1
|
Turati F, Rossi M, Spinazzè A, Pira E, Cavallo DM, Patel L, Mensi C, La Vecchia C, Negri E. Occupational asbestos exposure and ovarian cancer: updated systematic review. Occup Med (Lond) 2023; 73:532-540. [PMID: 38072464 DOI: 10.1093/occmed/kqad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The association between asbestos exposure and ovarian cancer has been questioned given the possible misdiagnosis of peritoneal mesothelioma as ovarian cancer. AIMS To update a systematic review on ovarian cancer risk in women occupationally exposed to asbestos, exploring the association with the time since first exposure and the duration of exposure. METHODS We searched PubMed from 2008 onwards, screened previous systematic reviews, combined standardized mortality ratios (SMR) using random effect models and quantified heterogeneity using the I2 statistic. To assess tumour misclassification, we compared the distribution of observed excess ovarian cancers (OEOC) to that expected (EEOC) from the distribution of peritoneal cancers in strata of latency and exposure duration. RESULTS Eighteen publications (20 populations), including a pooled analysis of 21 cohorts, were included. The pooled SMR was 1.79 (95% confidence interval 1.38-2.31), with moderate heterogeneity between studies (I2 = 42%), based on 144 ovarian cancer deaths/cases. The risk was increased for women with indirect indicators of higher exposure, longer duration and latency, and lower for chrysotile than for crocidolite exposure. The effect of duration and latency could not be completely disentangled, since no multivariate analysis was available for time-related variables. The dissimilarity index between OEOC and EEOC for the time since first exposure was small suggesting a similar pattern of risk. CONCLUSIONS While some misclassification between ovarian and peritoneal cancers cannot be excluded, the observed excess risk of ovarian cancer should be added to the overall disease burden of asbestos.
Collapse
Affiliation(s)
- F Turati
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - M Rossi
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - A Spinazzè
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - E Pira
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - D M Cavallo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - L Patel
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - C Mensi
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - E Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| |
Collapse
|
2
|
Marinaccio A, Di Marzio D, Mensi C, Consonni D, Gioscia C, Migliore E, Genova C, Rossetto Giaccherino R, Eccher S, Murano S, Comiati V, Casotto V, Negro C, Mangone L, Miligi L, Piro S, Angelini A, Grappasonni I, Madeo G, Cozzi I, Ancona L, Staniscia T, Carrozza F, Cavone D, Vimercati L, Labianca M, Tallarigo F, Cascone G, Melis M, Bonafede M, Scarselli A, Binazzi A. Incidence of mesothelioma in young people and causal exposure to asbestos in the Italian national mesothelioma registry (ReNaM). Occup Environ Med 2023; 80:603-609. [PMID: 37813485 DOI: 10.1136/oemed-2023-108983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/29/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The epidemiological surveillance of mesothelioma incidence is a crucial key for investigating the occupational and environmental sources of asbestos exposure. The median age at diagnosis is generally high, according to the long latency of the disease. The purposes of this study are to analyse the incidence of mesothelioma in young people and to evaluate the modalities of asbestos exposure. METHODS Incident malignant mesothelioma (MM) cases in the period 1993-2018 were retrieved from Italian national mesothelioma registry and analysed for gender, incidence period, morphology and exposure. Age-standardised rates have been calculated and the multiple correspondence analysis has been performed. The association between age and asbestos exposure has been tested by χ2 test. RESULTS From 1993 to 2018, 30 828 incident MM cases have been collected and 1278 (4.1%) presented diagnosis at early age (≤50 years). There is a substantial association between age at diagnosis and the type of asbestos exposure and a significantly lower frequency of cases with occupational exposure to asbestos (497 cases vs 701 expected) in young people has been documented. Paraoccupational and environmental exposure to asbestos have been found more frequent in young MM cases (85 and 93 observed cases vs 52 and 44 expected cases, respectively). CONCLUSIONS Mesothelioma incidence surveillance at population level and the anamnestic individual research of asbestos exposure is a fundamental tool for monitoring asbestos exposure health effects, supporting the exposure risks prevention policies. Clusters of mesothelioma incident cases in young people are a significant signal of a potential non-occupational exposure to asbestos.
