title: Epidemiologic surveillance of mesothelioma in Umbria.
abstract: BACKGROUND
  Malignant mesothelioma (MM) is becoming a prominent health issue due to its low survival and for its increasing incidence in various countries. The objectives of this study were to evaluate epidemiological characteristics and trends of MM in the Umbrian Region for the period 2003-2013.
  
  
  METHODS
  All cases of MM reported to Umbrian Population Cancer Registry between 2003 and 2013. Incidence Annual Standardized Rates (ASRs) were analyzed for all histological types of MM. Estimated Annual Percent Change (APC) and joinpoint regression analysis were used to out light the time trend of MM. Geographical distribution of the relative risk for each municipality was calculated by Standardized Incidence Ratios SIRs.
  
  
  RESULTS
  191 (156 males) MM cases were recorded in Umbrian residents in the period 2003-2013. Pleural mesothelioma affected 92.1% of the total. Gender ratio M/F was 5.9:1. ASRs for MM was 3.2 among men and 0.6 among women. Joinpoint analysis showed a decrease in females APC -8.4 (95% IC -33.7-26.6) and an increase in males APC 5.8 (95% IC -0.9-13.0). An occupational exposure was identified in 43.7% of females and in 90.7% of males.
  
  
  CONCLUSIONS
  The protracted cancer latency and the continued asbestos existence as environmental contaminant in existing buildings, as well as a carcinogenic risk for the workers involved in removing operations of material containing asbestos justifies the investment in a specific surveillance system. Also important would be to implement a national risk communication strategy addressed to the general population, environment surveillance of the high risk areas and guarantee that all workers involved that even may deal with asbestos are always fully equipped and trained, not only for their individual risk but also for the potential risk of non correct disposal.
authors.affiliation: Umbria Regional center of the National mesothelioma registry (ReNaM), Unit of Public Health, Department of Experimental Medicine, University of Perugia, Italy.
authors.forename: Maria Saba
authors.initials: MS
authors.lastname: Petrucci
authors.affiliation: School of Specialization in Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: De Lio
authors.affiliation: Local Health Agency of Umbria (ASL 1), Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: D'Alò
authors.affiliation: Umbria Regional center of the National mesothelioma registry (ReNaM), Unit of Public Health, Department of Experimental Medicine, University of Perugia, Italy - School of Specialization in Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stracci
authors.affiliation: Umbria Regional center of the National mesothelioma registry (ReNaM), Unit of Public Health, Department of Experimental Medicine, University of Perugia, Italy - School of Specialization in Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Italy.
authors.forename: Giuseppe Michele
authors.initials: GM
authors.lastname: Masanotti
mesh_terms: D001194:Asbestos / Q000009:adverse effects; D002273:Carcinogens / Q000633:toxicity; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D016273:Occupational Exposure / Q000009:adverse effects; D010997:Pleural Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012044:Regression Analysis; D012737:Sex Factors
chemical_list: D002273:Carcinogens; D001194:Asbestos
keywords: Incidence; Mesothelioma; Registry; Umbria