Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023
Main Article Content
Keywords
Malignant mesothelioma, asbestos exposure, occupational health, environmental health, Italy.
Abstract
Malignant mesothelioma (MM) is a rare but lethal cancer strongly associated with asbestos exposure. This retrospective study examines trends in asbestos exposure in Emilia-Romagna, Northern Italy. Between 1996 and 2023, 3,513 cases of MM were recorded, predominantly in males (72%) and in older than 65 years (79%). Occupational exposure accounted for 82% of cases, with a significant increase observed over time from 71% to 88% in the most recent period. A greater definition of professional exposure indicates that certain exposure has gone from 49% in the first period to 62% and 58% in the last two periods; probable exposure showed a decrease from 21% to 16% while possible exposure decreased from 16% to 13%. Familiar exposure remained relatively constant at around 8%, environmental exposure showed a slight decrease from 4% to 2%, while non-occupational exposure remained stable at 2%. Among patients with exclusively occupational exposure (1,826 cases), 87% were male and aged between 65 and 75 years (36%) and 75+ (41%).
The exposure rates for the province of residence see the province of Reggio Emilia with the highest occupational exposure rate (2.5 x 100,000 residents), followed by Ravenna (2.3 x 100,000 residents) and Parma and Piacenza which have similar exposure rates with 2.2 x 100,000 residents. Professional sectors such as construction, railway maintenance and metalworking are identified as high-risk industries. Despite efforts to mitigate exposure, non-occupational and environmental exposures persist. The study highlights the importance of continuous surveillance and exposure monitoring to guide effective interventions and legal recognition of MM.
References
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2. Noonan CW. Environmental asbestos exposure and risk of mesothelioma. Ann Transl Med. 2017 Jun;5(11):234.
3. Novello S, Pinto C, Torri V, Porcu L, Di Maio M, Tiseo M, Ceresoli G, Magnani C, Silvestri S, Veltri A, Papotti M, Rossi G, Ricardi U, Trodella L, Rea F, Facciolo F, Granieri A, Zagonel V, Scagliotti G. The Third Italian Consen-sus Conference for Malignant Pleural Mesothelioma: State of the art and recommendations. Crit Rev Oncol Hematol. 2016 Aug;104:9-20.
4. Magnani C, Fubini B, Mirabelli D, Bertazzi PA, Bianchi C, Chellini E, Gennaro V, Marinaccio A, Menegozzo M, Merler E, Merletti F, Musti M, Pira E, Romanelli A, Terracini B, Zona A. Pleural mesothelioma: epidemiologi-cal and public health issues. Report from the Second Italian Consensus Conference on Pleural Mesothelioma. Med Lav. 2013 May-Jun;104(3):191-202.
5. Marinaccio A, Binazzi A, Marzio DD, Scarselli A, Verardo M, Mirabelli D, Gennaro V, Mensi C, Riboldi L, Merler E, Zotti RD, Romanelli A, Chellini E, Silvestri S, Pascucci C, Romeo E, Menegozzo S, Musti M, Cavone D, Cau-zillo G, Tumino R, Nicita C, Melis M, Iavicoli S; ReNaM Working Group. Pleural malignant mesothelioma epi-demic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Reg-ister. Int J Cancer. 2012 May 1;130(9):2146-54.
6. Bertazzi PA. Descriptive epidemiology of malignant mesothelioma. Med Lav. 2005 Jul-Aug;96(4):287-303. PMID: 16457426.
7. IARC Working Group on the evaluation of Carcinogenic Risks to Humans “Arsenic, Metals, Fibres and Dusts”; IARC Monogr Eval Carcinog Risks Hum; Vol 100 C, Lyon, France 2012
8. Delgermaa V, Takahashi K, Park EK, Le GV, Hara T, Sorahan T. Global mesothelioma deaths reported to the World Health Organization between 1994 and 2008. Bull World Health Organ. 2011 Oct 1;89(10):716-24, 724A-724C.
9. Marinaccio A, Binazzi A, Di Marzio A, Mensi C, Consonni D, Chellini E, Angelini A, Baldassarre A, Cavone D, Vimercati L, Migliore E, Verardo M, Benfatto L, Malacarne D, Eccher S, Mazzoleni G, Comiati V, Negro C, Ro-manelli A, Grappasonni I, Pascucci C, Madeo G, Stracci F, Romeo E, Di Giammarco A, Carrozza F, Angelillo IF, Labianca M, Tallarigo F, Tumino R, Melis M, Bonafede M, Massari S, Scarselli A, Iavicoli S, Signorini S, and ReNaM Working Group. “Settimo Rapporto - il Registro Nazionale dei Mesoteliomi”; INAIL, MI dic 2021; www.inail.it/cs/internet/docs/alg-pubbl-il-registro-nazionale-mesoteliomi-settimo-rapporto.pdf
10. Mangone L, Mancuso P, Bisceglia I, Giorgi Rossi P, Chellini E, Negro C, Benfatto L, Migliore E, Casotto V, Mensi C, Romanelli A, Tumino R, Grappasonni I, Cavone D, Mazzoleni G, Tallarigo F, Marinaccio A; ReNaM Working Group. The impact of COVID-19 on new mesothelioma diagnoses in Italy. Thorac Cancer. 2022 Mar;13(5):702-707.
