Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources

Our plain-English summary of Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources, by A. Zona, L. Fazzo, G. Minelli, et al (Cancer Epidemiology, 2019).

The study

• Authors: A. Zona, L. Fazzo, G. Minelli, M. De Santis, C. Bruno, S. Conti, P. Comba
• Journal: Cancer Epidemiology
• Published: 2019;60:162-167
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: This study is part of a national plan of epidemiological surveillance of malignant mesothelioma (MM) mortality in Italy. The paper shows the results of malignant peritoneal mesothelioma (MPeM) mortality study in Italian Regions and municipalities.

Methods: National Bureau of Statistics data for MPeM municipal mortality (ICD-10, Code C45.1) were analyzed in the time-window 2003-2014: mortality standardized rates (reference Italian population, census 2011), temporal trends of the annual national rates, Standardized Mortality Ratios and a municipal clustering analysis were performed.

Results: 747 deaths for MPeM were recorded (0.10/100,000): 464 in men (0.14/100,000) and in 283 women (0.07/100,000). No significant MPeM mortality temporal trend was found. Seventeen municipalities showed excesses of mortality for MPeM in at least one gender and/or overall population. Four clusters in male population, and one in women were identified.

Conclusions: The study identifies some areas where remediation activities and/or health care actions may be warranted.

Copyright © 2019 Elsevier Ltd. All rights reserved.

In plain English

The study was part of Italy's national surveillance of mesothelioma deaths. It mapped 2003–2014 national death records for malignant peritoneal mesothelioma (cancer of the abdominal lining) across Italy's regions and municipalities. Rather than measuring individuals' asbestos exposure, the authors looked for known asbestos sources in places with excess deaths. There were 747 deaths (0.10 per 100,000): 464 in men (0.14 per 100,000) and 283 in women (0.07 per 100,000). No significant trend over time was found, probably, the authors said, because cases were few. Seventeen municipalities had statistically significant excesses in at least one sex or overall, each based on at least three deaths. Only Casale Monferrato, where an asbestos-cement plant employed most of the workforce, had excesses in both sexes. In 8 of the 11 with excesses only in men, the authors identified known asbestos sources, such as asbestos-cement plants and shipyards. In 3, no source was identified. Four clusters were found among men and one among women, and rates were higher in North-West Italy. The authors concluded that some areas may warrant remediation and/or health care actions.

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: National mortality surveillance study with spatial analysis of official death-record data (standardized rates, time trends, municipal Standardized Mortality Ratios and cluster analysis)
• Who was studied: Deaths from malignant peritoneal mesothelioma in Italy, 2003–2014, analyzed across geographic macro-areas and the 8,047 Italian municipalities; 747 deaths
• Exposure: Asbestos exposure was not measured for individuals. The authors searched for past asbestos sources in municipalities with excess deaths, such as asbestos-cement plants, shipyards and shipbuilding or repair, railway carriage construction or repair, textile industry, and a former talc mine (near Chiuro). No fiber types were specified.
• Main results:
  • 747 deaths from malignant peritoneal mesothelioma (0.10 per 100,000): 464 in men (0.14 per 100,000) and 283 in women (0.07 per 100,000)
  • No statistically significant trend in national death rates over time
  • 17 municipalities had statistically significant excess deaths in at least one sex or overall, each based on at least three cases. Casale Monferrato (asbestos-cement plant) was the only one with excesses in both men and women.
  • Of the 11 municipalities with excesses only in men, 8 had identified asbestos sources (asbestos-cement plants in Broni and Bari; shipyards or shipbuilding and repair in Sestri Levante, Ronchi de' Legionari, Gorizia, Livorno and Castellammare di Stabia; Fidenza is close to a municipality where an old oil refinery was located). In 3, no source was identified.
  • Statistically significant clusters (p less than 0.10): four among men (Casale Monferrato, Sestri Levante, Ronchi dei Legionari and Castellammare di Stabia areas) and one among women (Chiuro, near a former talc mine)
  • North-West Italy had higher rates than Italy overall: standardized relative risk 1.5 (95% CI 1.31-1.71) overall, 1.52 (1.28-1.8) in men and 1.48 (1.19-1.83) in women. The authors described a north-south gradient.
  • The male-to-female ratio of peritoneal mesothelioma deaths was 1.64
• The authors' conclusion: The authors concluded that the study identifies some areas where remediation activities and/or health care actions may be warranted. They also concluded that pleural and peritoneal mesothelioma should be monitored separately in national surveillance.
• Limitations the authors state:
  • The small number of cases probably explains why no significant time trend was found
  • Ovarian and other abdominal tumours may have been misclassified as peritoneal mesothelioma, which could partly explain the higher share of peritoneal cases among women

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Malignant Mesothelioma, standardized mortality ratio (SMR).

Related studies

• Spatial Analysis of Shared Risk Factors between Pleural and Ovarian Cancer Mortality in Lombardy (Italy) — G. Stoppa, C. Mensi, et al. (2022)
• Pleural mesothelioma mortality and asbestos exposure mapping in Italy — L. Fazzo, M. De Santis, et al. (2012)
• Epidemiological surveillance of mesothelioma mortality in Italy — L. Fazzo, G. Minelli, et al. (2018)
• Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence — S. Conti, G. Minelli, et al. (2015)
• Burden of Mortality from Asbestos-Related Diseases in Italy — L. Fazzo, A. Binazzi, et al. (2021)
• Forecast of Malignant Peritoneal Mesothelioma Mortality in Italy up to 2040 — E. Oddone, J. Bollon, et al. (2020)

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