Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023

Our plain-English summary of Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023, by F. Giacomino, F. Marinelli, I. Bisceglia, et al (La Medicina del Lavoro, 2024).

The study

• Authors: F. Giacomino, F. Marinelli, I. Bisceglia, M. Cacchi, C. Storchi, C. Pinto, L. Mangone, A. Romanelli, F. Morabito
• Journal: La Medicina del Lavoro
• Published: 2024;115(4):e2024028
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma (MM) is a rare but lethal cancer strongly associated with asbestos exposure. This retrospective study examines trends in asbestos exposure in Emilia-Romagna, Northern Italy. Between 1996 and 2023, 3,513 cases of MM were recorded, predominantly in males (72%) and in older than 65 years (79%). Occupational exposure accounted for 82% of cases, with a significant increase observed over time from 71% to 88% in the most recent period. A greater definition of professional exposure indicates that certain exposure has gone from 49% in the first period to 62% and 58% in the last two periods; probable exposure showed a decrease from 21% to 16% while possible exposure decreased from 16% to 13%. Familiar exposure remained relatively constant at around 8%, environmental exposure showed a slight decrease from 4% to 2%, while non-occupational exposure remained stable at 2%. Among patients with exclusively occupational exposure (1,826 cases), 87% were male and aged between 65 and 75 years (36%) and 75+ (41%). The exposure rates for the province of residence see the province of Reggio Emilia with the highest occupational exposure rate (2.5 x 100,000 residents), followed by Ravenna (2.3 x 100,000 residents) and Parma and Piacenza which have similar exposure rates with 2.2 x 100,000 residents. Professional sectors such as construction, railway maintenance and metalworking are identified as high-risk industries. Despite efforts to mitigate exposure, non-occupational and environmental exposures persist. The study highlights the importance of continuous surveillance and exposure monitoring to guide effective interventions and legal recognition of MM.

In plain English

This study used the Emilia-Romagna regional mesothelioma registry in northern Italy to describe malignant mesothelioma cases and asbestos exposure. Between 1 January 1996 and 30 June 2023, 3,513 cases were registered. Of these, 72% were in men, 3,225 (91.8%) involved the pleura and 256 (7.3%) the peritoneum. Exposure was assessed using 2,226 questionnaires covering 1996 to 2019, and 82% of these cases had occupational exposure. The share with occupational exposure rose from 70.7% in 1996-2000 to 87.9% in 2016-2019. Over the same span, cases classed as unexposed fell from 53 to 2. The authors suggested that this rise may reflect better definition of exposure more than a real increase. Among 1,826 cases with only occupational exposure, 87.4% were men. The methods describe provincial rates as standardized to the 2013 European standard population per 100,000 person-years. On that measure, Reggio Emilia had the highest rate of these occupationally exposed cases, 2.5, followed by Ravenna at 2.3. The authors' stated limitations included the retrospective design, difficulty assessing exposure and mesothelioma's long latency. The article did not report which asbestos fiber types were involved.

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: Retrospective descriptive study of cases in a regional mesothelioma registry (the Emilia-Romagna Regional Operating Center, COR)
• Who was studied: 3,513 malignant mesothelioma cases (pleura, peritoneum, pericardium, tunica vaginalis testis) in residents of Emilia-Romagna, northern Italy, registered 1 January 1996 to 30 June 2023. 72% were male, and 79% were aged 65 or older. Exposure analysis used 2,226 questionnaires from 1996 to 2019.
• Exposure: Asbestos exposure assessed by questionnaire and classified as occupational (certain, probable, possible), familial, environmental, other non-occupational, or unexposed. No fiber types are specified.
• Main results:
  • Among cases with questionnaires (2,226, years 1996-2019), occupational exposure was documented in 82%.
  • The share of questionnaire cases with occupational exposure increased from 70.7% in 1996-2000 to 87.9% in 2016-2019.
  • The number of cases classed as unexposed fell from 53 in the first period to 2 in the last period.
  • The authors stated that the rise in exposed cases may be due more to improved exposure definition than to a real increase in occupational exposure.
  • Among exposed cases only (2,077), certain occupational exposure rose from 49.2% in 1996-2000 to 62.3% in 2011-2015 and 58.5% in 2016-2019.
  • Among exposed cases only, probable occupational exposure decreased from 21.3% to 16.4% between the first and last periods.
  • Among exposed cases only, familial exposure stayed around 8%. Environmental exposure fell from 3.7% to 1.9%, and other non-occupational exposure stayed at about 2%.
  • Among the 1,826 cases with only occupational exposure, 87.4% were male.
  • Among the 1,826 cases with only occupational exposure, 35.6% were aged 65-74 and 41.1% were 75 or older.
  • According to the methods, provincial rates were standardized: adjusted to the 2013 European standard population and calculated per 100,000 person-years.
  • Mesothelioma cases with only occupational exposure were measured by province of residence. The authors labelled this measure the 'occupational exposure rate', and the results text expresses it per 100,000 residents. It was highest in Reggio Emilia, at 2.5.
  • On the same measure, Ravenna followed Reggio Emilia (2.3), with Parma and Piacenza at 2.2.
  • Of all 3,513 cases, 3,225 (91.8%) were pleural and 256 (7.3%) peritoneal.
  • In the discussion, without data shown in the tables, the authors named the following Emilia-Romagna industries as associated with mesothelioma onset: building construction, railway rolling stock construction or repair, metalworking, sugar factories and other food industries, and asbestos-cement manufacturing.
• The authors' conclusion: The authors concluded that their study highlights ongoing concerns about asbestos exposure in northern Italy, with persistent occupational risks and gender disparities. They called for continued research and data collection.
• Limitations the authors state:
  • The retrospective design introduces biases that may skew findings.
  • Assessing asbestos exposure accurately is difficult; relying on occupational histories or geographic data may miss environmental or distant exposures.
  • Mesothelioma's long latency requires prolonged follow-up to detect cases reliably.
  • Small sample sizes outside specific occupational groups limit generalizability.

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: Asbestos Exposure, Malignant Mesothelioma, Occupational Exposure, Environmental Exposure, Non-Occupational Exposure.

Related studies

• Incidence of malignant mesothelioma and asbestos exposure in the Emilia-Romagna region, Italy — L. Mangone, C. Storchi, et al. (2022)
• The contribution of environmental monitoring in the epidemiological assessment of exogenous risk. The experience of ARPA in the Emilia-Romagna Region of Italy — A. Zavatti, P. Lauriola (1999)
• Past trends and future prediction of mesothelioma incidence in an industrialized area of Italy, the Veneto Region — P. Girardi, V. Bressan, et al. (2014)
• Peritoneal mesothelioma in Italy: Trends and geography of mortality and incidence — S. Conti, G. Minelli, et al. (2015)
• 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)
• Incidence of mesothelioma in Lombardy, Italy: exposure to asbestos, time patterns and future projections — C. Mensi, S. De Matteis, et al. (2016)

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