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Han J, Park S, Yon DK, Lee SW, Woo W, Dragioti E, Koyanagi A, Jacob L, Kostev K, Radua J, Lee S, Shin JI, Smith L. Global, Regional, and National Burden of Mesothelioma 1990-2019: A Systematic Analysis of the Global Burden of Disease Study 2019. Ann Am Thorac Soc 2023; 20:976-983. [PMID: 36857650 DOI: 10.1513/annalsats.202209-802oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/01/2023] [Indexed: 03/03/2023] Open
Abstract
Rationale: Mesothelioma has become a major health burden since World War II because of the use of asbestos. Although many countries have imposed bans on asbestos, there remain significant mortality and morbidity from mesothelioma because of its long latent period and aggressiveness. Also, the use of asbestos is increasing in low-income countries, potentiating risk of mesothelioma in the coming decades. Assessment of the global burden of mesothelioma is required to take proper measures against the disease. Objectives: To assess the burden of mesothelioma from 1990 to 2019 at the global, regional, and national levels and to investigate patterns according to sex, age, sociodemographic index, and risk factors. Methods: The numbers, rates, and age-standardized rates of incidence, death, and disability-adjusted life years (DALYs) of mesothelioma in 204 countries and territories from 1990 to 2019 were estimated using vital registration and cancer registry data. The relationship between sociodemographic index and age-standardized DALY rate was determined, and DALYs attributable to occupational exposure to asbestos were calculated. Results: In 2019, there were 34,511 (95% uncertainty interval [UI], 31,199 to 37,771) incident cases of mesothelioma globally, with an age-standardized rate of 0.43 per 100,000 persons (95% UI, 0.38 to 0.47), which decreased between 1990 and 2019 by -12.6% (95% UI, -21.8% to -2.3%). Mesothelioma was responsible for 29,251 (95% UI, 26,668 to 31,006) deaths in 2019, with an age-standardized rate of 0.36 deaths per 100,000 persons (95% UI, 0.33 to 0.39), which decreased between 1990 and 2019 by -9.6% (95% UI, -17.8% to -1.1%). The age-standardized incidence rate increased in central Europe between 1990 and 2019 by 46.1% (95% UI, 16.6% to 72.4%). The Netherlands, Australia, and the United Kingdom had the highest age-standardized incidence rates. Incidence rates were higher in men than in women ages 45-49 to 90-94 years, peaking at 85-89 years. Occupational exposure to asbestos contributed to 85.2% (95% UI, 82.1% to 88.1%) of DALYs. Conclusions: The global burden of mesothelioma is decreasing in terms of age-standardized incidence and mortality rates. Mesothelioma remains a substantial public health challenge in many parts of the world.
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Affiliation(s)
- Jonghoon Han
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seoyeon Park
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong Keon Yon
- Medical Science Research Institute and
- Department of Pediatrics, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Won Lee
- School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, and
| | - Elena Dragioti
- Pain and Rehabilitation Centre and
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Ai Koyanagi
- Unidad de Investigación y Desarrollo, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Louis Jacob
- Unidad de Investigación y Desarrollo, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
- University Clinic of Marburg, Marburg, Germany
| | - Karel Kostev
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Joaquim Radua
- Imatge dels trastorns relacionats amb l'estat d'ànim i l'ansietat, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, University of Barcelona, Barcelona, Spain; and
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, and
| | | | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
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Janosikova M, Nakladalova M, Stepanek L. Current causes of mesothelioma: how has the asbestos ban changed the perspective? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 36883200 DOI: 10.5507/bp.2023.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
The association of mesothelioma, a lethal lung disease, with asbestos has led to an absolute ban on asbestos in at least 55 countries worldwide. The purpose of this paper is to review residual exposure to asbestos as well as other emerging causes of mesothelioma outside asbestos. The review provides detailed description of asbestos minerals, their geographical locations, mesothelioma in these areas, as well as contemporary possible sources of asbestos exposure. Second, we examine other emerging causes of mesothelioma including: ionizing radiation as the second most important risk factor after asbestos, particularly relevant to patients undergoing radiotherapy, third, carbon nanotubes which are under investigation and fourth, Simian virus 40. In the case of asbestos per se, the greatest risk is from occupational exposure during mining and subsequent processing. Of the non-occupational exposures, environmental exposure is most serious, followed by exposure from indoor asbestos minerals and secondary familial exposure. Overall, asbestos is still a major risk factor, but alternative causes should not be neglected, especially in young people, in women and those with a history of radiotherapy or living in high-risk locations.
