Alberto Scarselli

Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro, Milano, Lombardy, Italy

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Publications (57)68.01 Total impact

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    ABSTRACT: Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160 000 tons/year. The National Register of Mesotheliomas (ReNaM, "Registro Nazionale dei Mesoteliomi" in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure. The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases. Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100 000) for men and 1.45 for women, respectively. Among the 15 845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12 065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily). Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Full-text · Article · Jun 2015 · Occupational and environmental medicine
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    ABSTRACT: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs.
    Full-text · Article · Apr 2015 · BMC Cancer
  • Alberto Scarselli · Davide Di Marzio
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    ABSTRACT: Background: Hardwood dust is a well-known human carcinogen and its use is common in several economic activities. Objectives: The aim of this study was to assess the extent of occupational exposure to hardwood dust in certain sectors of Italian industry. Methods: Information on occupational exposures was collected from enterprise exposure registers that must by law be reported to the National Workers' Compensation Authority, as at 31 December 2011. Data stored in the database included economic activity sector, work force size and exposed workers. The number of workers potentially exposed was estimated for some of the industrial sectors from national occupational statistics in Italy. Results: The economic sector with the highest number of potentially exposed workers to hardwood dust was that classified as the manufacture of other wooden furniture with 15,760 men and 2,771 women, while the highest percentage of enterprises that had sent data (according to the ISTAT 2001 census) was in building and repair of non-metallic ships (21%). Conclusions: The systematic recording of occupational exposures is a source of data that permits recognition of high risk situations and aids exposure assessment for epidemiological studies.
    No preview · Article · Nov 2014 · La Medicina del lavoro
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    Alberto Scarselli · Marisa Corfiati · Davide Di Marzio · Sergio Iavicoli
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    ABSTRACT: Background: Crystalline silica is a human carcinogen and its use is widespread among construction, mining, foundries, and other manufacturing industries. Purpose: To evaluate occupational exposure to crystalline silica in Italy. Methods: Data were collected from exposure registries and descriptive statistics were calculated for exposure-related variables. The number of potentially exposed workers was estimated in a subset of industrial sectors. Linear mixed model analysis was performed to determine factors affecting the exposure level. Results: We found 1387 cases of crystalline silica exposure between 1996 and 2012. Exposure was most common in construction work (AM = 0·057 mg/m(3), N = 505), and among miners and quarry workers (AM = 0·048 mg/m(3), N = 238). We estimated that 41 643 workers were at risk of exposure in the selected industrial sectors during the same period. Conclusions: This study identified high-risk sectors for occupational exposure to crystalline silica, which can help guide targeted dust control interventions and health promotion campaigns in the workplace.
    Full-text · Article · Oct 2014 · International journal of occupational and environmental health
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    ABSTRACT: Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
    No preview · Article · Oct 2014 · Giornale italiano di medicina del lavoro ed ergonomia
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    ABSTRACT: Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
    No preview · Article · Oct 2014
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    ABSTRACT: Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.
    No preview · Article · Oct 2014 · Giornale italiano di medicina del lavoro ed ergonomia
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    ABSTRACT: BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are generally present in the workplace environment as complex mixtures and often difficult to identify a priori. OBJECTIVES: The aim of this study is to evaluate the level and coverage of occupational exposure to PAHs in Italy. METHODS: Data were collected from exposure registries of companies with mandatory reporting to the National Workers' Compensation Authority. Statistical analyses were carried out on the retrieved information and the number of workers potentially exposed was estimated for some industrial sectors. RESULTS: Overall 12,849 measurements of exposure levels to individual PAHs were selected from the database of registries in the period 1996-2010. Most exposures occurred in the manufacture of chemicals (N = 5,383, 51%), and the occupational group most frequently measured was chemical-processing-plant operator (N = 3,930, 31%). Measurements were associated to various PAHs, including benzo[a]pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, dibenz[a,h]anthracene, and benzo[j]fluoranthene. Overall, 39,230 workers were estimated as potentially at risk of exposure to PAHs in the selected industrial sectors. CONCLUSIONS: This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to PAHs. The systematic recording of occupational exposures is a source of data that allows the recognition, control, and prevention of high-risk situations for workers' health. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Aug 2013 · American Journal of Industrial Medicine
  • Alessandra Binazzi · Alberto Scarselli · Alessandro Marinaccio
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    ABSTRACT: The costs of productivity loss due to occupational cancer mortality are rarely investigated. An estimate of occupational cancer deaths in Italy in 2006 and an approximation of the resultant costs from medical and non-medical expenditures together with figures of remuneration lost are provided. Occupational cancer deaths, obtained from the application of the attributable fraction (AF) to mortality data (source: Italian National Institute of Statistics), were used to calculate the Potential Years of Life Lost (PYLLs), the Potential Years of Working Life Lost (PYWLLs) and the costs of the loss of productive life. The health care costs for any cancer was applied to the estimated number of occupational cancer cases to obtain the total cost. Around 8,000-8,500 deaths/year from occupational cancer are estimated to occur in Italy, corresponding to 170,000 PYLLs and more than 16,000 PYWLLs, leading to around 360,000,000 euros in indirect economic loss. Health care costs of occupational cancer are estimated at 456,000,000 euros. Occupational cancer is of major concern in terms of mortality and economic productivity loss. Preventive efforts in evaluating ongoing risks and current exposures are strongly recommended to health policy-makers. Am. J. Ind. Med. 2013 Wiley Periodicals, Inc.
