title: Modeling mesothelioma risk associated with environmental asbestos exposure.
abstract: BACKGROUND
  Environmental asbestos pollution can cause malignant mesothelioma, but few studies have involved dose-response analyses with detailed information on occupational, domestic, and environmental exposures.
  
  
  OBJECTIVE
  In the present study, we examined the spatial variation of mesothelioma risk in an area with high levels of asbestos pollution from an industrial plant, adjusting for occupational and domestic exposures.
  
  
  METHODS
  This population-based case-control study included 103 incident cases of mesothelioma and 272 controls in 1987-1993 in the area around Casale Monferrato, Italy, where an important asbestos cement plant had been active for decades. Information collected included lifelong occupational and residential histories. Mesothelioma risk was estimated through logistic regression and a mixed additive-multiplicative model in which an additive scale was assumed for the risk associated with both residential distance from the plant and occupational exposures. The adjusted excess risk gradient by residential distance was modeled as an exponential decay with a threshold.
  
  
  RESULTS
  Residents at the location of the asbestos cement factory had a relative risk for mesothelioma of 10.5 [95% confidence interval (CI), 3.8-50.1), adjusted for occupational and domestic exposures. Risk decreased rapidly with increasing distance from the factory, but at 10-km the risk was still 60% of its value at the source. The relative risk for occupational exposure was 6.0 (95% CI, 2.9-13.0), but this increased to 27.5 (95% CI, 7.8-153.4) when adjusted for residential distance.
  
  
  CONCLUSIONS
  This study provides strong evidence that asbestos pollution from an industrial source greatly increases mesothelioma risk. Furthermore, relative risks from occupational exposure were underestimated and were markedly increased when adjusted for residential distance.
authors.affiliation: Cancer Epidemiology Unit, CeRMS and CPO Piemonte, University of Turin, Turin, Italy. milena.maule@unito.it
authors.forename: Milena Maria
authors.initials: MM
authors.lastname: Maule
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
authors.forename: Paola
authors.initials: P
authors.lastname: Dalmasso
authors.forename: Dario
authors.initials: D
authors.lastname: Mirabelli
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Annibale
authors.initials: A
authors.lastname: Biggeri
mesh_terms: D001194:Asbestos / Q000633:toxicity*; D016022:Case-Control Studies; D004781:Environmental Exposure; D006801:Humans; D008654:Mesothelioma / Q000139:chemically induced*; D008962:Models, Theoretical; D018570:Risk Assessment
chemical_list: D001194:Asbestos