Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy

Pleural mesothelioma risk by industry and occupation: results from the Multicentre Italian Study on the Etiology of Mesothelioma (MISEM)

BACKGROUND

The Italian mesothelioma registry (ReNaM) estimates mesothelioma incidence and addresses its etiology by assessing cases' exposures but cannot provide relative risk estimates.

OBJECTIVES

i) To estimate pleural mesothelioma relative risk by industry and occupation and by ReNaM categories of asbestos exposure; and ii) to provide quantitative estimates of the exposure-response relationship.

METHODS

A population-based mesothelioma case-control study was conducted in 2012-2014 in five Italian regions. Cases and age and gender frequency-matched controls were interviewed using a standard ReNaM questionnaire. Experts coded work histories according to international standard classifications of industries/occupations and assigned asbestos exposure according to ReNaM categories. Job codes were further linked to SYN-JEM, a quantitative job-exposure matrix. Cumulative exposure (CE, f/mL-years) was computed by summing individual exposures over lifetime work history. Unconditional logistic regression analyses adjusted by gender, centre and age were fitted to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Among men we observed increased risks of mesothelioma in many industries and associated occupations, including: asbestos-cement (OR = 3.43), manufacture of railroad equipment (OR = 8.07), shipbuilding and repairing (OR = 2.34), iron and steel mills (OR = 2.15), and construction (OR = 1.94). ORs by ReNaM exposure categories were as follows: definite/probable occupational exposure (OR = 15.8, men; OR = 8.80, women), possible occupational (OR = 2.82, men; OR = 3.70, women), sharing home with an exposed worker (OR = 2.55, men; OR = 10.3, women), residential (OR = 2.14, men; OR = 3.24, women). Based on SYN-JEM, mesothelioma risk increased by almost 30% per f/mL-year (OR = 1.28, CI 1.16-1.42).

CONCLUSIONS

Out study involved five regions with historically different types and levels of industrial development, encompassing one third of the Italian population and half of Italian mesothelioma cases. As expected, we found increased pleural mesothelioma risk in the asbestos industry and in trades with large consumption of asbestos materials. Clear associations were found using both qualitative (ReNaM classifications) and quantitative estimates (using SYN-JEM) of past asbestos exposure, with clear evidence of an exposure-response relationship.

Asbestos Exposure and Malignant Mesothelioma in Construction Workers-Epidemiological Remarks by the Italian National Mesothelioma Registry (ReNaM)

Notwithstanding the ban in 1992, asbestos exposure for workers in the construction sector in Italy remains a concern. The purpose of this study is to describe the characteristics of malignant mesothelioma (MM) cases recorded by the Italian registry (ReNaM) among construction workers. Incident mesothelioma cases with a definite asbestos exposure have been analyzed. Characteristics of cases and territorial clusters of crude rates of MM in construction workers have been described, as well as the relation between asbestos use before the ban and the historical trend of workforce in the construction sector in Italy. ReNaM has collected 31,572 incident MM cases in the period from 1993 to 2018 and asbestos exposure has been assessed for 24,864 (78.2%) cases. An occupational exposure has been reported for 17,191 MM cases (69.1% of subjects with a definite asbestos exposure). Among them, 3574 had worked in the construction sector, with an increasing trend from 15.8% in the 1993–98 period to 23.9% in 2014–2018 and a ubiquitous territorial distribution. The large use of asbestos in construction sector before the ban makes probability of exposure for workers a real concern still today, particularly for those working in maintenance and removal of old buildings. There is a clear need to assess, inform, and prevent asbestos exposure in this sector.

Health, Transport and the Environment: The Impacts of the COVID-19 Lockdown on Air Pollution

Lockdown measures were initiated in Italy on March 9th after the start of the SARS-CoV-2 epidemic to flatten the epidemic curve. The aim of the present study was to assess the impact of restrictive measures in the Apulia Region, southern Italy, on air quality from March to April 2020. We applied a dual-track approach. We assessed citizen mobility and vehicle traffic with mobility network data and information obtained from satellite tracking, and we evaluated and compared pollutant concentration data as measured by monitoring stations maintained by the Regional Agency for Environmental Protection and Prevention of Apulia (ARPA). The results showed a decrease in the weekly mean NO₂ concentration recorded by urban traffic stations during the lockdown period. In particular, in the city of Bari, the average NO₂ concentration decreased from 62.2 μg/m³ in March 2019 to 48.2 μg/m³ in March 2020. Regarding PM10 levels, the average concentrations at the individual traffic stations showed no particular variation compared to those in the same months of the previous year, except for Bari-Caldarola Station in March 2019/2020 (p-value < 0.001) and in April 2019/2020 (p-value = 0.04). In particular the average in March 2019 was ~26.9 μg/m³, while that in March 2020 was ~22.9 μg/m³. For April, the average concentration of PM10 in 2019 was 27.9 μg/m³, while in 2020, the average was ~22.4 μg/m³. This can be explained by the fact that PM10 levels are influenced by multiple variables such as weather and climate conditions and desert dust advections.

