[Show abstract][Hide abstract]ABSTRACT: The Study describes the epidemiological surveillance of mesothelioma cases carried out by the Italian mesothelioma register (ReNaM). A Regional Operating Centre (COR) is present in nearly all Italian regions (17 out of 20) and it collects malignant mesothelioma cases and investigate the modalities of asbestos exposure by using a structured questionnaire. The register produces malignant mesothelioma incidence measures and analyses of the modalities of the asbestos exposure. The standardized incidence rate of malignant mesothelioma in 2001 was 2.98 (in 100,000 inhabitants) among men and 0.98 among women; a professional (certain, probable, possible) exposure has been detected in 67.4% of defined cases. In addition to the conventional sectors (shipbuilding, railways repair and demolition, asbestos-cement production), also textile, building, transport, chemical and glass industries, petroleum and sugar refineries, electricity production and distribution plants are getting involved. Despite the absence of some regions completing the national coverage and the non homogeneity in collecting and coding data, the epidemiological surveillance of malignant mesothelioma carried out by ReNaM is an important tool for the scientific knowledge and the prevention of asbestos-related diseases.
Full-text · Article · Jul 2007 · Epidemiologia e prevenzione
[Show abstract][Hide abstract]ABSTRACT: lung cancer is the first cause of death in the industrialized country among males and is increasing among females. In 2001 a uniform and standardised list of occupations or jobs known or suspected to be associated with lung cancer has been prepared. The aim of this study is to set up a database of Italian enterprises corresponding to activities related to this list and to assess the number of potentially exposed workers.
a detailed and unique list of codes, referred to Ateco91 ISTAT classification with exclusion of the State Railways and the public administration sectors, has been developed. The list is divided into two categories: respectively for occupations or jobs definitely entailing carcinogenic risk and for those which probably/possibly entail a risk. Firms have been selected from the ISPESL database of enterprises and the number of workers has been estimated on the basis of this list.
assessment of the number of workers potentially exposed to lung cancer risk and creation of a register of involved firms.
the number of potentially exposed workers in the industrial and services sector related to lung cancer risk is 650,886 blue collars and the number of firms censused in Italy is 117,006 units. Corresponding figures in the agriculture sector are 163,340 and 84,839. This type of evaluation, being based on administrative sources rather then on direct measures of exposure, certainly includes an overestimation of exposed workers.
the lists based on a standard classification which have been created allow for the creation of databases which can be used to control occupational exposure to carcinogens and to increase comparability between epidemiologic studies based on job-exposure matrix.
No preview · Article · Jul 2007 · Epidemiologia e prevenzione
[Show abstract][Hide abstract]ABSTRACT: To estimate cause specific mortality in a large cohort of Italian workers compensated for silicosis.
The cohort included 14 929 subjects (14,098 men and 831 women) compensated for silicosis between 1946 and 1979, alive on 1 January 1980, and resident in Tuscany (a region of central Italy with 3,547,000 inhabitants). Mortality follow up ranged from 1980 to 1999. Vital status and the causes of death were determined by linkage with the regional mortality registry and with the national mortality database. The cohort mortality rates were compared to the rates of the local reference population. SMRs and their 95% confidence intervals were computed assuming a Poisson distribution of the observed deaths. Specific SMR analyses were performed according to the level of disability, the year of compensation assignment, and the job type.
A significant excess mortality was observed in male silicotics for cancer of the lung, trachea, and bronchus and cancer of the liver, respiratory diseases (silicosis, asbestosis, antracosilicosis, and other pneumoconiosis), and for tubercolosis. Statistically significant mortality excess was observed in female silicotics for respiratory diseases (specifically silicosis and other pneumoconiosis) and tuberculosis. Analyses for period of compensation assignment showed a twofold increased SMR for biliary tract cancer among female workers and for liver cancer among male workers compensated before 1970.
The excess mortality from respiratory tract cancers and respiratory tract diseases detected in Italian compensated silicotics are in agreement with previous epidemiological studies. Although the twofold increased risk for liver cancer among males is suggestive of a possible association with silica dust exposure, the finding needs to be confirmed.
