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.
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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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