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Walker-Bone K, Benke G, MacFarlane E, Klebe S, Takahashi K, Brims F, Sim MR, Driscoll TR. Incidence and mortality from malignant mesothelioma 1982-2020 and relationship with asbestos exposure: the Australian Mesothelioma Registry. Occup Environ Med 2023; 80:186-191. [PMID: 36754595 DOI: 10.1136/oemed-2022-108669] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Malignant mesothelioma is an uncommon cancer associated with asbestos exposure, predominantly occupational. Asbestos has been banned in Australia since 2003 but mesothelioma has a long latency and incident cases continue to present. The Australian Mesothelioma Registry was incepted to collect systematic data about incidence and mortality alongside asbestos exposure. METHODS Benefiting from the Australian national system of cancer notification, all incident cases of mesothelioma in all states and territories are fast-tracked and notified regularly. Notified patients are contacted asking for consent to collect exposure information, initially by postal questionnaire and subsequently by telephone interview. Age-standardised annual incidence rates and mortality rates were calculated. Asbestos exposure was categorised as occupational, non-occupational, neither or, both; and as low, or high, probability of exposure. RESULTS Mesothelioma incidence appears to have peaked. The age-standardised incidence rates have declined steadily since the early 2000s (peaking in males at 5.9/100 000 and in all-persons at 3.2/100 000), driven by rates in males, who comprise the majority of diagnosed cases. Rates in women have remained fairly stable since that time. Age-standardised mortality rates have followed similar trends. Mesothelioma remains the most common in those aged over 80 years. Nearly all (94%) cases were linked with asbestos exposure (78% occupational in men; 6.8% in women). CONCLUSIONS With effective control of occupational asbestos use, the decline in age-standardised incidence and death rates has occurred. Incidence rates among women, in whom occupational asbestos exposure is rarely detectable, remain unchanged, pointing to the role of household and /or environmental asbestos exposure.
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Affiliation(s)
- Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Geza Benke
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ewan MacFarlane
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - S Klebe
- South Australia Pathology, Flinders Institute, Adelaide, Western Australia, Australia.,Asbestos Diseases Research Institute, Concord, New South Wales, Australia
| | - Ken Takahashi
- Asbestos Diseases Research Institute, Concord, New South Wales, Australia.,The University of Western Australia, Perth, Western Australia, Australia
| | - Fraser Brims
- Curtin Medical School, Curtin University - Perth City Campus, Perth, Western Australia, Australia.,Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Malcolm Ross Sim
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim R Driscoll
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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2
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Abstract
Epidemiological methods are essential for the discovery of cancer risks and prognostic factors as well as for the evaluation of cancer prevention measures. In this review, we discuss epidemiological surveillance procedures for data collection and processing to guide and evaluate the consequences of anticancer efforts for populations, assess the identification of cancer risk factors, examine barriers to cancer screening and recommended rules for early diagnosis programs. Epidemiological studies have shown that hindrances to cancer information assessment are currently encountered in developing countries. Known cancer risk factors include social determinants, lifestyle factors, occupational exposures, infectious agents, and genetic and epigenetic alterations. Challenges remain in studying the effectiveness of cancer screening; screening can have detrimental effects, and few cancers clearly benefit from screening. Currently, epidemiology faces the challenge of dealing with distinct levels of data, including factors related to social status, lifestyle and genetics, to reconstruct the causal traits of cancer. Additionally, translating epidemiological knowledge into cancer control demands more implementation studies in the population.
