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. 2015 Apr 15:15:286.
doi: 10.1186/s12885-015-1301-2.

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry

Marisa Corfiati  1 , Alberto Scarselli  2 , Alessandra Binazzi  3 , Davide Di Marzio  4 , Marina Verardo  5 , Dario Mirabelli  6 , Valerio Gennaro  7 , Carolina Mensi  8 , Gert Schallemberg  9 , Enzo Merler  10 , Corrado Negro  11 , Antonio Romanelli  12 , Elisabetta Chellini  13 , Stefano Silvestri  14 , Mario Cocchioni  15 , Cristiana Pascucci  16 , Fabrizio Stracci  17 , Elisa Romeo  18 , Luana Trafficante  19 , Italo Angelillo  20 , Simona Menegozzo  21 , Marina Musti  22 , Domenica Cavone  23 , Gabriella Cauzillo  24 , Federico Tallarigo  25 , Rosario Tumino  26 , Massimo Melis  27 , Sergio Iavicoli  28 , Alessandro Marinaccio  29 ; ReNaM Working Group
Collaborators, Affiliations

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry

Marisa Corfiati et al. BMC Cancer. .

Abstract

Background: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM).

Methods: In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster.

Results: Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters.

Conclusions: Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs.

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Figures

Figure 1
Figure 1
Identified clusters of malignant mesothelioma cases in the Northwest, Italy, ReNaM, 1993–2008. Smoothed relative risk (RR) estimates of incident cases of mesothelioma (all sites) recorded by the Italian registry of malignant mesothelioma (ReNaM) in the 1993–2008 period are mapped based on municipality of residence. Only municipalities with RR higher than 1 are shown in the figure and color-coded. Cluster labels refer to the municipality with the highest number of cases.
Figure 2
Figure 2
Identified clusters of malignant mesothelioma cases in the Northeast, Italy, ReNaM, 1993–2008. Smoothed relative risk (RR) estimates of incident cases of mesothelioma (all sites) recorded by the Italian registry of malignant mesothelioma (ReNaM) in the 1993–2008 period are mapped based on municipality of residence. No incidence data are available for autonomous province of Bolzano. Only municipalities with RR higher than 1 are shown in the figure and color-coded. Cluster labels refer to the municipality with the highest number of cases.
Figure 3
Figure 3
Identified clusters of malignant mesothelioma cases in the Centre, Italy, ReNaM, 1993–2008. Smoothed relative risk (RR) estimates of incident cases of mesothelioma (all sites) recorded by the Italian registry of malignant mesothelioma (ReNaM) in the 1993–2008 period are mapped based on municipality of residence. Only municipalities with RR higher than 1 are shown in the figure and color-coded. Cluster labels refer to the municipality with the highest number of cases.
Figure 4
Figure 4
Identified clusters of malignant mesothelioma cases in South & Islands, Italy, ReNaM, 1993–2008. Smoothed relative risk (RR) estimates of incident cases of mesothelioma (all sites) recorded by the Italian registry of malignant mesothelioma (ReNaM) in the 1993–2008 period are mapped based on municipality of residence. No incidence data are available for Molise, Calabria and Sardinia (not shown). Only municipalities with RR higher than 1 are shown in the figure and color-coded. Cluster labels refer to the municipality with the highest number of cases.
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