Full-text · Article · Dec 2006 · Occupational and environmental medicine
[Show abstract][Hide abstract]ABSTRACT: The Italian National Mesothelioma Registry (ReNaM) has been set up at the National Institute for Occupational Safety and Health (ISPESL), in order to estimate the incidence of malignant mesothelioma in Italy, to define the modalities of exposures to asbestos, to assess the impact and diffusion of the pathology in the population, and to identify underestimated (or unknown) sources of environmental contamination with asbestos. Regional Operating Centres (COR) have been set up in 16 Italian regions to identify and to investigate all cases of malignant mesothelioma diagnosed in each region, applying national guidelines. Each COR directly collects cases in those care institutions that diagnose and treat mesothelioma cases (anatomo-pathological units, pneumology units and chest surgery wards). Occupational history, lifestyle habits and areas of residence for each case are obtained by direct interview using a standard questionnaire, administered by a trained interviewer. The modalities of exposure are then classified by an industrial hygienist who evaluates whether the subject's work, private life or any particular environmental conditions could have involved exposure to asbestos. The data presented refer to a case series from 12 Italian regions in different periods during the years 1993-2001. 4,961 cases of malignant mesothelioma have been collected: pleural mesothelioma affected 93% of cases and the ratio pleural/peritoneal cases is 14.6:1. The percentage of female cases is remarkable: the gender ratio (M/F) is 2.6:1 over the entire case series. There is a wide variety of occupational exposures, in a large range of sectors, including some already known as high risk sectors and others unexpected. The most common occupational exposures occurred in the building and construction industries, metallurgy and steel, shipbuilding, and railway stock. Categories at high risk such as bricklayers, plumbers, carpenters in the building and construction industries, electricians, welders, installers and maintenance workers in the metallurgy and steel industry, and general labourers, tool makers and painters in shipbuilding repair and demolition and railway rolling stock maintenance have been encountered. Although the work of ReNaM currently suffers from many limitations, the research activity which it conducts regarding the epidemiology of the mesothelioma incident cases and the analysis of the modalities of exposure for each case, using national standardized criteria, is a fundamental tool for the primary prevention of asbestos-related diseases.
[Show abstract][Hide abstract]ABSTRACT: Italy was the second main asbestos producer in Europe, after the Soviet Union, until the end of the 1980s, and raw asbestos was imported on a large scale until 1992. The Italian pattern of asbestos consumption lags on average about 10 years behind the United States, Australia, the United Kingdom and the Nordic countries. Measures to reduce exposure were introduced in the mid-1970s in some workplaces. In 1986, limitations were imposed on the use of crocidolite and in 1992 asbestos was definitively banned. We have used primary pleural cancer mortality figures (1970-1999) to predict mortality from mesothelioma among Italian men in the next 30 years by age-cohort-period models and by a model based on asbestos consumption figures. The pleural cancer/mesothelioma ratio and mesothelioma misdiagnosis in the past were taken into account in the analysis. Estimated risks of birth cohorts born after 1945 decrease less quickly in Italy than in other Western countries. The findings predict a peak with about 800 mesothelioma annual deaths in the period 2012-2024. Results estimated using age-period-cohort models were similar to those obtained from the asbestos consumption model.
Full-text · Article · May 2005 · International Journal of Cancer
[Show abstract][Hide abstract]ABSTRACT: The Italian Institute for Occupational Prevention and Safety (ISPESL) carried out a register of enterprises operating in industry, services and agriculture sector to provide information on their location, economical activity and occupational data. This database has been built merging administrative files from the National Institute of Social Security (INPS) and the Computer Science Society of Italian Chambers of Commerce (InfoCamere). Enterprises have been classified by economic sector - in accordance with ISTAT (National Statistics Institute) "Ateco91" classification--and by accuracy level of the record linkage. In details, three different subsystems have been set up: (A) enterprises satisfying linkage; (B) enterprises in InfoCamere file not linked with INPS file; (C) enterprises in INPS file not linked with InfoCamere file. In the whole, 6.026.676 factories have been collected, of which 1.188.784 in group A, 4.543.091 in group B and 294.801 in group C. Establishing a database of information on industries may be useful to improve preventive programs and to plan health care surveillance systems.
No preview · Article · Jan 2005 · Giornale italiano di medicina del lavoro ed ergonomia
[Show abstract][Hide abstract]ABSTRACT: The article explains the role of the Italian National Institute for Occupational Safety and Prevention (ISPESL), a public research body dealing with occupational and environmental health. Its organization, institutional roles, activities, facilities, and resources are outlined. Especially important is ISPESL's participation in national and international occupational safety and health networks. The Institute is active in epidemiologic surveillance of workers exposed to physical, chemical, and biological hazards.
No preview · Article · Jan 2005 · International journal of occupational and environmental health
[Show abstract][Hide abstract]ABSTRACT: To his study describes the geographical distribution of pleural cancer deaths and asbestosis cases from 1980 to 2000 in Sardinia Region (Italy). For both conditions regionwide registration systems have been available for a relatively long time and allow the identification of statistically significant clusters.
