Epidemiologic surveillance for primary prevention of malignant mesothelioma: the Italian experience.
BACKGROUND
The Italian National Mesothelioma Registry (ReNaM) was set up at the National Institute for Occupational Safety and Health (ISPESL) to estimate Italian incidence of malignant mesothelioma (MM), define modalities of asbestos exposures, assess impact and diffusion of MM, identify underestimated sources of environmental contamination.


OBJECTIVE
To describe ReNaM activity, database dimension and epidemiological characteristics of the caselist.


METHODS
Regional Operating Centers (COR) in 16 Italian regions were set up to identify and investigate all cases of MM diagnosed in each region, applying national guidelines. COR collect cases in health care institutions. Occupational history, lifestyle and residence are obtained by direct interview using a standard questionnaire. Exposure modalities are classified by industrial hygienists, evaluating whether work, private life or any particular environmental condition could have involved asbestos exposure.


RESULTS
Data refer to 3,446 cases collected in 9 Italian regions during 1993-2001. Pleural mesothelioma affected 94% cases, pleural/peritoneal ratio was 16:1. Gender ratio (M/F) was 2.7:1 (1.3:1 for peritoneum). There was a variety of occupational exposures, some already known as high risk sectors and others unexpected. The most common exposures occurred in building and construction, metallurgy and steel, shipbuilding, and railway stock. High risk categories were encountered such as bricklayers, plumbers, carpenters, electricians, welders, installers and maintenance workers in metallurgy and the steel industry, general labourers, tool makers and painters in shipbuilding/repair/demolition.


CONCLUSIONS
Despite some ReNam's limitations, identification of MM cases and analysis of modality of exposure, with standardized criteria, are a fundamental tool for primary prevention of asbestos related diseases.
Nesti
M
M
ISPESL - National Institute for occupational safety and prevention, Occupational Medicine Department, Epidemiology Unit Rome, Italy.
Marinaccio
A
A
Gennaro
V
V
Gorini
G
G
Mirabelli
D
D
Mensi
Carolina
C
Merler
E
E
Montanaro
F
F
Musti
Marina
M
Pannelli
F
F
Romanelli
A
A
Tumino
R
R
D001194:Asbestos / Q000009:adverse effects; D002273:Carcinogens / Q000633:toxicity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016273:Occupational Exposure / Q000009:adverse effects; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D002273:Carcinogens; D001194:Asbestos