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Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register
  1. Alessandro Marinaccio1,
  2. Alessandra Binazzi1,
  3. Davide Di Marzio1,
  4. Alberto Scarselli1,
  5. Marina Verardo2,
  6. Dario Mirabelli3,
  7. Valerio Gennaro4,
  8. Carolina Mensi5,
  9. Enzo Merler6,
  10. Renata De Zotti7,
  11. Lucia Mangone8,
  12. Elisabetta Chellini9,
  13. Cristiana Pascucci10,
  14. Valeria Ascoli11,
  15. Simona Menegozzo12,
  16. Domenica Cavone13,
  17. Gabriella Cauzillo14,
  18. Carmela Nicita15,
  19. Massimo Melis16,
  20. Sergio Iavicoli1
  1. 1Epidemiology Unit, Occupational Medicine Department, Italian National Institute for Occupational Safety and Prevention, Rome, Italy
  2. 2Valle d'Aosta Regional Operating Center (COR Valle d'Aosta), Valle d'Aosta Health Local Unit, Aosta, Italy
  3. 3COR Piedmont, Cancer Prevention Unit, University of Turin and S. Giovanni Battista Hospital, Turin, Italy
  4. 4COR Liguria, Epidemiology and Prevention Department, National Cancer Research Institute (IST), Genoa, Italy
  5. 5COR Lombardy, Department of Occupational and Environmental Health, Fondazione IRCCS Policlinico, Mangiagalli, Regina Elena and University of Milan, Milan, Italy
  6. 6COR Veneto, Padua Health Local Unit, Padua, Italy
  7. 7COR Friuli-Venezia Giulia, University of Trieste -Trieste General Hospitals, Clinical Unit for Occupational Medicine, Trieste, Italy
  8. 8COR Emilia-Romagna, Local Health Unit, Public Health Department, Reggio Emilia, Italy
  9. 9COR Tuscany, Institute for Cancer Study and Prevention, Epidemiology Unit, Florence, Italy
  10. 10COR Marche, University of Camerino, Hygiene, Environmental and Health Sciences Department, Camerino, Italy
  11. 11COR Lazio, University La Sapienza, Department of Experimental Medicine, Rome, Italy
  12. 12COR Campania, II University of Naples, Experimental Medicine Department, Naples, Italy
  13. 13COR Puglia, University of Bari, Department of Internal Medicine and Public Medicine, Occupational Medicine ‘‘B. Ramazzini’’ Section, Bari, Italy
  14. 14COR Basilicata, Regional Epidemiology Center, Potenza, Italy
  15. 15COR Sicily, ‘‘Civile - M.P. Arezzo’’ Hospital, Ragusa Cancer Registry Unit, Ragusa, Italy
  16. 16COR Sardegna, Regional Epidemiology Center, Cagliari, Italy
  1. Correspondence to Alessandro Marinaccio, Epidemiology Unit, Department of Occupational Medicine, ISPESL (Italian National Institute for Occupational Safety and Prevention), Via Alessandria 220/E, 00198 Rome, Italy; alessandro.marinaccio{at}


Objectives The epidemiology of extrapleural malignant mesothelioma is rarely discussed and the risk of misdiagnosis and the very low incidence complicate the picture. This study presents data on extrapleural malignant mesothelioma from the Italian National Mesothelioma Register (ReNaM).

Methods ReNaM works on a regional basis, searching for cases and interviewing subjects to investigate asbestos exposure. Classification and code criteria for certainty of diagnosis and exposure modalities are set by national guidelines. Between 1993 and 2004, 681 cases were collected. Incidence measures and exposure data refer to the ReNaM database. Age-standardised rates were estimated by the direct method using the Italian resident population in 2001. Correlations between the incidence of pleural and non-pleural malignant mesothelioma for the 103 Italian provinces were analysed.

Results Standardised incidence rates (Italy, 2004, per million inhabitants) were 2.1 and 1.2 cases for the peritoneal site (in men and women, respectively), 0.2 cases for the tunica vaginalis testis, and 0.1 in the pericardial site, varying widely in different parts of the country. Mean age at diagnosis for all extrapleural malignant mesothelioma cases was 64.4 years and the men/women ratio was 1.57:1. Median latency was over 40 years for all extrapleural sites combined. The correlation between pleural and peritoneal mesothelioma was 0.71 (Pearson's r coefficient, p<0.001). Modalities of exposure to asbestos fibres were investigated for 392 cases.

Conclusions The rarity of the disease, the low specificity of diagnosis and difficulties in identifying the modalities of asbestos exposure call for caution in discussing aetiological factors other than asbestos.

  • Asbestos
  • mesothelioma
  • peritoneal
  • pericardial
  • testis
  • national register
  • Italy
  • epidemiology
  • public health

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  • Competing interests None.

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