articolo scientifico
Epidemiol Prev 2020; 44 (1): 23-30
DOI: https://doi.org/10.19191/EP20.1.P023.014

The epidemiological surveillance of malignant mesothelioma in Italy (1993-2015): methods, findings, and research perspectives

La sorveglianza epidemiologica dei casi di mesotelioma maligno in Italia (1993-2015): metodi, risultati e prospettive di ricerca

  • Alessandro Marinaccio1

  • Marisa Corfiati1

  • Alessandra Binazzi1

  • Davide Di Marzio1

  • Michela Bonafede1

  • Marina Verardo2

  • Enrica Migliore3

  • Valerio Gennaro4

  • Carolina Mensi5

  • Gert Schallemberg6

  • Guido Mazzoleni7

  • Ugo Fedeli8

  • Corrado Negro9

  • Antonio Romanelli10

  • Elisabetta Chellini11

  • Iolanda Grappasonni12

  • Cristiana Pascucci12

  • Gabriella Madeo13

  • Elisa Romeo14

  • Luana Trafficante15

  • Francesco Carrozza16

  • Italo Francesco Angelillo17

  • Domenica Cavone18

  • Gabriella Cauzillo19

  • Federico Tallarigo20

  • Rosario Tumino21

  • Massimo Melis22

  • ReNaM Working Group23

  1. Department of occupational and environmental medicine, epidemiology and hygiene, Italian Workers Compensation Authority (Inail), Roma (Italy)
  2. Regional Operating Center of Valle d’Aosta, Valle d’Aosta Local Health Unit, Aosta (Italy)
  3. Regional Operating Center of Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Turin (Italy)
  4. Regional Operating Center of Liguria, Operative unit of Epidemiology, IRCCS University Hospital San Martino, National Cancer Research Institute (IST), Genoa (Italy)
  5. Regional Operating Center of Lombrady, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico and University of Milan, Milan (Italy)
  6. Regional Operating Center of the Province of Trento, Provincial Unit of Health, hygiene and occupational medicine, Trento (Italy)
  7. Regional Operating Center of the Province of Bolzano, Alto Adige Local Health Unit, Bolzano (Italy)
  8. Regional Operating Center of Veneto, Epidemiological Department, Azienda Zero, Padua (Italy)
  9. Regional Operating Center of Friuli Venezia Giulia, University of Trieste, Clinical Unit of Occupational Medicine, Trieste General Hospitals, Trieste (Italy)
  10. Regional Operating Center of Emilia-Romagna, Public Health Department, Local Health Unit, Reggio Emilia (Italy)
  11. Regional Operating Center of Tuscany, Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute, Florence (Italy)
  12. Regional Operating Center of Marche, Hygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health, University of Camerino, Camerino (Italy)
  13. Regional Operating Center of Umbria, Department of Experimental Medicine, Public Health section, University of Perugia, Perugia (Italy)
  14. Regional Operating Center of Lazio, Department of Epidemiology, Lazio Region, Rome (Italy)
  15. Regional Operating Center of Abruzzo, Occupational Medicine Unit, Local Health Unit, Pescara (Italy)
  16. Regional Operating Center of Molise, Oncology Unit, Cardarelli Hospital, Campobasso (Italy)
  17. Regional Operating Center of Campania, Department of Experimental Medicine, Second University of Naples, Naples (Italy)
  18. Regional Operating Center of Puglia, Department of Interdisciplinary Medicine, Section of Occupational Medicine “B. Ramazzini”, University of Bari, Bari (Italy)
  19. Regional Operating Center of Basilicata, Epidemiological Regional Center, Potenza (Italy)
  20. Regional Operating Center of Calabria, Public Health Unit, Crotone (Italy)
  21. Regional Operating Center of Sicily, Cancer Registry, Provincial Health Department of Ragusa and Sicily Regional Epidemiological Observatory, Ragusa (Italy)
  22. Regional Operating Center of Sardegna, Regional Epidemiological Center, Cagliari (Italy)
  23. ReNaM Working Group
Alessandro Marinaccio -

Cosa si sapeva già

  • Italy is one of the most sensitive Country in asbestos-related diseases control, because of the large asbestos consumption until the ban in 1992.
  • In Italy, a national epidemiological surveillance system of mesothelioma cases has been established; regional registries actively search mesothelioma cases and investigate the modality of exposure to asbestos.

Cosa si aggiunge di nuovo

  • Italy is one of the most sensitive Country in asbestos-related diseases control, because of the large asbestos consumption until the ban in 1992.
  • In Italy, a national epidemiological surveillance system of mesothelioma cases has been established; regional registries actively search mesothelioma cases and investigate the modality of exposure to asbestos.