11. Mangone L, Storchi C, Pinto C, Giorgi Rossi P, Bisceglia I, Romanelli A. Incidence of malignant mesothelioma and asbestos exposure in the Emilia-Romagna region, Italy. Med Lav. 2022 Oct 24;113(5):e2022047.
12. Magnani C, Bianchi C, Chellini E, Consonni D, Fubini B, Gennaro V, Marinaccio A, Menegozzo M, Mirabelli D, Merler E, Merletti F, Musti M, Oddone E, Romanelli A, Terracini B, Zona A, Zocchetti C, Alessi M, Baldassarre A, Dianzani I, Maule M, Mensi C, Silvestri S. III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health, and Occupational Medicine related issues. Med Lav. 2015 Sep 9;106(5):325-32.
13. Sinn K, Mosleh B, Hoda MA. Malignant pleural mesothelioma: recent developments. Curr Opin Oncol. 2021 Jan;33(1):80-86.
14. Katz SI, Straus CM, Roshkovan L, Blyth KG, Frauenfelder T, Gill RR, Lalezari F, Erasmus J, Nowak AK, Gerbau-do VH, Francis RJ, Armato SG 3rd. Considerations for Imaging of Malignant Pleural Meso-thelioma: A Con-sensus Statement from the International Mesothelioma Interest Group. J Thorac Oncol. 2023 Mar;18(3):278-298.
15. Sahu RK, Ruhi S, Jeppu AK, Al-Goshae HA, Syed A, Nagdev S, Widyowati R, Ekasari W, Khan J, Bhattacharjee B, Goyal M, Bhattacharya S, Jangde RK. Malignant mesothelioma tumours: molecular pathogenesis, diagnosis, and therapies accompanying clinical studies. Front Oncol. 2023 Jul 4;13:1204722.
16. Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health. 2019 Aug 30;18(1):78.
17. Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol. 2017 May;27(5):348-359.e11. doi: 10.1016/j.annepidem.2017.04.001. Epub 2017 Apr 14. Erratum in: Ann Epidemiol. 2018 Jan;28(1):63.
18. Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P. Phase III study of pemetrexed in combination with cisplatin versus cis-platin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–2644.
19. Janne PA, Wozniak AJ, Belani CP, Keohan ML, Ross HJ, Polikoff JA, Mintzer DM, Taylor L, Ash-land J, Ye Z, Monberg MJ, Obasaju CK. Open-label study of pemetrexed alone or in combination with cisplatin for the treatment of patients with peritoneal mesothelioma: outcomes of an expanded access program. Clin Lung Cancer. 2005;7:40–46.
20. Carteni G, Manegold C, Garcia GM, Siena S, Zielinski CC, Amadori D, Liu Y, Blatter J, Visseren-Grul C, Stahel R. Malignant peritoneal mesothelioma-Results from the International Expanded Access Program using pemetrexed alone or in combination with a platinum agent. Lung Cancer. 2009;64:211–218
21. Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the North Western Cape Province. Br J Ind Med. 1960;17:260–271
22. Reid A, de Klerk NH, Magnani C, Ferrante D, Berry G, Musk AW, Merler E. Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis. Thorax. 2014;69:843–50
23. Henley SJ, Larson TC, Wu M, Antao VC, Lewis M, Pinheiro GA, Eheman C. Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003-2008. Int J Occup Environ Health. 2013;19:1–10.
24. Teta MJ, Lau E, Sceurman BK, Wagner ME. Therapeutic radiation for lymphoma: risk of malig-nant mesothe-lioma. Cancer. 2007;109:1432–1438
25. Baumann F, Ambrosi JP, Carbone M. Asbestos is not just asbestos: an unrecognised health hazard. Lancet Oncol. 2013;14:576–578
26. Carbone M, Pass HI, Rizzo P, Marinetti M, Di Muzio M, Mew DJ, Levine AS, Procopio A. Simian virus 40-like DNA sequences in human pleural mesothelioma. Oncogene. 1994;9:1781–1790
27. Dogan AU, Baris YI, Dogan M, Emri S, Steele I, Elmishad AG, Carbone M. Genetic predisposition to fiber car-cinogenesis causes a mesothelioma epidemic in Turkey. Cancer Res. 2006;66:5063–5068
28. http://wwwn.cdc.gov/eworld/Data/Malignant_mesothelioma_Number_of_deaths_by_sex_race_age_group_and_median_age_at_death_US_residents_age_15_and_over_20012010/20012434. (accessed on June 19, 2024)
29. Lanphear BP, Buncher CR. Latent period for malignant mesothelioma of occupational origin. J Occup Med. 1992;34:718–721.
