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Stella S, Consonni D, Migliore E, Stura A, Cavone D, Vimercati L, Miligi L, Piro S, Landi MT, Caporaso NE, Curti S, Mattioli S, Brandi G, Gioscia C, Eccher S, Murano S, Casotto V, Comiati V, Negro C, D'Agostin F, Genova C, Benfatto L, Romanelli A, Grappasonni I, Madeo G, Cozzi I, Romeo E, Tommaso S, Carrozza F, Labianca M, Tallarigo F, Cascone G, Melis M, Marinaccio A, Binazzi A, Mensi C. Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018. BMJ Open 2023; 13:e073480. [PMID: 37567753 PMCID: PMC10423786 DOI: 10.1136/bmjopen-2023-073480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/07/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES Workers in the construction industry have been exposed to asbestos in various occupations. In Italy, a National Mesothelioma Registry has been implemented more than 20 years ago. Using cases selected from this registry and exploiting existing control data sets, we estimated relative risks for pleural mesothelioma (PM) among construction workers. DESIGN Case-control study. SETTING Cases from the National Mesothelioma Registry (2000-2018), controls from three previous case-control studies. METHODS We selected male PM incident cases diagnosed in 2000-2018. Population controls were taken from three studies performed in six Italian regions within two periods (2002-2004 and 2012-2016). Age-adjusted and period-adjusted unconditional logistic regression models were fitted to estimate odds ratios (OR) for occupations in the construction industry. We followed two approaches, one (primary) excluding and the other (secondary) including subjects employed in other non-construction blue collar occupations for >5 years. For both approaches, we performed an overall analysis including all cases and, given the incomplete temporal and geographic overlap of cases and controls, three time or/and space restricted sensitivity analyses. RESULTS The whole data set included 15 592 cases and 2210 controls. With the primary approach (4797 cases and 1085 controls), OR was 3.64 (2181 cases) for subjects ever employed in construction. We found elevated risks for blue-collar occupations (1993 cases, OR 4.52), including bricklayers (988 cases, OR 7.05), general construction workers (320 cases, OR 4.66), plumbers and pipe fitters (305 cases, OR 9.13), painters (104 cases, OR 2.17) and several others. Sensitivity analyses yielded very similar findings. Using the secondary approach, we observed similar patterns, but ORs were remarkably lower. CONCLUSIONS We found markedly increased PM risks for most occupations in the construction industry. These findings are relevant for compensation of subjects affected with mesothelioma in the construction industry.
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Affiliation(s)
- Simona Stella
- Occupational Health Unit, Regional Operating Center of Lombardy (COR Lombardia), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Consonni
- Occupational Health Unit, Regional Operating Center of Lombardy (COR Lombardia), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrica Migliore
- COR Piemonte, Cancer Epidemiology Unit, CPO and University of Turin, Turin, Italy
| | - Antonella Stura
- COR Piemonte, Cancer Epidemiology Unit, CPO and University of Turin, Turin, Italy
| | - Domenica Cavone
- COR Puglia, Section of Occupational Medicine 'B Ramazzini', Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Luigi Vimercati
- COR Puglia, Section of Occupational Medicine 'B Ramazzini', Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Lucia Miligi
- COR Toscana, Unit of Environmental and Occupational Epidemiology, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Sara Piro
- COR Toscana, Unit of Environmental and Occupational Epidemiology, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Mattioli
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Brandi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carmela Gioscia
- COR Valle d'Aosta, Valle d'Aosta Health Local Unit, Aosta, Italy
| | - Silvia Eccher
- COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy
| | - Stefano Murano
- COR Province of Bolzano, Alto Adige Health Local Unit, Bolzano, Italy
| | - Veronica Casotto
- COR Veneto, Epidemiological Department, Azienda Zero, Padova, Italy
| | - Vera Comiati
- COR Veneto, Epidemiological Department, Azienda Zero, Padova, Italy
| | - Corrado Negro
- COR Friuli-Venezia Giulia, Clinical Unit of Occupational Medicine, University of Trieste-Trieste General Hospitals, Trieste, Italy
| | - Flavia D'Agostin
- COR Friuli-Venezia Giulia, Clinical Unit of Occupational Medicine, University of Trieste-Trieste General Hospitals, Trieste, Italy
| | - Carlo Genova
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Genova, Italy
| | - Lucia Benfatto
- COR Liguria, UO Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Antonio Romanelli
- COR Emilia-Romagna, Public Health Department, Health Local Unit, Reggio Emilia, Italy
| | - Iolanda Grappasonni
- COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Italy
| | - Gabriella Madeo
- COR Umbria, Servizio Prevenzione, Sanità Veterinaria e Sicurezza Alimentare, Regione Umbria, Perugia, Umbria, Italy
| | - Ilaria Cozzi