Riassunto:

BACKGROUND: as a legacy of the large asbestos consumption until the definitive ban in 1992, Italy had to tackle a real epidemic of asbestos related diseases. The Italian National Registry of Malignant Mesotheliomas (ReNaM) is a permanent surveillance system of mesothelioma incidence, with a regional structure. Aims, assignments and territorial network of ReNaM are described, as well as data collection, recording and coding procedures.
OBJECTIVES: to describe the Italian epidemiological surveillance system of mesothelioma incidence, to provide updated data about occurrence of malignant mesothelioma in Italy, and to discuss goals, attainments, and expectations of registering occupational cancer.
DESIGN: analysis of data by malignant mesothelioma incident cases surveillance system.
SETTING AND PARTICIPANTS: Italy, network of regional surveillance system, all Italian regions.
MAIN OUTCOME MEASURES
: a Regional Operating Centre (COR) is currently established in all the Italian regions, actively searching incident malignant mesothelioma cases from health care institutions. Occupational history, lifestyle habits, and residential history are obtained using a standardized questionnaire, administered to the subject or to the next of kin by a trained interviewer. The extent of dataset, epidemiological parameters, and occupations involved are report-ed updated at 31.12.2016, and standardized incidence rates are calculated.
RESULTS: at December 2016, ReNaM has collected 27,356 malignant mesothelioma cases, referring to the period of incidence between 1993 and 2015. The modalities of exposure to asbestos have been investigated for 21,387 (78%) and an occupational exposure has been defined for around 70% of defined cases (14,818).
CONCLUSIONS: the Italian experience shows that epidemiological systematic surveillance of asbestos related diseases incidence has a key importance for assessing and monitoring the public health impact of occupational and/or environmental hazards, programming preventive interventions, including remediation plans and information campaigns, and supporting the efficiency of insurance and welfare system. Monitoring the incidence of malignant mesothelioma through a specialized cancer registry is essential to follow-up the health effects of changing modalities and extent of occupational exposures over years and of environmental contamination. Such consolidated surveillance system is recommended also for occupational cancers with low aetiological fraction.

Abstract:

INTRODUZIONE: in ragione dei rilevanti consumi di amianto dal secondo dopoguerra fino al bando del 1992, l’Italia è oggi uno dei Paesi maggiormente colpiti dall’epidemia di malattie amianto correlate.
OBIETTIVI
: lo scopo di questo contributo è di descrivere l’attività di sorveglianza epidemiologica dei casi incidenti di mesotelioma maligno svolta dal Registro nazionale dei mesoteliomi, di fornire un quadro aggiornato dell’occorrenza della malattia nel nostro Paese e di discutere i possibili sviluppi del sistema.
DISEGNO
: analisi dei dati di un sistema nazionale di sorveglianzadei casi incidenti di mesotelioma maligno.
SETTING E PARTECIPANTI
: Italia, tutte le regioni.
PRINCIPALI MISURE DI OUTCOME
: in ogni regione d’Italia è attivo un Centro operativo (COR) per la rilevazione e la ricerca attiva dei casi incidenti di mesotelioma, su base di popolazione e a partire dalle strutture di diagnosi, ricovero e cura. Le modalità di esposizione sono definite tramite un questionario strutturato che indaga la storia professionale, residenziale e familiare del soggetto ammalato somministrato al soggetto o a un parente da parte di un intervistatore formato. Sono stati stimati i tassi standardizzati di incidenza e i più rilevanti parametri epidemiologici.
RISULTATI
: con riferimento al periodo di incidenza 1993-2015, sono state trasmesse al Registro nazionale informazioni relative a 27.336 casi di mesotelioma maligno. Le modalità di esposizione ad amianto sono state investigate per 21.387 casi, pari al 78% dei casi registrati. È stata definita un’esposizione di natura occupazionale per 14.818 casi pari al 69% dei casi analizzati per l’esposizione.
CONCLUSIONI: l’esperienza italiana di sorveglianza epidemiologica dei casi incidenti di mesotelioma mostra la rilevanza di questo strumento per la programmazione sanitaria, la prevenzione di eventuali ancora possibili rischi di esposizione ad amianto nei luoghi di vita e di lavoro, l’efficienza del sistema di tutele e di assicurazione dei lavoratori. È auspicabile che l’esperienza di azione integrata fra enti centrali e regioni per la sorveglianza epidemiologica dei mesoteliomi si estenda all’insieme delle neoplasie di sospetta origine professionale.


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