Collapse
Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Carolina Mensi
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carmela Gioscia
- Valle d'Aosta Health Local Unit, Valle d'Aosta Region, Aosta, Italy
| | - Enrica Migliore
- COR Piemonte, Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, Torino, Italy
| | - Carlo Genova
- Internal Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Silvia Eccher
- Provincial Unit of Health Hygiene and Occupational Medicine, COR Province of Trento- APSS, Trento, Italy
| | - Stefano Murano
- Occupational Medicine Unit, COR PA Bolzano, Bolzano, Italy
| | - Vera Comiati
- COR Veneto, Azienda Zero, Veneto Region, Padova, Italy
| | | | - Corrado Negro
- COR Friuli Venezia Giulia, Unit of Occupational Medicine, University of Trieste, Trieste Hospital, Trieste, Italy
| | | | | | | | | | | | | | - Ilaria Cozzi
- COR Lazio, Department of Epidemiology, Lazio Regional Health Service, ASL Roma1, Rome, Italy
| | - Laura Ancona
- COR Lazio, Department of Epidemiology, Lazio Regional Health Service, ASL Roma1, Rome, Italy
| | | | | | - Domenica Cavone
- Section Occupational Medicine, Interdisciplinary Department of Medicine, COR Puglia, University of Bari Aldo Moro, Bari, Italy
| | - Luigi Vimercati
- Section Occupational Medicine, Interdisciplinary Department of Medicine, COR Puglia, University of Bari Aldo Moro, Bari, Italy
| | - Michele Labianca
- COR Basilicata, Epidemiologic Regional Center, Basilicata Region, Potenza, Italy
| | | | - Giuseppe Cascone
- Public Health Agency Ragusa (ASP), COR Mesoteliomi della Sicilia, Ragusa, Italy
| | | | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| |
Collapse
|
3
|
Magnani C, Mensi C, Binazzi A, Marsili D, Grosso F, Ramos-Bonilla JP, Ferrante D, Migliore E, Mirabelli D, Terracini B, Consonni D, Degiovanni D, Lia M, Cely-García MF, Giraldo M, Lysaniuk B, Comba P, Marinaccio A. The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20020936. [PMID: 36673690 PMCID: PMC9858856 DOI: 10.3390/ijerph20020936] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023]
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.
Collapse
Affiliation(s)
- Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, ISS (Italian National Institute of Health), 00161 Rome, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Juan Pablo Ramos-Bonilla
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Benedetto Terracini
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Michela Lia
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | | | - Margarita Giraldo
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Pietro Comba
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Alessandro Marinaccio
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
| |
Collapse
|
4
|
Stoppa G, Mensi C, Fazzo L, Minelli G, Manno V, Consonni D, Biggeri A, Catelan D. Spatial Analysis of Shared Risk Factors between Pleural and Ovarian Cancer Mortality in Lombardy (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063467. [PMID: 35329152 PMCID: PMC8949464 DOI: 10.3390/ijerph19063467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 01/04/2023]
Abstract
Background: Asbestos exposure is a recognized risk factor for ovarian cancer and malignant mesothelioma. There are reports in the literature of geographical ecological associations between the occurrence of these two diseases. Our aim was to further explore this association by applying advanced Bayesian techniques to a large population (10 million people). Methods: We specified a series of Bayesian hierarchical shared models to the bivariate spatial distribution of ovarian and pleural cancer mortality by municipality in the Lombardy Region (Italy) in 2000–2018. Results: Pleural cancer showed a strongly clustered spatial distribution, while ovarian cancer showed a less structured spatial pattern. The most supported Bayesian models by predictive accuracy (widely applicable or Watanabe–Akaike information criterion, WAIC) provided evidence of a shared component between the two diseases. Among five municipalities with significant high standardized mortality ratios of ovarian cancer, three also had high pleural cancer rates. Wide uncertainty was present when addressing the risk of ovarian cancer associated with pleural cancer in areas at low background risk of ovarian cancer. Conclusions: We found evidence of a shared risk factor between ovarian and pleural cancer at the small geographical level. The impact of the shared risk factor can be relevant and can go unnoticed when the prevalence of other risk factors for ovarian cancer is low. Bayesian modelling provides useful information to tailor epidemiological surveillance.
Collapse
Affiliation(s)
- Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
- Correspondence: (G.S.); (C.M.)
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Correspondence: (G.S.); (C.M.)
| | - Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Rome, Italy;
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy; (G.M.); (V.M.)
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy; (G.M.); (V.M.)
