Exposures to IARC Carcinogenic Agents in Work Settings Not Traditionally Associated with Sinonasal Cancer Risk: The Experience of the Italian National Sinonasal Cancer Registry

The aim of this study is to highlight tasks and jobs not commonly considered at high risk for sinonasal cancer (SNC) identified by Regional Operating Centers currently active in the Italian National Sinonasal Cancer Registry (ReNaTuNS), which retrieve occupational histories through a standardized questionnaire. Data on exposures to IARC carcinogenic agents in work settings unknown to be associated with SNC risk were collected and analyzed. Out of 2,208 SNC cases recorded in the ReNaTuNS database, 216 cases and their worked exposure periods were analyzed. Unsuspected jobs with exposure to wood dust include construction-related tasks, production of resins, agriculture and livestock jobs (straw and sawdust), and heel factory work (cork dust). Other examples are hairdressers, bakers (formaldehyde), dressmakers, technical assistants, wool and artificial fiber spinners, and upholsterers (textile dusts). Moreover, settings with coexposure to different agents (e.g., wood with leather dusts and chromium–nickel compounds) were recognized. The study describes jobs where the existence of carcinogenic agents associated with SNC risk is unexpected or not resulting among primary materials employed. The systematic epidemiological surveillance of all epithelial SNC cases with a detailed collection of their work history, as performed by a dedicated population registry, is essential for detecting all potential occupational cases and should be considered in the context of forensic medicine and the compensation process.

[The new national guidelines for the keeping of the Italian Sinonasal Cancer Registry (ReNaTuNS)]

Sinonasal cancers (SNC) are rare tumours with predominant occupational aetiology associated with exposures to specific carcinogens. In Italy, SNC incidence has been under compulsory surveillance since 2008, through the National Sinonasal Cancer Registry (ReNaTuNS), a nationwide cancer registry coordinated by the National Institute for Insurance Against Accidents at Work (Inail). The ReNaTuNS has a regional structure with local registries, established at Regional Operating Centres (CORs). Currently, seven Italian Regions are active in SNC search and, together with Inail, have recently released a new version of the national guidelines for keeping the Registry (available on the Inail website). The aim of this text is to present the new guidelines, an updating version, and to underline the relevance of this tool in enforcing the role of the ReNaTuNS, considering the high occupational fraction of SNC and the unicity of the Italian Registry, which collects all the information available on occupational exposures of each SNC case registered. It is recommended that the active search for SNC cases and the analysis of exposure become a systematic and well-organized activity to prevent or reduce risks of exposure and to support and improve the efficiency of the compensation and welfare system.

[Pleural malignant mesotheliomas from environmental exposures to asbestos In Italy]

Pleural mesothelioma clusters from outdoor environmental exposure have been highlighted also in Italy and, on the basis of epidemiological surveillance coordinated by the Italian National Mesothelioma Register, their frequency has been estimated at about 4.5%. Epidemiological studies and evaluations of some regional mesothelioma registers have made it possible to highlight that the dispersion of asbestos fibers in the outdoor environment was the only ascertained cause of mesothelioma in subjects from asbestos-cement factories, from the Balangero mine (Piedmont Region), from some serpentine rock quarries with tremolite outcrops in the Southern Apennines and in Alta Val di Susa (Piedmont Region); from chrysotile and serpentine caves in Valmalenco (Lombardy Region). Furthermore, cases of pleural mesothelioma were clearly caused by environmental pollution from fluoroedenite fibers in Biancavilla (Sicily Region). On the other hand, regional mesothelioma registers have also reported other circumstances of environmental asbestos exposure, like in the case of steel industry, shipbuilding, chemical plants, railway lines, and repair/demolition of railway carriages. However, these reports have not found confirmation on the basis of ad-hoc studies and it is likely that there is a lack of homogeneity in the assessment of individual cases. Apart from the scenarios which have been the subject of ad-hoc studies, the assessment of the causal role of environmental exposure to "in place" asbestos in the onset of pleural mesothelioma is problematic without an effort to more carefully examine the circumstances of possible exposure, harmonization of the attribution criteria used in the individual regional registers, analytical assessment of the impact of such exposure on the risk of onset of mesothelioma.