- COR Lazio, Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Lazio, Italy
| | - Elisa Romeo
- COR Lazio, Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Lazio, Italy
| | | | | | | | | | - Giuseppe Cascone
- COR Sicilia, Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, Ragusa, Italy
| | - Massimo Melis
- COR Sardegna, Regional Epidemiological Center, Cagliari, Italy
| | - Alessandro Marinaccio
- 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
| | - Carolina Mensi
- Occupational Health Unit, Regional Operating Center of Lombardy (COR Lombardia), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Moline J, Patel K, Frank AL. Exposure to cosmetic talc and mesothelioma. J Occup Med Toxicol 2023; 18:1. [PMID: 36653798 PMCID: PMC9847157 DOI: 10.1186/s12995-023-00367-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
AIM Mesothelioma is associated with asbestos exposure. In this case series, we present 166 cases of individuals who had substantial asbestos exposure to cosmetic talc products as well as some who had potential or documented additional exposures to other asbestos-containing products and who subsequently developed mesothelioma. METHODS Data were gathered for all subjects referred to an occupational and environmental medicine specialist as part of medicolegal review. Years of total cosmetic talcum powder usage was noted as well as the latency from the onset of talcum powder use to the mesothelioma diagnosis. Alternate asbestos exposure in addition to the exposure from cosmetic talc was categorized as none, possible, likely, and definite. RESULTS In 122 cases, the only known exposure to asbestos was from cosmetic talc. For 44 cases, potential or documented alternate exposures in addition to the cosmetic talc were described. CONCLUSION Cumulative exposure to asbestos leads to mesothelioma; for individuals with mixed exposures to asbestos, all exposures should be considered. Use of cosmetic talc is often overlooked as a source of asbestos exposure. All individuals with mesothelioma should have a comprehensive history of asbestos exposure, including cosmetic talc exposure.
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Affiliation(s)
- Jacqueline Moline
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Great Neck, NY, 11021, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
| | - Kesha Patel
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Great Neck, NY, 11021, USA
| | - Arthur L Frank
- Dornsife School of Public Health of Drexel University, Philadelphia, PA, 19104, USA
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Migliore E, Consonni D, Peters S, Vermeulen RCH, Kromhout H, Baldassarre A, Cavone D, Chellini E, Magnani C, Mensi C, Merler E, Musti M, Marinaccio A, Mirabelli D. Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM). Environ Health 2022; 21:60. [PMID: 35717324 PMCID: PMC9206310 DOI: 10.1186/s12940-022-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Italian mesothelioma registry (ReNaM) estimates mesothelioma incidence and addresses its etiology by assessing cases' exposures but cannot provide relative risk estimates. OBJECTIVES i) To estimate pleural mesothelioma relative risk by industry and occupation and by ReNaM categories of asbestos exposure; and ii) to provide quantitative estimates of the exposure-response relationship. METHODS A population-based mesothelioma case-control study was conducted in 2012-2014 in five Italian regions. Cases and age and gender frequency-matched controls were interviewed using a standard ReNaM questionnaire. Experts coded work histories according to international standard classifications of industries/occupations and assigned asbestos exposure according to ReNaM categories. Job codes were further linked to SYN-JEM, a quantitative job-exposure matrix. Cumulative exposure (CE, f/mL-years) was computed by summing individual exposures over lifetime work history. Unconditional logistic regression analyses adjusted by gender, centre and age were fitted to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Among men we observed increased risks of mesothelioma in many industries and associated occupations, including: asbestos-cement (OR = 3.43), manufacture of railroad equipment (OR = 8.07), shipbuilding and repairing (OR = 2.34), iron and steel mills (OR = 2.15), and construction (OR = 1.94). ORs by ReNaM exposure categories were as follows: definite/probable occupational exposure (OR = 15.8, men; OR = 8.80, women), possible occupational (OR = 2.82, men; OR = 3.70, women), sharing home with an exposed worker (OR = 2.55, men; OR = 10.3, women), residential (OR = 2.14, men; OR = 3.24, women). Based on SYN-JEM, mesothelioma risk increased by almost 30% per f/mL-year (OR = 1.28, CI 1.16-1.42). CONCLUSIONS Out study involved five regions with historically different types and levels of industrial development, encompassing one third of the Italian population and half of Italian mesothelioma cases. As expected, we found increased pleural mesothelioma risk in the asbestos industry and in trades with large consumption of asbestos materials. Clear associations were found using both qualitative (ReNaM classifications) and quantitative estimates (using SYN-JEM) of past asbestos exposure, with clear evidence of an exposure-response relationship.