    No preview · Article · Jun 2013 · American Journal of Industrial Medicine
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    ABSTRACT: to show how malignant mesothelioma (MM) surveillance not only identifies settings of exposure representing past industrial history, but it may also detect conditions of current exposure relevant for the prevention, if the wide spectrum of asbestos uses is considered. active search of MM cases and exposure assessment at individual level through a questionnaire; identification of exposure circumstances relevant for prevention. Italy, all the Regions where a Regional Operating Centre (COR) is established to identify all MM cases diagnosed in the population and analyze their occupational, residential, household and environmental histories. Period of diagnosis: 1993-2008. descriptive analysis of MM cases and of asbestos exposures. ReNaM includes 15,845 cases of MM diagnosed between 1993 and 2008.The male/female ratio is 2.5.Mean age at diagnosis is 69 years. Pleural MMs represent 93% of all cases. Exposures have been investigated in 12,065 cases (76%). The median latency time is 46 years. In addition to clusters of MM cases in activities well known to entail asbestos use, different current exposure circumstances requiring intervention have been evidenced. on the basis of this experience, epidemiological surveillance of all occupational cancers should be implemented to foster synergies with the compensation system and the Local Health Authorities' occupational safety and health services, as required by the Italian Legislative Decree N. 81/2008.
    Full-text · Article · Apr 2013 · Epidemiologia e prevenzione
  • Alberto Scarselli
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    ABSTRACT: The recording of occupational exposure to carcinogens is a fundamental step in order to assess exposure risk factors in workplaces. The aim of this paper is to describe the characteristics of the Italian register of occupational exposures to carcinogen agents (SIREP). The core data collected in the system are: firm characteristics, worker demographics, and exposure information. Statistical descriptive analyses were performed by economic activity sector, carcinogen agent and geographic location. Currently, the information recorded regard: 12,300 firms, 130,000 workers, and 250,000 exposures. The SIREP database has been set up in order to assess, control and reduce the carcinogen risk at workplace.
    No preview · Article · Feb 2013 · Giornale italiano di medicina del lavoro ed ergonomia
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    ABSTRACT: Hexavalent chromium (Cr(VI)) compounds have been classified as carcinogenic to humans. This study evaluates the extent and magnitude of occupational exposures to Cr(VI) in Italy. Data were collected from exposure registries of companies compulsorily notified by the National Workers' Compensation Authority. Each measurement was characterized by economic activity sector, work force size, worker personal data, job description, year of measurement, and level of exposure. Descriptive statistical analysis was carried out on the retrieved information. The number of workers potentially exposed was estimated for some industrial sectors. A mixed-effects model was adopted to evaluate the association between exposure variables and exposure concentrations. Over 8400 measurements of Cr(VI) exposures were selected from the database of registries for 1996-2009. Most exposures occurred in the manufacture of fabricated metal products (>50%), and the occupational group most frequently measured was metal finishing-, plating- and coating-machine operators (>52%). Measurements were associated with various Cr(VI) compounds, including chromium trioxide, potassium dichromate, sodium dichromate, strontium chromate, and zinc chromate. Cr(VI) exposure has decreased in more recent years, and the fixed-effects (Cr(VI) compound, activity sector, size and location of the facility, job category, and year of measurement of the final statistical model explained more than 70% of the variance in the observed exposure data. This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to Cr(VI). The mean level of exposure to Cr(VI) was 30.41 μg/m³, and 50,118 workers were estimated at exposure risk in the selected industrial sectors. Systematic recording of occupational exposures is a source of data that allows recognition of high risk situations and improvements in exposure assessment for epidemiologic studies.