For each town we have estimated Standardized Mortality Ratios (SMRs) for pleural cancer and Standardized Incidence Ratios (SIRs) for asbestosis. Expected cases were estimated from age- and gender specific rates in Sardinia. SatScan software was used to identify clusters and to verify their statistical significance.
Sardinia Region (Italy).
Standardized mortality and incidence rates respectively for pleural cancers and asbestosis cases and territorial clusters.
The most important cluster of pleural cancer was identified in the area defined by Carloforte, Calasetta, Portoscuso and Sant'Antioco municipalities (Southwestern Sardinia) with 15 observed cases (p value= 0.003). Other clusters were detected in the municipality of La Maddalena (11 observed cases against 1.91, expected p value= 0.008) and in Southern Sardinia between Cagliari and Sarroch (p value= 0.018). The town of Marrubiu is clearly the most important cluster (p value= 0. 001) with 6 asbestosis cases in the period.
These results indicate the urgency of the epidemiological surveillance of asbestos related diseases in Sardinia. The active search for incident cases of malignant mesothelioma in the whole Region and the analysis of modalities of asbestos exposure (according to national guidelines) is an indispensable tool for the primary prevention of occupational, environmental and domestic exposures from unknown asbestos sources of contamination.
No preview · Article · Jan 2005 · Epidemiologia e prevenzione
[Show abstract][Hide abstract]ABSTRACT: The Italian Occupation and Safety Act (d.lgs 626/94) provided for the establishment of a nationwide occupational cancer registry, under the National Institute for Occupational Health and Safety (ISPESL), with the aim of detecting cancer cases of occupational origin and estimating the influence of occupation in cancer causation.
Information on cancer cases, drawn from six Italian population-based cancer registries (CRs of Friuli Venezia Giulia Region, Genoa Town and Genoa Province, Macerata Town, Umbria Region, Varese Town, Veneto Region), and on a random sample of population controls selected in each CRs area were linked with data on subjects employed in private enterprises that have been available in electronic form since 1974 at the National Institute for Social Security (INPS). In this way, both for cases and controls, the occupational histories of past employment were collected. A population-based case-control study covering the period 1990-1998 was carried out with the aim of estimating occupational cancer risk in the private sector by site and economic category in each area. Since one of the major drawbacks of this approach is the difficulty in distinguishing true occupational hazards from incidental findings derived from multiple comparisons, an extensive research of occupational literature was carried out, independently of the study results, to compare our results with existing knowledge on occupational risks.
Pooled analysis of the most recent incidence data based on 36,379 cases and 29,572 controls was performed; 34 "statistically significant" associations were found for 11 economic categories. Using our literature review, 10 associations were supported by more than 5 publishedpapers, 14 by a number of papers between 1 and 5, and 10 associations had not been previously reported.
This system appears suitable for assessing existing occupational cancer risks and can eventually lead to detecting occupational hazards in many areas of Italy. The system can also provide a list of cases suitable for in-depth search for past occupational exposures.
No preview · Article · Jan 2005 · La Medicina del lavoro
[Show abstract][Hide abstract]ABSTRACT: The Italian National Mesothelioma Registry (ReNaM) was set up at the National Institute for Occupational Safety and Health (ISPESL) to estimate Italian incidence of malignant mesothelioma (MM), define modalities of asbestos exposures, assess impact and diffusion of MM, identify underestimated sources of environmental contamination.
To describe ReNaM activity, database dimension and epidemiological characteristics of the caselist.
Regional Operating Centers (COR) in 16 Italian regions were set up to identify and investigate all cases of MM diagnosed in each region, applying national guidelines. COR collect cases in health care institutions. Occupational history, lifestyle and residence are obtained by direct interview using a standard questionnaire. Exposure modalities are classified by industrial hygienists, evaluating whether work, private life or any particular environmental condition could have involved asbestos exposure.
Data refer to 3,446 cases collected in 9 Italian regions during 1993-2001. Pleural mesothelioma affected 94% cases, pleural/peritoneal ratio was 16:1. Gender ratio (M/F) was 2.7:1 (1.3:1 for peritoneum). There was a variety of occupational exposures, some already known as high risk sectors and others unexpected. The most common exposures occurred in building and construction, metallurgy and steel, shipbuilding, and railway stock. High risk categories were encountered such as bricklayers, plumbers, carpenters, electricians, welders, installers and maintenance workers in metallurgy and the steel industry, general labourers, tool makers and painters in shipbuilding/repair/demolition.