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
| | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35131 Padova, Italy; (A.B.); (D.C.)
| |
Collapse
|
5
|
Fazzo L, Binazzi A, Ferrante D, Minelli G, Consonni D, Bauleo L, Bruno C, Bugani M, De Santis M, Iavarone I, Magnani C, Romeo E, Zona A, Alessi M, Comba P, Marinaccio A. Burden of Mortality from Asbestos-Related Diseases in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10012. [PMID: 34639316 PMCID: PMC8508095 DOI: 10.3390/ijerph181910012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
Collapse
Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Lisa Bauleo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Marcella Bugani
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Elisa Romeo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Mariano Alessi
- Department of Prevention, Ministry of Health, 00100 Roma, Italy;
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| |
Collapse
|
6
|
Oddone E, Bollon J, Nava CR, Minelli G, Imbriani M, Consonni D, Marinaccio A, Magnani C, Barone-Adesi F. Forecast of Malignant Peritoneal Mesothelioma Mortality in Italy up to 2040. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010160. [PMID: 33379304 PMCID: PMC7796001 DOI: 10.3390/ijerph18010160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 01/03/2023]
Abstract
Despite their differences, pleural and peritoneal mesothelioma are frequently lumped together to describe epidemic curves and to forecast future mesothelioma trends. This study aims to describe the malignant peritoneal mesothelioma (MPeM) epidemic in Italy (1996-2016) and to forecast future trends up to 2040 in order to contribute to the assessment of MPeM future burden. All MPeM deaths in Italy from 1996-2016 were collected (as provided by the Italian National Statistical Institute (ISTAT)) in order to estimate MPeM mortality rates for each 3-year period from 1996 to 2016. Poisson age-period-cohort (APC) models were then used to forecast MPeM future trends. Between 2017 and 2040, 1333 MPeM deaths are expected. The number of MPeM deaths, as well as mortality rates, are expected to constantly decrease throughout the considered period. Based on considering the information from this study, it can be concluded that the MPeM epidemic has probably already reached its peak in Italy.
Collapse
Affiliation(s)
- Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Occupational Medicine Unit (UOOML), ICS Maugeri IRCCS, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382592708
| | - Jordy Bollon
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (J.B.); (C.M.); (F.B.-A.)
| | - Consuelo Rubina Nava
- Department of Economics and Statistics Cognetti de Martiis, University of Turin, 10124 Turin, Italy;
| | - Giada Minelli
- Statistics Service, Italian National Institute of Health (ISS), 00161 Rome, Italy;
| | - Marcello Imbriani
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Occupational Medicine Unit (UOOML), ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00187 Rome, Italy;
| | - Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (J.B.); (C.M.); (F.B.-A.)
| | - Francesco Barone-Adesi
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (J.B.); (C.M.); (F.B.-A.)
| |
Collapse
|
7
|
Marinaccio A, Consonni D, Mensi C, Mirabelli D, Migliore E, Magnani C, Di Marzio D, Gennaro V, Mazzoleni G, Girardi P, Negro C, Romanelli A, Chellini E, Grappasonni I, Madeo G, Romeo E, Ascoli V, Carrozza F, Angelillo IF, Cavone D, Tumino R, Melis M, Curti S, Brandi G, Mattioli S, Iavicoli S. Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks. Scand J Work Environ Health 2020; 46:609-617. [PMID: 32253443 PMCID: PMC7737812 DOI: 10.5271/sjweh.3895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives The purposes of this study are to describe the epidemiology of pericardial and tunica vaginalis testis mesothelioma and assess the role of asbestos exposure for these rare diseases. Methods Based on incident pericardial and tunica vaginalis testis mesothelioma cases collected from the Italian national mesothelioma registry (ReNaM) in the period 1993-2015, incidence rates, survival median period and prognostic factors have been evaluated. A case-control study has been performed to analyze the association with asbestos exposure (occupational and non-occupational) for these diseases. Results Between 1993 and 2015, 58 pericardial (20 women and 38 men) and 80 tunica vaginalis testis mesothelioma cases have been registered with a mean annual standardized (world standard population as reference) incidence rates of 0.049 (per million) in men and 0.023 in women for the pericardial site, and 0.095 for tunica vaginalis testis mesothelioma. Occupational exposure to asbestos was significantly associated with the risk of the diseases [odds ratio (OR) 3.68, 95% confidence interval (CI) 1.85-7.31 and OR 3.42, 95% CI 1.93-6.04 in pericardial and tunica vaginalis testis mesothelioma, respectively]. The median survival was 2.5 months for pericardial and 33.0 months for tunica vaginalis testis mesotheliomas. Age was the main predictive factor for survival for both anatomical sites. Conclusions For the first time in an analytical study, asbestos exposure was associated with pericardial and tunica vaginalis testis mesothelioma risk, supporting the causal role of asbestos for all anatomical sites. The extreme rarity of the diseases, the poor survival and the prognostic role of age have been confirmed based on population and nationwide mesothelioma registry data.