SARS-CoV-2 and Asbestos Exposure: Can Our Experience With Mesothelioma Patients Help Us Understand the Psychological Consequences of COVID-19 and Develop Interventions?

Since its emergence, the novel coronavirus disease of 2019 (COVID-19) has had enormous physical, social, and psychological impacts worldwide. The aim of this article was to identify elements of our knowledge on asbestos exposure and malignant mesothelioma (MM) that can provide insight into the psychological impact of the COVID-19 pandemic and be used to develop adequate interventions. Although the etiology of Covid-19 and MM differs, their psychological impacts have common characteristics: in both diseases, there is a feeling of being exposed through aerial contagion to an "invisible killer" without boundaries that can strike even the strongest individuals. In both cases, affected persons can experience personality dysfunction, anxiety, depression, and posttraumatic symptoms; helplessness, hopelessness, and projection of destructive thoughts onto external forces often emerge, while defense mechanisms such as denial, splitting, repression, and reduced emotional expression are used by individuals to contain their overwhelming anxieties. We believe that in both diseases, an integrated multidimensional intervention offered by hospitals and other public health services is the most effective approach to alleviating patients' and caregivers' psychological distress. In particular, we emphasize that in the context of both MM and COVID-19, Brief Psychoanalytic Group therapy can help patients and caregivers attribute meaning to the significant changes in their lives related to the experience of the disease and identify adaptive strategies and more realistic relational modalities to deal with what has happened to them. We also highlight the importance of developing a surveillance system that includes individual anamnestic evaluation of occupational risk factors for COVID-19 disease.

Association between Exposure to Ambient Air Pollution and Age-Related Cataract: A Nationwide Population-Based Retrospective Cohort Study

This study aimed to investigate the association between ambient air pollutants and cataracts in the general population aged 50 years or older using data from the Korean National Insurance Service-National Sample Cohort. Cataract patients were defined as those diagnosed by a physician and having undergone cataract surgery. After matching the average concentrations of PM2.5, PM10, NO2, CO, SO2, and O3 in residential areas, the association between quartile level of air pollutants and incidence of cataract was analyzed using a multivariate Cox-proportional hazard risk model. Among the 115,728 participants, 16,814 (14.5%) were newly diagnosed with cataract and underwent related surgery between 1 January 2004, and 31 December 2015. Exposure to PM10, NO2, and SO2 was positively associated with cataract incidence, while O3 was negatively associated. The adjusted hazard ratio (HR) with 95% confidence interval was 1.069 (1.025-1.115) in PM10 and 1.080 (1.030-1.133) in NO2. However, the association between cataract and the quartile of PM2.5 measured during one year in 2015 was not clear. The HR of female participants aged 65 or older was significantly increased according to quartile of air pollutants. We identified exposure to PM10, NO2, SO2, and O3 associated with cataract development in Korean adults aged ≥ 50 years. This information may be helpful for policymaking to control air pollution as a risk factor for eye health.

Multiplex Soluble Biomarker Analysis from Pleural Effusion

Malignant pleural mesothelioma (MPM) is a highly aggressive and therapy resistant pleural malignancy that is caused by asbestos exposure. MPM is associated with poor prognosis and a short patient survival. The survival time is strongly influenced by the subtype of the tumor. Dyspnea and accumulation of pleural effusion in the pleural cavity are common symptoms of MPM. The diagnostic distinction from other malignancies and reactive conditions is done using histopathology or cytopathology, always supported by immunohistochemistry, and sometimes also by analyses of soluble biomarkers in effusion supernatant. We evaluated the soluble angiogenesis related molecules as possible prognostic and diagnostic biomarkers for MPM by Luminex multiplex assay. Pleural effusion from 42 patients with malignant pleural mesothelioma (MPM), 36 patients with adenocarcinoma (AD) and 40 benign (BE) effusions were analyzed for 10 different analytes that, in previous studies, were associated with angiogenesis, consisting of Angiopoietin-1, HGF, MMP-7, Osteopontin, TIMP-1, Galectin, Mesothelin, NRG1-b1, Syndecan-1 (SDC-1) and VEGF by a Human Premixed Multi-Analyte Luminex kit. We found that shed SDC-1 and MMP-7 levels were significantly lower, whereas Mesothelin and Galectin-1 levels were significantly higher in malignant mesothelioma effusions, compared to adenocarcinoma. Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1, NRG1-β1, VEGF and TIMP-1 were significantly higher in malignant pleural mesothelioma effusions compared to benign samples. Moreover, there is a negative correlation between Mesothelin and shed SDC-1 and positive correlation between VEGF, Angiopoietin-1 and shed SDC-1 level in the pleural effusion from malignant cases. Shed SDC-1 and VEGF have a prognostic value in malignant mesothelioma patients. Collectively, our data suggest that MMP-7, shed SDC-1, Mesothelin and Galectin-1 can be diagnostic and VEGF and SDC-1 prognostic markers in MPM patients. Additionally, Galectin-1, HGF, Mesothelin, MMP-7, Osteopontin, shed SDC-1 and TIMP-1 can be diagnostic for malignant cases.

