Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register

Our plain-English summary of Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register, by A. Marinaccio, A. Binazzi, D.D. Marzio, et al (International Journal of Cancer, 2012).

The study

• Authors: A. Marinaccio, A. Binazzi, D.D. Marzio, A. Scarselli, M. Verardo, D. Mirabelli, V. Gennaro, C. Mensi, L. Riboldi, E. Merler, R.D. Zotti, A. Romanelli, E. Chellini, S. Silvestri, C. Pascucci, E. Romeo, S. Menegozzo, M. Musti, D. Cavone, G. Cauzillo, R. Tumino, C. Nicita, M. Melis, S. Iavicoli, ReNaM Working Group
• Journal: International Journal of Cancer
• Published: 2012;130(9):2146-54
• Cited by: 118 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as "at risk" (asbestos-cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading.

Copyright © 2011 UICC.

In plain English

This study described pleural malignant mesothelioma cases in Italy's National Mesothelioma Register (ReNaM), which collects new cases and interviews patients or their relatives about asbestos exposure. From 1993 to 2004 the register recorded 8,868 pleural cases (6,455 men, 2,413 women). Exposure histories were investigated for 6,603. In 2004, in regions sending complete incidence data, the age-standardized rate was 3.49 per 100,000 for men and 1.25 for women, highest for men in Liguria (14.13). Among cases with defined exposure, 69% were exposed at work, 4.4% lived with an occupationally exposed person (generally the husband), 4.7% lived near a contamination source and 1.6% were exposed during leisure. For 20% the exposure was unknown or unlikely. Exposed workers' median year of first exposure was 1957, and mean latency was 43.7 years. Among cases of occupational origin, shipbuilding and repair, asbestos-cement and railway carriage maintenance accounted for 23%, a decreasing share. Construction's share of occupationally exposed cases rose from 16% in 1993–1998 to 25% in 1999–2004. The authors concluded that surveillance supports prevention and compensation. They noted that uneven regional coverage strongly limits trend evaluations.

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: Descriptive analysis of cases from a national mesothelioma surveillance register, with exposure assessed by standardized questionnaire interviews
• Who was studied: 8,868 pleural malignant mesothelioma cases (6,455 men, 2,413 women) registered in Italy, 1993 to 2004. Exposure modalities were investigated for 6,603, of which 1,321 remained unknown or unlikely. Incidence rates covered only regions transmitting complete data.
• Exposure: Asbestos exposure classified as occupational, familial (cohabitation), environmental (residential) or leisure. Occupational cases were grouped by economic sector and mode of asbestos use. Fiber types were not specified.
• Main results:
  • Age-standardized incidence of pleural MM (certain, probable and possible) in 2004 was 3.49 per 100,000 for men and 1.25 for women. Rates were estimated only for the pooled regions transmitting complete incidence data.
  • Regional peaks were, for men, Liguria (14.13), Friuli-Venezia Giulia (6.28) and Piedmont (5.56); for women, Piedmont (3.18) and Liguria (2.23).
  • Restricting to cases diagnosed as certain MM reduced incidence rates by about 20%.
  • Of cases with defined exposure modalities, 69% had occupational exposure.
  • Of cases with defined exposure modalities, 4.4% were exposed through cohabitation with an occupationally exposed person (generally the husband), 4.7% environmentally from living near a contamination source, and 1.6% during leisure.
  • For 20% of cases (1,321 of 6,603) the modalities of exposure were unknown or unlikely. Identifying the source was more difficult for women.
  • Exposure was unknown after 10.8% of direct interviews (355 of 3,299) and after 22.1% of indirect interviews with relatives (660 of 2,988).
  • Among occupationally exposed workers, the median year of first exposure was 1957 and mean latency was 43.7 years.
  • Among cases of occupational origin, direct use of raw asbestos in shipbuilding and repair, the asbestos-cement industry and railway carriage maintenance accounted for 23%, with a decreasing trend.
  • Construction accounted for 15% of occupationally exposed cases over the period. Its share of those cases rose significantly from 16% in 1993–1998 to 25% in 1999–2004.
  • 19% of occupational cases came from accidental or unaware exposure in jobs not generally considered at risk, such as car mechanics, jute sack users and service workers.
  • The highest crude incidence rates were in areas with asbestos industries, including the asbestos-cement plants of Casale Monferrato and Broni, shipyards, asbestos textile plants and railway carriage repair. High rates also occurred at Biancavilla in Sicily, an area of natural environmental contamination.
• The authors' conclusion: The authors concluded that systematic mesothelioma surveillance is relevant for preventing the disease and for supporting an efficient compensation system. They also suggested Italy adopt a fund like France's for people exposed outside work.
• Limitations the authors state:
  • The register developed unevenly across regions, and data collection was not consistent, so trend evaluations of incidence are strongly limited.
  • No national pathology panel yet validates cases with an uncertain diagnosis.
  • Many exposures were assessed by interviewing relatives rather than patients, which lowers information quality.
  • Assigning each case to the sector with the longest exposure may underestimate jobs with shorter or occasional exposures.
  • Uneven territorial coverage could bias comparisons of exposure sectors over time. Relative risks by industrial sector are not yet available in Italy.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Mesothelioma, Incidence, Environmental Exposure, Occupational Exposure, Latency, Asbestos-Cement.

Related studies

• Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register — A. Marinaccio, A. Binazzi, et al. (2010)
• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Analysis of latency time and its determinants in asbestos related malignant mesothelioma cases of the Italian register — A. Marinaccio, A. Binazzi, et al. (2007)
• Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM) — A. Binazzi, D. Di Marzio, et al. (2021)
• Non-occupational exposure to asbestos and malignant mesothelioma in the Italian National Registry of Mesotheliomas — D. Mirabelli, D. Cavone, et al. (2010)

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