Collapse
Affiliation(s)
- Alessandro Marinaccio
- Epidemiology Unit, Occupational and Environmental Medicine, Epidemiology and Hygiene Department, INAIL, Via Stefano Gradi 55, 00143 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Slomovitz B, de Haydu C, Taub M, Coleman RL, Monk BJ. Asbestos and ovarian cancer: examining the historical evidence. Int J Gynecol Cancer 2020; 31:122-128. [PMID: 33037108 DOI: 10.1136/ijgc-2020-001672] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Asbestos recently returned to the spotlight when Johnson & Johnson halted sales of baby powder due to lawsuits claiming that the talc in baby powder may have been contaminated with asbestos, which has been linked to the risk of ovarian cancer development. Although talc and asbestos have some structural similarities, only asbestos is considered causally associated with ovarian cancer by the WHO's International Agency for Research on Cancer. While it is useful to understand the types and properties of asbestos and its oncologic biology, the history of its association with ovarian cancer is largely based on retrospective observational studies in women working in high asbestos exposure environments. In reviewing the literature, it is critical to understand the distinction between associative risk and causality, and to examine the strength of association in the context of how the diagnosis of ovarian cancer is made and how the disease should be distinguished from a similar appearing but unrelated neoplasm, malignant mesothelioma. Based on contextual misinterpretation of these factors, it is imperative to question the International Agency for Research on Cancer's assertion that asbestos has a clear causal inference to ovarian cancer. This has important clinical implications in the way patients are conceivably counseled and provides motivation to continue research to improve the understanding of the association between asbestos and ovarian cancer.
Collapse
Affiliation(s)
- Brian Slomovitz
- Gynecologic Oncology, Broward Health, Fort Lauderdale, Florida, USA .,Obstetrics and Gynecology, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Christopher de Haydu
- Division of Gynecologic Oncology of the Department of Obstetrics, Gynecology, & Reproductive Sciences, No Affiliation, Miami, Florida, USA
| | - Michael Taub
- Stony Brook University, Stony Brook, New York, USA
| | | | - Bradley J Monk
- Gynecologic Oncology, Obstetrics and Gynecology, Arizona Oncology (US Oncology Network), Phoenix, Arizona, USA.,Gynecologic Oncology, Obstetrics and Gynecology, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona, USA
| |
Collapse
|
9
|
Luberto F, Ferrante D, Silvestri S, Angelini A, Cuccaro F, Nannavecchia AM, Oddone E, Vicentini M, Barone-Adesi F, Cena T, Mirabelli D, Mangone L, Roncaglia F, Sala O, Menegozzo S, Pirastu R, Azzolina D, Tunesi S, Chellini E, Miligi L, Perticaroli P, Pettinari A, Bressan V, Merler E, Girardi P, Bisceglia L, Marinaccio A, Massari S, Magnani C. Cumulative asbestos exposure and mortality from asbestos related diseases in a pooled analysis of 21 asbestos cement cohorts in Italy. Environ Health 2019; 18:71. [PMID: 31391078 PMCID: PMC6686495 DOI: 10.1186/s12940-019-0510-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Despite the available information on cancer risk, asbestos is used in large areas in the world, mostly in the production of asbestos cement. Moreover, questions are raised regarding the shape of the dose response relation, the relation with time since exposure and the association with neoplasms in various organs. We conducted a study on the relationship between cumulative asbestos exposure and mortality from asbestos related diseases in a large Italian pool of 21 cohorts of asbestos-cement workers with protracted exposure to both chrysotile and amphibole asbestos. METHODS The cohort included 13,076 workers, 81.9% men and 18.1% women, working in 21 Italian asbestos-cement factories, with over 40 years of observation. Exposure was estimated by plant and period, and weighted for the type of asbestos used. Data were analysed with consideration of cause of death, cumulative exposure and time since first exposure (TSFE), and by gender. SMRs were computed using reference rates by region, gender and calendar time. Poisson regression models including cubic splines were used to analyse the effect of cumulative exposure to asbestos and TSFE on mortality for asbestos-related diseases. 95% Confidence Intervals (CI) were computed according to the Poisson distribution. RESULTS Mortality was significantly increased for 'All Causes' and 'All Malignant Neoplasm (MN)', in both genders. Considering asbestos related diseases (ARDs), statistically significant excesses were observed for MN of peritoneum (SMR: men 14.19; women 15.14), pleura (SMR: 22.35 and 48.10), lung (SMR: 1.67 and 1.67), ovary (in the highest exposure class SMR 2.45), and asbestosis (SMR: 507 and 1023). Mortality for ARDs, in particular pleural and peritoneal malignancies, lung cancer, ovarian cancer and asbestosis increased monotonically with cumulative exposure. Pleural MN mortality increased progressively in the first 40 years of TSFE, then reached a plateau, while peritoneal MN showed a continuous increase. The trend of lung cancer SMRs also showed a flattening after 40 years of TSFE. Attributable proportions for pleural, peritoneal, and lung MN were respectively 96, 93 and 40%. CONCLUSIONS Mortality for ARDs was associated with cumulative exposure to asbestos. Risk of death from pleural MN did not increase indefinitely with TSFE but eventually reached a plateau, consistently with reports from other recent studies.
