Alessandro Marinaccio1, Alessandra Binazzi1, Michela Bonafede1, Marisa Corfiati1, Davide Di Marzio1, Alberto Scarselli1, Marina Verardo2, Dario Mirabelli3, Valerio Gennaro4, Carolina Mensi5, Gert Schallemberg6, Enzo Merler7, Corrado Negro8, Antonio Romanelli9, Elisabetta Chellini10, Stefano Silvestri10, Mario Cocchioni11, Cristiana Pascucci11, Fabrizio Stracci12, Valeria Ascoli13, Luana Trafficante14, Italo Angelillo15, Marina Musti16, Domenica Cavone16, Gabriella Cauzillo17, Federico Tallarigo18, Rosario Tumino19, Massimo Melis20. 1. 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. 2. Valle d'Aosta Health Local Unit, Regional Operating Centre of Valle d'Aosta (COR Valle d'Aosta), Aosta, Italy. 3. COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy. 4. COR Liguria, UO Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy. 5. COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy. 6. COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy. 7. COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy. 8. Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste-Trieste General Hospitals, Trieste, Italy. 9. COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy. 10. Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Florence, Italy. 11. Environmental and Health Sciences Department, COR Marche, University of Camerino, Hygiene, Camerino, Italy. 12. Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy. 13. Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy. 14. COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy. 15. Department of Experimental Medicine, COR Campania, Second University of Naples, Naples, Italy. 16. Department of Internal Medicine and Public Medicine, Section of Occupational Medicine ''B.Ramazzini'', COR Puglia, University of Bari, Bari, Italy. 17. COR Basilicata, Epidemiologic Regional Centre, Potenza, Italy. 18. COR Calabria, Public Health Unit, Crotone, Italy. 19. Ragusa Cancer Register Unit, COR Sicily, 'Civile-M.P. Arezzo' Hospital, Ragusa, Italy. 20. COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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