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Affiliation(s)
- Tatiana N Toporcov
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Victor Wünsch Filho
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Asbestos Exposure and the Mesothelioma Incidence in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081741. [PMID: 30104558 PMCID: PMC6121399 DOI: 10.3390/ijerph15081741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/29/2018] [Accepted: 08/10/2018] [Indexed: 11/16/2022]
Abstract
Asbestos is carcinogenic to humans; the exposure to asbestos causes a wide range of diseases. Aim: Malignant mesothelioma (MM) is unique for asbestos exposure. Methods: Based on the physical inventory of asbestos-cement roofing, the social-economic situation of communes, the proximity of asbestos manufacturing plants, the land use data referring to the surface of the built-up area, and the historical data on the annexations, the amount of asbestos-containing products in use was estimated by computing best Random Forest models. Per capita asbestos use is an indicator to compare the state of asbestos use among countries. MM cases in the local administrative units (provinces) were tested by the application of Moran’s I and Getis and Ord statistic. Results: The total amount of asbestos roofing in Poland was estimated at 738,068,000 m2 (8.2 million tons). In total there were 28 plants in Poland located in 11 provinces throughout the country. The amount of asbestos-cement roofing in use is correlated primarily with the measurements of asbestos concentration fibers (rs = 0.597). MM raw morbidity rate was calculated, stratified by province, and classified into five groups with respect to incidence. Hotspots of MM cases are in the southern part of Poland. Conclusions: MM cases are concentrated in the same geographical areas, which may indicate an increasing impact of environmental exposure. The results of the local and global autocorrelation clearly indicate a statistically significant relationship between incidences of MM in provinces. Poland and other Eastern European countries are among countries with low MM incidence rate. Detailed investigation is desirable since the current MM morbidity rate in Poland seems to be underestimated.
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Aguilar-Madrid G, Pesch B, Calderón-Aranda ES, Burek K, Jiménez-Ramírez C, Juárez-Pérez CA, Ochoa-Vázquez MD, Torre-Bouscoulet L, Acosta-Saavedra LC, Sada-Ovalle I, García-Figueroa J, Alvarado-Cabrero I, Castillo-González P, Báez-Saldaña AR, Pérez-Padilla JR, Osnaya-Juárez J, Rivera-Rosales RM, García-Bazán EM, Bautista-Aragón YL, Lazcano-Hernandez E, Munguía-Canales DA, Argote-Greene LM, Taeger D, Weber DG, Casjens S, Raiko I, Brüning T, Johnen G. Biomarkers for Predicting Malignant Pleural Mesothelioma in a Mexican Population. Int J Med Sci 2018; 15:883-891. [PMID: 30008600 PMCID: PMC6036095 DOI: 10.7150/ijms.23939] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.
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Affiliation(s)
- Guadalupe Aguilar-Madrid
- Research Unit Health at Work, XXI Century National Medical Center (CMNSXXI), Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Beate Pesch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Emma S Calderón-Aranda
- Department of Toxicology, Center for Research and Advanced Studies, CINVESTAV, Mexico City, Mexico
| | - Katarzyna Burek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Carmina Jiménez-Ramírez
- Research Unit Health at Work, XXI Century National Medical Center (CMNSXXI), Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.,Clinical Analysis Laboratory, Traumatology Hospital "Dr. Victorio De la Fuente Narvaez", IMSS, Mexico City, Mexico
| | - Cuauhtémoc Arturo Juárez-Pérez
- Research Unit Health at Work, XXI Century National Medical Center (CMNSXXI), Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Luis Torre-Bouscoulet
- Clinical Research, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | | | | | | | - Isabel Alvarado-Cabrero
- Service Pathology, High Specialty Medical Unit (UMAE), Oncology Hospital, CMNSXXI, IMSS, Mexico City, Mexico
| | | | | | | | - Juvencio Osnaya-Juárez
- Pneumology Service of the General Hospital, Medical Center La Raza, IMSS, Mexico City, Mexico
| | | | - Eric Marco García-Bazán
- Thorax Service, Oncology Hospital, High Specialty Medical Unit (UMAE), CMNSXXI, IMSS, Mexico City, Mexico
| | | | - Elimelec Lazcano-Hernandez
- Thorax Service, Oncology Hospital, High Specialty Medical Unit (UMAE), CMNSXXI, IMSS, Mexico City, Mexico
| | | | | | - Dirk Taeger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Daniel Gilbert Weber
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Swaantje Casjens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Irina Raiko
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
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Walls KL, Boulic M, Boddy JWD. The Built Environment-A Missing "Cause of the Causes" of Non-Communicable Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E956. [PMID: 27690064 PMCID: PMC5086695 DOI: 10.3390/ijerph13100956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
The United Nations "25 × 25 Strategy" of decreasing non-communicable diseases (NCDs), including cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, by 25% by 2025 does not appear to take into account all causes of NCDs. Its focus is on a few diseases, which are often linked with life-style factors with "voluntary" "modifiable behavioral risk factors" causes tending towards an over-simplification of the issues. We propose to add some aspects of our built environment related to hazardous building materials, and detailed form of the construction of infrastructure and buildings, which we think are some of the missing causes of NCDs. Some of these could be termed "involuntary causes", as they relate to factors that are beyond the control of the general public.
