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Original Article
The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure
  1. Alessandro Marinaccio1,
  2. Marisa Corfiati1,
  3. Alessandra Binazzi1,
  4. Davide Di Marzio1,
  5. Alberto Scarselli1,
  6. Pierpaolo Ferrante1,
  7. Michela Bonafede1,
  8. Marina Verardo2,
  9. Dario Mirabelli3,
  10. Valerio Gennaro4,
  11. Carolina Mensi5,
  12. Gert Schallemberg6,
  13. Guido Mazzoleni7,
  14. Enzo Merler8,
  15. Paolo Girardi8,
  16. Corrado Negro9,
  17. Flavia D’Agostin9,
  18. Antonio Romanelli10,
  19. Elisabetta Chellini11,
  20. Stefano Silvestri12,
  21. Cristiana Pascucci13,
  22. Roberto Calisti13,
  23. Fabrizio Stracci14,
  24. Elisa Romeo15,
  25. Valeria Ascoli16,
  26. Luana Trafficante17,
  27. Francesco Carrozza18,
  28. Italo Francesco Angelillo19,
  29. Domenica Cavone20,
  30. Gabriella Cauzillo21,
  31. Federico Tallarigo22,
  32. Rosario Tumino23,
  33. Massimo Melis24,
  34. Sergio Iavicoli1
  35. ReNaM Working Group
    1. 1Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Rome, Italy
    2. 2Valle d’Aosta Health Local Unit, Regional Operating Centre of Valle d’Aosta (COR Valle d’Aosta), Aosta, Italy
    3. 3COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy
    4. 4COR Liguria, UO Epidemiology, IRCCS Az, Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy
    5. 5COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy
    6. 6Provincial Unit of Health, Hygiene and Occupational Medicine, COR Province of Trento, Trento, Italy
    7. 7Alto Adige Health Local Unit, COR Province of Bolzano, Bolzano, Italy
    8. 8Occupational Health Unit, Department of Prevention, COR Veneto, Padua, Italy
    9. 9Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals, Trieste, Italy
    10. 10Health Local Unit, Public Health Department, COR Emilia-Romagna, Reggio Emilia, Italy
    11. 11Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Firenze, Italy
    12. 12Cancer Prevention and Research Institute, Firenze, Italy
    13. 13Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, COR Marche, University of Camerino, Camerino, Italy
    14. 14Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy
    15. 15Department of Epidemiology, COR Lazio, Lazio Region, Rome, Italy
    16. 16Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy
    17. 17Health Local Unit, Occupational Medicine Unit, COR Abruzzo, Pescara, Italy
    18. 18Oncology Unit, COR Molise, Cardarelli Hospital, Campobasso, Italy
    19. 19Department of Experimental Medicine, COR Campania, Second University of Naples, Napoli, Italy
    20. 20Department of Interdisciplinary Medicine, Section of Occupational Medicine ’B.Ramazzini', COR Puglia, University of Bari, Firenze, Italy
    21. 21COR Basilicata, Epidemiologic Regional Centre, Potenza, Italy
    22. 22Public Health Unit, COR Calabria, Crotone, Italy
    23. 23Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, COR Sicily, Policlinico, Italy
    24. 24COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy
    1. Correspondence to Dr Alessandro Marinaccio, Epidemiology Unit, Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian national workers compensation authority (INAIL), Rome 00143, Italy; a.marinaccio{at}inail.it

    Abstract

    Introduction The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register.

    Methods Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated.

    Results In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries.

    Conclusions The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

    • mesothelioma
    • asbestos
    • gender

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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    Footnotes

    • Contributors AM designed the study, performed statistical analyses, interpreted the data and drafted the manuscript, AB, MC, DD, AS, PF participated in performing statistical analyses and in interpreting the data, SI participated in designing the study and interpreting the data, MV, DM, VG, CM, GS, GM, EM, PG, CN, FD, AR, EC, SS, CP, RC, FS, ER, VA, LT, IA, DC, GC, FT, RT, MM collected data, defined asbestos exposure. All authors participated in revising the manuscript.

    • Funding This research was supported and founded by INAIL (Italian Workers Compensation Authority). The units of epidemiology or occupational health hosting the Regional Operating Centres belong to the National Health Service and are financed by their health authorities.

    • Competing interests The following authors reported that they have served as expert witness for the public prosecutor in court trials on asbestos-related diseases: EM, DM, SS, VG, CM, RC.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Detragiache E (Regional Operating Centre of Valle d’Aosta (COR Valle d’Aosta), Valle d’Aosta Health Local Unit, Aosta, Italy); Merletti F, Gangemi M, Stura A, Brentisci C, Cammarieri Diglio G, Macerata V, Gilardetti M (COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy); Lazzarotto A, Benfatto L, Bianchelli M, Mazzucco G, Campi MG, Malacarne D, Camposeragno D, Di Giorgio F, Canessa PA (COR Liguria, UO Epidemiology, IRCCS Az. Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy); Consonni D , Pesatori AC , Riboldi L (COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and University of Milan, Milano, Italy); Bressan V, Gioffrè, Ballarin M (COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy); Chermaz C, De Michieli P (COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy); Mangone L, Storchi C , Sala O (COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy); Badiali AM, Cacciarini V, Giovannetti L, Martini A(COR Tuscany, Cancer Prevention and Research Institute, Unit of Environmental and Occupational Epidemiology, Firenze, Italy); Grappasonni I(COR Marche, University of Camerino, Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, Camerino, Italy); Masanotti G, D’Alo’ D, Petrucci MS (COR Umbria, University of Perugia, Department of Hygiene and Public Health, Perugia, Italy); Davoli M, Forastiere F, Cavariani F, Ancona L (COR Lazio, University La Sapienza, Department of Experimental Medicine, Roma, Italy); Di Giammarco A (COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy); Menegozzo S, Canfora ML, Santoro M, Viscardi F, Brangi A, Cozza V (COR Campania, Second University of Naples, Department of Experimental Medicine, Napoli, Italy); Vimercati L (COR Puglia, University of Bari, Department of Interdisciplinary Medicine, Section of Occupational Medicine ’B.Ramazzini’' Bari, Italy); Lio SG (COR Calabria, Public Health Unit, Crotone, Italy); Cascone G, Frasca G, Giurdanella MC, Martorana C, Nicita C, Rollo P, Spata E, Dardanoni G, Scondotto S (COR Sicily, Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, Italy); Nieddu V, Pergola M, Stecchi S (COR Sardegna. Regional Epidemiological Centre, Cagliari, Italy).

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