Occupational cancer in Italy

Our plain-English summary of Occupational cancer in Italy, by E. Merler, P. Vineis, D. Alhaique, et al (Environmental Health Perspectives, 1999).

The study

• Authors: E. Merler, P. Vineis, D. Alhaique, L. Miligi
• Journal: Environmental Health Perspectives
• Published: 1999;107 Suppl 2(Suppl 2):259-71
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This article is a discussion of occupational cancer in Italy. The introduction provides the necessary context of Italian industrialization and occupational health regulation. This is followed by a review of Italian epidemiologic studies of occupational cancer risks considered in terms of relative measures of risk and attributable risk of carcinogenic agents or exposure circumstances. We attempt to establish the number of workers exposed to carcinogens in Italy and the intensity of their exposures. Finally, the Italian system of compensation for occupational cancer is discussed. Several cohort and case-control studies have addressed the issue of occupational risks, mostly among male workers. The results of these studies suggest that the growing incidence of and mortality by mesothelioma is explained by the widespread and intense exposure to asbestos in some Italian industrial settings. A high attributable risk of lung tumors among male populations in industrial areas of northern Italy is explained by occupational exposures. However, insufficient data are available for clear definition of the extent and intensity of occupational exposure to carcinogenic substances. In Italy, we must prioritize and maximize resources in occupational cancer epidemiology and revitalize the role of national institutions. Recent legislation has established new regulations on the handling of carcinogenic substances in industrial settings, a new list of occupational diseases, and a national registry of mesothelioma linked to asbestos exposure. These legislative changes are expected to have positive effects.

In plain English

This article was a review of occupational cancer in Italy, not a new study of workers. The authors reviewed Italian cohort and case-control studies published in peer-reviewed journals between 1975 and 1994. They also re-examined control-group data from three earlier case-control studies and described Italy's compensation system. In the reviewed cohort studies, relative risks for primary pleural cancer ranged from 5.6 to 150. The attributable risk for pleural cancer among asbestos-exposed workers was approximately 100%. In two case-control studies, asbestos accounted for 20% of lung cancer among men in Trieste and 50% of respiratory cancer among men in one area of northern Italy. In the re-examined control groups, 7.8% of subjects in a larynx cancer study were certainly exposed to asbestos, as were 4.8% of men in a nine-area study and 12% in Trieste. Since 1988, the main insurer had rejected 53% of 466 cancer claims. Mesothelioma without asbestosis was not on the compensation list until 1994. The authors concluded that widespread, intense asbestos exposure explained Italy's growing mesothelioma rates.

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: Review (systematic review of published Italian epidemiologic studies), with the authors' re-examination of control-group data from three earlier case-control studies and a description of the compensation system
• Who was studied: Italian cohort and case-control studies of occupational cancer published 1975 to 1994, mostly of male workers in northern and central Italy; plus controls from three case-control studies (799 male controls in Turin and Varese, 1,386 controls from nine areas, 755 male controls in Trieste)
• Exposure: Occupational carcinogens in general, including asbestos (chrysotile was mined in Italy; amosite and crocidolite were also widely used), silica, dyestuffs, polycyclic aromatic hydrocarbons, wood and leather dust, and benzene
• Main results:
  • Across the reviewed cohort studies, relative risks for primary pleural cancer ranged from 5.6 to 150, the highest being among asbestos-exposed workers
  • Attributable risk among the exposed of approximately 100% for pleural cancer in asbestos-exposed workers (derived from cohort studies with significant excesses)
  • In two case-control studies, asbestos explained the largest share of population attributable risk: 20% of lung cancer among men in Trieste and 50% of respiratory cancer among men in a restricted area of northern Italy
  • In the larynx cancer study (Turin and Varese controls), 7.8% of subjects were certainly exposed to asbestos
  • In the hematolymphopoietic malignancy study controls, 35 men (4.8%) and 6 women (1%) were certainly exposed to asbestos
  • The share of controls exposed to asbestos was 12% in Trieste, an area dominated by shipbuilding
  • Since 1988, 53% of 466 cancer compensation claims were rejected by the insurer covering the largest number of industrial workers
  • Mesothelioma without asbestosis was not on the list of compensable occupational diseases until 1994
• The authors' conclusion: The authors concluded that the reviewed studies suggest the growing incidence of and mortality from mesothelioma is explained by widespread and intense asbestos exposure in some Italian industrial settings
• Limitations the authors state:
  • The extent and severity of occupational cancer in Italy could not be adequately described for lack of information on exposed worker numbers and exposure intensity
  • The three re-examined studies covered few carcinogens and relatively few subjects, and their areas were not representative of Italy
  • Attributable risks are specific to the time and place of each study
  • Only 36% of cohort studies had workplace hygiene data, impairing exposure assessment
  • The reviewed studies tended to be small

Topics

Medical terms in this study, explained in our Lexicon: Attributable Risk, Carcinogenic, Mesothelioma, Occupational Exposure, Epidemiology, Occupational Disease, Asbestos Exposure.

Related studies

• Occupational cancer in Germany — I. Brüske-Hohlfeld (1999)
• Occupational cancer in Italy: evaluating the extent of compensated cases in the period 1994-2006 — A. Scarselli, P. Scano, et al. (2009)
• Occupational cancer in Canada: what do we know? — K. Teschke, M.C. Barroetavena (1992)
• Italian National Register of Occupational Cancers: data system and findings — A. Scarselli, S. Massari, et al. (2010)
• Occupational cancer in the United Kingdom — D. Coggon (1999)
• Estimation of Occupational Exposure to Asbestos in Italy by the Linkage of Mesothelioma Registry (ReNaM) and National Insurance Archives. Methodology and Results — C. Airoldi, D. Ferrante, et al. (2020)

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