The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos

Abstract

Asbestos (all forms, including chrysotile, crocidolite, amosite, tremolite, actinolite, and anthophyllite) is carcinogenic to humans and causally associated with mesothelioma and cancer of the lung, larynx, and ovary. It is one of the carcinogens most diffuse in the world, in workplaces, but also in the environment and is responsible for a very high global cancer burden. A large number of countries, mostly with high-income economies, has banned the use of asbestos which, however, is still widespread in low- and middle-income countries. It remains, thus, one of the most common occupational and environmental carcinogens worldwide. Italy issued an asbestos ban in 1992, following the dramatic observation of a large increase in mortality from mesothelioma and other asbestos-related diseases in exposed workers and also in subjects with non-occupational exposure. A mesothelioma registry was also organized and still monitors the occurrence of mesothelioma cases, conducting a case-by-case evaluation of asbestos exposure. In this report, we describe two Italian communities, Casale Monferrato and Broni, that faced an epidemic of mesothelioma resulting from the production of asbestos cement and the diffuse environmental exposure; we present the activity and results of the Italian mesothelioma registry (ReNaM), describe the risk-communication activities at the local and national level with a focus on international cooperation and also describe the interaction between mesothelioma registration and medical services specialized in mesothelioma diagnosis and treatment in an area at high risk of mesothelioma. Finally, we assess the potential application of the solutions and methods already developed in Italy in a city in Colombia with high mesothelioma incidence associated with the production of asbestos-cement materials and the presence of diffuse environmental asbestos pollution.

The Brazilian System for Monitoring Workers and General Population Exposed to Asbestos: Development, Challenges, and Opportunities for Workers’ Health Surveillance

“…Its gradual construction should prioritize regions where asbestos facilities or mines have operated and where the health systems are the strongest and more developed. Then, successful local experiences could be improved, shared, and replicated in other regions [21].…”

“…For this to happen, dedicated staff and coordination between health services involved in a patient's diagnosis and treatment are essential. An adequate risk mitigation strategy, based on long-lasting multidisciplinary plans and periodic updates, can help guide and increase awareness of affected communities, decision-makers, victims' organizations, and trade unions [21].…”

Utilizing residential histories to assess environmental exposure and socioeconomic status over the life course among mesothelioma patients

“…Workplace asbestos exposure is the dominant contributor to mesothelioma, though para-occupational (or take-home) exposure and environmental exposure to asbestos (e.g., residing in close proximity to asbestos sources) also play a critical role of mesothelioma development ( 5 - 9 ). Studies from mesothelioma registries in many countries have been instrumental in providing rich information, including specifically residential histories, to understand the impact of asbestos exposure at scale, and to investigate known and unknown asbestos exposure sources ( 8 , 10 - 12 ). A considerable portion (14–59%) of the mesothelioma cases lacks an identifiable source of asbestos exposure ( 13 ).…”

“…However, methodological and practical issues such as small sample size and recall bias have proven to be significant challenges ( 17 ). Some researchers were able to take advantage of the comprehensive national-level cancer registry and population health databases to obtain partial or complete residential history information ( 7 , 8 , 12 , 31 - 33 ), while others have used non-street-level address geographic information [e.g., coarse geography such as a county or zone improvement plan (ZIP) code] to estimate residential mobility ( 34 - 36 ).…”