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Occup Environ Med. 2019 Aug;76(8):545-553. doi: 10.1136/oemed-2019-105826. Epub 2019 Jul 8.

Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy.

Author information

Occupational Health Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Fondazione Bruno Kessler, Trento, Italy.
National Heart and Lung Institute, Imperial College, London, UK.
Medical School, Humanitas University, Milan, Italy.
Cancer Epidemiology, CPO and University of Turin, Turin, Italy.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
Department of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy.



Asbestos is the main risk factor for peritoneal mesothelioma (PeM). However, due to its rarity, PeM has rarely been investigated in community-based studies. We examined the association between asbestos exposure and PeM risk in a general population in Lombardy, Italy.


From the regional mesothelioma registry, we selected PeM cases diagnosed in 2000-2015. Population controls (matched by area, gender and age) came from two case-control studies in Lombardy on lung cancer (2002-2004) and pleural mesothelioma (2014). Assessment of exposure to asbestos was performed through a quantitative job-exposure matrix (SYN-JEM) and expert evaluation based on a standardised questionnaire. We calculated period-specific and gender-specific OR and 90% CI using conditional logistic regression adjusted for age, province of residence and education.


We selected 68 cases and 2116 controls (2000-2007) and 159 cases and 205 controls (2008-2015). The ORs for ever asbestos exposure (expert-based, 2008-2015 only) were 5.78 (90% CI 3.03 to 11.0) in men and 8.00 (2.56 to 25.0) in women; the ORs for definite occupational exposure were 12.3 (5.62 to 26.7) in men and 14.3 (3.16 to 65.0) in women. The ORs for ever versus never occupational asbestos exposure based on SYN-JEM (both periods) were 2.05 (90% CI 1.39 to 3.01) in men and 1.62 (0.79 to 3.27) in women. In men, clear positive associations were found for duration, cumulative exposure (OR 1.33 (1.19 to 1.48) per fibres/mL-years) and latency.


Using two different methods of exposure assessment we provided evidence of a clear association between asbestos exposure and PeM risk in the general population.


asbestos; mesothelioma; peritoneum; population–based case–control study

Conflict of interest statement

Competing interests: DC and CM served as consultants for the court in litigations concerning asbestos-related diseases. DM served as consultant for the public prosecutor in litigations concerning asbestos-related diseases.

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