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Affiliation(s)
- Kelvin L Walls
- Building Code Consultants Ltd., P.O. Box 99613, Newmarket, Auckland 1149, New Zealand.
| | - Mikael Boulic
- School of Engineering and Advanced Technology, Massey University, Auckland 0745, New Zealand.
| | - John W D Boddy
- Urban Planning and Environmental Services, MWH Stantec, Level 3, 111 Carlton Gore Road, Auckland 0745, New Zealand.
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7
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Teschke K. Thinking about Occupation–Response and Exposure–Response Relationships: Vehicle Mechanics, Chrysotile, and Mesothelioma. ANNALS OF OCCUPATIONAL HYGIENE 2016; 60:528-30. [DOI: 10.1093/annhyg/mew015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/10/2016] [Indexed: 12/30/2022]
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8
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Egilman D, Bird T. Short fiber tremolite free chrysotile mesothelioma cohort revealed. Am J Ind Med 2016; 59:196-9. [PMID: 26725926 DOI: 10.1002/ajim.22552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/07/2022]
Abstract
In 1995, Dell and Teta published a cohort mortality study of asbestos molding compound workers at a Union Carbide Corporation (UCC) plastics manufacturing plant in Bound Brook, New Jersey. They reported that the factory workers were exposed to "asbestos (mostly chrysotile)," implying that the asbestos used at the Bound Brook plant occasionally contained amphiboles. However, UCC statements and testimony from recent litigation indicate that the Bound Brook plant exclusively used short fiber chrysotile asbestos. These recent documents also point to lower exposures than those reported by Dell and Teta. This chrysotile-only cohort should be included in analyses of chrysotile potency.
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Affiliation(s)
- David Egilman
- Clinical Professor of Family Medicine; Alpert School of Medicine at Brown University; Attleboro Massachusetts
| | - Tess Bird
- Never Again Consulting; Attleboro Massachusetts
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9
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Baumann F, Carbone M. Environmental risk of mesothelioma in the United States: An emerging concern-epidemiological issues. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2016; 19:231-249. [PMID: 27705543 DOI: 10.1080/10937404.2016.1195322] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Despite predictions of decline in mesothelioma following the ban of asbestos in most industrial countries, the incidence is still increasing globally, particularly in women. Because occupational exposure to asbestos is the main cause of mesothelioma, it occurs four- to eightfold more frequently in men than women, at a median age of 74 years. When mesothelioma is due to an environmental exposure, the M:F sex ratio is 1:1 and the median age at diagnosis is ~60 years. Studying environmental risk of mesothelioma is challenging because of the long latency period and small numbers, and because this type of exposure is involuntary and unknown. Individual-based methods cannot be used, and new approaches need to be found. To better understand the most recent trends of mesothelioma in the United States, all mesothelioma deaths reported to the Centers for Disease Control and Prevention (CDC) during 1999-2010 were analyzed. Among all mesothelioma deaths in the United States, the 1920s birth cohort significantly predominated, and the proportion of younger cohorts constantly decreased with time, suggesting a decline in occupational exposure in these cohorts. The M:F mesothelioma sex ratio fell with time, suggesting an increased proportion of environmental cases. Environmental exposures occur in specific geographic areas. At the large scale of a state, mesotheliomas related to environmental exposure are diluted among occupational cases. The spatial analysis at a smaller scale, such as county, enables detection of areas with higher proportions of female and young mesothelioma cases, thus indicating possible environmental exposure, where geological and environmental investigations need to be carried out.