Collapse
Affiliation(s)
- Ferdinando Luberto
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy.
- CPO-Piedmont, Novara, Italy.
| | - Stefano Silvestri
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Alessia Angelini
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Francesco Cuccaro
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Anna Maria Nannavecchia
- Unit of Epidemiology and Statistics, Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, and ICS Maugeri IRCCS, Pavia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Barone-Adesi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, and CPO Piedmont, Novara, Italy
| | - Tiziana Cena
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, CPO Piedmont and University of Turin, Turin, Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic Particulates, University of Turin, Turin, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Orietta Sala
- Regional Agency for Prevention, Environment and Energy Emilia-Romagna, Provincial Office of Reggio Emilia, Reggio Emilia, Italy
| | - Simona Menegozzo
- National Cancer Institute IRCCS Fondazione Pascale, Naples, Italy
| | - Roberta Pirastu
- Department of Biology and Biotechnologies "Charles Darwin", Sapienza University, Rome, Italy
| | - Danila Azzolina
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Sara Tunesi
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit - Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Lucia Miligi
- Occupational & Environmental Epidemiology Unit - Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | | | | | - Enzo Merler
- Mesothelioma Register of the Veneto Region, Regional Epidemiologic System, Local Health Unit 6, Padua, Italy
| | - Paolo Girardi
- UOSD Servizio di Epidemiologia AULSS6 EUGANEA, Padua, Italy
| | - Lucia Bisceglia
- Apulia Regional Agency for Health and Social Policies - ARESS Puglia, Bari, Italy
| | - Alessandro Marinaccio
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
| | - Stefania Massari
- Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
| | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, via Solaroli 17, 28100, Novara, Italy
- CPO-Piedmont, Novara, Italy
- Interdepartmental Centre G. Scansetti for Studies on Asbestos and other Toxic Particulates, University of Turin, Turin, Italy
| |
Collapse
|
10
|
Consonni D, Calvi C, De Matteis S, Mirabelli D, Landi MT, Caporaso NE, Peters S, Vermeulen R, Kromhout H, Dallari B, Pesatori AC, Riboldi L, Mensi C. Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy. Occup Environ Med 2019; 76:545-553. [PMID: 31285358 PMCID: PMC6703122 DOI: 10.1136/oemed-2019-105826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/25/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Asbestos is the main risk factor for peritoneal mesothelioma (PeM). However, due to its rarity, PeM has rarely been investigated in community-based studies. We examined the association between asbestos exposure and PeM risk in a general population in Lombardy, Italy. METHODS From the regional mesothelioma registry, we selected PeM cases diagnosed in 2000-2015. Population controls (matched by area, gender and age) came from two case-control studies in Lombardy on lung cancer (2002-2004) and pleural mesothelioma (2014). Assessment of exposure to asbestos was performed through a quantitative job-exposure matrix (SYN-JEM) and expert evaluation based on a standardised questionnaire. We calculated period-specific and gender-specific OR and 90% CI using conditional logistic regression adjusted for age, province of residence and education. RESULTS We selected 68 cases and 2116 controls (2000-2007) and 159 cases and 205 controls (2008-2015). The ORs for ever asbestos exposure (expert-based, 2008-2015 only) were 5.78 (90% CI 3.03 to 11.0) in men and 8.00 (2.56 to 25.0) in women; the ORs for definite occupational exposure were 12.3 (5.62 to 26.7) in men and 14.3 (3.16 to 65.0) in women. The ORs for ever versus never occupational asbestos exposure based on SYN-JEM (both periods) were 2.05 (90% CI 1.39 to 3.01) in men and 1.62 (0.79 to 3.27) in women. In men, clear positive associations were found for duration, cumulative exposure (OR 1.33 (1.19 to 1.48) per fibres/mL-years) and latency. CONCLUSIONS Using two different methods of exposure assessment we provided evidence of a clear association between asbestos exposure and PeM risk in the general population.
