagnosed at local hospitals over four decades, with occupational interviews and lung asbestos body examination
• Who was studied: 811 patients with malignant pleural mesothelioma diagnosed at hospitals of Trieste (1968-2008) and Monfalcone (October 1979-2008), north-eastern Italy. There were 717 men aged 32 to 93 (mean 68.7) and 94 women aged 40 to 93 (mean 73.2). Diagnosis was confirmed or made at necropsy in 610 cases.
• Exposure: Asbestos exposure (fiber types not specified) from occupations, mainly shipbuilding, maritime trades and port work, plus other industries and domestic exposure from cleaning family members' work clothes. Occupational data were sufficient for 732 cases.
• Main results:
  • Among the 732 cases with detailed occupational data, 449 had worked in shipbuilding, 56 in maritime trades and 39 in port activities.
  • 34 women reported domestic exposure from cleaning the work clothes of occupationally exposed family members.
  • Environmental asbestos exposure was considered the cause in 2 cases and suspected in 2 others. One patient had received radiotherapy for Hodgkin's disease 34 years earlier.
  • First-exposure dates were tabulated for 587 cases. In 475 of these, first exposure was before 1960, which the text describes as about 80% of the patients.
  • Duration of exposure was calculated in 504 cases, and 73% of these had been exposed for 20 years or more.
  • Latency was calculated in 552 cases, and 77% of these had latency longer than 40 years.
  • Latency was shorter among insulators and dock workers than in other occupational categories.
  • Asbestos bodies were detected on routine lung sections in 343 of the 500 cases examined (68.6%).
  • In the 143 cases where asbestos bodies were isolated and counted, burdens ranged from two bodies to about 10 million per gram of dry lung tissue.
• The authors' conclusion: The authors stated that asbestos use in the area was limited from the late 1970s, reduced further in shipyards in the 1980s, and banned in Italy in 1992. Despite this, the mesothelioma epidemic did not show signs of abatement and continues to be a major problem in the area. They also suggested, from their data and other studies, an inverse relationship between intensity of exposure and length of latency.
• Limitations the authors state:
  • The authors noted that occupational histories are sometimes difficult to interpret because of the long latency periods. Workplaces may have closed decades earlier, making past work conditions hard to reconstruct.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Autopsy, Asbestos Bodies, Asbestos Exposure, Latency, Insulator, Asbestos Body Formation.

Related studies

• Mesothelioma among shipyard workers in Monfalcone, Italy — C. Bianchi, T. Bianchi (2012)
• Asbestos-related mesothelioma in Monfalcone, Italy — C. Bianchi, A. Brollo, et al. (1993)
• Malignant mesothelioma of the pleura in Trieste, Italy — L. Giarelli, C. Bianchi, et al. (1992)
• Asbestos exposure in a shipyard area, northeastern Italy — C. Bianchi, A. Brollo, et al. (2000)
• Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009 — P. Piselli, D. Serraino, et al. (2013)
• Increased risk of malignant mesothelioma of the pleura after residential or domestic exposure to asbestos: a case-control study in Casale Monferrato, Italy — C. Magnani, P. Dalmasso, et al. (2001)

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