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BMC Cancer. 2015 Apr 15;15:286. doi: 10.1186/s12885-015-1301-2.

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry.

Author information

1
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. m.corfiati@inail.it.
2
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.scarselli@inail.it.
3
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.binazzi@inail.it.
4
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. d.dimarzio@inail.it.
5
Regional Operating Center of Valle d'Aosta (COR Valle d'Aosta), Valle d'Aosta Health Local Unit, Aosta, Italy. mverardo@ausl.vda.it.
6
COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy. dario.mirabelli@cpo.it.
7
COR Liguria, Epidemiology and Prevention Department, National Cancer Research Institute (IST), Genova, Italy. valerio.gennaro@istge.it.
8
COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy. carolina.mensi@unimi.it.
9
COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy. gert.schallenberg@apss.tn.it.
10
COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy. enzo.merler@sanita.padova.it.
11
COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy. negro@units.it.
12
COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy. romanellia@ausl.re.it.
13
COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy. e.chellini@ispo.toscana.it.
14
COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy. s.silvestri@ispo.toscana.it.
15
COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy. mario.cocchioni@unicam.it.
16
COR Marche, Environmental and Health Sciences Department, University of Camerino, Hygienistic, Camerino, Italy. cristiana.pascucci@unicam.it.
17
COR Umbria, University of Perugia, Department of Hygiene and public health, Perugia, Italy. fabs@unipg.it.
18
COR Lazio, Department of Experimental Medicine, University La Sapienza, Roma, Italy. e.romeo@deplazio.it.
19
COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy. medlav.tocco@virgilio.it.
20
COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy. italof.angelillo@unina2.it.
21
COR Campania, Department of Experimental Medicine, Second University of Naples, Napoli, Italy. simonamenegozzo@alice.it.
22
COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy. m.musti@medlav.uniba.it.
23
COR Puglia, Department of Internal Medicine and Public Medicine, University of Bari, Section of Occupational Medicine "B. Ramazzini", Bari, Italy. d.cavone@medlav.uniba.it.
24
COR Basilicata, Epidemiologic Regional Center, Potenza, Italy. gabriella.cauzillo@regione.basilicata.it.
25
COR Calabria, Public Health Unit, Crotone, Italy. federicotallarigo@libero.it.
26
COR Sicily, "Civile - M.P. Arezzo" Hospital, Ragusa Cancer Register Unit, Ragusa, Italy. rtumino@tin.it.
27
COR Sardegna, Regional Epidemiological Center, Cagliari, Italy. massimelis@gmail.com.
28
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. s.iavicoli@inail.it.
29
Epidemiology Unit, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy. a.marinaccio@inail.it.

Abstract

BACKGROUND:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
25885893
PMCID:
PMC4404011
DOI:
10.1186/s12885-015-1301-2
[Indexed for MEDLINE]
Free PMC Article

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