Fabio Montanaro

Pleural mesothelioma incidence in Europe: Evidence of some deceleration in the increasing trends

Objective: To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries. Material and methods: The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents. Truncated age-standardized rates per 100,000 for the ages 40–74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986–1990 and 1991–1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988–1997) were compared with trends in the previous decade. Fitted rates in younger (40–64) and older adults (65–74) in the most recent period were also compared. Results: There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings. Conclusions: While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.

Survival of peritoneal malignant mesothelioma in Italy: a population-based study.

In some population‐based studies, a shorter median survival was observed in peritoneal as compared with pleural, malignant mesothelioma, but in others, longer median survival times or higher proportions of long‐term survivors were reported. Statistical instability could have caused these differences. We analyzed survival in peritoneal mesothelioma in a large and unselected population‐based case series. Cases (338) registered from 1990 to 2001 by 9 Italian regional mesothelioma registries contributing to the network of the National Mesothelioma Registry were followed until December 31, 2005. Univariate (Kaplan‐Meier) and multivariate (Cox proportional hazards regression) analyses of survival were performed according to selected individual characteristics, including limited treatment information in a subset of 194 cases. The results were compared with those obtained in a parallel study on pleural mesothelioma cases. Epithelioid histotype, younger age at diagnosis and, to a lesser degree, gender (women), and being diagnosed in a hospital with a thoracic surgery unit positively and significantly affected survival. The effect of treatment was positive but not statistically significant. No trend in the risk of death according to calendar period of diagnosis was present. Peritoneal mesothelioma cases had shorter median survival time than pleural cases, but a larger proportion of long‐term survivors. Survival patterns after peritoneal and pleural mesothelioma differed markedly. Treatment was not associated with a statistically significant improvement in survival, but our study included cases first diagnosed before the introduction of the most recent therapeutic approaches. This provides a large historical comparison for future studies on survival trends at the population level.

Predictions of mortality from pleural mesothelioma in Italy: A model based on asbestos consumption figures supports results from age-period-cohort models

Italy was the second main asbestos producer in Europe, after the Soviet Union, until the end of the 1980s, and raw asbestos was imported on a large scale until 1992. The Italian pattern of asbestos consumption lags on average about 10 years behind the United States, Australia, the United Kingdom and the Nordic countries. Measures to reduce exposure were introduced in the mid‐1970s in some workplaces. In 1986, limitations were imposed on the use of crocidolite and in 1992 asbestos was definitively banned. We have used primary pleural cancer mortality figures (1970–1999) to predict mortality from mesothelioma among Italian men in the next 30 years by age‐cohort‐period models and by a model based on asbestos consumption figures. The pleural cancer/mesothelioma ratio and mesothelioma misdiagnosis in the past were taken into account in the analysis. Estimated risks of birth cohorts born after 1945 decrease less quickly in Italy than in other Western countries. The findings predict a peak with about 800 mesothelioma annual deaths in the period 2012–2024. Results estimated using age‐period‐cohort models were similar to those obtained from the asbestos consumption model.

Mesothelioma and lung tumors attributable to asbestos among petroleum workers

BACKGROUND Asbestos exposure has been definitively found to be associated with both mesothelioma and lung cancer. Nevertheless, in the overall population of oil refinery workers potentially exposed to asbestos, many studies clearly show a definitely increased risk of mesothelioma, but no proven excess of lung cancer after comparison to the general population. Through the presentation of new data and the re-appraisal of two recent and independent epidemiological studies conducted in Liguria, Italy, and Ontario, Canada, we attempt to shed light on this apparently paradoxical finding. METHODS Lung cancer mortality was studied among maintenance workers exposed to asbestos, and among two other subgroups of refinery employees: blue collar and white collar workers. The comparison with blue collar workers was performed in order to take into account the role of healthy worker effect, smoking habit, and the socioeconomic level. The comparison with white collar workers was performed to control for other occupational lung carcinogens. RESULTS AND CONCLUSIONS Results reveal a consistency between the two studies and show that 96-100% of the mesotheliomas and 42-49% of the lung tumors arising among maintenance workers were attributable to asbestos exposure. Our new analysis, estimating two cases of asbestos-related lung cancer for each case of mesothelioma, confirms published findings on the magnitude of asbestos-related tumors in oil refineries.

