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Impact of an asbestos cement factory on mesothelioma incidence in a community in Italy

Abstract Background Broni is a small town (9000 inhabitants) in the province of Pavia, Lombardy, north-west Italy, where the second largest Italian asbestos cement factory (Fibronit) was in operation between 1932 and 1993. Based on Lombardy Mesothelioma Registry (RML) data (2000–2011), we previously showed a high impact of asbestos exposure on malignant mesothelioma (MM) incidence among Fibronit workers, their families, and people living in Broni and in the nearby town of Stradella (11,000 residents). Given the great concern of the community, we have recently updated the data regarding 5 more years (2012–2016). Methods From the RML database we extracted subjects who ever worked in Fibronit, their family members, ever residents in Broni, and subjects living in Stradella and nearby towns at the time of diagnosis. For each type of exposure we calculated standardized incidence ratios (SIR = observed/expected cases). Results In the period 2000–2016 we registered 56 cases (2.52 expected, SIR = 22.2), 49 men (41 pleural, 8 peritoneal MM), 7 women (5 pleural, 2 peritoneal MM) with past occupational exposure in Fibronit. Among subjects never occupationally exposed and never exposed to extra-occupational sources unrelated to Fibronit, we counted 39 cases (4.24 expected, SIR = 9.2), 10 men (all pleural MM), 29 women (28 pleural, 1 peritoneal MM) in Fibronit workers' families, 91 pleural mesothelioma cases (7.43 expected, SIR = 12.2, 31 men, 60 women), ever residents in Broni, and 25 pleural mesothelioma cases (3.05 expected, SIR = 8.2, 6 men, 19 women) living in Stradella at the time of diagnosis. The overall number of excess cases was about 194 (211 against 17.24 expected). In the remaining adjacent (No. 8) and surrounding (No. 17) municipalities (32,000 people) there were 7 cases (1 men, 6 women, 8.85 expected). Conclusion The mesothelioma burden related to the asbestos cement factory is still high on factory workers, their families, and residents in Broni and Stradella towns

ITINERARIO TERAPÉUTICO INFORMADO POR FAMILIARES DE PERSONAS CON MESOTELIOMA: ESTUDIOS DE CASOS MÚLTIPLES

ABSTRACT Objective: to describe the therapeutic itinerary revealed by the relatives of individuals with mesothelioma. Method: a multiple case study with a qualitative approach. Six family members of the cases occurred in the state of Paraná (Brazil). Data was collected from medical records and interviews between January and July 2016 and submitted to comparative and content analysis, supported by the Health Care System framework. Results: seven categories emerged from the data: Acknowledgment of the illness; Popular care and the attempt to escape from the illness; The popular subsystem directs to the professional subsystem; Professional subsystem: unraveling the mystery of the disease; Family: care supremacy; Religion: hope and encouragement; and Disease due to mesothelioma from the perspective of the family member. Conclusion: the therapeutic itinerary was built from early symptoms detection and common sense practices. The family was the central unit of care; the professional subsystem, with the challenge of diagnosing the disease, and religion, which represented the person's and family members' hope. Studying the topic can contribute to improve the planning of the health actions promoted to individuals with mesothelioma, from the diagnosis process, treatment to death

Asbestos Exposure in Patients with Malignant Pleural Mesothelioma included in the PRIMATE Study, Lombardy, Italy

The PRIMATE study is an Italian translational research project, which aims to identify personalized biomarkers associated with clinical characteristics of malignant pleural mesothelioma (MPM). For this purpose, characteristics of MPM patients with different degrees of asbestos exposure will be compared to identify somatic mutations, germline polymorphism, and blood inflammatory biomarkers. In this framework, we assessed exposure to asbestos for 562 cases of MPM extracted from the Lombardy region Mesothelioma Registry (RML), for which a complete interview based on a standardized national questionnaire and histopathological specimens were available. Exposure assessment was performed: (1) through experts' evaluation (considered as the gold standard for the purpose of this study), according to the guidelines of the Italian National Mesothelioma Registry (ReNaM) and (2) using a job-exposure matrix (SYN-JEM) to obtain qualitative (ever/never) and quantitative estimates of occupational asbestos exposure (cumulative exposure expressed in fibers per mL (f/mL)). The performance of SYN-JEM was evaluated against the experts' evaluation. According to experts' evaluation, occupational asbestos exposure was recognized in 73.6% of men and 23.6% of women; furthermore, 29 men (7.8%) and 70 women (36.9%) had non-occupational exposure to asbestos. When applying SYN-JEM, 225 men (60.5%) and 25 women (13.2%) were classified as occupationally exposed, with a median cumulative exposure higher for men (1.7 f/mL-years) than for women (1.2 f/mL-years). The concordance between the two methods (Cohen’s kappa) for occupational exposure assessment was 0.46 overall (0.41 in men, and 0.07 in women). Sensitivity was higher in men (0.73) than in women (0.18), while specificity was higher in women (0.88) than in men (0.74). Overall, both methods can be used to reconstruct past occupational exposure to asbestos, each with its own advantages and limitations. View Full-Tex