Collapse
Grants
- Intramural Research Program of the National Institutes of Health, the National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland, USA
- Associazione Italiana per la Ricerca sul Cancro (AIRC), Milan, Italy
- Ministry of Health, CCM (Centro Nazionale per la Prevenzione e il Controllo delle Malattie), Rome, Italy
- Istituto Nazionale per l’Assicurazione contro gli Infortuni sul Lavoro (INAIL), Rome, Italy
Collapse
Affiliation(s)
- Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Sara De Matteis
- National Heart and Lung Institute, Imperial College, London, UK
- Medical School, Humanitas University, Milan, Italy
| | - Dario Mirabelli
- Cancer Epidemiology, CPO and University of Turin, Turin, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Susan Peters
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel Vermeulen
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Barbara Dallari
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Cecilia Pesatori
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Luciano Riboldi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
11
|
Zona A, Fazzo L, Minelli G, De Santis M, Bruno C, Conti S, Comba P. Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources. Cancer Epidemiol 2019; 60:162-167. [PMID: 31030080 DOI: 10.1016/j.canep.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/08/2019] [Accepted: 04/02/2019] [Indexed: 01/20/2023]
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.
Collapse
Affiliation(s)
- A Zona
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - L Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - G Minelli
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - M De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - C Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - S Conti
- Statistical Service, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| | - P Comba
- Department of Environment and Health, Istituto Superiore di Sanità, viale Regina Elena, 299 I-00161 Rome, Italy.
| |
Collapse
|
12
|
Marinaccio A, Corfiati M, Binazzi A, Di Marzio D, Scarselli A, Ferrante P, Bonafede M, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Mazzoleni G, Merler E, Girardi P, Negro C, D’Agostin F, Romanelli A, Chellini E, Silvestri S, Pascucci C, Calisti R, Stracci F, Romeo E, Ascoli V, Trafficante L, Carrozza F, Angelillo IF, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M, Iavicoli S. The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure. Occup Environ Med 2018; 75:254-262. [PMID: 29269563 PMCID: PMC5878657 DOI: 10.1136/oemed-2016-104119] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/04/2017] [Accepted: 10/05/2017] [Indexed: 12/04/2022]
Abstract
INTRODUCTION The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.