    No preview · Article · Jun 2012 · Journal of Occupational and Environmental Hygiene
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    ABSTRACT: Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as "at risk" (asbestos-cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading.
    Full-text · Article · May 2012 · International Journal of Cancer
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    ABSTRACT: Malignant mesothelioma is an aggressive and lethal tumour strongly associated with exposure to asbestos (mainly occupational). In Italy a large proportion of workers are protected from occupational diseases by public insurance and an epidemiological surveillance system for incident mesothelioma cases. We set up an individual linkage between the Italian national mesothelioma register (ReNaM) and the Italian workers' compensation authority (INAIL) archives. Logistic regression models were used to identify and test explanatory variables. We extracted 3270 mesothelioma cases with occupational origins from the ReNaM, matching them with 1625 subjects in INAIL (49.7%); 91.2% (1,482) of the claims received compensation. The risk of not seeking compensation is significantly higher for women and the elderly. Claims have increased significantly in recent years and there is a clear geographical gradient (northern and more developed regions having higher claims rates). The highest rates of compensation claims were after work known to involve asbestos. Our data illustrate the importance of documentation and dissemination of all asbestos exposure modalities. Strategies focused on structural and systematic interaction between epidemiological surveillance and insurance systems are needed.
    Full-text · Article · Apr 2012 · BMC Public Health
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    ABSTRACT: During the 1990's, the traditional unimodal treatments (surgery, radiotherapy, chemotherapy, immunotherapy) for malignant pleural mesothelioma started to be combined in bimodal or multimodal strategies. However, recent population-based analyses of the survival of patients with malignant pleural mesothelioma indicate that even these treatments have not led to significant improvements in prognosis, which remains very poor. The present study assessed the survival of patients given combined treatments and multimodal therapies in a specialized hospital department. The study population comprised 530 patients diagnosed with malignant pleural mesothelioma from 1982 to 2006: 343 of them were residents in the province of Brescia (Lombardy, Northern Italy) and 187 were residents outside the province, with a follow-up to 31 December 2009. Kaplan-Meier survival analyses and Cox proportional risks model were used to test sex, age at diagnosis, histological type and treatments, as prognostic factors. The estimated median survival for the whole group of patients was 317 days (257 for residents and 398 for non-residents), and respectively 310 and 340 days in the groups diagnosed in the periods 1982-2000 and 2001-2006. Multivariate analysis confirmed that the prognosis was better for younger patients and cases of epithelioid type malignant pleural mesothelioma, whereas for patients receiving any single treatment the prognosis was not significantly better than for those given palliative care alone. However, patients receiving combined treatments or the multimodality approach had significantly longer median survival and the relative risk of death was respectively 0.57 and 0.61 compared to untreated patients (or those only given symptomatic therapy). This is the first study in Italy to assess the effectiveness of different treatment approaches in a significant number of patients treated in one hospital. Further studies are needed to confirm the improvement in prognosis - even if modest--on larger numbers of patients and taking into account the different stages of the disease.
    No preview · Article · Mar 2012
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    ABSTRACT: National surveillance systems of occupational diseases may contribute to evaluate the work-related component of diseases investigated in SENTIERI Project. For a description of SENTIERI, refer to the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI Project. The National Workers Compensation Authority (INAIL) archives all occupational diseases claims (more than 230 000 in the period 2000-2007) and is in charge of their compensation. The Italian National Mesothelioma Register (ReNaM) and the Sinonasal Cancer Register (ReNaTuNS) record high occupational etiological fraction neoplasms (i.e. mesothelioma and sinonasal cancers). The former has identified more than 10 000 mesothelioma cases until now, and covers almost the whole country; the latter is active only in three Italian regions, Piemonte, Lombardia and Toscana. The monitoring of cancer sites at lower occupational etiological fraction is based on a record-linkage procedure between population-based cancer registries and employment history data, available at the Italian National Institute for Social Security (INPS). Finally, the informative system Mal.Prof collects and classifies all the diseases possibly related to the work environment reported by the Prevention Services of the Local Health Units.
