The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos

Our plain-English summary of The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos, by C. Magnani, C. Mensi, A. Binazzi, et al (International Journal of Environmental Research and Public Health, 2023).

The study

• Authors: C. Magnani, C. Mensi, A. Binazzi, D. Marsili, F. Grosso, J.P. Ramos-Bonilla, D. Ferrante, E. Migliore, D. Mirabelli, B. Terracini, D. Consonni, D. Degiovanni, M. Lia, M.F. Cely-García, M. Giraldo, B. Lysaniuk, P. Comba, A. Marinaccio
• Journal: International Journal of Environmental Research and Public Health
• Published: 2023;20(2)
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.

In plain English

This article is a perspective in which researchers, physicians and officials described Italy's experience with mesothelioma since the 1980s, to guide other countries. It draws largely on earlier studies. In Casale Monferrato, home of the Eternit asbestos-cement plant, registry counts for 1990 to 2017 showed 162 mesothelioma cases in people who had ever worked at Eternit. There were 477 cases in people who never worked there but were indirectly exposed. The ratio of indirect to direct cases rose from 1.2 in 1990 to 1994 to 9.4 in 2015 to 2017. In the Broni area, the Lombardy registry identified 218 people with mesothelioma linked to the Fibronit asbestos-cement factory between 2000 and 2016, and three-fourths of the cases were attributed to familial or environmental exposure. The national registry (ReNaM) reported 31,572 cases from 1993 to 2018. Of the 24,864 whose exposure was investigated, 69.1% had occupational exposure. The authors also described a pleural mesothelioma cluster in Sibaté, Colombia. They concluded that mesothelioma surveillance systems are effective tools for public health.

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: Perspective article (narrative review of the Italian experience with mesothelioma registries, drawing largely on previously published studies and registry reports)
• Who was studied: Residents and workers of two Italian towns with asbestos-cement factories (Casale Monferrato and Broni), mesothelioma cases in the Italian national registry (ReNaM, 1993 to 2018), and the town of Sibaté, Colombia
• Exposure: Asbestos from asbestos-cement production (Eternit in Casale Monferrato, Fibronit in Broni, a facility in Sibaté), including occupational, familial, domestic and environmental exposure; crocidolite was part of the Eternit mixture
• Main results:
  • Casale Monferrato residents, 1990 to 2017: 162 mesothelioma cases among people who had ever worked at Eternit (40 women, 122 men) and 477 among people who never worked there but were indirectly exposed (238 women, 239 men). The ratio of indirect to direct cases rose from 1.2 (1990 to 1994) to 9.4 (2015 to 2017).
  • District of Casale Monferrato, 2013 to 2017: pleural mesothelioma incidence of 54 per 100,000 person-years in men (132 cases) and 32 per 100,000 in women (97 cases), age-adjusted, as reported from the regional registry
  • Broni area, 2000 to 2016: 218 people with mesothelioma (207 pleural, 11 peritoneal) with asbestos exposure related to the Fibronit factory, standardized incidence ratio 8.4 overall; 97 men (SIR 6.4) and 121 women (SIR 11.1)
  • Broni and Stradella: about 194 excess cases estimated over 17 years (211 observed against about 17 expected); three-fourths of cases were attributable to familial or environmental exposure
  • Italian national registry (ReNaM) Seventh Report: 31,572 incident mesothelioma cases from 1993 to 2018
  • Of 24,864 ReNaM cases whose exposure was investigated: occupational exposure in 69.1%, familial exposure in 5.1%, environmental exposure in 4.3%, leisure-related exposure in 1.5%; exposure unknown or unlikely in 20%
  • Sibaté, Colombia: a pleural mesothelioma cluster, documented initially with 15 confirmed cases; most people diagnosed did not work in the asbestos-cement facility
• The authors' conclusion: The authors concluded that epidemiological surveillance systems for mesothelioma that share their results with communities and stakeholders are effective tools for public health and welfare policies
• Limitations the authors state:
  • The Casale Monferrato table does not include all cases linked to Eternit; cases in residents of other towns were not tabulated
  • In Broni, the gender differences by exposure source depend partly on the classification scheme, which assigns people with both occupational and non-occupational exposure to occupational exposure
  • Problems in official Colombian health databases could lead to an underestimate of the number of cases in Sibaté
  • The paper covers only mesothelioma, not other asbestos-related diseases

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: Mesothelioma, Chrysotile, Crocidolite, Amosite, Tremolite, Actinolite, Anthophyllite, Carcinogenic.

Related studies

• An Approach to Overcome the Limitations of Surveillance of Asbestos Related Diseases in Low- and Middle-Income Countries: What We Learned from the Sibaté Study in Colombia — J.P. Ramos-Bonilla, M. Giraldo, et al. (2023)
• 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)
• Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register — L. Vimercati, D. Cavone, et al. (2023)
• Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM) — E. Migliore, D. Consonni, et al. (2022)
• 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)
• 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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