Despite some ReNam's limitations, identification of MM cases and analysis of modality of exposure, with standardized criteria, are a fundamental tool for primary prevention of asbestos related diseases.
Full-text · Article · Jan 2005 · La Medicina del lavoro
[Show abstract][Hide abstract]ABSTRACT: The Italian National Mesothelioma Register (ReNaM) was set up at the Istituto Superiore Prevenzione e Sicurezza Lavoro (ISPESL), in Rome, in accordance with Art. 36 of Italian Legislative Decree No. 277 .
Five Italian regions, Piedmont, Liguria, Emilia-Romagna, Tuscany, and Apulia, agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data systematically to ISPESL.
Four hundred and twenty-nine mesothelioma cases, diagnosed in 1997, are recorded. The standardized annual incidence rate for definite pleural mesothelioma is 1.51 per 100,000 inhabitants (2.26 for males and 0.79 for females). Exposure was defined for 198 mesotheliomas with a histological diagnosis: 125 (63%) refer to occupational exposure, 10 (5%) to environmental exposure, and 5 (2.5%) to household exposure.
Despite the ReNaM's work, many limitations still have to be overcome. Clear-cut information on asbestos exposure is available for a limited number of cases; and differing regional procedures in collecting and evaluating mesotheloma cases exist. At this stage the identification and evaluation of a large number of cases of mesothelioma is a worthwhile result. This epidemiological surveillance, currently being extended to other regions, will enable us to better assess the impact and diffusion of this disease in future, and to monitor more closely the effects of ceasing asbestos use in 1992, and the efficacy of preventive measures since mid '70s. Am. J. Ind. Med. 45:55-62, 2004.
No preview · Article · Jan 2004 · American Journal of Industrial Medicine
[Show abstract][Hide abstract]ABSTRACT: To study the survival for malignant mesothelioma on general population cases over the 1982-2000 period and to evaluate the effectiveness of the new therapeutic protocols (intrapleural immunotherapy and mulitmodality therapy) to improve the prognosis on the group of selected hospital patients treated from 1996 to 2000.
Survival analysis of malignant mesothelioma on the general population cases and survival analysis for the 1996-2000 period on the selected group of hospital patients.
The Malignant Mesothelioma Register of the Brescia Province (northern Italy) and Pulmonology Dept. of the General hospital of Brescia.
353 mesothelioma cases observed in the province of Brescia from 1982 to 2000, 215 of which are residents in the province and 138 from other provinces, 324 are pleural and 29 peritoneal mesothelioma, 141 of all diagnosed between 1982 and 1995 and 212 between 1996 and 2000.
Observed survival (%) at one, three, five-year and median survival by gender, site and residence on the general population cases treated with conventional therapy and on selected hospital patients group treated with intrapleural immunotherapy and mulimodality therapy.
Median survival for pleural mesothelioma is of 233 days for the men and 291 days for the women in the group of incident cases; median survival is higher for cases from other provinces (388 and 496 days respectively). From 1996 the number of cases treated with new therapic protocols is steadily increasing, patients without therapy (or only talcaggio) passed from 87% in the period between 1982-1995 to 43% in the period 1996-2000. Nevertheless, multivariate analysis by the Cox model based on incident cases proved that histological subtype and age are the only most important prognostic factors (cases with fibrous morphology and older age are associated with lower survival).
In the incident case group the increase of survival for pleural mesothelioma of cases treated with recent therapeutic protocols doesn't reach statistical significance. These results are similar to those of previous studies conducted to identify prognostic factors for mesothelioma survival; they don't permit confirmation of the efficacy of the recent therapy on the population base cases and only allow one to suppose them in the cases of the non resident population. The efficacy of the recent therapy has to be further investigated with regard to the stage of the disease.
No preview · Article · Jan 2004 · Epidemiologia e prevenzione
[Show abstract][Hide abstract]ABSTRACT: The Italian National Mesothelioma Register (ReNaM) was set up at ISPESL (the National Institute for Occupational Safety and Prevention) in 1993. Five Italian regions (Piedmont, Liguria, Emilia-Romagna, Tuscany and Puglia, with a total of approximately 17500000 inhabitants) agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data to ISPESL. We describe an analysis of survival of 429 mesothelioma cases-392 pleural, 34 peritoneal and 3 in the pericardium-diagnosed during 1997, with variable follow-up from June 1999 to December 2001. The Kaplan-Meier method was used to estimate survival rates, the log rank non-parametric test and Cox proportional hazard model to assess the role of prognostic factors such as age, gender, morphology, level of diagnostic certainty and modality of exposure. Median survival was 275 days (95% confidence interval (CI) 241-309) for pleural mesotheliomas and 157 days (95% CI: 118-196) for peritoneal mesotheliomas. Survival after diagnosis of malignant pleural mesothelioma showed a statistically significant linear trend for age group at diagnosis, for males and females (P=0.006 and 0.008, respectively). The Cox proportional hazard model gave an adjusted relative risk (RR(adj)), for the fibrous histotype, of 2.96 (95% CI: 1.28-6.81; P=0.012) compared with cases with unspecified morphology; for epithelioid and biphasic morphologies, the risk was lower than unity. There was no significant difference in survival for cases with confirmed exposure (occupational, household or environmental) or without.
