Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM)

The study describes the 466 cases of malignant mesotheliomas (MM) collected by the National Mesothelioma Register (ReNaM) in Italy in the period 1993-2018 relating to subjects with exclusive asbestos exposure in merchant or military navy. The cases among maritime workers represent 1.8% of the total cases with defined exposure registred in the ReNaM, of which 212 cases (45.4%) among merchant maritime workers and 254 cases (54.5%) among navy. The distribution by site of mesothelioma showed 453 (97.2%) MM cases of the pleura, 11 (2.3%) of the peritoneum and 2 (0.4%) of the tunica vaginalis of the testis. With regard to occupational exposure, it was classified as certain in 318 (68.2%) cases, probable in 69 (14.8%) cases and possible in 79 (16.9%) cases. Among the 23 classified jobs, the highest percentages of certain exposures are among naval engineers, motor mechanics, machine captains and sailors. Machine crew accounted for 49.3% of the cases, deck crew for 27.6%. All cases began exposure on board between 1926 and 1988. Seamen were exposed to asbestos while at sea by virtue of living onboard ships and from continual release of asbestos fibers due to the motion of a vessel. Epidemiological surveillance through the ReNaM has allowed us to verify among cases in the maritime, navy and merchant marine sectors, that in the past, subjects were exposed regardless of the ship's department where have provided service therefore all these cases must be considered as occupational diseases.

[Incidence of malignant tumours (1996-2012) in young Italian soldiers sent on mission abroad. Preliminary analysis of the data of the Parliamentary Enquiring Commission on depleted uranium and vaccines (CUC)]

INTRODUCTION

since 2000s, epidemiological studies conducted by the Italian Ministry of Defence on Italian soldiers sent on a mission abroad showed excess mortality and/or incidence for Hodgkin lymphomas and also a significant reduction of all tumours and of all diseases.

OBJECTIVES

this analysis aim to evaluate tumour incidence and overall mortality among Italian soldiers sent on a mission abroad (period 1996-2012; 3,663 cases). This investigation is preliminary to a more complete retrospective study on the cohort of soldiers affected by tumour (No. 6,104 cases) diagnosed in the period 1973-2017 and registered by the Epidemiological Defence Observatory (OED).

MATERIALS AND METHODS

cohort data were acquired by the Uranium Commission of the Chamber of Deputies (CUC, 2016-2018). For statistical and epidemiological reasons, mainly dictated by the number, completeness, and quality of information concerning patients (or deceased) and the study population. The survey was temporarily limited to male military aged between 20 and 59 during the period 1996-2012 (No. 3,663; 60% of the total). Military from the four Italian defence forces - Air force, Carabinieri, Army, and Navy - were, respectively, divided into two groups: those involved in at least one mission abroad ("missionaries"; No. 874; 24%) and all the others ("non-missionaries"; No. 2,789; 76%). Using the method of indirect rate standardization, the age-standardized incidence ratio comparing missionaries and non-missionaries (SIRm) and comparing missionaries and the general population considered as an external reference (SIR) were calculated, with respective 90% confidence intervals (95%CI). Similarly, the overall mortality risk among missionaries was investigated.

RESULTS

considering the population of the non-missionaries, the analysis of tumour incidence (TM) by military forces identified excesses in the missionaries of the Air Force (SIRm: 126.7; 90% CI 107.9-147.9), Carabinieri (SIRm: 152.8; 90%CI 134.0-173.7), and the Army (SIRm: 116.2; 90%CI 108.1-125.6). Taking into account missionaries, there was an excess of risk for specific neoplasia: for hemolymphopoietic system in Carabinieri (SIRm: 150.1; 90%CI 106.0 - 207.1) and in the Army (SIRm: 109.0; 90%CI 93.9-125.9); for Hodgkin lymphoma in Air force (SIRm: 187.7; 90%CI 88.1-352.5), Carabinieri (SIRm: 187.3; 90%CI 87.9-351.8), and the Army (SIRm; 104.5; 90%CI 81.2-132.6); for leukaemia in the Army (SIRm: 142.4; 90%CI 107.5-185.4). Significant risk excesses were also observed in missionaries for stomach, testis, kidney, bladder, and thyroid tumours. On the other hand, for missionaries in the Navy, a statistically significant risk reduction for all tumours emerged (SIRm: 61.1; IC90% 51.0-72.6). Missionaries showed a higher mortality for all causes.

CONCLUSIONS

this preliminary study confirms the need for an in-depth survey on the health status of Italian soldiers. In particular, the risk for diseases, even non-neoplastic and after 2012, should be investigated in the military over the age of 60, who has a greater risk of incidence and mortality, not only for tumour. All potential disease determinants, both environmental and personal, should also be studied.