Collapse
Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Marisa Corfiati
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Pierpaolo Ferrante
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| | - Marina Verardo
- Valle d’Aosta Health Local Unit, Regional Operating Centre of Valle d’Aosta (COR Valle d’Aosta), Aosta, Italy
| | - Dario Mirabelli
- COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy
| | - Valerio Gennaro
- COR Liguria, UO Epidemiology, IRCCS Az, Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy
| | - Carolina Mensi
- COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy
| | - Gert Schallemberg
- Provincial Unit of Health, Hygiene and Occupational Medicine, COR Province of Trento, Trento, Italy
| | - Guido Mazzoleni
- Alto Adige Health Local Unit, COR Province of Bolzano, Bolzano, Italy
| | - Enzo Merler
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Paolo Girardi
- Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
| | - Corrado Negro
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals, Trieste, Italy
| | - Flavia D’Agostin
- Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals, Trieste, Italy
| | - Antonio Romanelli
- Health Local Unit, Public Health Department, COR Emilia-Romagna, Reggio Emilia, Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Firenze, Italy
| | | | - Cristiana Pascucci
- Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, COR Marche, University of Camerino, Camerino, Italy
| | - Roberto Calisti
- Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, COR Marche, University of Camerino, Camerino, Italy
| | - Fabrizio Stracci
- Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy
| | - Elisa Romeo
- Department of Epidemiology, COR Lazio, Lazio Region, Rome, Italy
| | - Valeria Ascoli
- Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy
| | - Luana Trafficante
- Health Local Unit, Occupational Medicine Unit, COR Abruzzo, Pescara, Italy
| | | | | | - Domenica Cavone
- Department of Interdisciplinary Medicine, Section of Occupational Medicine ’B.Ramazzini', COR Puglia, University of Bari, Firenze, Italy
| | | | | | - Rosario Tumino
- Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, COR Sicily, Policlinico, Italy
| | - Massimo Melis
- COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy
| | - Sergio Iavicoli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
| |
Collapse
|
13
|
Marinaccio A, Binazzi A, Bonafede M, Di Marzio D, Scarselli A. Epidemiology of malignant mesothelioma in Italy: surveillance systems, territorial clusters and occupations involved. J Thorac Dis 2018; 10:S221-S227. [PMID: 29507789 DOI: 10.21037/jtd.2017.12.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background As a legacy of the large asbestos consumption until the definitive ban in 1992, Italy is currently suffering a severe epidemic of asbestos related diseases. The aim of this paper is to describe the surveillance system for mesothelioma incidence and to provide evidences regarding the occurrence of the disease in Italy and the circumstances of asbestos exposure. Methods Italian National Register of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with Regional Operating Centres (CORs) active in each Italian region, identifying incident malignant mesothelioma (MM) cases from health care structures. Occupational history, lifestyle habits and residential history are obtained using a standardised questionnaire, administered by a trained interviewer, to the subject or to the next of kin. Descriptive epidemiological figures, occupations involved in exposures and territorial maps of MM cases have been produced. Results At December 2016, ReNaM has collected 27,356 MM cases for the incidence period between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of interviewed cases (14,818). Non-occupational exposure is still relevant with 4.9% and 4.4% of cases for which respectively a familial exposure (due to the cohabitation with an occupational exposed subject) and an environmental exposure (due to the residence near a contaminated site) has been detected. Discussion The epidemiological surveillance of MM incident cases, by the means of a national register for estimating the occurrence of the disease and identifying the circumstances of asbestos exposure, is a relevant tool for preventing asbestos exposure, for supporting the effectiveness of insurance system and for estimating reliable epidemiological figures.
Collapse
Affiliation(s)
- Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Davide Di Marzio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Alberto Scarselli
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Occupational and Environmental Epidemiology Unit, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | | |
Collapse
|
14
|
Differences between peritoneal and pleural mesothelioma in Lombardy, Italy. Cancer Epidemiol 2017; 51:68-73. [DOI: 10.1016/j.canep.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022]
|
15
|
Salo SAS, Ilonen I, Laaksonen S, Myllärniemi M, Salo JA, Rantanen T. Epidemiology of malignant peritoneal mesothelioma: A population-based study. Cancer Epidemiol 2017; 51:81-86. [PMID: 29080447 DOI: 10.1016/j.canep.2017.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the mesothelial cells in the peritoneum with poor prognosis. Earlier reports from other countries indicate an incidence of 0.2-3 new cases per million per year. No previous studies have examined the national epidemiology of MPeM in Nordic countries. This study aimed to clarify the epidemiology of MPeM in Finland over a 12-year period. METHODS The data consisted of cancer notifications, laboratory notifications, and death certificate information in the Finnish Cancer Registry (FCR) and Statistics Finland (SF) of all MPeM patients from 2000 to 2012 in Finland. We also collected data on occupational disease compensations from the Workers' Compensation Center (WCC) of Finland. Any missing information was collected from the respective patient's file of every patient obtained from health institutions that had treated the patients. RESULTS Between January 1, 2000 and December 31, 2012, 90 new MPeM cases (56 males, 34 females) occurred in Finland. Median annual incidence was four new cases, which corresponded to 0.74 new cases per million per year. MPeM was deemed an occupational disease in 21 patients (23.3%). 71 patients (78.9%) of whom had a known cause of death, with a median survival of 4 months. The number of deaths linked to other disease than mesothelioma was 28/74 (37.8%). CONCLUSIONS Our study indicates that MPeM in Finland is rare and fatal, which is in accordance with previous reports from other countries. MPeM is also a fatal disease, since most of the patients died due to MPeM.
