Objective Asbestos is a known human carcinogen, with evidence for malignant mesothelioma (MM), cancers of lung, ovary, larynx and possibly other organs. MM rates are predicted to increase with a power of time since first exposure (TSFE), but the possible long-term attenuation of the trend is debated. The asbestos ban enforced in Italy in 1992 gives an opportunity to measure long-term cancer risk in formerly exposed workers.
Methods Pool of 43 previously studied Italian asbestos cohorts (asbestos cement, rolling stock, shipbuilding), with mortality follow-up updated to 2010. SMRs were computed for the 1970â€“2010 period, for the major causes, with consideration of duration and TSFE, using reference rates by age, sex, region and calendar period.
Results The study included 51 801 subjects (5741 women): 55.9% alive, 42.6% died (cause known for 95%) and 1.5% lost to follow-up. Mortality was significantly increased for all deaths (SMR: men: 1.05, 95% CI 1.03 to 1.06; women: 1.17, 95% CI to 1.12 to 1.22), all malignancies combined (SMR: men: 1.17, 95% CI to 1.14 to 1.20; women: 1.33, 95% CI 1.24 to 1.43), pleural and peritoneal malignancies (SMR: men: 13.28 and 4.77, 95% CI 12.24 to 14.37 and 4.00 to 5.64; women: 28.44 and 6.75, 95% CI 23.83 to 33.69 and 4.70 to 9.39), lung (SMR: men: 1.26, 95% CI 1.21 to 1.31; women: 1.43, 95% CI 1.13 to 1.78) and ovarian cancer (SMR=1.38, 95% CI 1.00 to 1.87) and asbestosis (SMR: men: 300.7, 95% CI 270.7 to 333.2; women: 389.6, 95% CI 290.1 to 512.3). Pleural cancer rate increased during the first 40 years of TSFE and reached a plateau after.
Discussion The study confirmed the increased risk for cancer of the lung, ovary, pleura and peritoneum but not of the larynx and the digestive tract. Pleural cancer mortality reached a plateau at long TSFE, coherently with recent reports.
- malignant mesothelioma
- occupational cancer
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Contributors DF: design of the study, design and conduct of data analysis and drafting of the article. EC, EM,VP, LM, GG, VB, LA, ER, FL, OS, CS, SM, EO, PP, AP, FC, SM, AB and MM: design of the study, conduct of the study and critical revision of the article. SS: overview of exposure information and critical revision of the article. PG: design of the study and of data analysis and critical revision of the article. ST: data analysis and critical revision of the article. FB-A: planning and overview of data analysis and critical revision of the article. TC and AR: data management, data analysis and critical revision of the article. PL: evaluation of exposure information and critical revision of the article. AM: design of the study, incidence data collection coordination, and critical revision of the article. DM: design of the study, evaluation of exposure information and critical revision of the article. RP: design of the study, overview of mortality data analyses and critical revision of the article. CM: PI of the study, overview of the study and critical revision of the article.
Funding National Institute of Health - Istituto Superiore di Sanità (ISS). Asbestos Project - Ricerca corrente 2012: Progetto Amianto.
Competing interests The following authors reported that they served as expert witness for the public prosecutor in court trials on asbestos related diseases: CM, EM, DM, EO, SS.
Ethics approval University of Eastern Piedmont Ethical Review Board (Authorization CE 112/13, 12 July, 2013).
Provenance and peer review Not commissioned; externally peer reviewed.
Collaborators M.N.Ballarin2, C. Brentisci5, B.Cortini1, S.Curti6, M.Gangemi5, F.Gioffrè2, L.Mangone4, F.Marinelli6, P.Marinilli3, C.Panato2, F.Roncaglia4, C.Storchi4, A.Stura5, M.Vicentini4, S.Verdi1, A.M. Nannavecchia7, L.Bisceglia8. (1)Occupational & Environmental Epidemiology Unit - Cancer Prevention and Research Institute (ISPO), Florence. (2)Mesothelioma Register of the Veneto Region, Local Health Unit. Padua. (3)Department of Public Health, Prevention and Security Area Work Environments, Local Health Authority, Bologna. (4)Inter-institutional Epidemiology Unit, AUSL ReggioEmilia and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia.(5)Unit of Cancer Epidemiology, CPO Piemonte and University of Turin, Turin.(6)Department Medical and Surgical Sciences, Universityof Bologna, and Unit of Occupational Medicine, S.Orsola-Malpighi University Hospital, Bologna. (7)Cancer Institute IRCCS Giovanni XXIII, Bari. (8)Regional Health Agency of Puglia, Bari.