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Berge LAM, Shala NK, Barone-Adesi F, Hosgood HD, Samuelsen SO, Bråtveit M, Kirkeleit J, Silverman D, Friesen MC, Babigumira R, Grimsrud TK, Veierød MB, Stenehjem JS. Exposure to fibres and risk of pleural mesothelioma in the Norwegian Offshore Petroleum Workers cohort. Occup Environ Med 2024; 81:331-338. [PMID: 38955483 DOI: 10.1136/oemed-2024-109424] [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: 01/11/2024] [Accepted: 05/21/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES Pleural mesothelioma is a rare respiratory cancer, mainly caused by inhalation of asbestos fibres. Other inorganic fibres are also suggested risk factors. We aimed to investigate the association between exposure to asbestos or refractory ceramic fibres (RCFs) and pleural mesothelioma among male Norwegian offshore petroleum workers. METHODS Among 25 347 men in the Norwegian Offshore Petroleum Workers (NOPW) cohort (1965-1998), 43 pleural mesothelioma cases were identified through the Cancer Registry of Norway (1999-2022). A case-cohort study was conducted with 2095 randomly drawn non-cases from the cohort. Asbestos and RCF exposures were assessed with expert-made job-exposure matrices (JEMs). Weighted Cox regression was used to estimate HRs and 95% CIs, adjusted for age at baseline and pre-offshore employment with likely asbestos exposure. RESULTS An increased risk of pleural mesothelioma was indicated for the highest versus lowest tertile of average intensity of asbestos (HR=1.21, 95% CI: 0.57 to 2.54). Pre-offshore asbestos exposure (vs no such exposure) was associated with increased risk of pleural mesothelioma (HR=2.06, 95% CI: 1.11 to 3.81). For offshore workers with no pre-offshore asbestos exposure, an increased risk of pleural mesothelioma was found for the highest tertile of average intensity of asbestos (HR=4.13, 95% CI: 0.93 to 18), versus the lowest tertile. No associations were found between RCF and pleural mesothelioma. CONCLUSIONS Associations between JEM-based offshore asbestos exposure and pleural mesothelioma were confirmed in the NOPW cohort. Pleural mesothelioma risk was also associated with asbestos exposure before work in the offshore petroleum industry.
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Affiliation(s)
- Leon Alexander Mclaren Berge
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Research, Cancer Registry of Norway, National Institute of Public Health, Oslo, Norway
| | - Nita Kaupang Shala
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Research, Cancer Registry of Norway, National Institute of Public Health, Oslo, Norway
| | | | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Magne Bråtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jorunn Kirkeleit
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Debra Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Melissa C Friesen
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ronnie Babigumira
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Research, Cancer Registry of Norway, National Institute of Public Health, Oslo, Norway
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, National Institute of Public Health, Oslo, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jo S Stenehjem
- Department of Research, Cancer Registry of Norway, National Institute of Public Health, Oslo, Norway
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Schüz J, Kovalevskiy E, Olsson A, Moissonnier M, Ostroumova E, Ferro G, Feletto E, Schonfeld SJ, Byrnes G, Tskhomariia I, Straif K, Morozova T, Kromhout H, Bukhtiyarov I. Cancer mortality in chrysotile miners and millers, Russian Federation: main results (Asbest Chrysotile Cohort-Study). J Natl Cancer Inst 2024; 116:866-875. [PMID: 38247448 PMCID: PMC11160488 DOI: 10.1093/jnci/djad262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated mortality in workers of the world's largest chrysotile mine and enrichment factories located in the town of Asbest, Russian Federation. METHODS This historical cohort study included all workers employed for at least 1 year between 1975 and 2010 and follow-up until the end of 2015. Cumulative exposure to dust was estimated based on workers' complete occupational history linked to dust measurements systematically collected from the 1950s. Exposure to chrysotile fibers was estimated using dust-to-fiber conversion factors. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated as mortality rate ratios in Poisson regression models. RESULTS A total of 30 445 (32% women) workers accumulated 721 312 person-years at risk and 11 110 (36%) died. Of the workers, 54% had more than 30 years since their first exposure. We found an exposure-response between cumulative dust and lung cancer mortality in men. No clear association with dust exposure but a modest increase in the highest category of fiber exposure was seen for lung cancer in women. Mesothelioma mortality was increased (RR = 7.64, 95% CI = 1.18 to 49.5, to at least 80 fibers per cm3 years and RR = 4.56, 95% CI = 0.94 to 22.1, to at least 150 mg/m3 years [dust]), based on 13 deaths. For colorectal and stomach cancer, there were inconsistent associations. No associations were seen for laryngeal or ovarian cancer. CONCLUSION In this large-scale epidemiological study in the world's largest active asbestos mine, we confirmed an increased risk of mesothelioma with high fiber exposure and an increasing mortality for lung cancer in men with increasing dust exposure. Less clear-cut increased lung cancer mortality was seen in the women. Continued mortality follow-up is warranted.
