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O32-3 A pooled cohort study on cancer risk among former asbestos-exposed workers: role of asbestos clearance in explaining long-term mortality trend for pleural cancer
  1. Corrado Magnani1,
  2. Francesco Barone-Adesi2,
  3. Daniela Ferrante1,
  4. Laura Ancona3,
  5. Antonio Baldassarre4,
  6. Vittoria Bressan5,
  7. Tizian Cena1,
  8. Elisabetta Chellini6,
  9. Francesco Cuccaro7,
  10. Patrizia Legittimo8,
  11. Ferdinando Luberto9,
  12. Alessandro Marinaccio10,
  13. Stefano Mattioli8,
  14. Simona Menegozzo11,
  15. Enzo Merler5,
  16. Lucia Miligi6,
  17. Dario Mirabelli12,
  18. Marina Musti4,
  19. Enrico Oddone13,
  20. Venere Pavone14,
  21. Patrizia Perticaroli15,
  22. Aldo Pettinari15,
  23. Roberta Pirastu16,
  24. Alessandra Ranucci1,
  25. Elisa Romeo3,
  26. Orietta Sala17,
  27. Corrado Scarnato14,
  28. Stefano Silvestri18,
  29. G W19
  1. 1Department of Translational Medicine, University Eastern Piedmont, and CPO Piemonte, Novara, Italy
  2. 2Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
  3. 3Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
  4. 4Interdisciplinary Department of Medicine, Occupational Medicine “B. Ramazzini”, University of Bari, Bari, Italy
  5. 5Mesothelioma Register of the Veneto Region, Padua Local Health Unit, Padua, Italy
  6. 6Occupational and Environmental Epidemiology Unit-Cancer Research and Prevention Institute (ISPO), Florence, Firenze, Italy
  7. 7Azienda Sanitaria Locale BAT (Barletta, Andria, Trani), Unità Operativa Epidemiologia E Statistica, Barletta, Italy
  8. 8Department Medical and Surgical Sciences, University of Bologna, and Unit of Occupational Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy
  9. 9Inter-Institutional Epidemiology Unit, AUSL Reggio Emilia and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
  10. 10Italian Workers’ Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
  11. 11National Cancer Institute IRCCS Fondazione Pascale, Napoli, Italy
  12. 12Unit of Cancer Epidemiology, CPO Piemonte and University of Turin, Turin, Torino, Italy
  13. 13Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
  14. 14Department of Public Health, Prevention and Security, Work Environment Area; Local Health Authority, Bologna, Italy
  15. 15Prevention Department, ASUR Marche, Senigallia, Italy
  16. 16Department of Biology and Biotechnologies Charles Darwin, Sapienza Rome University, Rome, Italy
  17. 17A.R.P.A. Emilia Romagna, Sezione Provinciale Di Reggio Emilia, Reggio Emilia, Italy
  18. 18Cancer Prevention and Research Institute (ISPO), Florence, Firenze, Italy
  19. 19The Working Group for the Pooled Asbestos Cohort Study

Abstract

Objective Asbestos causes mesothelioma (MM) and cancer of lung, ovary, larynx and possibly other organs. Risk reduction after cessation of exposure and at long latency is debated. For MM, the predicted increase of rates with time since first exposure (TSFE) might be attenuated by fibre clearance. The ban of asbestos use in Italy gives an opportunity to measure long term risk in formerly exposed workers.

Methods In a pool of 43 Italian asbestos cohorts (asbestos-cement, rolling stock, shipbuilding and other industries), standardised mortality ratios (SMRs) were computed for the major causes, with consideration of time factors (period, duration, latency). The functional relation between pleural cancer mortality rates and TSFE was evaluated using Poisson regression, including a term for fibre clearance.

Results The study includes 54,409 subjects (6,054 women): 55.3% alive, 43.0% died (cause known for 94%; 789 pleural cancers), and 1.7% lost to follow-up. Mortality was increased for all causes (SMR = 1.06; p < 0.001), all malignancies (SMR = 1.18; p < 0.01), pleural and peritoneal malignancies (SMRs = 14.66 and 6.95; both p < 0.01), lung (SMR = 1.26; p < 0.01) and ovarian cancer (SMR = 1.39; p < 0.05). Pleural cancer rate increased during the first 40 years of TSFE and reached a plateau thereafter. The model including asbestos elimination fitted the data much better than the traditional model (p = 0.0004; estimated asbestos elimination rate of 5% per year).

Discussion Our results provide information on the risk after asbestos exposure, even for rarer diseases. Increased risk for ovarian cancer is confirmed. Results agree with the hypothesis that pleural cancer risk, rather than increasing indefinitely, reaches a plateau at long latency, coherently with asbestos clearance from the lungs. As a consequence, early exposures to asbestos cannot be considered to be the exclusive determinant of the long term development of pleural cancer, with implications also for the risk related to non occupational exposure and for asbestos removal.

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