III Italian Consensus Conference on Malignant Mesothelioma of the Pleura. Epidemiology, Public Health and Occupational Medicine related issues

Main Article Content

Corrado Magnani
Claudio Bianchi
Elisabetta Chellini
Dario Consonni
Bice Fubini
Valerio Gennaro
Alessandro Marinaccio
Massimo Menegozzo
Dario Mirabelli
Enzo Merler
Franco Merletti
Marina Musti
Enrico Oddone
Antonio Romanelli
Benedetto Terracini
Amerigo Zona
Carlo Zocchetti
Mariano Alessi
Antonio Baldassarre
Irma Dianzani
Milena Maule
Carolina Mensi
Stefano Silvestri

Keywords

Mesothelioma, pleura, asbestos

Abstract

The III Italian Consensus Conference on Pleural Mesothelioma (MM) convened on January 29th 2015. This report presents the conclusions of the ‘Epidemiology, Public Health and Occupational Medicine’ section. MM incidence in 2011 in Italy was 3.64 per 100,000 person/years in men and 1.32 in women. Incidence trends are starting to level off. Ten percent of cases are due to non-occupational exposure. Incidence among women is very high in Italy, because of both non-occupational and occupational exposure. The removal of asbestos in place is proceeding slowly, with remaining exposure. Recent literature confirms the causal role of chrysotile. Fibrous fluoro-edenite was classified as carcinogenic by IARC (Group 1) on the basis of MM data. A specific type (MWCNT-7) of Carbon Nanotubes was classified 2B. For pleural MM, after about 45 years since first exposure, the incidence trend slowed down; with more studies needed. Cumulative exposure is a proxy of the relevant exposure, but does not allow to distinguish if duration or intensity may possibly play a prominent role, neither to evaluate the temporal sequence of exposures. Studies showed that duration and intensity are independent determinants of MM. Blood related MM are less than 2.5%. The role of BAP1 germline mutations is limited to the BAP1 cancer syndrome, but negligible for sporadic cases. Correct MM diagnosis is baseline; guidelines agree on the importance of the tumor gross appearance and of the hematoxylin-eosin-based histology. Immunohistochemical markers contribute to diagnostic confirmation: the selection depends on morphology, location, and differential diagnosis. The WG suggested that 1) General Cancer Registries and ReNaM Regional Operational Centres (COR) interact and systematically compare MM cases; 2) ReNaM should report results presenting the diagnostic certainty codes and the diagnostic basis, separately; 3) General Cancer Registries and COR should interact with pathologists to assure the up-to-date methodology; 4) Necroscopy should be practiced for validation. Expert referral centres could contribute to the definition of uncertain cases. Health surveillance should aim to all asbestos effects. No diagnostic test is recommended for MM screening. Health surveillance should provide information on risks, medical perspective, and smoking cessation. The economic burden associated to MM was estimated in 250,000 Euro per case.
Abstract 502 | PDF Downloads 99

References

1. Ascoli V, Cavone D, Merler E et al. Mesothelioma in Blood Related Subjects: Report of 11 Clusters Among 1954 Italy Cases and Review of the Literature. Am J Ind Med. 2007; 50:357-369
2. Ascoli V, Romeo E, Carnovale Scalzo C, et al. Familial malignant mesothelioma: a population-based study in central Italy (1980-2012).Cancer Epidemiol. 2014;38:273-8
3. Berry G. Relative risk and acceleration in lung cancer. Statist Med 2007;26:3511-7
4. Betti M, Casalone E, Ferrante D, et al. Inference on germline BAP1 mutations and asbestos exposure from the analysis of familial and sporadic mesothelioma in a high-risk area. Genes Chromosomes Cancer. 2015;54:51-62.
5. Cadby G, Mukherjee S, Musk AW, et al. A genome-wide association study for malignant mesothelioma risk. Lung Cancer. 2013;82:1-8.
6. Checkoway H, Pearce N, Kriebel D. Research methods in occupational epidemiology, Second Edition. Oxford University Press 2004. pp. 163-167
7. de Klerk N, Alfonso H, Olsen N, et al. Familial aggregation of malignant mesothelioma in former workers and residents of Wittenoom, Western Australia. Int J Cancer. 2013;132:1423-8.
8. Esteban D, Whelan S, Laudico A and Parkin DM (Eds). Manual for Cancer Registry Personnel. IARC Technical Report No. 10, Lyon 1995. In: http://www.iarc.fr/en/publications/pdfs-online/treport-pub/treport-pub10/index.php
9. Grosse Y, Loomis D, Guyton KZ et al. Carcinogenicity of fluoro-edenite, silicon carbide fibres and whiskers, and carbon nanotubes. Lancet Oncol 2014; 15: 1427-1428
10. IARC International Agency for Research on Cancer (IARC). Arsenic, metals, fibres, and dusts. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt C):11-465
11. Iavicoli S, Buresti G, Colonna F, et al. Economic burden of Mesothelioma in Italy. Communication at International Conference on Monitoring and Surveillance of Asbestos-related diseases 2014, Helsinki, 11-13 February 2014. Book of proceedings, abstract.