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. 2017 Dec;74(12):887-898.
doi: 10.1136/oemed-2016-104100. Epub 2017 Aug 3.

Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure

Daniela Ferrante  1 , Elisabetta Chellini  2 , Enzo Merler  3 , Venere Pavone  4 , Stefano Silvestri  5 , Lucia Miligi  2 , Giuseppe Gorini  2 , Vittoria Bressan  3 , Paolo Girardi  3 , Laura Ancona  6 , Elisa Romeo  6 , Ferdinando Luberto  7 , Orietta Sala  8 , Corrado Scarnato  4 , Simona Menegozzo  9 , Enrico Oddone  10 , Sara Tunesi  1   11 , Patrizia Perticaroli  12 , Aldo Pettinari  12 , Francesco Cuccaro  13 , Stefano Mattioli  14   15 , Antonio Baldassarre  16 , Francesco Barone-Adesi  17 , Tiziana Cena  1 , Patrizia Legittimo  14   15 , Alessandro Marinaccio  18 , Dario Mirabelli  11 , Marina Musti  16 , Roberta Pirastu  19 , Alessandra Ranucci  1 , Corrado Magnani  1 ; the working group
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Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure

Daniela Ferrante et al. Occup Environ Med. 2017 Dec.

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 1970â€"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.

Keywords: asbestos; malignant mesothelioma; occupational cancer; ovary; peritoneum; pleura.

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Conflict of interest statement

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.

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