Uma proposta de criação de um sistema para monitoramento dos casos de mesotelioma maligno em Curitiba, Paraná, Brasil

Este estudo objetivou propor a criação de um sistema de monitoramento dos casos de mesotelioma maligno no Município de Curitiba, Paraná, Brasil, desenvolvido com base no modelo italiano. Trata-se de uma pesquisa-ação tipo diagnóstica, que utiliza as fases exploratória e de planejamento, desenvolvida no período de julho de 2015 a maio de 2017. Utilizaram-se como ferramentas de busca os seguintes instrumentos: Integrador de Registro Hospitalar de Câncer, com as morfologias específicas para mesotelioma; Registro Hospitalar de Câncer, com os códigos C38.4 e C45, da Classificação Internacional de Doenças, 10ª revisão, e/ou registros codificados pelo CID-O, com as topografias C38 e C48; Registro de Câncer de base populacional da Secretaria Municipal de Saúde de Curitiba, com os mesmos códigos. Também foram conhecidos, analisados e adaptados para a realidade brasileira o modelo, os questionários e o software de registro de mesotelioma da Lombardia, na Itália. Observou-se que, no Integrador de Registro Hospitalar de Câncer, foram registrados 15 casos de mesotelioma. No Registro Hospitalar de Câncer do hospital universitário, foram dois. No hospital oncológico, 16. Os dados do Registro de Câncer de Base Populacional, por sua vez, indicaram 317 registros relativos ao período. Apesar de algumas informações estarem mais completas, existe a falta de dados relacionados à história laboral, impossibilitando estabelecer o nexo causal. Com o aumento do número de casos de mesotelioma previstos para as próximas décadas e o atendimento às demandas legais, a implantação de registros torna-se essencial para auxiliar no conhecimento, no acompanhamento, na determinação de nexo causal e nas fontes de contaminação específicas no país

MONITORAMENTO DO MESOTELIOMA NO SUL DO BRASIL: UMA REALIDADE AINDA A SER ESTUDADA

Brazil is one of the world’s greatest producers of chrysotile, but the occurrence of mesothelioma is apparently low. However, identification of cases of mesothelioma is difficult due to errors of diagnosis and registries of deaths. This is an epidemiological, descriptive and retrospective study of hospital records of Brazil’s National Institute of Cancer (INCA). Records of pleural cancer or mesothelioma histology from the 2001-2014 period were selected. We identified 208 records, but only 58 cases of mesothelioma histology. Notably, 13 (22%) had been incorrectly coded as lung cancer. In half the cases, there was no registration of the latest occupations of the patients. We conclude that hospital data on mesothelioma is still imprecise and was incorrectly coded. Besides, the registries do not include information on the workplace and occupation. These findings confirm the need for a proper registry of cases of mesothelioma.O Brasil é um dos maiores produtores de crisotila do mundo, mas a ocorrência de mesotelioma é aparentemente baixa. No entanto, a identificação dos casos torna-se difícil por causa de erros de diagnóstico e registro de morte. Este é um estudo epidemiológico, descritivo e retrospectivo de registros hospitalares do Instituto Nacional de Câncer do Brasil, foram selecionados registros câncer de pleura ou histologia do mesotelioma entre 2001-2014. Foram identificados 208 registros, entretanto apenas 58 casos com histologia de mesotelioma. Notavelmente, 13 (22%) tinham sido codificados incorretamente como câncer de pulmão. A última atividade laboral estava ausente em metade dos casos. Concluiu-se que os dados hospitalares existentes em relação ao mesotelioma ainda são inadequados por imprecisão e codificação errônea. Além disso, nos registros ainda não existem informações do local de trabalho, bem como da ocupação. Estes achados confirmam a necessidade de um registro de casos de mesotelioma.Mientras se apunta que Brasil es un de los mayores productores de crisotila en el mundo, la ocurrencia de mesotelioma es aparentemente baja. Sin embargo, la identificación de los casos es dificil a causa de errores de diagnóstico y registro de muerte. Este es un estudio epidemiológico, descriptivo y retrospectivo de registros hospitalarios del Instituto Nacional de Cáncer de Brasil. Fueron seleccionados registros de cáncer de pleura o histología del mesotelioma entre 2001 y 2014. Se identificaron 208 registros, pero solamente 58 casos con histología de mesotelioma. Se constató que 13 (22%) fueron codificados de modo incorrecto como cáncer de pulmón. La última actividad laboral no estaba presente en mitad de los casos. Se concluye que los datos hospitalarios existentes acerca del mesotelioma todavía son inadecuados por imprecisión y codificación errónea. Además, en los registros no hay informaciones del local de trabajo, así como de la ocupación del paciente. Estos hallados confirman la necesidad de un registro de casos de mesotelioma