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Affiliation(s)
- Enrica Migliore
- Cancer Epidemiology Unit, CPO Piemonte and University of Turin, Turin, Italy.
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy.
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susan Peters
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Roel C H 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
| | | | - Domenica Cavone
- Interdisciplinary Department of Medicine, Section of Occupational Medicine "B. Ramazzini", University of Bari, Bari, Italy
| | - Elisabetta Chellini
- Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Florence, Italy
| | - Corrado Magnani
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont and CPO Piemonte, Novara, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enzo Merler
- Occupational Health Unit, Department of Prevention, Padua, Italy
| | - Marina Musti
- Interdisciplinary Department of Medicine, Section of Occupational Medicine "B. Ramazzini", University of Bari, Bari, Italy
| | - Alessandro Marinaccio
- Unit of Occupational and Environmental Epidemiology - Italian Mesothelioma Register, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy
| | - Dario Mirabelli
- Cancer Epidemiology Unit, CPO Piemonte and University of Turin, Turin, Italy
- Interdepartmental Centre G. Scansetti for Studies On Asbestos and Other Toxic Particulates, University of Turin, Turin, Italy
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Tai S, Wu J, Lee LJ, Lu T. Which ICD-9 codes were assigned for malignant mesothelioma in the mortality data in the United States before the ICD-10 was introduced? Am J Ind Med 2022; 65:143-148. [PMID: 34779537 DOI: 10.1002/ajim.23309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Malignant mesothelioma (MM) is rare and fatal; survival in most cases is only about one year. Mortality rate is, therefore, a good proxy measure of incidence rate. However, the specific International Classification of Diseases (ICD) code for MM was not available until the Tenth Revision ICD (ICD-10). Little is known on which Ninth Revision ICD (ICD-9) codes were assigned for MM in the ICD-9 era. METHODS We used a 1996 double-coded mortality file compiled by the National Center for Health Statistics to calculate the detection rate (DR) and confirmation rate (CR) of selected ICD-9 codes. RESULTS Of 2386 decedents whose underlying cause of death was MM (ICD-10 code C45), the DR (deaths) of corresponding ICD-9 code was 57% (1365) for code 199 "malignant neoplasm without specification of site;" 19% (448) for code 162.9 "malignant neoplasm of trachea, bronchus, and lung, unspecified;" 13% (310) for code 163 "malignant neoplasm of pleura;" and 11% (271) for other codes. The CR (deaths) for the aforementioned three ICD-9 codes were 4.0% (1365/33,942), 0.3% (448/150,342), and 70.8% (310/438), respectively. CONCLUSIONS The three ICD-9 codes (199, 162.9, and 163) were the most commonly used codes for MM and composed nine-tenths of all MM deaths in the years before the ICD-10 was introduced. Using only ICD-9 code 163, the code most often used as the surrogate measure of MM in mortality studies in the ICD-9 era, capture may have been only 13% of all MM deaths in the US, and the estimated number of MM deaths missed in 1996 would be 2086.