[Effects of Asbestos on Human Health. Document of the Italian Epidemiological Association (AIE)]

OBJECTIVES

the Italian Epidemiological Association (AIE) intends to formulate assessments and recommendations on the most relevant and critical aspects in the preparation, conduct, and interpretation of epidemiological investigations on the health effects of exposure to asbestos and asbestos-like fibres.

DESIGN, SETTING, AND PARTICIPANTS

the document was prepared by a working group of AIE associates, with a broad curriculum of epidemiological investigations, starting from the evaluation of scientific evidence, and was subsequently evaluated by the AIE governing body.

RESULTS

the topics covered included: • consumption and presence of asbestos; • association between asbestos exposure and disease; • epidemiological surveillance of asbestos related diseases in Italy; • risk function for asbestos related diseases; • increased risk and anticipation of the disease; • interaction between asbestos and other carcinogens; • diagnosis in epidemiological studies; • assessment of exposure to asbestos; • epidemiological evidence on asbestos related diseases.

CONCLUSIONS

the document ends with a summary of the conclusions of scientific research shared by AIE, with reflection on the methodology to be followed for the application at individual level of the results of epidemiological studies, and the proposal of themes on which to direct research.

SARS-CoV-2: exposure to high external doses as determinants of higher viral loads and of increased risk for COVID-19. A systematic review of the literature

The determinants of the risk of becoming infected by SARS-CoV-2, contracting COVID-19, and being affected by the more serious forms of the disease have been generally explored in merely qualitative terms. It seems reasonable to argue that the risk patterns for COVID-19 have to be usefully studied in quantitative terms too, whenever possible applying the same approach to the relationship 'dose of the exposure vs pathological response' commonly used for chemicals and already followed for several biological agents to SARS-CoV-2, too. Such an approach is of particular relevance in the fields of both occupational epidemiology and occupational medicine, where the identification of the sources of a dangerous exposure and of the web of causation of a disease is often questionable and questioned: it is relevant when evaluating the population risk, too. Specific occupational scenarios, basically involving health workers, exhibit important proportions of both subjects simply infected by SARS-CoV-2 and of ill subjects with, respectively, mild, moderate, and severe disease. Similar patterns have been described referring to various circumstances of community exposure, e.g., standing in crowded public places, travelling on crowded means of transport, living in accommodation or care homes, living in the same household as a COVID-19 case. The hypothesis that these findings are a consequence not only of high probabilities of exposure, but also of high doses (as a product of both intensity and duration, with possible autonomous effects of peaks of exposure) deserves to be systematically tested, in order to reconstruct the web of causation of COVID-19 individual and clustered cases and to cope with situations at critical risk for SARS-CoV-2, needing to be identified, mapped, and dealt with at the right time. A limited but consistent set of papers supporting these assumptions has been traced in the literature. Under these premises, the creation of a structured inventory of both values of viral concentrations in the air (in case and if possible, of surface contaminations too) and of viral loads in biological matrixes is proposed, with the subsequent construction of a scenario-exposure matrix. A scenario-exposure matrix for SARS-CoV-2 may represent a useful tool for research and practical risk management purposes, helping to understand the possibly critical circumstances for which no direct exposure measure is available (this is an especially frequent case, in contexts of low socio-economic level) and providing guidance to determine evidence-based public health strategies.

[The new ReNaTuNS operating manual for nasal sinus tumor case management]

No abstract available.