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Affiliation(s)
| | - Michele Carbone
- b Cancer Center , University of Hawaii , Honolulu , Hawaii , USA
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10
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Corfiati M, Scarselli A, Binazzi A, Di Marzio D, Verardo M, Mirabelli D, Gennaro V, Mensi C, Schallemberg G, Merler E, Negro C, Romanelli A, Chellini E, Silvestri S, Cocchioni M, Pascucci C, Stracci F, Romeo E, Trafficante L, Angelillo I, Menegozzo S, Musti M, Cavone D, Cauzillo G, Tallarigo F, Tumino R, Melis M, Iavicoli S, Marinaccio A. Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry. BMC Cancer 2015; 15:286. [PMID: 25885893 PMCID: PMC4404011 DOI: 10.1186/s12885-015-1301-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). Methods In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. Results Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. Conclusions Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1301-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marisa Corfiati
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alberto Scarselli
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alessandra Binazzi
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Davide Di Marzio
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Marina Verardo
- Regional Operating Center of Valle d'Aosta (COR Valle d'Aosta), Valle d'Aosta Health Local Unit, Aosta, Italy.
| | - Dario Mirabelli
- COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy.
| | - Valerio Gennaro
- COR Liguria, Epidemiology and Prevention Department, 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
- COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy.
| | - Enzo Merler
- COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy.
| | - Corrado Negro
- COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy.
| | - Antonio Romanelli
- COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy.
| | - Elisabetta Chellini
- COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy.
| | - Stefano Silvestri
- COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy.
| | - Mario Cocchioni
- COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy.
| | - Cristiana Pascucci
- COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy.
| | - Fabrizio Stracci
- COR Umbria, University of Perugia, Department of Hygiene and public health, Perugia, Italy.
| | - Elisa Romeo
- COR Lazio, Department of Experimental Medicine, University La Sapienza, Roma, Italy.
| | - Luana Trafficante
- COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy.
| | - Italo Angelillo
- COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy.
| | - Simona Menegozzo
- COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy.
| | - Marina Musti
- COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy.
| | - Domenica Cavone
- COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy.
| | | | | | - Rosario Tumino
- COR Sicily, "Civile - M.P. Arezzo" Hospital, Ragusa Cancer Register Unit, Ragusa, Italy.
| | - Massimo Melis
- COR Sardegna, Regional Epidemiological Center, Cagliari, Italy.
| | - Sergio Iavicoli
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
| | - Alessandro Marinaccio
- Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.
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Heederik D, Lenters V, Vermeulen R. Reply: response to the letter by Drs Berman and Case. ANNALS OF OCCUPATIONAL HYGIENE 2013; 57:675-7. [PMID: 23940847 DOI: 10.1093/annhyg/met017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lenters V, Burdorf A, Vermeulen R, Stayner L, Heederik D. Quality of Evidence Must Guide Risk Assessment of Asbestos. ACTA ACUST UNITED AC 2012; 56:879-87. [DOI: 10.1093/annhyg/mes065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Virissa Lenters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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Berman DW, Case BW. Overreliance on a single study: there is no real evidence that applying quality criteria to exposure in asbestos epidemiology affects the estimated risk. ANNALS OF OCCUPATIONAL HYGIENE 2012; 56:869-78. [PMID: 22826537 DOI: 10.1093/annhyg/mes027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A critical need exists for reliable risk management policies and practices that can effectively mitigate asbestos-related health threats, and such policies and practices need to be based on sound science that adequately distinguishes hazardous situations from those that are not. Toward that end, the disparate means by which study quality has been addressed in recent meta-analyses used to establish potency factors (K ( L ) and K ( M ) values) for asbestos cancer risks were compared by conducting additional sensitivity analyses. Results suggest that, other than placing undue emphasis on the influence of the K ( L ) and K ( M ) values reported from a single study, there appears to be little to no evidence of a systematic effect of study quality on K ( L ) or K ( M ) values; none of the findings warrant excluding studies from current or future meta-analyses. Thus, we argue that it is better to include as much of the available data as possible in these analyses while formally addressing uncertainty as part of the analysis itself, rather than sequentially excluding studies based on one type of limitation or another. Throwing out data without clearly proving some type of bias is never a good idea because it will limit both the power to test various hypotheses and the confidence that can be placed in any findings that are derived from the resulting, truncated data set. We also believe that it is better to identify the factors that contribute to variation between studies included in a meta-analysis and, by adjusting for such factors as part of a model, showing that the disparate values from individual studies can be reconciled. If such factors are biologically reasonable (based on other evidence) and, if such a model can be shown to fit the data from all studies in the meta-analysis, the model is likely to be predictive of the parameters being evaluated and can then be applied to new (unstudied) environments.
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