    No preview · Article · Sep 2011 · Epidemiologia e prevenzione
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    ABSTRACT: Occupational exposure to silica dust occurs in many workplaces and is well known to cause silicosis. However, the link between silica exposure, silicosis and other diseases is still disputed. To evaluate cause-specific mortality in a cohort of Italian silicotics. The cohort included 2034 male compensated for silicosis between 1943 and 1986, alive on 1 January 1987 and resident in the Latium region (Italy). Mortality follow-up was from 1987 to 2006. Vital status and death causes were ascertained from the regional mortality archive. Standardized mortality ratios (SMRs) were computed assuming a Poisson distribution of observed deaths. Significant excess mortality was observed from all causes (SMR: 1.17, 95% CI: 1.11-1.24), cancer of trachea, bronchus and lung (SMR: 1.39, 95% CI: 1.17-1.64), cancer of larynx (SMR: 2.18, 95% CI: 1.32-3.60) and tuberculosis (SMR: 5.85, 95% CI: 3.03-11.30). Higher risks were observed for masons (lung cancer, SMR: 2.46, 95% CI: 1.65-3.66) and miners (larynx cancer, SMR: 5.31, 95% CI: 1.88-15.03). In a Poisson regression analysis, the relative risk of death from lung cancer and silicosis increased with silicosis severity and decreased in more recent compensation periods. The excess mortality from respiratory tract cancers and other diseases detected among Italian workers compensated for silicosis confirms previous epidemiological findings.
    No preview · Article · Jun 2011 · Occupational Medicine
  • Alberto Scarselli · Alessandra Binazzi · Davide Di Marzio
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    ABSTRACT: Benzene is classified as human carcinogen and the association with lymphohaematopoietic cancer has been observed in many occupational epidemiological studies. The aim of this study is to summarize data about occupational exposure levels to benzene in Italy. Airborne concentrations of benzene were selected from the Italian database on occupational exposure to carcinogens in the period 1996-2007. Descriptive statistics were calculated for exposure-related variables. The number of workers potentially exposed was estimated for the industrial sectors better characterized in the database. An analysis through linear mixed model was performed to determine factors affecting the exposure level. The total number of benzene exposure measurements was 15,776, with an overall arithmetic mean of 0.09 ppm and a geometric mean of 0.02 ppm. Economic sectors with a higher number of measurements (N) were the manufacturing of chemicals (N = 10,480) and the petrochemical industry (N = 2,652). The number of workers potentially exposed in the selected sectors was 37,137, and the most predictive independent variables of the exposure level were measurement year and job category. Occupational benzene exposure is still widespread in many different industries, and proactive measures are needed to reduce its impact on the workers' health. The potential of occupational exposure databases as a source of data for exposure assessment is confirmed.
    No preview · Article · Feb 2011 · International Archives of Occupational and Environmental Health
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    ABSTRACT: Bladder cancer is one of the most common occupational tumours. The objective of this study is to evaluate the number of workers potentially at risk in Italy. Economic activities entailing bladder cancer risk were selected on the basis of the excesses resulting from studies reporting risk estimates. Firms and the number of workers potentially at risk were retrieved from the National Institute for Occupational Safety and Prevention (ISPESL) database of enterprises. Excluding low level exposures, the number of workers (blue-collars) likely exposed to bladder cancer risk in the industry and services is 366 175 ± 11 096 (248 573 ± 7 533 men, and 117 603 ± 3564 women). The North-Western area of Italy shows the majority of workers potentially at risk (86 625 ± 2625 men, and 27 225 ± 725 women). Quantify the number of exposed workers is the first step for performing analyses on occupational cancer risks. National database of enterprises may be useful in identifying potential risk situations for worker's health.
    Full-text · Article · Jan 2011 · Annali dell'Istituto superiore di sanita
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    ABSTRACT: The association between cancer incidence and the residence near polluting facilities in an industrial area nearby Taranto has been investigated. Age, sex and occupational exposure were controlled as confounding variables in a case-control study (658 cases, 2092 controls). High risks were evidenced close to the steel mill (OR: 3.54), coke plant (OR: 4.80), mineral deposit (OR: 3.33) and shipbuilding (OR: 4.29) for pleural neoplasm, and to the steel mill (OR: 1.65) and shipbuilding (OR: 1.79) for lung cancer. After adjustment for occupational exposure, increasing trends of risk were observed both for lung and bladder cancers. Cancer risks were evidenced near industrial sites and the introduction of "occupational exposure" as a confounder modified significantly the risks with respect to distance from the source of pollution, particularly for pleural, lung and bladder cancers.
    No preview · Article · Jan 2011 · Annali dell'Istituto superiore di sanita