Biological Monitoring of Exposure to Benzene in Port Workers

Port workers are exposed to a wide range of occupational hazards that can cause injuries and occupational diseases. Among these, exposure to benzene is one of the most important but least studied. The highest occupational exposures for port workers occur during the filling and loading of gasoline, and cleaning of tanks and receptacles. The aim of the study was to evaluate occupational exposure to low levels of benzene by measuring trans,trans-muconic acid (t,t-MA) in urine samples from workers operating at fuelling stations in a tourist port of Southern Italy. The overall sample was composed of 43 port workers of a tourist port in Southern Italy. In 2018, each participant provided two (morning and evening) urine samples for the determination of urinary t,t-MA. Urinary excretion of t,t-MA was always higher at the end of the work shift than at the beginning with significant difference (p = 0.002). In smokers, median t,t-MA urinary excretion is higher than non-smokers both at the beginning (90.5 μg/g creatinine vs. 61.45 μg/g creatinine) and at the end of the work shift (128.2 μg/g creatinine vs. 89.5 μg/g creatinine). Urinary excretion of t,t-MA is higher at the end of the work shift than at the beginning in both smokers and non-smokers, but the difference is significantly higher in non-smokers (p = 0.003) than in smokers (p = 0.05). In conclusion, our results showed that the role of inhaled benzene at fuelling stations in a tourist port can be relevant. On the basis of these results and the known adverse effects of benzene on human health, we encourage the use of personal protective equipment in the fuelling area of ports in order to minimize exposure to benzene to workers.

Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory

The study describes a cluster of 71 malignant mesothelioma cases among Bari residents without asbestos exposure other than residential exposure. This small cohort, as expected, was composed of a majority of females (56.34%) with a M/F ratio of 0.8, ages ≤ 65 years old (52.11%) and the epithelioid morphological type (78.87%). Sixty-four subjects (90.14%) lived between 10 m and 1000 m from the asbestos cement factory (Fibronit), and the latency length was longer than 55 years for 25 subjects (35.21%). The adjusted risk (adjusted OR) of observing the epithelial form of mesothelioma among subjects living at small distances from Fibronit was high (OR = 1.870 (0.353-9.905)) for people living 550-1000 m from the site and for those living less than 550 m from the site (OR = 1.470 (0.262-8.248)). Additionally, the subjects with a high length of exposure showed a relevant risk of epithelioid mesothelioma both for 21-40 years of exposure (OR = 2.027 (0.521-7.890)) and more than 40 years of exposure (OR = 2.879 (0.651-12.736)). All of the estimates were high but not significant because this transitional study has a typically low power. The adjustment for latency showed the same trend. Using detailed information collected by the regional mesothelioma registry, this study provided evidence of a continuing health impact of the Fibronit asbestos cement factory in Bari on the resident population.

Environmental Monitoring of PAHs Exposure, Biomarkers and Vital Status in Coke Oven Workers

A follow-up study of a cohort of workers from a coke plant compared with a control group from the same industrial area was conducted in 2019. The recruitment and environmental and biomarker measurements were performed during 1993/1994. The environmental concentrations of polycyclic aromatic hydrocarbons (PAH), B(a)P, pyrene and nitro-PAH were measured. Personal data were collected via an individual semi-structured questionnaire by a trained physician. All biomarkers were measured after a specific blood drawing for every test. Significant risks (ORs) were observed for nitro-PAH (≥0.12 µg/m³) [OR = 7.96 (1.01–62.82)], urinary 1-hydroxypyrene (1-OHpy) (≥0.99 µmoles/moles of creatinine) [OR = 11.71 (1.47–92.90)], PAH DNA adducts (P³²) (≥2.69 adducts/10⁸ nucleotides) [OR = 5.46 (1.17–25.58)], total nitro-PAH hemoglobin adducts (≥161.68 fg/µg of Hb) [OR = 5.92 (1.26–27.86)], sister chromatid exchange (SCE) with TCR (≥377.84 SCE/cell chromosomes) [OR = 13.06 (3.95–93.10)], sister chromatid exchange with T (≥394.72 total SCE) [OR = 13.06 (3.95–93.10)], and sister chromatid exchange with X (≥8.19 mean SCE) [OR = 13.06 (3.95–93.10)]. Significant risk of death for all causes and chromosomal aberrations (48 h) (OR = 7.19 [1.19–43.44]) or micronuclei in culture at 48 h (OR = 3.86 [1.04–14.38]) were also found.