title: Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues.
abstract: BACKGROUND
  Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160,000 tons/year. The National Register of Mesotheliomas (ReNaM, "Registro Nazionale dei Mesoteliomi" in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure.
  
  
  METHODS
  The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases.
  
  
  RESULTS
  Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100,000) for men and 1.45 for women, respectively. Among the 15,845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12,065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily).
  
  
  CONCLUSIONS
  Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos.
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marinaccio
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Binazzi
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Bonafede
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Corfiati
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Di Marzio
authors.affiliation: Italian Workers' Compensation Authority (INAIL), Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Unit of Occupational and Environmental Epidemiology, Italian Mesothelioma Register, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Scarselli
authors.affiliation: Valle d'Aosta Health Local Unit, Regional Operating Centre of Valle d'Aosta (COR Valle d'Aosta), Aosta, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Verardo
authors.affiliation: COR Piedmont, Unit of Cancer Prevention, University of Turin and CPO-Piemonte, Torino, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Mirabelli
authors.affiliation: COR Liguria, UO Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST), Genova, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Gennaro
authors.affiliation: COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and University of Milan, Milan, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Mensi
authors.affiliation: COR Province of Trento, Provincial Unit of Health, Hygiene and Occupational Medicine, Trento, Italy.
authors.forename: Gert
authors.initials: G
authors.lastname: Schallemberg
authors.affiliation: COR Veneto, Occupational Health Unit, Department of Prevention, Padua, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Merler
authors.affiliation: Clinical Unit of Occupational Medicine, COR Friuli-Venezia Giulia, University of Trieste-Trieste General Hospitals, Trieste, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Negro
authors.affiliation: COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romanelli
authors.affiliation: Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Chellini
authors.affiliation: Unit of Environmental and Occupational Epidemiology, COR Tuscany, Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Silvestri
authors.affiliation: Environmental and Health Sciences Department, COR Marche, University of Camerino, Hygiene, Camerino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cocchioni
authors.affiliation: Environmental and Health Sciences Department, COR Marche, University of Camerino, Hygiene, Camerino, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Pascucci
authors.affiliation: Department of Hygiene and Public Health, COR Umbria, University of Perugia, Perugia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stracci
authors.affiliation: Department of Experimental Medicine, COR Lazio, University La Sapienza, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Ascoli
authors.affiliation: COR Abruzzo, Health Local Unit, Occupational Medicine Unit, Pescara, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Trafficante
authors.affiliation: Department of Experimental Medicine, COR Campania, Second University of Naples, Naples, Italy.
authors.forename: Italo
authors.initials: I
authors.lastname: Angelillo
authors.affiliation: Department of Internal Medicine and Public Medicine, Section of Occupational Medicine ''B.Ramazzini'', COR Puglia, University of Bari, Bari, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Musti
authors.affiliation: Department of Internal Medicine and Public Medicine, Section of Occupational Medicine ''B.Ramazzini'', COR Puglia, University of Bari, Bari, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Cavone
authors.affiliation: COR Basilicata, Epidemiologic Regional Centre, Potenza, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cauzillo
authors.affiliation: COR Calabria, Public Health Unit, Crotone, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Tallarigo
authors.affiliation: Ragusa Cancer Register Unit, COR Sicily, 'Civile-M.P. Arezzo' Hospital, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: COR Sardegna, Regional Epidemiological Centre, Cagliari, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Melis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000209:etiology*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance; D011634:Public Health; D012737:Sex Factors; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D001194:Asbestos