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Affiliation(s)
- Joachim Schüz
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Evgeny Kovalevskiy
- Federal State Budgetary Scientific Institution, Izmerov Research Institute of Occupational Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ann Olsson
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Monika Moissonnier
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Evgenia Ostroumova
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Gilles Ferro
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Eleonora Feletto
- International Agency for Research on Cancer-World Health Organization, Lyon, France
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, Australia
| | - Sara J Schonfeld
- International Agency for Research on Cancer-World Health Organization, Lyon, France
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Graham Byrnes
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Iraklii Tskhomariia
- Federal State Budgetary Scientific Institution, Izmerov Research Institute of Occupational Health, Moscow, Russian Federation
| | - Kurt Straif
- International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Tatiana Morozova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Igor Bukhtiyarov
- Federal State Budgetary Scientific Institution, Izmerov Research Institute of Occupational Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Gogou E, Hatzoglou C, Siachpazidou D, Zarogiannis SG, Gourgoulianis KI. Asbestos ban policies and mesothelioma mortality in Greece. BMC Public Health 2024; 24:1177. [PMID: 38671450 PMCID: PMC11055379 DOI: 10.1186/s12889-024-18030-x] [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: 09/19/2023] [Accepted: 02/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Malignant mesothelioma is a rare form of cancer that mostly affects the pleura and has a strong link to asbestos exposure. Greece banned the use of asbestos in 2005, however, the public was already aware of this substance in the 1980s. This research aims to present an overview of Greece's mesothelioma age-standardized mortality rates (ASMR) from 1983 to 2019 by age, gender, and geographic region and to determine whether the actions to ban asbestos impacted these rates. METHODS Data were retrieved by the Hellenic Statistical Authority (HSA) from death certificates that mentioned mesothelioma as the cause of death from 1983 to 2019 with details on the residence, gender, and age. Statistical analysis was performed using PRISM 6.0 software, a two-way ANOVA test, Trend analysis was conducted using Joinpoint Regression Program 5.0 software. The linear and non-linear model was used to calculate the age-standardized rates of annual percentage change (APC) and its 95% confidential interval (95% CI). RESULTS From 1983 to 2019, 850 total mesothelioma deaths were recorded, the majority of whom were males (634). A rate of 74.6% accounts for males and 25.4% for females, and the ratio of Males: Females was 3:1. Males' ASMR and the whole population's ASMR reached their highest levels in 2011 (0.93/100000person-years and 0.53/100000person-years, respectively). To look for potential changes between the first two decades of the 21st century, we compared the mean ASMR of each geographic region in Greece between two different 10-year subperiods (2000-2009 and 2010-2019). Except for Epirus, all regions of Greece had elevated regional ASMRs, particularly in those with the highest asbestos deposits. Notably, the ASMR in Epirus decreased from 0.54/100000person-years (2000-2009) to 0.31/100000person-years (2010-2019). After 2011, the ASMR for men and the general population stabilized. This stability is important since mesothelioma in men is associated with occupational asbestos exposure. The intriguing discovery of a lower ASMR in Epirus emphasizes the need to raise awareness of the condition and implement effective public health measures. CONCLUSIONS In Greece, the annual ASMR for males and the whole population reached its highest level in 2011, which is positive and encouraging and may be a sign that the rate will stabilize during the following years. Moreover, this study showed that the actions made in the 1980s regarding public awareness and surveillance directly impacted the decrease in Epirus rates. Future research, continual awareness, information, and recording are needed to monitor the mesothelioma epidemic. The possible benefit of a mesothelioma registry and the epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, need to be addressed. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Evdoxia Gogou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.
