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      The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure

      1 , 1 , 1 , 1 , 1 , 1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 8 , 9 , 9 , 10 , 11 , 12 , 13 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 1 , ReNaM Working Group
      Occupational and Environmental Medicine
      BMJ Publishing Group
      mesothelioma, asbestos, gender

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          The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register.


          Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated.


          In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries.


          The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

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          Most cited references31

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          Malignant mesothelioma: global incidence and relationship with asbestos.

          Mesothelioma incidence varies markedly from one country to another. The highest annual crude incidence rates (about 30 cases per million) are observed in Australia, Belgium, and Great Britain. A lot of data indicate a relationship between mesothelioma and asbestos. The hot areas for mesothelioma exactly correspond to the sites of industries with high asbestos use, such as shipbuilding and asbestos-cement industry. However, in many countries with high asbestos consumption, mesothelioma incidence is low. The reasons for this fact are not clear. The latency periods elapsing between first exposure to asbestos and development of mesothelioma are mostly longer than 40 yr. An inverse relationship exists between intensity of asbestos exposure and length of the latency period. Mesothelioma generally develops after long-time exposures to asbestos. Some recent studies show that the risk increases with the duration of exposure. Possible co-factors in the pathogenesis of asbestos-related mesothelioma include genetic predisposition, diets poor in fruit and vegetables, viruses, immune impairment, recurrent serosal inflammation. The study of co-morbidity in mesothelioma could give an insight into the pathogenesis of the tumor. While a levelling-off in mesothelioma incidence has been registered in some countries, a worsening of the epidemic is predictable in large parts of the world.
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            Global Magnitude of Reported and Unreported Mesothelioma

            Background Little is known about the global magnitude of mesothelioma. In particular, many developing countries, including some with extensive historical use of asbestos, do not report mesothelioma. Objectives We estimated the global magnitude of mesothelioma accounting for reported and unreported cases. Methods For all countries with available data on mesothelioma frequency and asbestos use (n = 56), we calculated the 15-year cumulative number of mesotheliomas during 1994–2008 from data available for fewer years and assessed its relationship with levels of cumulative asbestos use during 1920–1970. We used this relationship to predict the number of unreported mesotheliomas in countries for which no information on mesothelioma is available but which have recorded asbestos use (n = 33). Results Within the group of 56 countries with data on mesothelioma occurrence and asbestos use, the 15-year cumulative number of mesothelioma was approximately 174,300. There was a statistically significant positive linear relation between the log-transformed national cumulative mesothelioma numbers and the log-transformed cumulative asbestos use (adjusted R 2 = 0.83, p < 0.0001). Extrapolated to the group of 33 countries without reported mesothelioma, a total of approximately 38,900 (95% confidence interval, 36,700–41,100) mesothelioma cases were estimated to have occurred in the 15-year period (1994–2008). Conclusions We estimate conservatively that, globally, one mesothelioma case has been overlooked for every four to five reported cases. Because our estimation is based on asbestos use until 1970, the many countries that increased asbestos use since then should anticipate a higher disease burden in the immediate decades ahead.
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              Occupational, domestic and environmental mesothelioma risks in the British population: a case–control study

              We obtained lifetime occupational and residential histories by telephone interview with 622 mesothelioma patients (512 men, 110 women) and 1420 population controls. Odds ratios (ORs) were converted to lifetime risk (LR) estimates for Britons born in the 1940s. Male ORs (95% confidence interval (CI)) relative to low-risk occupations for >10 years of exposure before the age of 30 years were 50.0 (25.8–96.8) for carpenters (LR 1 in 17), 17.1 (10.3–28.3) for plumbers, electricians and painters, 7.0 (3.2–15.2) for other construction workers, 15.3 (9.0–26.2) for other recognised high-risk occupations and 5.2 (3.1–8.5) in other industries where asbestos may be encountered. The LR was similar in apparently unexposed men and women (∼1 in 1000), and this was approximately doubled in exposed workers' relatives (OR 2.0, 95% CI 1.3–3.2). No other environmental hazards were identified. In all, 14% of male and 62% of female cases were not attributable to occupational or domestic asbestos exposure. Approximately half of the male cases were construction workers, and only four had worked for more than 5 years in asbestos product manufacture.