[About the asbestos and the Position Paper on asbestos of the Italian Society of Occupational Medicine]

The SIML Position Paper dedicated to asbestos (PPA) is addressed (mainly) to competent practitioners (CP) for the purposes to provide a guidance about a set of items classified as markedly interesting: the actuality of asbestos exposure and the evaluation of the related risk; the diagnosis of the asbestos related diseases; the shape of the risk functions (namely about mesotheliomas); the causal relationship between exposure and disease; the medical surveillance of the workers currently and previously exposed. The scientific literature doesn't acknowledge the idea that nowadays in Italy the frequency of pleural mesotheliomas deriving from environmental asbestos from outdoor sources exposures is really a relevant item. Inside the SIML PPA the chapter concerning industrial hygiene and environmental monitoring themes shows inaccuracies and deficiencies, so resulting of scarce utility for the CPs that should be called for a more cooperative role in front of the employers. The arguments of the diagnosis of the asbestos related diseases is developed with an undue emphasis upon the differential histological diagnosis of asbestosis and, especially, of pleural mesothelioma: nosographic aspects that hardly are posed to the attention of the CP. A similar emphasis is posed towards the shape of the risk function for pleural mesothelioma, a theme absent from the current practice of the CP such as of other occupational practitioners. In conclusion, next to themes of undoubted interest for the PC, the SIML PPA dwells on the scrutiny of some topics representing critical elements of the current contrast between consultants and valuers in the context of criminal prosecutions: subjects having forensic relevance but far from the "application actuality" for the CP invoked in the PPA. A greater transparency, last but not least, was to have been posed, inside the SIML PPA, in the disclosure of the conflict of interests (COIs) of some Authors, declaring their consultancy in favour of companies.

[The "new carcinogens' directive" from the European Union: new tasks waiting for us, new opportunities in front of us (and that we need not to waste) in Italy]

The new EU directive on the protection of workers from the risks related to exposure to carcinogens and mutagens at work, issued on December 2017, will be integrated inside the Member States' national laws not later than 17th January 2020. The new directive brings in force new binding occupational exposure limit values (BOELVs) for several agents, some of great importance such as hard wood dusts, a set of hexavalent chromium compounds and crystalline silica dust; for some cases, the entry into force of the new limits is delayed in time. The new directive clarifies that the limit values are established considering factors distinct from health necessities too. The Member States are bound to adopt national limit values not avexceeding the corresponding EU ones, but are empowered to lower them. It is essential that the control of the actual respect of the limit values results not only from the application of theoretic previsional models, but is entrusted mainly to high quality exposure measurements and to estimates directly derived from measurements, on the base of publicly available JEMs. The specific health surveillance to be provided to any person both exposed and previously exposed to carcinogens at work should not be limited to proper oncological screening actions, but should include programs for biological monitoring of both exposures and related pre-neoplastic effects, every time any of these is possible and useful. A fair mapping of the exposures to carcinogens and mutagens at work and a systematical registration of cases of cancers attributable to occupational exposures will be placed side to side.

Feasibility study for interspecialistic collaboration in active research of urothelial neoplasms of professional origin

INTRODUCTION

In Italy only a small fraction of cancer is reported to the supervisory body and recognised as professional by the insurance institution. Among the causes of this sub-notification, especially for lowgrade etiologic fractional cancers such as bladder cancers are the lack of knowledge of carcinogenicity in the occupational field and the consequent incomplete medical history collections.

OBJECTIVES

Diagnosis of occupational bladder neoplasms and activation of systematic surveillance of tumors of professional origin through an "active research" program.

METHODS

From July 2010 to July 2017, all patients diagnosed with Bladder Cancer in the departments of Urology of Area Vasta 3 ASUR Marche underwent a first interview and a further anamnestic study in selected cases.When an occupational exposure was recognised, more information for preventive, social security and criminal justice has been acquired.

RESULTS

The study highlighted 18 cases of bladder tumors due to occupational exposure to aromatic amines and polycyclic aromatic hydrocarbons, which are the most important risk factor for BC after tobacco smoking.

CONCLUSIONS

Our study confirmed that active research is an useful tool both for the activation of epidemiological surveillance and for the regional registration of professional tumors. In addition active research of occupational exposure allow obtaining information that can be used for preventive purposes, for criminal justice and for the initiation of medico-legal actions and improvement of working conditions aimed at guaranteeing workers' rights.