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Affiliation(s)
- Shu‐Yu Tai
- Department of Family Medicine, School of Medicine, College of Medicine Kaohsiung Medical University Kaohsiung City Taiwan
- Department of Family Medicine Kaohsiung Municipal Ta‐Tung Hospital Kaohsiung City Taiwan
- Department of Family Medicine Kaohsiung Medical University Hospital Kaohsiung City Taiwan
| | - Jingyi Wu
- Department of Public Health, College of Medicine National Cheng Kung University Tainan Taiwan
| | - Lukas Jyuhn‐Hsiarn Lee
- National Institute of Environmental Health Sciences National Health Research Institutes Zhuna Taiwan
| | - Tsung‐Hsueh Lu
- Department of Public Health, College of Medicine National Cheng Kung University Tainan Taiwan
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Tai SY, Wu J, Lee LJH, Lu TH. How Malignant Mesothelioma Was Coded in Mortality Data in Taiwan During Years When the Specific ICD Code Was Not Available? Clin Epidemiol 2022; 13:1135-1140. [PMID: 34992464 PMCID: PMC8713711 DOI: 10.2147/clep.s339956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Malignant mesothelioma (MM) is associated with past exposure to asbestos and the latency period ranged from 20 to 40 years. Asbestos consumption reached a peak in the 1980s in Taiwan, and the MM mortality is expected to increase since 2000s. However, no specific code for MM was available before the International Classification of Disease, Tenth Revision (ICD-10), which was launched in 2008 in Taiwan. We examined how MM was coded in mortality data in Taiwan during the years when the ICD, Ninth Revision (ICD-9) was used. Patients and Methods Double-coded mortality data (each death coded according to both ICD-10 and ICD-9 codes) for the period 2002–2008 were obtained for analysis. Detection rates (similar to sensitivity) and confirmation rates (similar to positive predictive value) for various potential proxy ICD-9 codes for MM were calculated. Results For 113 deaths, for which the underlying cause of death was ICD-10 code C45 (MM), 14 corresponding ICD-9 codes were used. Four ICD-9 codes constituted 77% (87/113) of all MM deaths. The detection rate for code 199 (malignant neoplasm [MN] without specification of site) was 37% (42/113), that for code 163 (MN of pleura) was 18% (20/113), that for code 162 (MN of trachea, bronchus, and lung) was 12% (14/113), and that for code 173 (other MN of skin) was 10% (11/113). The confirmation rates for codes 199, 163, 162, and 173 were 0.9% (42/4759), 14.3% (20/140), 0.03% (14/51,778), and 1.5% (11/717), respectively. Conclusion ICD-9 codes 199, 163, 162, and 173 were most commonly used for MM deaths in Taiwan during the years before the ICD-10 introduction. However, when we used only ICD-9 code 163, which was most commonly used as a surrogate measure of MM in mortality studies during the ICD-9 era, we could detect only one-fifth of MM deaths in Taiwan.
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Affiliation(s)
- Shu-Yu Tai
- Department of Family Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Jingyi Wu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lukas Jyuhn-Hsiarn Lee
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhuna, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Dodge DG, Engel AM, Prueitt RL, Peterson MK, Goodman JE. US EPA's TSCA risk assessment approach: a case study of asbestos in automotive brakes. Inhal Toxicol 2021; 33:295-307. [PMID: 34788178 DOI: 10.1080/08958378.2021.1998258] [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: 10/19/2022]
Abstract
The United States Environmental Protection Agency (US EPA) is currently refining its approach for risk assessments conducted under the amended Toxic Substances Control Act (TSCA), largely based on recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM). We identified several issues with the current TSCA risk assessment approach that were not addressed by NASEM in its recommendations. Here, we demonstrate these issues with a case study of the 'Risk Evaluation for Asbestos, Part 1: Chrysotile Asbestos,' which US EPA released in December 2020. In this evaluation, US EPA found that occupational and some consumer uses of automotive brakes and clutches that contain asbestos result in unreasonable risks. These risks were calculated from estimated exposures during brake work and an inhalation unit risk (IUR) developed for chrysotile asbestos. We found that US EPA overestimated risk as a result of unrealistic inputs to both the exposure and toxicity components of the risk equation, and because the Agency did not fully consider relevant epidemiology and toxicity evidence in its systematic review. Our evaluation demonstrates areas in which the TSCA risk assessment approach could be improved to result in risk evaluations that are supported by the available scientific evidence.
