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

C Magnani1, C Bianchi, E Chellini

  • 1Dipartimento di Medicina Traslazionale - Università del Piemonte Orientale. corrado.magnani@med.unipmn.it.

La Medicina Del Lavoro
|September 19, 2015
PubMed

Insights

Pleural mesothelioma (MM) incidence is leveling off in Italy, with non-occupational exposure contributing to cases, especially in women. Asbestos removal is slow, and chrysotile remains a confirmed cause of MM.

Area of Science:

  • Epidemiology and Public Health
  • Occupational Medicine
  • Environmental Carcinogenesis

Background:

  • Pleural mesothelioma (MM) incidence trends in Italy show a leveling off, with specific figures for men (3.64/100,000) and women (1.32/100,000) in 2011.
  • Non-occupational exposure accounts for 10% of MM cases, with a notably high incidence in women attributed to both occupational and non-occupational factors.
  • Continued slow removal of asbestos in place indicates ongoing exposure risks.

Framework:

  • Recent literature confirms chrysotile asbestos as a causal agent for MM.
  • Fibrous fluoro-edenite is classified as a Group 1 carcinogen (IARC), and MWCNT-7 Carbon Nanotubes as Group 2B, based on MM data.
  • The latency period for pleural MM is approximately 45 years post-exposure, with incidence trends slowing thereafter, necessitating further research.

Implementation:

  • Both exposure duration and intensity are identified as independent determinants of MM risk.
  • Genetic factors, such as BAP1 germline mutations, are relevant for BAP1 cancer syndrome but not significant for sporadic MM cases.
  • Accurate diagnosis relies on gross tumor appearance, hematoxylin-eosin histology, and specific immunohistochemical markers, guided by morphology and differential diagnosis.

Implications:

  • Recommendations include enhanced collaboration between Cancer Registries and the National Mesothelioma Registry (ReNaM) for systematic case comparison and reporting.
  • Pathologist engagement is crucial for updating diagnostic methodologies, with necroscopy suggested for validation.
  • Health surveillance should encompass all asbestos-related effects, emphasizing risk communication, medical guidance, and smoking cessation; no MM screening tests are recommended.

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