The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure

INTRODUCTION

The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register.

METHODS

Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated.

RESULTS

In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries.

CONCLUSIONS

The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

Sinonasal cancer in the Italian national surveillance system: Epidemiology, occupation, and public health implications

BACKGROUND

Sinonasal cancer (SNC) is a rare tumor with predominant occupational etiology associated with exposures to specific carcinogens. The aim of this study is to describe SNC cases recorded in Italy in the period 2000-2016.

METHODS

Clinical information, occupational history, and lifestyle habits of SNC cases collected in the Italian Sinonasal Cancer Register were examined. Age-standardized rates were estimated.

RESULTS

Overall, 1529 cases were recorded. The age-standardized incidence rates per 100 000 person-years were 0.65 in men and 0.26 in women. Occupational exposures were predominant among the attributed exposure settings, primarily to wood and leather dusts. Other putative causal agents included chrome, solvents, tannins, formaldehyde, textile dusts, and pesticides. Many cases had unknown exposure.

CONCLUSIONS

Epidemiological surveillance of SNC cases and their occupational history is fundamental for monitoring the occurrence of the disease in exposed workers in industrial sectors generally not considered at risk of SNC as well as in non-occupational settings.

Fatal silicosis in a funeral arts' craftsman

BACKGROUND

The current scientific debate on silica and cancer has often led to overlooking the persisting risk of lung fibrosis from crystalline silica.

CASE REPORT

During 2000, when 54 years old, a funeral arts' craftsman began to suffer from persistent, hacking cough; radiography and high resolution computed tomography (HRCT) showed thin sub-pleural nodulations of the lungs, mainly in the upper fields. Two years later, increasing dyspnoea appeared and HRCT revealed vast consolidative opacities in both upper fields. Bronchial biopsies documented lung fibrosis and silicosis was diagnosed. In 2003, large amounts of crystalline silica were found in a stone used by the patient and in the dust deposited inside his workshop. In 2004 the patient abandoned his work. He died in 2008 from respiratory failure and infectious complications.

DISCUSSION

Histology is uncommonly available for the differential diagnosis of lung fibrosis so that, when imaging is not accompanied by appropriate recollection and assessment of occupational histories, new cases of silicosis may easily remain unrecognized. After some years from its onset, this fatal silicosis case showed a relatively rapid progression, that continued after exposure cessation. The disease derived from working conditions that the patient and his only colleague, both craftsmen operating in their own workshop, didn't recognize as hazardous prior to an external intervention.

CONCLUSIONS

Severe and fatal silicosis is still present in Italy, even in unusual occupational contexts. At present the disease may be more difficult to identify than in the past; collaboration between clinicians, radiologists and occupational physicians is strongly needed. Ad hoc industrial hygiene surveys give a very relevant support to diagnosis and prevention of silicosis.

Upper airway and eye involvement in polyurethane shoe sole production workers

OBJECTIVES

This cross-sectional study was aimed to investigate the prevalence of work-related upper and lower airway and eye symptoms in 118 workers in polyurethane shoe soles (PSS) production.

METHODS

Workplace monitoring of methylene diphenyl diisocyanate (MDI) and solvents was performed. Subjects completed a study-specific questionnaire and underwent anterior rhinoscopy, skin prick tests for common aeroallergens, spirometry, nasal peak inspiratory (NPIF) and expiratory flow (NPEF).

RESULTS

MDI and solvent levels were below threshold limit value-time-weighted average (TLW-TWA) except for two measures of dichloromethane and tetrachloroethylene, respectively, and in one measure of acetonitrile, which were higher then TLW-TWA. In exposed workers the prevalence of cough (p < 0.05) and nasal congestion at rhinoscopy (p = 0.05) was more frequent than in non-exposed workers. Occupational exposure (OR 4.5, 95% CI 1.2-16.5) and a low FEV1 (OR 2.6, 95% CI 1.1-6.3) were significant predictors of cough.

