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Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues
  1. Alessandro Marinaccio1,
  2. Alessandra Binazzi1,
  3. Michela Bonafede1,
  4. Marisa Corfiati1,
  5. Davide Di Marzio1,
  6. Alberto Scarselli1,
  7. Marina Verardo2,
  8. Dario Mirabelli3,
  9. Valerio Gennaro4,
  10. Carolina Mensi5,
  11. Gert Schallemberg6,
  12. Enzo Merler7,
  13. Corrado Negro8,
  14. Antonio Romanelli9,
  15. Elisabetta Chellini10,
  16. Stefano Silvestri10,
  17. Mario Cocchioni11,
  18. Cristiana Pascucci11,
  19. Fabrizio Stracci12,
  20. Valeria Ascoli13,
  21. Luana Trafficante14,
  22. Italo Angelillo15,
  23. Marina Musti16,
  24. Domenica Cavone16,
  25. Gabriella Cauzillo17,
  26. Federico Tallarigo18,
  27. Rosario Tumino19,
  28. Massimo Melis20,
  29. ReNaM Working Group
    1. 1Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, 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 Azienda 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, Milan, Italy
    6. 6COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy
    7. 7COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy
    8. 8Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste—Trieste General Hospitals, Trieste, Italy
    9. 9COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy
    10. 10Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Florence, Italy
    11. 11Environmental and Health Sciences Department, COR Marche, University of Camerino, Hygiene, Camerino, Italy
    12. 12Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy
    13. 13Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy
    14. 14COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy
    15. 15Department of Experimental Medicine, COR Campania, Second University of Naples, Naples, Italy
    16. 16Department of Internal Medicine and Public Medicine, Section of Occupational Medicine ‘‘B.Ramazzini’’, COR Puglia, University of Bari, Bari, Italy
    17. 17COR Basilicata, Epidemiologic Regional Centre, Potenza, Italy
    18. 18COR Calabria, Public Health Unit, Crotone, Italy
    19. 19Ragusa Cancer Register Unit, COR Sicily, ‘Civile—M.P. Arezzo’ Hospital, Ragusa, Italy
    20. 20COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy
    1. Correspondence to Dr Alessandro Marinaccio, Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Via Stefano Gradi 55, Rome 00143, Italy; a.marinaccio{at}


    Introduction Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160 000 tons/year. The National Register of Mesotheliomas (ReNaM, “Registro Nazionale dei Mesoteliomi” in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure.

    Methods The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases.

    Results Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100 000) for men and 1.45 for women, respectively. Among the 15 845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12 065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily).

    Conclusions Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos.

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