| | - Chryssi Hatzoglou
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Dimitra Siachpazidou
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
| | - Sotirios G Zarogiannis
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece
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Fazzo L, Grande E, Zona A, Minelli G, Crialesi R, Iavarone I, Grippo F. Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic. Front Public Health 2024; 11:1243261. [PMID: 38292377 PMCID: PMC10824953 DOI: 10.3389/fpubh.2023.1243261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background and aim Patients with interstitial lung diseases, including asbestosis, showed high susceptibility to the SARS-CoV-2 virus and a high risk of severe COVID-19 symptoms. Italy, highly impacted by asbestos-related diseases, in 2020 was among the European countries with the highest number of COVID-19 cases. The mortality related to malignant mesotheliomas and asbestosis in 2020 and its relationship with COVID-19 in Italy are investigated. Methods All death certificates involving malignant mesotheliomas or asbestosis in 2010-2020 and those involving COVID-19 in 2020 were retrieved from the National Registry of Causes of Death. Annual mortality rates and rate ratios (RRs) of 2020 and 2010-2014 compared to 2015-2019 were calculated. The association between malignant pleural mesothelioma (MPM) and asbestosis with COVID-19 in deceased adults ≥80 years old was evaluated through a logistic regression analysis (odds ratios: ORs), using MPM and asbestosis deaths COVID-19-free as the reference group. The hospitalization for asbestosis in 2010-2020, based on National Hospital Discharge Database, was analyzed. Results In 2020, 746,343 people died; out of them, 1,348 involved MPM and 286 involved asbestosis. Compared to the period 2015-2019, the mortality involving the two diseases decreased in age groups below 80 years; meanwhile, an increasing trend was observed in subjects aged 80 years and older, with a relative mortality risks of 1.10 for MPM and 1.17 for asbestosis. In subjects aged ≥80 years, deaths with COVID-19 were less likely to have MPM in both genders (men: OR = 0.22; women: OR = 0.44), while no departure was observed for asbestosis. A decrease in hospitalization in 2020 with respect to those in 2010-2019 in all age groups, both considering asbestosis as the primary or secondary diagnosis, was observed. Conclusions The increasing mortality involving asbestosis and, even if of slight entity, MPM, observed in people aged over 80 years during the 1st year of the COVID-19 pandemic, aligned in part with the previous temporal trend, could be due to several factors. Although no positive association with COVID-19 mortality was observed, the decrease in hospitalizations for asbestosis among individuals aged over 80 years, coupled with the increase in deaths, highlights the importance of enhancing home-based assistance during the pandemic periods for vulnerable patients with asbestos-related conditions.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Crialesi
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
- World Health Organization Collaborating Centre for Environmental Health in Contaminated Sites, Rome, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
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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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Fazzo L, Minelli G, De Santis M, Ceccarelli E, Iavarone I, Zona A. The Epidemiological Surveillance of Mesothelioma Mortality in Italy as a Tool for the Prevention of Asbestos Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5957. [PMID: 37297561 PMCID: PMC10252364 DOI: 10.3390/ijerph20115957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
As part of a surveillance plan active since the early 1990s, this study evaluates malignant mesothelioma (MM) mortality for the time-window 2010-2019 in Italy, a country that banned asbestos in 1992. National and regional mortality rates for MM, and municipal standardized mortality ratios (all mesotheliomas, pleural (MPM) and peritoneal (MPeM)), by gender and age group were calculated. A municipal clustering analysis was also performed. There were 15,446 deaths from MM (11,161 males, 3.8 × 100,000; 4285 females, 1.1 × 100,000), of which 12,496 were MPM and 661 were MPeM. In the study period, 266 people ≤50 years died from MM. A slightly decreasing rate among males since 2014 was observed. The areas at major risk hosted asbestos-cement plants, asbestos mines (chrysotile in Balangero), shipyards, petrochemical and chemical plants, and refineries. Female mortality excesses particularly were found in municipalities with a fluoro-edenite-contaminated mine (Biancavilla) and textile facilities. Excesses were also found in a region with the presence of natural asbestos fibres and in males living in two small islands. The Italian National Prevention Plan stated recommendations to eliminate asbestos exposures and to implement health surveillance and healthcare for people exposed to asbestos.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.M.); (E.C.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Emiliano Ceccarelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (G.M.); (E.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.D.S.); (I.I.); (A.Z.)