CONCLUSIONS

In workers exposed to low levels of MDI and solvents in polyurethane shoe sole production there was a high prevalence of cough and nasal congestion. An improvement in the exhaust ventilation system and other preventive measures were needed.

[Assessment of exposure to polycyclic aromatic hydrocarbons in asphalt workers by measurement of urinary 1-hydroxypyrene]

INTRODUCTION

Asphalt workers are potentially exposed to polycyclic aromatic hydrocarbons (PAHs). As some PAHs are classified as carcinogenic, the assessment of occupational exposure to these agents is of the utmost importance in preventing toxic effects.

OBJECTIVES

To assess exposure to PAHs by urinary 1-hydroxypyrene (1-OHPyr).

METHODS

We studied 22 asphalt workers (14 smokers) and 5 control subjects (1 smoker). Multiple samples of urine (up to 4per subject) were collected at the end of the shift for the measurement of 1-OHPyr by LCMS/MS. Univariate and multivariate linear models for repeated measurements were used to evaluate the differences between groups and to identify the variables influencing of exposure.

RESULTS

The median urinary excretion of 1-OHPyr in asphalt workers was low, but higher than that of control subjects (184 vs. <20 ng/L, or 106 vs. <20 ng/g creatinine, p < 0.001); cigarette smoking marginally increased 1-OHPyr in smoking asphalt workers in comparison to non-smokers (129 vs. 208 ng/L p= 0.09 or 94 vs. 121 ng/g creatinine, p = 0.06). The number of consecutive days at work significantly influenced the urinary excretion of l-OHPyr [+59% every day, CI: (2, 147), p = 0.04]. Subjects using paving machines had the highest exposure. A strong association between 1-OHPyr and urinary creatinine was observed.

CONCLUSIONS

urinary 1-OHPyr is a useful indicator of occupational exposure to low levels of PAHs, such as those found in the subjects studied; in using this biomarker it is recommended to collect urine samples at the end of the working week and to express levels of the biomarker corrected for urinary creatinine.

[Biological monitoring of PAH exposure among asphalt workers]

Aim of this work was the assessment of exposure to polycyclic aromatic hydrocarbons (PAHs) by urinary 1-hydroxypyrene (1-OHPyr) in asphalt workers. Median levels of 1-OHPyr resulted higher in asphalt workers than in controls (184 vs. < 20 ng/L, p < 0.001). The determinants of exposure of 1-OHPyr resulted smoking habit, the number of consecutive days at work and the job task; 1-OHPyr was also associated to urinary creatinine. End of work week 1-OHPyr is suggested as an useful indicator of occupational exposure to PAHs in bitumen fumes.

[Preventing asbestos-related diseases: operative action for Italian cooperation with Latin-American countries]

The present paper was aimed at promoting countermeasures based on scientific evidence and international cooperation for evaluating the impact on health caused by exposure to asbestos fibres in the workplace and the environment. Scientific evidence regarding asbestos made available by the international scientific community, decades of experience gained in Italy on this issue and being aware that adopting measures to combat the health effects caused by asbestos exposure should be verified considering the specificity of various national and local contexts in Latin-America form the basis for identifying four main areas for intervention which may be developed in the field of technical and scientific cooperation between Italy and Latin-America countries: promoting access to information about asbestos, interventions for reducing exposure to asbestos, health surveillance of exposed subjects and mesothelioma detection. Integrating Colombian and Italian researchers' abilities may lead to such results being achieved, thereby contributing to banning asbestos, which is already underway in Latin-America.

