Para-occupational exposures to asbestos: lessons learned from Casale Monferrato, Italy

Our plain-English summary of Para-occupational exposures to asbestos: lessons learned from Casale Monferrato, Italy, by L.T. Stayner (Occupational and Environmental Medicine, 2016).

The study

• Author: L.T. Stayner
• Journal: Occupational and Environmental Medicine
• Published: 2016;73(3):145-6
• Type of article: Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this commissioned commentary, the author discussed a case-control study by Ferrante et al. of pleural mesothelioma and asbestos exposure in Casale Monferrato, Italy, the site of an Eternit asbestos cement plant. That study found roughly twofold risks for having lived with a family member who worked at the plant (OR=2.4, 95% CI 1.3 to 4.4) and for domestic or environmental exposure (OR=2.0, 95% CI 1.2 to 3.2). The author highlighted its analysis of exposure-response across all sources of cumulative exposure. That analysis found an approximately fourfold risk at 0.1 to <1 fibre/mL-years (OR=4.4, 95% CI 1.7 to 11.3) and a similar risk for non-occupational sources alone (OR=3.8, 95% CI 1.3 to 11.1). He calculated that 1 fibre/mL-year corresponded to about 0.01 fibre/mL over 70 years of residence, roughly two orders of magnitude below levels reported in the past in other asbestos communities. Asbestos-cement roofing (OR=2.5) and pavement with asbestos tailings (OR=3.6) were also associated with mesothelioma. The author argued that continued worldwide use of about two million metric tons per year remained a concern even where only chrysotile was used, given the risks of lung, laryngeal and ovarian cancer and asbestosis. He noted cleanup costs in Libby, Montana, of at least $447 million since 1999. He concluded that countries using or producing asbestos should heed the lessons of Casale Monferrato, Libby and other affected communities.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This commentary, not an original study, discussed Ferrante and colleagues' case-control study of pleural mesothelioma around the Eternit asbestos cement plant in Casale Monferrato, Italy. As the author reported it, that study found higher odds of pleural mesothelioma among people who had lived with a family member who worked at the plant (OR=2.4, 95% CI 1.3 to 4.4) and among people exposed from domestic or environmental sources (OR=2.0, 95% CI 1.2 to 3.2). Risk rose with higher cumulative exposure from all sources. At 0.1 to less than 1 fibre/mL-years the odds ratio was 4.4 (95% CI 1.7 to 11.3), and 3.8 (95% CI 1.3 to 11.1) for non-occupational sources only. Asbestos-cement roofing (OR=2.5, 95% CI 1.4 to 4.5) and pavement made with asbestos tailings (OR=3.6, 95% CI 1.4 to 9.2) were also associated with the disease. The author estimated 1 fibre/mL-year equals about 0.01 fibre/mL averaged over 70 years' residence. The author concluded the findings have serious implications for communities still using or producing asbestos. The author disclosed past expert-witness work for US asbestos victims, unrelated to Casale Monferrato.

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: Commissioned commentary on another study (Ferrante et al, a case-control study with quantitative risk assessment). It is not original research.
• Who was studied: The commentary discusses Ferrante et al's study of pleural mesothelioma in relation to the workers and community of Casale Monferrato, Italy. The commentary does not give numbers of cases or controls, or study dates.
• Exposure: Asbestos from the Eternit asbestos cement facility. This includes occupational exposure, living with a family member who worked at the plant, domestic and environmental sources, asbestos-cement roofing, and pavement made with asbestos tailings. Cumulative exposure was measured in fibre/mL-years.
• Main results:
  • As reported in the commentary from Ferrante et al: people who had lived with a family member who worked in the Eternit plant had higher odds of pleural mesothelioma, OR=2.4 (95% CI 1.3 to 4.4).
  • As reported from Ferrante et al: people exposed from domestic or environmental sources had higher odds of pleural mesothelioma, OR=2.0 (95% CI 1.2 to 3.2).
  • As reported from Ferrante et al: higher cumulative asbestos exposure from all sources was associated with increased risk of pleural mesothelioma (an exposure–response relationship).
  • As reported from Ferrante et al: at 0.1 to less than 1 fibre/mL-years, the OR for pleural mesothelioma was 4.4 (95% CI 1.7 to 11.3). Restricted to non-occupational sources, the OR was 3.8 (95% CI 1.3 to 11.1).
  • The author's own calculation: 1 fibre/mL-year corresponds to an average of about 0.01 fibre/mL for someone living 70 years in the community. The author described this as roughly two orders of magnitude lower than levels reported in other communities with an asbestos industry.
  • As reported from Ferrante et al: pleural mesothelioma was associated with asbestos-cement roofing, OR=2.5 (95% CI 1.4 to 4.5), and with pavement with asbestos tailings, OR=3.6 (95% CI 1.4 to 9.2).
• The authors' conclusion: The author concluded that the results have serious implications for communities currently using or producing asbestos. In the author's view, the industrial use and production of asbestos can affect communities long after the industries are gone.

Topics

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

Medical terms in this study, explained in our Lexicon: Take-home Exposure, Casale Monferrato, Case-Control Study, Pleural Mesothelioma, Asbestos Exposure, Eternit, Asbestos-Cement, Environmental Exposure.

Related studies

• 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)
• Cancer mortality and incidence of mesothelioma in a cohort of wives of asbestos workers in Casale Monferrato, Italy — D. Ferrante, M. Bertolotti, et al. (2007)
• A cohort study on mortality among wives of workers in the asbestos cement industry in Casale Monferrato, Italy — C. Magnani, B. Terracini, et al. (1993)
• Environmental Health Education for Asbestos-Contaminated Communities in Italy: The Casale Monferrato Case Study — D. Marsili, A. Canepa, et al. (2019)
• Pleural mesothelioma and occupational and non-occupational asbestos exposure: a case-control study with quantitative risk assessment — D. Ferrante, D. Mirabelli, et al. (2016)
• Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato — M. Bonafede, A. Granieri, et al. (2020)

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