Full-text · Article · Jul 2003 · European Journal of Cancer
[Show abstract][Hide abstract]ABSTRACT: La mortalità per tumore maligno della pleura nei comuni italiani (1988-1997) Marina Mastrantonio (a), Stefano Belli (b), Alessandra Binazzi (a), Marcello Carboni (b), Pietro Comba (b), Paola Fusco (b), Mario Grignoli (b), Ivano Iavarone (b), Marco Martuzzi (c), Massimo Nesti (d), Stefania Trinca (b), Raffaella Uccelli (a) (a) Divisione Caratterizzazione dell'Ambiente e del Territorio, ENEA (Casaccia), Roma (b) Laboratorio di Igiene Ambientale, Istituto Superiore di Sanità, Roma (c) Centro Europeo Ambiente e Salute, Organizzazione Mondiale della Sanità (OMS), Roma (d) Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro (ISPESL), Roma
[Show abstract][Hide abstract]ABSTRACT: 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.
No preview · Article · Jan 2001 · Epidemiologia e prevenzione
[Show abstract][Hide abstract]ABSTRACT: In a recent epidemiological study, researchers investigated mortality from malignant pleural neoplasms in Italy, and they detected some geographic clusters of cases of this disease. We found a town located in a volcanic area of eastern Sicily to be of special interest. The residents, some of whom were diagnosed with pleural mesothelioma, had never had any relevant exposure to asbestos during their professional lives. The results of an environmental survey suggested that a possible cause of asbestos exposure was the stone quarries near the town. The products of the quarries contain fibrous amphiboles, which are used widely in the local building industry. These fibrous amphiboles were identified as intermediate phases between tremolite and actinolite. Samples were collected from buildings in the town, and concentrations of amphibole fibers were evaluated. Fibrous phases were detected in 71% of the samples, and fiber concentrations ranged from a few thousand to more than 4 x 10(4) fibers/mg of material. In addition, we conducted a study on the mineral fiber lung burden in a pleural mesothelioma case. Many mineral fibers that were classified as the same tremolite-actinolite fibrous amphibole found in the quarries and in the building materials were detected in the lung tissue. The results suggest that the inhabitants of the town we studied had been exposed for several decades to asbestos fibers that were present in the material extracted from the local stone quarries. The material was subsequently used in the building industry, and this has caused an increased risk of pleural mesothelioma in the area.
No preview · Article · Nov 2000 · Archives of Environmental Health An International Journal
[Show abstract][Hide abstract]ABSTRACT: The carcinogenic effect of asbestos is accepted for lung cancer and mesothelioma, while conflicting opinions exist for other cancer sites. The aim of the present investigation is to study cause-specific mortality of women compensated for asbestosis who had certainly been exposed to high levels of asbestos fibers.
The cause-specific mortality of all Italian women compensated for asbestosis and alive December 31, 1979, was investigated through October 30, 1997. In the total cohort, which included 631 subjects, 277 deaths occurred. Cause-specific SMRs (Standardized Mortality Ratio) were computed using the national rates for comparison.
A significantly increased mortality for all diseases related to asbestos exposure was observed. Mortality for all causes, all neoplasms, lung cancer, uterine cancer, ovarian cancer, and non-neoplastic respiratory diseases was significantly increased. Separate analyses for textile (n = 276) and asbestos-cement (n = 278) workers were performed. Women employed in the textile industry, mainly exposed to chrysotile, who are compensated at a younger age, showed higher SMRs for lung cancer and asbestosis. Women in the asbestos-cement industry, mainly exposed to crocidolite containing asbestos mixtures, experienced higher mortality for pleural malignancies.
The role of asbestos exposure in the development of gastrointestinal and genital neoplasms is discussed.
No preview · Article · Aug 1999 · American Journal of Industrial Medicine