title: Epidemiologic surveillance for primary prevention of malignant mesothelioma: the Italian experience.
abstract: 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.
authors.affiliation: ISPESL - National Institute for occupational safety and prevention, Occupational Medicine Department, Epidemiology Unit Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nesti
authors.forename: A
authors.initials: A
authors.lastname: Marinaccio
authors.forename: V
authors.initials: V
authors.lastname: Gennaro
authors.forename: G
authors.initials: G
authors.lastname: Gorini
authors.forename: D
authors.initials: D
authors.lastname: Mirabelli
authors.forename: Carolina
authors.initials: C
authors.lastname: Mensi
authors.forename: E
authors.initials: E
authors.lastname: Merler
authors.forename: F
authors.initials: F
authors.lastname: Montanaro
authors.forename: Marina
authors.initials: M
authors.lastname: Musti
authors.forename: F
authors.initials: F
authors.lastname: Pannelli
authors.forename: A
authors.initials: A
authors.lastname: Romanelli
authors.forename: R
authors.initials: R
authors.lastname: Tumino
mesh_terms: 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
chemical_list: D002273:Carcinogens; D001194:Asbestos