30. Iwatsubo Y, Pairon JC, Boutin C, Ménard O, Massin N, Caillaud D, Orlowski E, Galateau-Salle F, Bignon J, Bro-chard P. Pleural mesothelioma: dose-response relation at low levels of asbestos exposure in a French popu-lation-based case-control study. Am J Epidemiol. 1998 Jul 15;148(2):133-42.
31. Shukla A, Vacek P, Mossman BT. Dose-Response Relationships in Expression of Bi-omarkers of Cell Prolifera-tion in in vitro Assays and Inhalation Experiments. Nonlinearity Biol Toxicol Med. 2004 Apr;2(2):117-28.
32. Saba R, Aronu GN, Bhatti RP, Mirrakhimov AE, Anusim N, Barbaryan A, Kwatra SG, Iroegbu N. Malignant mesothelioma after household exposure to asbestos. Case Rep Oncol Med. 2013;2013:570487.
33. D' Agostin F, de Michieli P, Negro C. Pleural mesothelioma in household members of asbestos-exposed workers in Friuli Venezia Giulia, Italy. Int J Occup Med Environ Health. 2017 May 8;30(3):419-431.
34. Airoldi C, Magnani C, Lazzarato F. Mirabelli D, Tunesi S, Ferrante D. Environmental asbestos exposure and clustering of malignant mesothelioma in community: a spatial analysis in a population-based case–control study. Environ Health 20, 103 (2021).
35. Magnani C, Ivaldi C, Botta M, Terracini B. Pleural malignant mesothelioma and environmental asbestos ex-posure in Casale Monferrato, Piedmont. Preliminary analysis of a case-control study. Med Lav. 1997 Jul-Aug;88(4):302-9.
36. Nesti M, Adamoli S, Ammirabile F. Linee Guida per la rilevazione e la definizione dei casi di mesotelioma ma-ligno e la trasmissione delle informazioni all’ISPESL da parte dei Centri Operativi Regionali. II Edizione. Ro-ma; maggio 2004.
37. Alpert N, van Gerwen M, Flores R, Taioli E. Gender Differences in Outcomes of Patients With Mesothelioma. Am J Clin Oncol. 2020 Nov;43(11):792-797.
38. Vicari K, Ribeiro IM, Aguiar BF, Brey C, Boller S, Miranda FMD. Occupational characterization of workers ex-posed to asbestos: an integrative review. Rev Bras Med Trab. 2023 Feb 13;20(4):650-658.
39. Miao X, Yao T, Dong C, Chen Z, Wei W, Shi Z, Xu T, Shao J, Niu Q, Rui D, Hu Y, Yan Y. Global, regional, and na-tional burden of non-communicable diseases attributable to occupational asbestos exposure 1990–2019 and prediction to 2035: worsening or improving?. BMC Public Health 24, 832 (2024).
40. https://www.consilium.europa.eu/en/infographics/impact-asbestos-workers-health/ (accessed on 6 May 2024)
41. https://www.mesotheliomahope.com/asbestos/statistics/ b(accessed on May 6, 2024)
42. Mensi C, De Matteis S, Dallari B, Riboldi L, Bertazzi PA, Consonni D. Incidence of mesothelioma in Lombardy, Italy: exposure to asbestos, time patterns and future projections. Occup Environ Med. 2016 Sep;73(9):607-13
.
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Aug 27, 2024
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Giacomino F, Marinelli F, Bisceglia I, Cacchi M, Storchi C, Pinto C, et al. Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023. Med Lav [Internet]. 2024 Aug. 27 [cited 2024 Dec. 21];115(4):e2024028. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/16005
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How to Cite
1.
Giacomino F, Marinelli F, Bisceglia I, Cacchi M, Storchi C, Pinto C, et al. Trends in Asbestos Exposure and Malignant Mesothelioma Incidence in Emilia-Romagna Italy: A Retrospective Study 1996-2023. Med Lav [Internet]. 2024 Aug. 27 [cited 2024 Dec. 21];115(4):e2024028. Available from: https://mattioli1885journals.com/index.php/lamedicinadellavoro/article/view/16005