Reanalysis of updated mortality among vinyl and polyvinyl chloride workers: Confirmation of historical evidence and new findings

BackgroundThe production of vinyl chloride (VC) and polyvinyl chloride (PVC) involves the use of various chemicals, some known to be toxic and potentially or definitely carcinogenic. The related potential risk often has not been properly investigated. Updated cancer mortality among different subgroups of workers employed in a VC-PVC production plant located in Porto Marghera (Italy) was re-analyzed using an internal reference group of workers with low (or null) exposure to VC.MethodsMortality of 1658 male workers was analyzed by Poisson regression. Relative risks (RRs) and 95% confidence intervals (CIs) for blue collar workers and their specific subgroups of PVC baggers, PVC compound, autoclave and other blue collar workers were calculated using technicians and clerks as an internal reference group. The follow-up covered the period 1972–1999.ResultsSignificantly increased mortality rates were observed for all causes of death among the whole blue collar workforce (RR = 1.55; 95% CI = 1.03–2.35; 229 deaths), PVC baggers (1.72; 95% CI = 1.04–2.83; 49 deaths) and PVC compound workers (1.71; 95% CI = 1.09–2.67; 72 deaths). Liver cancer, including angiosarcoma, was increased among autoclave workers (9.57; 95% CI = 3.71–24.68; 7 deaths) and cardiovascular diseases among PVC baggers (2.25; 95% CI = 1.08–4.70; 12 deaths). Hemolymphopoietic system tumors, leukemias and lymphomas prevalently, were found only among exposed workers, with 4, 4 and 6 deaths observed among PVC baggers, PVC compound and other blue collar workers, respectively. An excess of lung cancer was found among PVC baggers.ConclusionThis cohort analysis, based on internal comparison, confirmed previously reported specific risk excesses for liver tumors and liver cirrhosis among autoclave workers and for lung cancer among PVC baggers, and revealed PVC compound workers as a possible new at risk group for all causes, all tumors and for liver and lung tumors. In conclusion, RRs for all causes of death and all tumors were increased among all blue collar workers.

Serum anti-p53 autoantibodies in pleural malignant mesothelioma, lung cancer and non-neoplastic lung diseases.

Alterations of the p53 gene may lead to the production of detectable autoantibodies (p53-Abs) in cancer patients. In order to evaluate the association of p53-Abs with pleuropulmonary diseases, four groups of subjects were analyzed by ELISA for serum p53-Abs, in the framework of a molecular epidemiologic study. Two of 30 pleural malignant mesothelioma patients (MM; 6.7%) and 8/48 lung cancer patients (LC; 16.7%) were seropositive, while all 51 healthy controls (HC) were negative. Two of 55 (3.6%) at-risk controls (RC) with non-malignant respiratory diseases were positive and were not subsequently diagnosed any cancer. The difference was statistically significant between LC and RC or HC (P = 0.01), but not between MM and any other group. No correlation was found with age, sex, cancer stage or histology, cigarette smoking or occupational exposure. A longer survival (not significant) was shown in seropositive LC but not in MM. p53 expression in tumor tissue was also evaluated in a subgroup of MM. In conclusion, the presence of detectable p53-Abs in serum was associated in a statistically significant proportion of cases with LC but only occasionally with MM. The longer survival among positive LC patients and the presence of two seropositive among patients with non-neoplastic respiratory diseases should be further investigated.

Asbestos Exposure and Cancer Mortality among Petroleum Refinery Workers: A Poisson Regression Analysis of Updated Data

The authors investigated the relationship between asbestos exposure and respiratory cancer mortality among maintenance workers and other blue-collar workers at an Italian oil refinery. The cohort contained 931 men, 29,511 person-years, and 489 deaths. Poisson regression analysis using white-collar workers as an internal referent group provided relative risk estimates (RRs) for main causes of death, adjusted for age, age at hiring, calendar period, length of exposure, and latency. Among maintenance workers, RRs for all tumors (RR = 1.50), digestive system cancers (RR = 1.41), lung cancers (RR = 1.53), and nonmalignant respiratory diseases (RR = 1.71) were significantly increased (p 0.05); no significant excess was found for all causes and among maintenance (RR = 1.12) and other blue-collar workers (RR - 1.01). Results confirm the increased risk of death from respiratory diseases and cancer among maintenance workers exposed to asbestos, whereas other smoking-related diseases (circulatory system) were not statistically different among groups.

Risk of leukaemia and residential exposure to air pollution in an industrial area in Northern Italy: a case-control study

Leukaemia risk in adult populations exposed to environmental air pollution is poorly investigated. We have carried out a population-based case-control study in an area that included a fossil fuel power plant, a coke oven and two big chemical industries. Information on residential history and several risk factors for leukaemia was obtained from 164 cases, diagnosed between 2002 and 2005, and 279 controls. A higher risk for subjects residing in polluted areas was observed, but statistical significance was not reached (adjusted OR = 1.11 and 1.56 for subjects living in moderately and in heavily polluted zones, respectively, p = 0.190). Results suggest a possible aetiological role of residential air pollution from industrial sites on the risk of developing leukaemia in adult populations. However, the proportion of eligible subjects excluded from the study and the lack of any measure of air pollution prevent definitive conclusions from being drawn.