[Methodology and results of an experience of medical surveillance of people previously exposed to asbestos in Tuscany].

Although medical surveillance of workers previously exposed to asbestos has been made mandatory by several laws since 1991 (recently confirmed by the law 81/08), neither the subject encharged of it nor the medical protocols have been yet established. In the absence of a specific regulation different medical protocols have been proposed by several centers often with no respect of ethical or radioprotectionist principles, such as some screening programs exclusively based on radiologic exams. With the aim of setting up a secondary preventive health program according both to a correct ethical and economic cost-effective balance, we followed up a cohort of 647 workers. The medical protocol included a physical exam, functional respiratory tests, thoracic Xray and low dose CT scans along with some experimental biologic markers such as mesothelin and osteopontin. All the mentioned tests were periodically administered to asbestos workers according to the individual level of risk. This risk-modulated preventive medical protocol allowed us to diagnose respiratory diseases in up to 39% of the investigated population, 2/3 of which were classified as asbestos-related occupational diseases. In conclusion our data suggest that the integration of different kind of exams, with limited use of radiology, is effective in the medical follow-up of asbestos-exposed workers. Regional health politics should begin to take into account this reported evidence.