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Affiliation(s)
- Magdalena Janosikova
- Department of Occupational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
| | - Marie Nakladalova
- Department of Occupational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
| | - Ladislav Stepanek
- Department of Occupational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
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Mortality for Mesothelioma and Lung Cancer in a Cohort of Asbestos Cement Workers in BARI (Italy): Time Related Aspects of Exposure. J Occup Environ Med 2020; 61:410-416. [PMID: 30870398 DOI: 10.1097/jom.0000000000001580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In this cohort mortality study we used an exposure index to evaluate individual cumulative exposure as proxy of asbestos dose and we evaluated change in cancer mortality pattern after long time since the end of exposure. METHODS We calculated standardized mortality ratios (SMRs) for several causes of death stratified by latency, cumulative exposure, and time since last exposure (TSLE). RESULTS Latency: we observed a peak and then a decrease in SMR for lung, pleural, and peritoneal cancer. Cumulative Exposure: We observed a peak and then a decrease in SMR for lung and pleural cancer, not for peritoneal cancer. TSLE: Pleural cancer SMR peaked at 20 to 29 years, then decreased, peritoneal cancer SMR reached a plateau after 20 years and lung cancer mortality was in excess in each class. CONCLUSIONS We found different patterns in mortality in the main asbestos-related tumors.
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Torres-Roman JS, Gomez-Rubio V, Sanchez-Trujillo L, Delgado-Rosas E, Puche-Vergara F, Sanz-Anquela JM, Ortega MA. Geographic study of mortality due to mesothelioma in Peru and its evolution. Cancer Epidemiol 2020; 68:101791. [PMID: 32823056 DOI: 10.1016/j.canep.2020.101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Peru has a public health problem because of asbestos imports. We analyzed the mortality trends for mesothelioma in Peru and its provinces from 2005 to 2014 and estimated their relationship with the amount of asbestos imported previously. METHODS We computed age-standardized mortality rates (ASMRs) per 100,000 population (direct method and SEGI world standard population reference), and the standardized mortality ratio (SMR). The relationship between the amount of asbestos imported annually along the period 1965-2010 and the number of mesothelioma deaths per year from 2005 to 2014 was estimated by log-linear Poisson regression models and Pearson correlation calculations. RESULTS After correcting the number of deaths, Peru registered 428 cases (or 430 when corrected cases are rounded by sex) between 2005 and 2014. The highest ASMRs were in Arequipa and Callao (range: 0.40-0.41/100,000 population), followed by Huancavelica (0.36/100,000 population). This translates into approximately one death per each 68-111 of asbestos tons imported. The latency period for the higher level of positive correlation found was 8 years (r = 0.8). Male female sex ratio was lower in provinces such as Junin and Hunacavelica with geological asbestos risk. CONCLUSIONS Two patterns of mesothelioma risk have been detected, occupational and environmental. During the 2002-2006 years, Peru increased the asbestos use. If crocidolite imports were also increased, this could be behind the 8 years latency period detected. Peru should boost strategies towards the total ban of all forms of asbestos.
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Affiliation(s)
- J Smith Torres-Roman
- Universidad Católica Los Ángeles de Chimbote, Instituto de Investigación, Chimbote, Peru; Maestria en Epidemiología y Bioestadistica, Universidad Cientifica del Sur, Lima, Peru
| | | | - Lara Sanchez-Trujillo
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain
| | | | | | - Jose Miguel Sanz-Anquela
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain
| | - Miguel Angel Ortega
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, Alcalá de Henares, Madrid, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain; Ramón y Cajal Institute of Healthcare Research (IRYCIS), Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Alcalá de Henares, Madrid, Spain.
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Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051662. [PMID: 32143364 PMCID: PMC7084874 DOI: 10.3390/ijerph17051662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022]
Abstract
Krówczyńska M [...].
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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.
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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
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West GH, Sokas RK, Welch LS. Change in prevalence of asbestos-related disease among sheet metal workers 1986 to 2016. Am J Ind Med 2019; 62:609-615. [PMID: 31168870 DOI: 10.1002/ajim.22998] [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] [Accepted: 05/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND A medical screening program began in 1986 for sheet metal workers exposed to asbestos, primarily while working alongside insulators applying spray-on asbestos materials, a practice banned in 1973. Exposure continues during maintenance, renovation, and repair. METHODS Radiographic abnormalities among 26 397 sheet metal workers examined from 1986 to 2016 were analyzed by year of entry into the trade. Logistic regression was used to examine risk factors for parenchymal and pleural abnormalities among the overall study population and among the subcohort who entered the trade after 1973. RESULTS Prevalence of parenchymal disease was 17.4% for those starting work before 1950 compared with 0.8% for those starting work after 1973 (adjusted prevalence odds ratio [pOR] = 26.65, 95% confidence interval [CI] = 18.46-38.46). For each calendar year after 1973, entering the trade 1 year later was associated with an estimated 12.7% decreased odds of acquiring asbestos-related disease (adjusted pOR = 0.873, 95% CI = 0.832-0.916). CONCLUSION Sheet metal workers who began work after the US implemented environmental and occupational regulations develop asbestos-related disease at much reduced rates, consistent with regulatory projections made for nonmalignant asbestos-related disease by the Occupational Safety and Health Administration at the time. Cancer remains a concern among this cohort, and lung cancer screening recommendations should consider year of entry into the trade. This study highlights the importance of regulatory intervention and of continued surveillance.