                Author and article information

                Occup Environ Med
                Occup Environ Med
                Occupational and Environmental Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                April 2018
                21 December 2017
                : 75
                : 4
                : 254-262
                [1 ] departmentOccupational and Environmental Medicine, Epidemiology and Hygiene Department , Italian Workers’ Compensation Authority (INAIL) , Rome, Italy
                [2 ] departmentValle d’Aosta Health Local Unit , Regional Operating Centre of Valle d’Aosta (COR Valle d’Aosta) , Aosta, Italy
                [3 ] departmentCOR Piedmont, Unit of Cancer Prevention , University of Turin and CPO-Piemonte , Torino, Italy
                [4 ] departmentCOR Liguria, UO Epidemiology, IRCCS Az , Ospedaliera Universitaria San Martino, National Cancer Research Institute (IST) , Genova, Italy
                [5 ] departmentCOR Lombardy, Department of Preventive Medicine , Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico and University of Milan , Milano, Italy
                [6 ] departmentProvincial Unit of Health, Hygiene and Occupational Medicine , COR Province of Trento , Trento, Italy
                [7 ] departmentAlto Adige Health Local Unit , COR Province of Bolzano , Bolzano, Italy
                [8 ] departmentOccupational Health Unit, Department of Prevention , COR Veneto , Padua, Italy
                [9 ] departmentClinical Unit of Occupational Medicine , COR Friuli-Venezia Giulia, University of Trieste – Trieste General Hospitals , Trieste, Italy
                [10 ] departmentHealth Local Unit, Public Health Department , COR Emilia-Romagna , Reggio Emilia, Italy
                [11 ] departmentUnit of Environmental and Occupational Epidemiology , COR Tuscany, Cancer Prevention and Research Institute , Firenze, Italy
                [12 ] Cancer Prevention and Research Institute , Firenze, Italy
                [13 ] departmentHygienistic, Environmental and Health Sciences Department, School of Sciences of the drug and the products of health , COR Marche, University of Camerino , Camerino, Italy
                [14 ] departmentDepartment of Hygiene and Public Health , COR Umbria, University of Perugia , Perugia, Italy
                [15 ] departmentDepartment of Epidemiology , COR Lazio, Lazio Region , Rome, Italy
                [16 ] departmentDepartment of Experimental Medicine , COR Lazio, University La Sapienza , Rome, Italy
                [17 ] departmentHealth Local Unit, Occupational Medicine Unit , COR Abruzzo , Pescara, Italy
                [18 ] departmentOncology Unit , COR Molise, Cardarelli Hospital , Campobasso, Italy
                [19 ] departmentDepartment of Experimental Medicine , COR Campania, Second University of Naples , Napoli, Italy
                [20 ] departmentDepartment of Interdisciplinary Medicine, Section of Occupational Medicine ’B.Ramazzini' , COR Puglia, University of Bari , Firenze, Italy
                [21 ] COR Basilicata, Epidemiologic Regional Centre , Potenza, Italy
                [22 ] departmentPublic Health Unit , COR Calabria , Crotone, Italy
                [23 ] departmentCancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory , COR Sicily , Policlinico, Italy
                [24 ] COR Sardegna, Regional Epidemiological Centre , Cagliari, Italy
                Author notes
                [Correspondence to ] Dr Alessandro Marinaccio, Epidemiology Unit, Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian National Workers Compensation Authority (INAIL), Rome 00143, Italy; a.marinaccio@ 123456inail.it
                Author information
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                : 28 September 2016
                : 04 September 2017
                : 05 October 2017
                Funded by: INAIL, Italian national workers compensation authority;
                Original article
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                Occupational & Environmental medicine
                Occupational & Environmental medicine
                mesothelioma, asbestos, gender


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