Persistence burden and poor survival of pleural mesothelioma in central Italy, 2013-2022: a population-based study thirty years after asbestos ban

Our plain-English summary of Persistence burden and poor survival of pleural mesothelioma in central Italy, 2013-2022: a population-based study thirty years after asbestos ban, by M. Iommi, M. Bonifazi, D. Sarti, et al (BMC Public Health, 2026).

The study

• Authors: M. Iommi, M. Bonifazi, D. Sarti, F. Mei, M. Franchi, M. Rossi, M. Pompili, E. Prospero, F. Carle, R. Gesuita, E. Skrami
• Journal: BMC Public Health
• Published: 2026;26(1)
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND: Pleural Mesothelioma (PM) is an asbestos-related cancer with poor prognosis. Despite the 1992 national asbestos ban, new cases continue to occur due to the long latency of the disease. The study aim was to evaluate incidence and survival trends of pleural mesothelioma in the Marche Region, central Italy, between 2013 and 2022. METHODS: This population-based incidence study included adult residents of the Marche Region between 2013 and 2022. Incident PM cases were identified from the Cancer Registry of Marche Region. Incidence rates per 100,000 person-years (py) were calculated and stratified by sex, age, and province of residence. Temporal trend and covariates effect were assessed with Poisson regression. Overall survival was estimated using the Kaplan-Meier method and compared across subgroups; adjusted hazard ratios (HR) were obtained from multiple Cox regression model. RESULTS: Between 2013 and 2022, there were 322 incident PM cases (82% male; median age 77 years). The crude incidence rate was 2.1 per 100,000 py (95% CI: 1.9–2.4), with no temporal change over the study period. The highest rates were observed in men, in age-group 75–79 years, and in the province of Ancona. One- and five-year survival rates were 48.8% and 8.3%, respectively. Older age and non-epithelioid histology were independently associated with higher mortality. CONCLUSIONS: The incidence of pleural mesothelioma in the Marche Region remained stable between 2013 and 2022, with a peak in 2018 requiring further observation to confirm it. The persistently high burden among men, older adults, and those living in industrialized coastal areas reflects the legacy of historical asbestos exposure. Continued population-based surveillance, integrated with follow-up of previously exposed workers, remains essential to monitor disease trends and support timely diagnosis and appropriate care pathways.

In plain English

This population-based study used the Marche Region Cancer Registry (central Italy) to count new pleural mesothelioma cases among adults in 2013–2022 and track survival. It had no information on asbestos exposure. There were 322 new cases; 295 patients died during follow-up. The crude incidence was 2.1 per 100,000 person-years (95% CI 1.9–2.4): 3.6 in men (3.2–4.0) and 0.7 in women (0.6–1.0). Yearly rates ranged from 1.5 in 2014 (95% CI 0.9–2.2) to 2.6 in 2018 (1.9–3.6), with no statistical trend. Rates were highest at ages 75–79 and in the province of Ancona. Median survival was 11.8 months (95% CI 10.4–13.7); 48.8% (43.6%–54.5%) were alive at one year and 8.3% (5.6%–12.3%) at five years. After adjustment, risk of death was higher at ages 80–84 and 85 or older than under 65, and for fibrous or biphasic than unspecified mesothelioma; sex was not associated with it. The authors concluded that incidence remained stable and that the 2018 peak needs longer observation to confirm. They noted that the small number of cases may have limited detection of subtle variations.

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: Population-based incidence and survival study using secondary data from the regional cancer registry linked to a regional health beneficiaries database (Poisson regression for incidence trends; Kaplan-Meier and Cox regression for survival)
• Who was studied: Residents of the Marche Region, central Italy, older than 18 and covered by the Italian National Health Service, 2013–2022. There were 322 incident pleural mesothelioma cases (ICD-10 C45.0); 82% were male and the median age at diagnosis was 77. Follow-up ran to December 31, 2023.
• Exposure: Not measured. The study had no information on occupational or environmental asbestos exposure (no fiber types, jobs or doses). It analysed incidence and survival by sex, age group, province of residence, year of diagnosis and histological subtype.
• Main results:
  • Overall crude incidence over 2013–2022 was 2.1 per 100,000 person-years (95% CI 1.9–2.4). It was 3.6 in males (95% CI 3.2–4.0) and 0.7 in females (95% CI 0.6–1.0).
  • Annual incidence ranged from 1.5 per 100,000 person-years in 2014 (95% CI 0.9–2.2) to 2.6 in 2018 (95% CI 1.9–3.6).
  • There was no trend in incidence over the study period (IRR per year 0.99; 95% CI 0.96–1.04; p = 0.866). Segmented analysis found no breakpoints.
  • Males had a 6-fold higher incidence rate than females (IRR 6.0, 95% CI 4.5–8.0).
  • Compared with people under 65, incidence peaked at ages 75–79 (IRR 43.2; 95% CI 29.9–63.5) and declined slightly in older age groups.
  • The province of Ancona had the highest incidence rate: 3.5 per 100,000 person-years (95% CI 3.0–4.1). IRRs for the other provinces compared with Ancona ranged from 0.3 (Ascoli Piceno) to 0.5 (Fermo).
  • Of the 322 cases, 295 died during follow-up. Median survival was 11.8 months (95% CI 10.4–13.7).
  • For all cases, 1-year survival was 48.8% (95% CI 43.6%–54.5%) and 5-year survival was 8.3% (95% CI 5.6%–12.3%).
  • By histological subtype, epithelioid mesothelioma had 1-year survival of 61.4% (95% CI 54.5–69.2). Fibrous mesothelioma had 1-year survival of 18.9% and biphasic mesothelioma 32.3%; 5-year survival for these two subtypes was around 5%.
  • In the multiple Cox model, risk of death was higher than for patients under 65 at ages 80–84 (HR 2.42; 95% CI 1.53–3.82) and at 85 or older (HR 4.87; 95% CI 2.91–8.15).
  • Compared with unspecified mesothelioma, both fibrous mesothelioma (HR 1.58; 95% CI 1.04–2.38) and biphasic mesothelioma (HR 1.74; 95% CI 1.1–2.75) were associated with higher mortality. The HR for epithelioid mesothelioma was 0.77 (95% CI 0.58–1.02).
  • Sex was not associated with risk of death in the multiple Cox model (males vs females HR 1.29; 95% CI 0.93–1.79).
  • Patients residing in Macerata had a lower risk of death than those in Ancona (HR 0.6; 95% CI 0.4–0.9).
  • Year of diagnosis was not associated with mortality; the authors read this as stable survival over the study period.
• The authors' conclusion: The authors concluded that pleural mesothelioma incidence in the Marche Region remained stable between 2013 and 2022. They said the peak of new cases in 2018 needs a longer observation period to be confirmed.
• Limitations the authors state:
  • No information was available on occupational or environmental exposure, lifestyle or clinical conditions, so incidence patterns could not be linked directly to exposure history.
  • The relatively small number of cases may have reduced the ability to detect subtle temporal, demographic or geographic variations.
  • Differences in case definition and morphology classification between cancer registries and specialized mesothelioma registries could influence the estimates.
  • Possible differences in access to diagnostic pathways across provinces could have affected case finding and led to underestimation of incidence.
  • Because of the long latency of the disease, place of residence at diagnosis may not reflect where exposure occurred.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Latency, Cancer Registry, Incidence, Overall Survival, Hazard Ratio, Non-epithelioid.

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