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Paustenbach D, Brew D, Ligas S, Heywood J. A critical review of the 2020 EPA risk assessment for chrysotile and its many shortcomings. Crit Rev Toxicol 2021; 51:509-539. [PMID: 34651555 DOI: 10.1080/10408444.2021.1968337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
From 2018 to 2020, the United States Environmental Protection Agency (EPA) performed a risk evaluation of chrysotile asbestos to evaluate the hazards of asbestos-containing products (e.g. encapsulated products), including brakes and gaskets, allegedly currently sold in the United States. During the public review period, the EPA received more than 100 letters commenting on the proposed risk evaluation. The Science Advisory Committee on Chemicals (SACC), which peer reviewed the document, asked approximately 100 questions of the EPA that they expected to be addressed prior to publication of the final version of the risk assessment on 30 December 2020. After careful analysis, the authors of this manuscript found many significant scientific shortcomings in both the EPA's draft and final versions of the chrysotile risk evaluation. First, the EPA provided insufficient evidence regarding the current number of chrysotile-containing brakes and gaskets being sold in the United States, which influences the need for regulatory oversight. Second, the Agency did not give adequate consideration to the more than 200 air samples detailed in the published literature of auto mechanics who changed brakes in the 1970-1989 era. Third, the Agency did not consider more than 15 epidemiology studies indicating that exposures to encapsulated chrysotile asbestos in brakes and gaskets, which were generally in commerce from approximately 1950-1985, did not increase the incidence of any asbestos-related disease. Fourth, the concern about chrysotile asbestos being a mesothelioma hazard was based on populations in two facilities where mixed exposure to chrysotile and commercial amphibole asbestos (amosite and crocidolite) occurred. All 8 cases of pleural cancer and mesothelioma in the examined populations arose in facilities where amphiboles were present. It was therefore inappropriate to rely on these cohorts to predict the health risks of exposure to short fiber chrysotile, especially of those fibers filled with phenolic resins. Fifth, the suggested inhalation unit risk (IUR) for chrysotile asbestos was far too high since it was not markedly different than for amosite, despite the fact that the amphiboles are a far more potent carcinogen. Sixth, the approach to low dose modeling was not the most appropriate one in several respects, but, without question, it should have accounted for the background rate of mesothelioma in the general population. Just one month after this assessment was published, the National Academies of Science notified the EPA that the Agency's systematic review process was flawed. The result of the EPA's chrysotile asbestos risk evaluation is that society can expect dozens of years of scientifically unwarranted litigation. Due to an aging population and because some fraction of the population is naturally predisposed to mesothelioma given the presence of various genetic mutations in DNA repair mechanisms (e.g. BAP1 and others), the vast majority of mesotheliomas in the post-2035 era are expected to be spontaneous and unrelated in any way to exposure to asbestos. Due to the EPA's analysis, it is our belief that those who handled brakes and gaskets in the post-1985 era may now believe that those exposures were the cause of their mesothelioma, when a risk assessment based on the scientific weight of evidence would indicate otherwise.
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Affiliation(s)
| | - David Brew
- Paustenbach and Associates, Jackson, WY, USA
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Thomsen RW, Riis AH, Flachs EM, Garabrant DH, Bonde JPE, Toft Sørensen H. Risk of asbestosis, mesothelioma, other lung disease or death among motor vehicle mechanics: a 45-year Danish cohort study. Thorax 2021; 77:477-485. [PMID: 34244457 DOI: 10.1136/thoraxjnl-2020-215041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/18/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The risk of asbestosis, malignant mesothelioma and lung cancer among motor vehicle mechanics is of concern because of potential exposure to chrysotile asbestos during brake, clutch and gasket repair and maintenance. Asbestos has also been used in insulation and exhaust systems. METHODS We examined the long-term risk of incident mesothelioma, lung cancer, asbestosis and other lung diseases and mortality due to mesothelioma, lung cancer, asbestosis and other lung diseases in a nationwide cohort of all men registered as motor vehicle mechanics since 1970 in Denmark. This was compared with the corresponding risk in a cohort of male workers matched 10:1 by age and calendar year, with similar socioeconomic status (instrument makers, dairymen, upholsterers, glaziers, butchers, bakers, drivers, farmers and workers in the food industry, trade or public services). RESULTS Our study included 138 559 motor vehicle mechanics (median age 24 years; median follow-up 20 years (maximum 45 years)) and 1 385 590 comparison workers (median age 25 years; median follow-up 19 years (maximum 45 years)). Compared with other workers, vehicle mechanics had a lower risk of morbidity due to mesothelioma/pleural cancer (n=47 cases) (age-adjusted and calendar-year-adjusted HR=0.74 (95% CI 0.55 to 0.99)), a slightly increased risk of lung cancer (HR=1.09 (95% CI 1.03 to 1.14)), increased risk of asbestosis (HR=1.50 (95% CI 1.10 to 2.03)) and a chronic obstructive pulmonary disease risk close to unity (HR=1.02 (95% CI 0.99 to 1.05)). Corresponding HRs for mortality were 0.86 (95% CI 0.64 to 1.15) for mesothelioma/pleural cancer, 1.06 (95% CI 1.01 to 1.12) for lung cancer, 1.79 (95% CI 1.10 to 2.92) for asbestosis, 1.06 (95% CI 0.86 to 1.30) for other lung diseases caused by external agents and 1.00 (95% CI 0.98 to 1.01) for death due to all causes. CONCLUSIONS We found that the risk of asbestosis was increased among vehicle mechanics. The risk of malignant mesothelioma/pleural cancers was not increased among vehicle mechanics.