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Affiliation(s)
- Gavin H. West
- CPWR—The Center for Construction Research and TrainingSilver Spring Maryland
| | - Rosemary K. Sokas
- CPWR—The Center for Construction Research and TrainingSilver Spring Maryland
- Department of Human Science, School of Nursing and Health StudiesGeorgetown UniversityWashington District of Columbia
| | - Laura S. Welch
- CPWR—The Center for Construction Research and TrainingSilver Spring Maryland
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Boffetta P, Donato F, Pira E, Luu HN, La Vecchia C. Risk of mesothelioma after cessation of asbestos exposure: a systematic review and meta-regression. Int Arch Occup Environ Health 2019; 92:949-957. [PMID: 30993422 DOI: 10.1007/s00420-019-01433-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE A 'risk reversal' has been observed for several human carcinogens following cessation of exposure, but it is unclear whether it also exists for asbestos-related mesothelioma. METHODS We conducted a systematic review of the literature and identified nine studies that reported information on risk of mesothelioma after cessation of asbestos exposure, and performed a meta-regression based on random effects models. As comparison we analyzed results on lung cancer risk from four of these studies. RESULTS A total of six risk estimates from five studies were included in the meta-analysis. The summary relative risk (RR) of mesothelioma for 10-year interval since cessation of exposure was 1.02 [95% confidence interval (CI) 0.87-1.19; p-heterogeneity 0.01]. The corresponding RR of lung cancer was 0.91 (95% CI 0.84-0.98). CONCLUSIONS This analysis provides evidence that the risk of mesothelioma does not decrease after cessation of asbestos exposure, while lung cancer risk does.
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Affiliation(s)
- Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA. .,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Donato
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Enrico Pira
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Hung N Luu
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ampollini L, Barocelli E, Cavazzoni A, Petronini P, Mucchino C, Cantoni AM, Leonardi F, Ventura L, Barbieri S, Colombo P, Fusari A, Carbognani P, Rusca M, Sonvico F. Polymeric films loaded with cisplatin for malignant pleural mesothelioma: a pharmacokinetic study in an ovine model. J Thorac Dis 2018; 10:S207-S220. [PMID: 29507788 PMCID: PMC5830553 DOI: 10.21037/jtd.2017.10.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) continues to be a distressing tumor due to its aggressive biologic behavior and scanty prognosis. Several therapeutic approaches have been tested both in clinical and preclinical settings, being intrapleural chemotherapy one of the most promising. Some years ago, our interest focused on polymeric films loaded with cisplatin for the adjuvant intrapleural treatment of surgical patients. After in vitro and in vivo studies in a rat recurrence model of MPM, the aim of this study was to evaluate the pharmacokinetics of the polymeric films in a sheep model in view of further studies in a clinical setting. METHODS An ovine model was used. Animals were divided into four groups according to pharmacologic treatment: control group (three animals undergoing left pneumonectomy and saline-NaCl solution); intrapleural hyaluronate cisplatin films (HYALCIS) group (six animals undergoing left pneumonectomy and intrapleural application of polymeric films loaded with cisplatin); intrapleural cisplatin solution (six animals undergoing left pneumonectomy and intrapleural application of cisplatin solution); intravenous cisplatin (five animals undergoing left pneumonectomy and intravenous administration of cisplatin solution). The primary objective was the plasmatic and pleural concentration of cisplatin in the treatment groups. The secondary objective was the treatment-related toxicity evaluated by plasmatic analysis performed at prearranged time intervals and histological examinations of tissue samples collected during animal autopsy. Analysis of variance (ANOVA) was used for statistical analysis. Bonferroni correction was applied for comparison between all groups. RESULTS Twenty female Sardinian sheep with a mean weight of 45.1 kg were studied. All animals survived the surgical procedures. The whole surgical procedure had a mean duration of 113 minutes. Cisplatin blood levels obtained from polymeric films application were low during the first 24 hours after the application; then, the cisplatin blood level increased gradually and progressively until it reached significantly higher plasmatic concentrations after 120 hours compared to intrapleural cisplatin solution (P=0.004) and intravenous administration (P=0.001), respectively. Considering cisplatin concentration at 168 hours after the application, animals treated with polymeric films had higher plasmatic values than animals treated with intrapleural cisplatin solution and intravenous cisplatin (P=0.001). Despite the high cisplatin plasmatic concentrations, treatment related-toxicity towards kidneys and liver was comparatively lower compared to the intravenous and intrapleural cisplatin administration and closer to the control levels. CONCLUSIONS Polymeric films loaded with cisplatin allowed to reach significantly higher intrapleural and plasmatic cisplatin concentrations compared to intrapleural and intravenous cisplatin solution, providing at the same time, a significant reduction of treatment related toxicity.
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Affiliation(s)
- Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | | | - Andrea Cavazzoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Claudio Mucchino
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | | | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Stefano Barbieri
- Biopharmanet-TEC, University of Parma, Parma, Italy
- Department of Food and Drug, University of Parma, Parma, Italy
| | | | - Antonella Fusari
- Department of Veterinary Medicine, University of Parma, Parma, Italy
| | - Paolo Carbognani
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Michele Rusca
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Fabio Sonvico
- Biopharmanet-TEC, University of Parma, Parma, Italy
- Department of Food and Drug, University of Parma, Parma, Italy
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