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Collatuzzo G, Turati F, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Attributable Fraction of Cancer Related to Occupational Exposure in Italy. Cancers (Basel) 2023; 15:cancers15082234. [PMID: 37190163 DOI: 10.3390/cancers15082234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Exposure to occupational carcinogens is an important and avoidable cause of cancer. We aimed to provide an evidence-based estimate of the burden of occupation-related cancers in Italy. METHODS The attributable fraction (AF) was calculated based on the counterfactual scenario of no occupational exposure to carcinogens. We included exposures classified as IARC group 1 and with reliable evidence of exposure in Italy. Relative risk estimates for selected cancers and prevalences of exposure were derived from large-scale studies. Except for mesothelioma, a 15-20-year latency period between exposure and cancer was considered. The data on cancer incidence in 2020 and mortality in 2017 in Italy were obtained from the Italian Association of Cancer Registries. RESULTS The most prevalent exposures were UV radiation (5.8%), diesel exhaust (4.3%), wood dust (2.3%) and silica dust (2.1%). Mesothelioma had the largest AF to occupational carcinogens (86.6%), followed by sinonasal cancer (11.8%) and lung cancer (3.8%). We estimated that 0.9% of cancer cases (N~3500) and 1.6% of cancer deaths (N~2800) were attributable to occupational carcinogens in Italy. Of these, about 60% were attributable to asbestos, 17.5% to diesel exhaust, followed by chromium and silica dust (7% and 5%). CONCLUSIONS Our estimates provide up-to-date quantification of the low, but persistent, burden of occupational cancers in Italy.
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Affiliation(s)
- Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
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Magnani C, Mensi C, Binazzi A, Marsili D, Grosso F, Ramos-Bonilla JP, Ferrante D, Migliore E, Mirabelli D, Terracini B, Consonni D, Degiovanni D, Lia M, Cely-García MF, Giraldo M, Lysaniuk B, Comba P, Marinaccio A. The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20020936. [PMID: 36673690 PMCID: PMC9858856 DOI: 10.3390/ijerph20020936] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023]
Abstract
Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.
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Affiliation(s)
- Corrado Magnani
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Carolina Mensi
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
| | - Daniela Marsili
- Department of Environment and Health, Istituto Superiore di Sanità, ISS (Italian National Institute of Health), 00161 Rome, Italy
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Juan Pablo Ramos-Bonilla
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Daniela Ferrante
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Mirabelli
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Benedetto Terracini
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Unit of Cancer Epidemiology, Regional Operating Center of Piemonte (COR Piemonte), University of Torino and CPO-Piemonte, 10126 Torin, Italy
| | - Dario Consonni
- Occupational Health Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Michela Lia
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | | | - Margarita Giraldo
- Departamento de Ingeniería Civil y Ambiental, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Pietro Comba
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
| | - Alessandro Marinaccio
- Collegium Ramazzini, Bentivoglio, 40010 Modena, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority, 00143 Rome, Italy
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Asbestos Consumption and Malignant Mesothelioma Mortality Trends in the Major User Countries. Ann Glob Health 2023; 89:11. [PMID: 36819965 PMCID: PMC9936915 DOI: 10.5334/aogh.4012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Abstract
Background The causal association between mesothelioma and asbestos exposure is conclusive, and many studies have proved that the trend in asbestos use is a strong predictor of the pattern in mesothelioma cases with an adequate latency time (generally around 30-40 years or more). Recently, a novel approach for predicting malignant pleural mesothelioma, based on asbestos consumption trend and using distributed non-linear models, has been applied. Objectives The purpose of this study is to analyse trends in asbestos consumption and malignant mesothelioma mortality in the major asbestos-user countries. Furthermore, we applied distributed non-linear models to estimate and compare epidemiological relationships between asbestos consumption and mesothelioma mortality across these countries. Methods The study involves major asbestos-user countries in which historical asbestos consumption and mesothelioma mortality data are available. Data on asbestos consumption were derived from worldwide asbestos supply and mesothelioma mortality data from World Health Organization (WHO) mortality archives. A quasi-Poisson generalized linear model was used to model past asbestos exposure and male mesothelioma mortality rates in each country. Exposure-response associations have been modelled using distributed lag non-linear models. Findings and conclusions According to the criteria defined above, we selected 18 countries with raw asbestos cumulative consumptions higher than two million tons in the period 1933-2012. Overall, a clear linear relationship can be observed between total consumption and total deaths for mesothelioma. Country-specific exposure, lag and age-response relationships were identified and common functions extracted by a meta-analysis procedure. Non-linear models appear suitable and flexible tools for investigating the association between mesothelioma mortality and asbestos consumption. There is a need to improve the global epidemiological surveillance of asbestos-related diseases, particularly mesothelioma mortality, and the absence of reliable data for some major asbestos-user countries is a real concern. A reliable assessment of mesothelioma mortality is a fundamental step towards increasing the awareness of related risks and the need of an international ban on asbestos.