Collapse
Affiliation(s)
- Silja A S Salo
- Department of Surgery, Institute of Clinical Medicine, University of Eastern Finland, Finland
| | - Ilkka Ilonen
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Finland; Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Sanna Laaksonen
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Finland; Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Finland
| | - Marjukka Myllärniemi
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Finland; Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Finland
| | - Jarmo A Salo
- Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Finland; Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Tuomo Rantanen
- Department of Surgery, Institute of Clinical Medicine, University of Eastern Finland, Finland; Department of Surgery, Kuopio University Hospital, Finland.
| |
Collapse
|
16
|
Jiang Z, Chen T, Chen J, Ying S, Gao Z, He X, Miao C, Yu M, Feng L, Xia H, Wu W, Chen R, Morinaga K, Lou J, Zhang X. Hand-spinning chrysotile exposure and risk of malignant mesothelioma: A case-control study in Southeastern China. Int J Cancer 2017; 142:514-523. [PMID: 28949000 DOI: 10.1002/ijc.31077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 08/10/2017] [Accepted: 09/01/2017] [Indexed: 01/01/2023]
Abstract
While chrysotile has been commonly used by Chinese textile industry for many years, investigations on the association of chrysotile exposure with risk of mesothelioma in China are scarce. We conducted a case-control study in a county located at Southeastern China, including 46 cases and 230 individually matched controls. A semi-quantitative method based on experts' assessment was used for evaluating hand-spinning chrysotile exposure. Conditional logistic regression models were used to assess the association of asbestos exposure with risk of mesothelioma. We found that hand-spinning chrysotile exposure was associated with significantly elevated risk of mesothelioma, reaching OR =10 (95% CIs: 1.4-65) for possible exposure and 64 (12-328) for definite exposure. Our data suggested a dose-response relationship of chrysotile exposure duration with risk of mesothelioma, reaching 28 (6-134) for <6 years, 51 (11-247) for 7-17 years and 56 (9-351) for ≥18 years. A dose-response relationship of cumulative exposure index (CEI) with risk of mesothelioma was found, reaching 28 (6-137) for CEI at 0-0.5 fibers per milliliter years (f/mL-year), 36 (7-184) for CEI at 0.5-28.6 f/mL-years and 79 (14-451) for CEI > 28.6 f/mL-years. We found a dose-response relationship of chrysotile exposure duration and CEI with risk of mesothelioma in Southeastern China, adding valuable information on health hazards of chrysotile exposure in China where chrysotile is still used nationwide.
Collapse
Affiliation(s)
- Zhaoqiang Jiang
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Tianhui Chen
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Junqiang Chen
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Shibo Ying
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Zhibin Gao
- Department of Pathology, Yuyao People's Hospital, Yuyao, Zhejiang Province, China
| | - Xianglei He
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Chao Miao
- Yuyao Center of Disease Control and Prevention, Yuyao, Zhejiang Province, China
| | - Min Yu
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Lingfang Feng
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Hailing Xia
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Wei Wu
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Riping Chen
- Institute of Hygiene, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Kenji Morinaga
- Department of Asbestos Related Health Damage Relief, Environmental Restoration and Conservation Agency, Kawasaki, Japan
| | - Jianlin Lou
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| | - Xing Zhang
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang Province, China
| |
Collapse
|
17
|
Fernández-Fontelo A, Cabaña A, Puig P, Moriña D. Under-reported data analysis with INAR-hidden Markov chains. Stat Med 2016; 35:4875-4890. [PMID: 27396957 DOI: 10.1002/sim.7026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/05/2016] [Accepted: 06/09/2016] [Indexed: 12/29/2022]
Abstract
In this work, we deal with correlated under-reported data through INAR(1)-hidden Markov chain models. These models are very flexible and can be identified through its autocorrelation function, which has a very simple form. A naïve method of parameter estimation is proposed, jointly with the maximum likelihood method based on a revised version of the forward algorithm. The most-probable unobserved time series is reconstructed by means of the Viterbi algorithm. Several examples of application in the field of public health are discussed illustrating the utility of the models. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Alejandra Cabaña
- Departament de Matemàtiques, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pedro Puig
- Departament de Matemàtiques, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Moriña
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,rups de Recerca d'Àfrica i Amèrica Llatines (GRAAL), Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| |
Collapse
|