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Original Article
Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure
  1. Daniela Ferrante1,
  2. Elisabetta Chellini2,
  3. Enzo Merler3,
  4. Venere Pavone4,
  5. Stefano Silvestri5,
  6. Lucia Miligi2,
  7. Giuseppe Gorini2,
  8. Vittoria Bressan3,
  9. Paolo Girardi3,
  10. Laura Ancona6,
  11. Elisa Romeo6,
  12. Ferdinando Luberto7,
  13. Orietta Sala8,
  14. Corrado Scarnato4,
  15. Simona Menegozzo9,
  16. Enrico Oddone10,
  17. Sara Tunesi1,11,
  18. Patrizia Perticaroli12,
  19. Aldo Pettinari12,
  20. Francesco Cuccaro13,
  21. Stefano Mattioli14,15,
  22. Antonio Baldassarre16,
  23. Francesco Barone-Adesi17,
  24. Tiziana Cena1,
  25. Patrizia Legittimo14,15,
  26. Alessandro Marinaccio18,
  27. Dario Mirabelli11,
  28. Marina Musti16,
  29. Roberta Pirastu19,
  30. Alessandra Ranucci1,
  31. Corrado Magnani1
  32. and the working group
  1. 1 Department of Translational Medicine, Unit of Medical Statistics and Epidemiology, University of Eastern Piedmont, and CPO-Piemonte, Novara, Italy
  2. 2 Occupational & Environmental Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy
  3. 3 Local Health Unit, Mesothelioma Register of the Veneto Region, Padua, Italy
  4. 4 Department of Public Health, Prevention and Security Area Work Environments, Local Health Authority, Bologna, Italy
  5. 5 Cancer Prevention and Research Institute (ISPO), Florence, Italy
  6. 6 Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
  7. 7 Inter-institutional Epidemiology Unit, AUSL Reggio Emilia and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
  8. 8 ARPAE Emilia Romagna, Sezione Provinciale di Reggio Emilia, Reggio Emilia, Italy
  9. 9 National Cancer Institute IRCCS Fondazione Pascale, Napoli, Italy
  10. 10 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
  11. 11 Unit of Cancer Epidemiology, CPO Piemonte and University of Turin, Turin, Italy
  12. 12 Prevention Department, ASUR Marche, Senigallia, Italy
  13. 13 Unit of Epidemiology and Statistics -Local Health Unit of Barletta-Andria-Trani, Barletta, Italy
  14. 14 Department Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  15. 15 Unit of Occupational Medicine, S.Orsola-Malpighi University Hospital, Bari, Italy
  16. 16 Interdisciplinary Department of Medicine, Occupational Medicine ’B. Ramazzini, University of Bari, Bari, Italy
  17. 17 Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
  18. 18 Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy
  19. 19 Department of Biology and Biotechnologies’Charles Darwin', Sapienza Rome University, Rome, Italy
  1. Correspondence to Prof Corrado Magnani, Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, Novara 28100, Italy; magnani{at}med.unipmn.it

Abstract

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 1970–2010 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.

  • asbestos
  • malignant mesothelioma
  • occupational cancer
  • pleura
  • peritoneum
  • ovary

https://doi.org/10.1136/oemed-2016-104100

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    Footnotes

    • 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.