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Jiang Z, Chen J, Chen J, Feng L, Jin M, Zhong H, Ju L, Zhu L, Xiao Y, Jia Z, Xu C, Yu D, Zhang X, Lou J. Mortality due to respiratory system disease and lung cancer among female workers exposed to chrysotile in Eastern China: A cross-sectional study. Front Oncol 2022; 12:928839. [PMID: 35978837 PMCID: PMC9376437 DOI: 10.3389/fonc.2022.928839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
Female workers in the asbestos processing industry of Eastern China are at high risk of developing multiple types of cancer, and more data are urgently needed to better understand and address this issue. Death certificate data were selected from an asbestos processing city in China from 2005 to 2006. Information was investigated using the relatives of those individuals who had died as sources of information. Individuals were classified into one of three asbestos exposure levels. Standardized mortality ratio and 95% confidence interval were calculated. A total of 2,964 individual deaths were identified from 2005 to 2006; of these, 21.4% were occupationally exposed to asbestos. The main cause of death was circulatory system diseases (21.2%). The proportion of individuals with respiratory system diseases increased by age among each exposure subgroup (Ptrend < 0.01). Among females, a significant trend was observed between increased asbestos exposure and mortality due to respiratory system diseases and lung cancer. Our study indicated that asbestos exposure was associated with excess mortality from lung cancer and respiratory diseases, particularly among female workers in an asbestos processing area in Eastern China.
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Affiliation(s)
- Zhaoqiang Jiang
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Junqiang Chen
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Junfei Chen
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lingfang Feng
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Mingying Jin
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Huixian Zhong
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Li Ju
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lijin Zhu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Yun Xiao
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Zhenyu Jia
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Chengmin Xu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Difang Yu
- Emergency Management Bureau of Hangzhou Bay New Area, Ningbo, China
| | - Xing Zhang
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Jianlin Lou
- School of Public Health, Hangzhou Medical College, Hangzhou, China
- School of Medicine, and The First Affiliated Hospital, Huzhou University, Huzhou, China
- *Correspondence: Jianlin Lou,
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11
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Fazzo L, Binazzi A, Ferrante D, Minelli G, Consonni D, Bauleo L, Bruno C, Bugani M, De Santis M, Iavarone I, Magnani C, Romeo E, Zona A, Alessi M, Comba P, Marinaccio A. Burden of Mortality from Asbestos-Related Diseases in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10012. [PMID: 34639316 PMCID: PMC8508095 DOI: 10.3390/ijerph181910012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022]
Abstract
Asbestos is one of the major worldwide occupational carcinogens. The global burden of asbestos-related diseases (ARDs) was estimated around 231,000 cases/year. Italy was one of the main European asbestos producers until the 1992 ban. The WHO recommended national programs, including epidemiological surveillance, to eliminate ARDs. The present paper shows the estimate of the burden of mortality from ARDs in Italy, established for the first time. National standardized rates of mortality from mesothelioma and asbestosis and their temporal trends, based on the National Institute of Statistics database, were computed. Deaths from lung cancer attributable to asbestos exposure were estimated using population-based case-control studies. Asbestos-related lung and ovarian cancer deaths attributable to occupational exposure were estimated, considering the Italian occupational cohort studies. In the 2010-2016 period, 4400 deaths/year attributable to asbestos were estimated: 1515 from mesothelioma, 58 from asbestosis, 2830 from lung and 16 from ovarian cancers. The estimates based on occupational cohorts showed that each year 271 deaths from mesothelioma, 302 from lung cancer and 16 from ovarian cancer were attributable to occupational asbestos exposure in industrial sectors with high asbestos levels. The important health impact of asbestos in Italy, 10-25 years after the ban, was highlighted. These results suggest the need for appropriate interventions in terms of prevention, health care and social security at the local level and could contribute to the global estimate of ARDs.
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Affiliation(s)
- Lucia Fazzo
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandra Binazzi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Daniela Ferrante
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00100 Roma, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20100 Milano, Italy;
| | - Lisa Bauleo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Caterina Bruno
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Marcella Bugani
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
| | - Marco De Santis
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Corrado Magnani
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy; (D.F.); (C.M.)
| | - Elisa Romeo
- Department of Epidemiology, Servizio Sanitario Regionale del Lazio, 00100 Roma, Italy; (L.B.); (E.R.)
| | - Amerigo Zona
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Mariano Alessi
- Department of Prevention, Ministry of Health, 00100 Roma, Italy;
| | - Pietro Comba
- Department of Environment and Health, Istituto Superiore di Sanità, 00100 Roma, Italy; (C.B.); (M.D.S.); (I.I.); (A.Z.); (P.C.)
| | - Alessandro Marinaccio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l’Assicurazione Contro gli Infortuni sul Lavoro, 00100 Roma, Italy; (A.B.); (M.B.); (A.M.)
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