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Occup Environ Med. 2017 Dec;74(12):887-898. doi: 10.1136/oemed-2016-104100. Epub 2017 Aug 3.

Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure.

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Department of Translational Medicine, Unit of Medical Statistics and Epidemiology, University of Eastern Piedmont, and CPO-Piemonte, Novara, Italy.
Occupational & Environmental Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
Local Health Unit, Mesothelioma Register of the Veneto Region, Padua, Italy.
Department of Public Health, Prevention and Security Area Work Environments, Local Health Authority, Bologna, Italy.
Cancer Prevention and Research Institute (ISPO), Florence, Italy.
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Inter-institutional Epidemiology Unit, AUSL Reggio Emilia and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
ARPAE Emilia Romagna, Sezione Provinciale di Reggio Emilia, Reggio Emilia, Italy.
National Cancer Institute IRCCS Fondazione Pascale, Napoli, Italy.
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Unit of Cancer Epidemiology, CPO Piemonte and University of Turin, Turin, Italy.
Prevention Department, ASUR Marche, Senigallia, Italy.
Unit of Epidemiology and Statistics -Local Health Unit of Barletta-Andria-Trani, Barletta, Italy.
Department Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Unit of Occupational Medicine, S.Orsola-Malpighi University Hospital, Bari, Italy.
Interdisciplinary Department of Medicine, Occupational Medicine 'B. Ramazzini, University of Bari, Bari, Italy.
Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy.
Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
Department of Biology and Biotechnologies'Charles Darwin', Sapienza Rome University, Rome, Italy.



Asbestos is a known human carcinogen, with evidence for malignant mesothelioma (MM), cancers of lung, ovary, larynx and possibly other organs. MM rates are predicted to increase with a power of time since first exposure (TSFE), but the possible long-term attenuation of the trend is debated. The asbestos ban enforced in Italy in 1992 gives an opportunity to measure long-term cancer risk in formerly exposed workers.


Pool of 43 previously studied Italian asbestos cohorts (asbestos cement, rolling stock, shipbuilding), with mortality follow-up updated to 2010. SMRs were computed for the 1970â€"2010 period, for the major causes, with consideration of duration and TSFE, using reference rates by age, sex, region and calendar period.


The study included 51 801 subjects (5741 women): 55.9% alive, 42.6% died (cause known for 95%) and 1.5% lost to follow-up. Mortality was significantly increased for all deaths (SMR: men: 1.05, 95% CI 1.03 to 1.06; women: 1.17, 95% CI to 1.12 to 1.22), all malignancies combined (SMR: men: 1.17, 95% CI to 1.14 to 1.20; women: 1.33, 95% CI 1.24 to 1.43), pleural and peritoneal malignancies (SMR: men: 13.28 and 4.77, 95% CI 12.24 to 14.37 and 4.00 to 5.64; women: 28.44 and 6.75, 95% CI 23.83 to 33.69 and 4.70 to 9.39), lung (SMR: men: 1.26, 95% CI 1.21 to 1.31; women: 1.43, 95% CI 1.13 to 1.78) and ovarian cancer (SMR=1.38, 95% CI 1.00 to 1.87) and asbestosis (SMR: men: 300.7, 95% CI 270.7 to 333.2; women: 389.6, 95% CI 290.1 to 512.3). Pleural cancer rate increased during the first 40 years of TSFE and reached a plateau after.


The study confirmed the increased risk for cancer of the lung, ovary, pleura and peritoneum but not of the larynx and the digestive tract. Pleural cancer mortality reached a plateau at long TSFE, coherently with recent reports.


asbestos; malignant mesothelioma; occupational cancer; ovary; peritoneum; pleura

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