[The LaboRisCh algorithm, a tool for the assessing chemical risk for health: scientific uncertainty management]

The LaboRisCh algorithm is a practical tool for the first-level assessment of the health risk from chemicals in research laboratories and similar workplaces. Through the assessment of the risk index related to each agent (Ra), the algorithm leads to the calculation of the value of a baseline risk index (Rb), and finally to a corrected risk index (Rc). The value of Rc sets the relevant condition in one of three health risk zones. The algorithm also includes carcinogens and mutagens, whose presence mandates the addition of the c/m subscript (Rc(c/m)). The addition is automatic for agents allocated the EU risk phrases R40, R45, R46, R49 and R68; whereas it is at the discretion of the evaluator for non EU-classified agents that belong to EU categories 1 or 2 and/or to IARC categories 1, 2A or 2B. Further research has led to integration of the algorithm. For instance, similarly to the provision for carcinogens and mutagens, the r subscript (Rc(r)) is now required for agents that are considered toxic to reproduction allocated or attributable to risk phrases R60, R61, R62 and R63.

Excess of mesotheliomas after exposure to chrysotile in Balangero, Italy

BACKGROUND

Chrysotile from the mine in Balangero, Italy is considered to be free of tremolite. In a cohort study of miners and millers only two pleural cancers were reported, a finding considered to indicate that chrysotile has a low potency for inducing mesothelioma. However, follow-up ended in 1987 and white-collar workers and the employees of subcontractors were not studied.

METHODS

To complete the case ascertainment, the study searched the Registry of Malignant Mesotheliomas of Piedmont for records of cases of pleural mesothelioma among the following: mine employees; employees of subcontractors or of other firms transporting or refining Balangero asbestos, asbestos ore or mine tailings; individuals exposed to air pollution from the mine or living with mine employees; and individuals exposed to mine tailings from Balangero.

RESULTS

The study identified four new cases of pleural mesothelioma among blue-collar workers in the mine, in addition to the two reported in the cohort study. Thus, six mesotheliomas occurred, compared to the 1.5 expected (p<0.01). The study also identified three mesothelioma cases among white-collar employees at the mine, five in workers in the mine hired by subcontracting firms, and three among workers processing Balangero chrysotile outside the mine. Finally, 10 additional cases due to non-occupational exposure or exposure to re-used mine tailings were identified.

CONCLUSIONS

The cluster of 14 mesothelioma cases among workers who were active in the mine and 13 among other people exposed to Balangero chrysotile provides further evidence that tremolite-free chrysotile is carcinogenic.

[LaboRisCh: an algorithm for assessment of health risks due to chemicals in research laboratories and similar workplaces]

BACKGROUND

Chemical risk assessment in research laboratories is complicated by factors such as the large number of agents to be considered, each present in small quantities, and the very short and erratic periods of exposure, all of which make reliable environmental and biological monitoring particularly difficult and at times impossible. In such environments, a preliminary evaluation procedure based on algorithms would be useful to establish the hazard potential of a given situation and to guide the appropriate intervention.

OBJECTIVES

The LaboRisCh model was expressly designed to assess the health risk due to chemicals in research laboratories and similar workplaces.

METHODS

The model is based on the calculation of the value of a synthetic single risk index for each substance and compound found in a laboratory and, subsequently, of a further synthetic single risk index for the whole laboratory or, where required, a section thereof. This makes LaboRisCh a compromise between need for information, ease of use, and resources required for the assessment. The risk index includes several items, chiefly the physical and chemical properties, intrinsic hazard potential, amount, dilution, and time of exposure to each agent; waste management; possible interactions; presence and efficiency of collective and individual protection devices, and staff training in good laboratory practices. The value of the synthetic single index corresponds to one of three areas: no risk (green), possible risk (yellow), and certain risk (red).

CONCLUSIONS

Preliminary data confirm the model. LaboRisCh appears to be a reliable method for chemical risk assessment in research laboratories and similar workplaces.

Occupational exposure to diesel exhausts and risk for lung cancer in a population-based case–control study in Italy

BACKGROUND

We studied the effect of exposure to diesel exhausts on lung cancer risk in a population-based case-control study in the city of Turin, Italy.

