Mesotheliomas due to asbestos used in railroads in Italy

Our plain-English summary of Mesotheliomas due to asbestos used in railroads in Italy, by C. Maltoni, C. Pinto, A. Mobiglia (Annals of the New York Academy of Sciences, 1991).

The study

• Authors: C. Maltoni, C. Pinto, A. Mobiglia
• Journal: Annals of the New York Academy of Sciences
• Published: 1991;643:347-67
• Type of article: Review
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004162).

Abstract

The available knowledge of the oncogenic risks of asbestos, the presentation of some data on the uses of asbestos in railroads, with particular regard to the Italian State Railroads (Ferrovie dello Stato = FS), and the identification of groups at risk because of exposure to asbestos used in railroads are briefly reviewed. The available data in the literature on the pathologic effects of such exposure, and in particular on the onset of mesotheliomas among machinists and other railroad workers, are also summarized. Eighty-three cases, in various Italian regions, of mesothelioma (78 pleural, 4, peritoneal, and 1 pericardial) are reported that are related to the exposure to asbestos used in railroads. Twenty-six of these cases (among which 25 were reported in the Emilia-Romagna region) were submitted to a detailed study at the Bologna Institute of Oncology. Forty-nine cases of mesothelioma occurred among FS workers, in particular machinists; 29 cases occurred among machinists of rolling-stock workshops not belonging to the FS; 3 cases occurred among travelling workers of rolling-stock not belonging to the FS; 2 cases were found in members of the family (a daughter and a wife) of FS workers. This series of cases, together with similar data from the literature, proves the existence and gravity of an actual health risk due to asbestos used in the railroads. On the basis of the available data, the following steps are considered necessary: the adoption of preventive measures, the performance of medical oncological surveillance, the promotion of systematic epidemiologic investigations, and, finally, the placement of greater emphasis on basic research, aimed at generating information on the biological events taking place during the incubation period of the tumors. This information, hopefully, could be used to reduce the biological effect of exposure, and therefore for controlling the neoplastic process before onset of the disease in those who, having been exposed, although healthy, are potentially at risk.

In plain English

This article briefly reviewed background information and earlier reports, then presented 83 cases of mesothelioma in Italy among people exposed to asbestos used in railroads. The authors stated that the series was not the result of an epidemiological investigation but of largely occasional observations. Of the 83 cases, 78 were pleural, 4 peritoneal and 1 pericardial. Forty-nine occurred among workers of the Italian State Railroads (FS), mainly machinists. Twenty-nine occurred among rolling-stock machinists in workshops not belonging to the FS, and 3 among non-FS personnel working on rolling stock. Two were in family members of FS workers, a daughter and a wife. Cases came from 13 regions, with the largest number from Emilia-Romagna, and most occurred in the 1980s. Average latency was 28 years for FS workers and 29 years for non-FS workshop machinists. Chrysotile was the asbestos type mainly used in Italian railroads. The authors concluded that the cases prove, but do not quantify, the risk, and that the true number of cases is likely higher than the number they found.

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 made up of largely occasional observations, not an epidemiological investigation. It was preceded by a brief review of background information and earlier reports. The authors' institute studied 26 of the cases in detail.
• Who was studied: 83 people in 13 Italian regions who had mesothelioma and had been exposed to asbestos used in railroads. The deaths listed range from the 1960s to 1989. The Bologna Institute of Oncology studied 26 of the cases in detail: 25 in Emilia-Romagna and 1 in Vicenza, Veneto.
• Exposure: Asbestos used in railroad rolling stock in Italy. It was used to insulate boilers and mains from the 1940s, the driving cabin of one type of locomotive in the 1960s, and carriages from the 1950s to the 1970s (up to 1,000 kg per carriage). Chrysotile was the main type used. Exposed groups included FS workers (especially machinists), machinists in non-FS rolling-stock workshops, non-FS personnel working on rolling stock, and family members of FS workers.
• Main results:
  • Of the 83 cases, 78 were pleural, 4 peritoneal and 1 pericardial mesothelioma.
  • 49 cases were among FS workers, in particular machinists.
  • 29 cases were among machinists of rolling-stock workshops not belonging to the FS.
  • 3 cases were among travelling workers on rolling stock not employed by the FS: a military radar operator, a post office clerk and a sleeping-car attendant.
  • 2 cases of pleural mesothelioma were in family members of FS workers: the daughter of a pointsman and the wife of a major repair workshop mechanic.
  • Cases were observed in 13 Italian regions.
  • The Emilia-Romagna Region had the largest number of cases of any region, though not a majority of them.
  • Most reported cases occurred in the 1980s. The authors described the trend as sharply increasing.
  • Average latency was 28 years among FS workers and 29 years among workers of non-FS workshops.
  • Average age at death was 58 years for the FS worker cases (Table 2) and 52 years for the non-FS workshop machinist cases (Table 3).
  • Table 10 covers 19 deceased occupational cases of pleural mesothelioma in Emilia-Romagna. In this group, average survival from first signs or symptoms to death was 13 months. The authors stated that the survival data confirm the poor prognosis of mesothelioma.
• The authors' conclusion: The authors concluded that the reported cases prove, but do not quantify, the risk from asbestos used in railroads. They called for primary prevention, medical surveillance of exposed workers, systematic epidemiologic investigations and basic research on the latency period.
• Limitations the authors state:
  • The cases did not come from a systematic epidemiologic investigation, so the series cannot measure the size of the risk.
  • The number of cases found is probably lower than the actual number.
  • The high number of cases in Emilia-Romagna may reflect a particular local risk, more accurate registration of cases, or both.
  • Peritoneal and pericardial mesotheliomas may be harder to diagnose and register than pleural ones.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pericardial.

Related studies

• Mesotheliomas following exposure to asbestos used in railroads: the Italian cases — C. Maltoni, C. Pinto, et al. (1991)
• Relative risk of mesothelioma among railroad machinists exposed to chrysotile — T.F. Mancuso (1988)
• Re: Mesothelioma in railroad machinists — A. Churg, F. Green (1990)
• Relative risk of mesothelioma among railroad machinists exposed to chrysotile — I. Higgins (1989)
• A retrospective cohort study of lung cancer and diesel exhaust exposure in railroad workers — E. Garshick, M.B. Schenker, et al. (1988)
• A case-control study of lung cancer and diesel exhaust exposure in railroad workers — E. Garshick, M.B. Schenker, et al. (1987)

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