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Affiliation(s)
| | | | | | - David H Garabrant
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Rossi G, Davoli F, Poletti V, Cavazza A, Lococo F. When the Diagnosis of Mesothelioma Challenges Textbooks and Guidelines. J Clin Med 2021; 10:jcm10112434. [PMID: 34070888 PMCID: PMC8198453 DOI: 10.3390/jcm10112434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 01/15/2023] Open
Abstract
The diagnosis of malignant mesothelioma (MPM) does not pose difficulties when presenting with usual clinico-radiologic features and morphology. Pathology textbooks and national/international guidelines generally describe the findings of classic MPM, underlining common clinical presentation, the gold standard of sampling techniques, usual morphologic variants, immunohistochemical results of several positive and negative primary antibodies in the differential diagnosis, and the role of novel molecular markers. Nevertheless, MPM often does not follow the golden rules in routine practice, while the literature generally does not sufficiently emphasize unusual features of its manifestation. This gap may potentially create problems for patients in sustaining a difficult diagnosis of MPM in clinical practice and during legal disputes. Indeed, the guidelines accidentally tend to favor the job of lawyers and pathologists defending asbestos-producing industries against patients suffering from MPM characterized by uncommon features. The current review is aimed at underlining the wide spectrum of clinical and radiological presentation of MPM, the possibility to consistently use cytology for diagnostic intent, the aberrant immunohistochemical expression using so-called specific negative and positive primary antibodies, and finally proposing some alternative and more unbiased approaches to the diagnosis of MPM.
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Affiliation(s)
- Giulio Rossi
- Anatomy and Pathological Histology Unit, Infermi Hospital, 47923 Rimini, Italy
- Operative Unit of Pathologic Anatomy, AUSL Romagna, Santa Maria delle Croci Hospital of Ravenna, 47923 Rimini, Italy
- Correspondence: ; Tel.: +39-0544-285-368; Fax: +39-054-4285-758
| | - Fabio Davoli
- Thoracic Surgery Unit, Department of Thoracic Diseases, AUSL Romagna, S. Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, 47121 Forlì, Italy;
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Alberto Cavazza
- Department of Pathology, Arcispedale S Maria Nuova, IRCCS Reggio Emilia, 42124 Reggio Emilia, Italy;
| | - Filippo Lococo
- Department of Thoracic Surgery, Faculty of Medicine, University Cattolica del Sacro Cuore, 20123 Rome, Italy;
- Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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10
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Vimercati L, Cavone D, Caputi A, Delfino MC, De Maria L, Ferri GM, Serio G. Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy. BMC Res Notes 2019; 12:636. [PMID: 31564247 PMCID: PMC6767638 DOI: 10.1186/s13104-019-4675-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Asbestos was widely used in construction in both a friable and a compact form until the 1990s, before its use was banned. Today, many of these materials are still in situ and represent a source of risk for construction workers. The objective of the study was to analyse the cases of mesothelioma arising among construction workers registered in the Apulia regional register of mesothelioma. Results For the period 1993–2018, there were 178 male cases, and 10.2% of the cases were present in the regional register. The average age at diagnosis was 64.7 years. The site was pleural in 96.06% of cases, with a diagnosis of certainty in 86.5% of the total cases and 61.8% of cases with epithelial histology. The average latency is 43.9 years. In 75.2% of cases, the exposure began between 1941 and 1970, with an average duration of 24.3 years. The age at the start of exposure in 68.5% of cases is between 8 and 20 years. The ORs were 2.5 (C.I. 95% 1.01–6.17) for the epithelioid histotype and the high duration of exposure. The data underline the need for prevention and information on all activities involving construction workers in which asbestos-containing materials are still used.
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Affiliation(s)
- L Vimercati
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy.
| | - D Cavone
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
| | - A Caputi
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
| | - M C Delfino
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
| | - L De Maria
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
| | - G M Ferri
- School of Medicine, Interdisciplinary Department of Medicine (DIM), Ramazzini Occupational Medicine Section, "Policlinico" University Hospital, UOC of Occupational Medicine, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
| | - G Serio
- School of Medicine, Department of Emergency and Organ Transplantation (DETO), Division of Pathology, University of Bari "A. Moro", Piazza G, Cesare 11, 70124, Bari, Italy
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