PATIENTS AND METHODS

Information on occupational histories of 595 incident lung cancer cases diagnosed in 1991-1992 and 845 population controls was obtained. During the interviews, diesel job-specific modules (D-JSMs) were administered whenever subjects had worked in occupations included in the following nine categories: railroad workers, miners, professional drivers and transport conductors, heavy-machine operators, mechanics and testers, filling station attendants, motor-vehicle park attendants, transport equipment operators, and occupations carried out in/near urban roads. All D-JSMs were evaluated for probability, intensity and frequency of exposure.

RESULTS

The odds ratio for ever exposure to diesel exhausts was 1.04 (95% confidence interval 0.79-1.37), after adjusting for age, sex, smoking and having worked in occupations entailing exposure to known lung carcinogens. No association was found with intensity, probability and duration of exposure.

CONCLUSIONS

Although misclassification of the exposure may have contributed to the negative results, we did not find an association between occupational exposure to diesel exhausts and lung cancer risk.

Mesotheliomas among Italians, returned to the home country, who worked when migrant at a cement-asbestos factory in Switzerland

OBJECTIVES

To report the occurrence of mesotheliomas in Italy among subjects who worked, when migrant, at a cement-asbestos factory in Niederurnen, Switzerland, and had resettled to the home country.

METHODS

Information about the disease and on the working history of subjects was collected by regional mesothelioma registries. Only cases diagnosed by means of histo-pathological examinations have been considered here.

RESULTS

15 mesotheliomas (13 pleural, 2 perithoneal; 12 among males, 3 among females) have been identified among Italians, who had worked at the factory. None of them had other occupational exposure to asbestos. The majority was living in the Veneto Region (North East of Italy), and in Puglia (Southern Italy).

CONCLUSIONS

Exposure to asbestos at this factory has already caused an important number of occupational cancers among the employees, a large fraction being constituted of migrants. In order to avoid under-estimation of risks and to allow compensation, diseases which occur among foreign workers returned to their home country should be evaluated. Migration for work is at the genesis of asbestos-related mesotheliomas now occurring in Italy.

Malignant pleural mesothelioma in bakers and pastry cooks

BACKGROUND

The occurrence of malignant pleural mesothelioma (MPM) among bakers and pastry cooks has never been documented.

CASE REPORTS

We detected eight cases of MPM in bakers, pastry cooks, and biscuit cooks engaged in making, baking/cooking, and selling pastry/bread in two hospital-based series (Rome and Orbassano/Turin, Italy; period 1990-1997; 222 cases). Field-investigations revealed asbestos-containing material (ACM) in ovens for baking bread, that were manufactured prior to the 1980s.

CONCLUSIONS

It is suggested that there is a possible new association of the risk of having worked as a baker or pastry cook and MPM. Presumptive source of exposure to asbestos was the use of asbestos-insulated ovens.

[Database of occupations and industrial activities that involve the risk of pulmonary tumors]

Lists of occupations and industries associated with lung cancer are a useful tool to estimate attributable risks for occupational exposures. They were first published in 1982, based on IARC Monographs. List A included industries, processes and occupations definitely entailing carcinogenic risk, list B those probably/possibly carcinogenic. In 1995 the lists had been updated. We carried out a further update, reviewing IARC Monographs Volumes 62-75, focusing on Group 1, 2 A, and 2 B agents, and coded the lists according to widely used classifications: ISIC Rev. 2, ISIC Rev. 3, NACE Rev. 1, and ISTAT ATECO 1991 (for economic activities); ILO-ISCO 1968 and ISTAT-Classificazione delle professioni 1991 (for occupations). In order to evaluate temporal and geographical variations in attributable risk, exposure assessment must be performed consistently across different studies and standard tools to identify exposures, such as the one we propose here, are needed. The lists can also help to develop maps of industrial activities entailing carcinogenic risk at local, regional, and national level, and to identify economic activities that deserve priority action to control occupational exposures to carcinogens. The classifications were originally developed for economic and demographic purposes, and some exposure circumstances cannot be coded with sufficient specificity. This applies to productions or processes (i.e.: PVC production) that could be classified only by codes corresponding to wide groups of economic activities and/or occupations: in these instances we associated no code, so as not to inflate the estimates of exposed workers. As a consequence, however, certain exposures are not represented in the coded version of the lists. Even keeping in mind such limitations, coding makes the lists easier to apply, and increases the comparability of studies on lung cancer and occupation, as well as of surveys on exposure prevalence.

[Dispersion of asbestos fibers and artificial mineral fibers (MMMF) inside truck cabs: a possible exposure of truck drivers]

Tests on samples of braided asbestos cord used in truck exhaust systems revealed a constant presence of chrysotile. Amosite fibres were also observed in many of the samples. Following a case of asbestosis in a truck driver, it was assumed that asbestos fibres could reach the driver's cab through the openings of the ventilation and heating system and also through the spaces between the bonnet and the floor of the driver's cab. Dust samples taken in the driver's cab of 10 (no.) trucks revealed the presence of asbestos fibres in 3 cases; MMMF were present in 7 cases, very likely originating from the noise insulation panelling. It is therefore suggested that there is a possible risk for truck drivers of exposure to asbestos and MMMF fibres dispersed inside the driver's cab.

[Asbestosis in a truck driver: a clinical case and analysis of the exposure]

The paper reports a case of asbestosis in a truck driver whose anamnesis, at first, revealed no evidence of previous exposure to asbestos, whether occupational or extra occupational. A pleuro-pulmonary fibrosis was discovered in 1987, following an episode of exudative pleurisy on the right side. The thickened pleura was then surgically removed. In the samples of pleuro-pulmonary fibroid tissue taken during the operation, typical asbestos bodies were demonstrated in optical microscopy. The analysis of possible exposure to asbestos that might not have been referred in the anamnesis revealed that in at least six widely used truck models (of which three were driven by the worker from 1958 to 1984), the presence of an asbestos winding around a manifold found on the bottom or on the side of the engine. In such trucks, the engine is inside the driver's cab, covered by a cowling set on the floor. Asbestos fibers could enter the driver's cab through a little window in the cowling or through outlets in the dashboard, carried by the airflow generated by the big fan at the back of the radiator and by the truck motion itself. The window or the outlets remained open during cold periods of the year to allow the air, warmed by the motor, to enter the driver's cab.

Urinary excretion of 2,5-hexanedione and peripheral polyneuropathies workers exposed to hexane

Forty shoe factory workers who were exposed to hexane were investigated to see if there was a correlation between electroneuromyographic changes indicative of neuropathy and urinary excretion of 2,5-hexanedione. Urinary samples were analyzed for the presence of the metabolic products of n-hexane and its isomers. Electrodiagnostic examination was carried out following the urinary sampling. A rating scale was used to obtain a cumulative numeric index of electrodiagnostic findings. 2,5-Hexanedione and gamma-valerolactone were discovered in all cases, while 2-hexanol was found in 11 cases. 2,5-Hexanedione was the main metabolite in most cases (39 of 40). Only in 1 case was a low level of 2-methyl-2-pentanol detected; 3-methyl-2-pentanol was never detected. Metabolic products of cyclohexane were present in about one-fifth of the cases, while trichloroethanol, a metabolic product of trichoroethylene, was nearly always present, all at very low concentrations. Electromyographic abnormalities significant for early detection of toxic polyneuropathy were found in 14 cases. A statistically significant correlation of the electroneuromyographic scoring on the urinary concentrations of measured metabolites was observed only with 2,5-hexanedione and gamma-valerolactone, both derived from n-hexane. Since gamma-valerolactone is probably not a true metabolite of n-hexane, our results support the hypothesis that polyneuropathies in shoemakers are due to 2,5-hexanedione. For practical purposes the urinary concentration of 2,5-hexanedione can serve as a predictive measurement for early detection of neurotoxic lesions at preclinical states.