Gorini G, Silvestri S, Merler E, Chellini E, Cacciarini V, Seniori Costantini A Seniori
UO Epidemiologia Occupazionale e Ambientale, Centro per lo Studio e la Prevenzione Oncologica (CSPO), Istituto Scientifico della Regione Toscana, Firenze.
Med Lav. 2002 Nov-Dec;93(6):507-18.
The Tuscany Mesothelioma Register (ARTMM) records pleural malignant mesothelioma cases of Tuscany residents, diagnosed by histological, cytological, or clinical (radiography or computerized tomography) examinations. The ARTMM began in 1988 and estimates mesothelioma incidence in Tuscany and collects information on past asbestos exposure of mesothelioma cases.
The aim of this paper was to describe the incidence of pleural mesothelioma cases in Tuscany and to analyse their possible past asbestos exposures.
We considered pleural mesothelioma cases recorded in ARTMM in the period 1988-2000 and interviews collected for these cases. In order to identify past asbestos exposure in the occupational and non-occupational history of patients, interviews were carried out using a standardised questionnaire.
In the period 1988-2000, 494 pleural malignant mesothelioma cases were recorded in the ARTMM; 82% were males. In the periods 1988-1993, 1994-1997, 1998-2000 the incidence rates, standardised on the Italian population (per 100,000), were respectively 1.15, 1.57, 2.58 among males; 0.29; 0.27; 0.29 among females. Information on occupational history was collected for 418 mesothelioma patients (85% of recorded cases): 173 mesothelioma cases were directly interviewed; for 245 cases relatives or work colleagues were interviewed. Occupational asbestos exposure was ranked as certain, probable or possible in 72% of the interviewed cases (80% of males; 20% of females). Environmental and non-occupational asbestos exposure was identified in 1% of males, and 3% of females. In 24% of the interviewed cases (15% of males; 74% of females) no known asbestos exposure was identified. Occupational asbestos exposure occurred in maritime activities (shipyards, dock work, merchant and regular Navy), the building industry, railway carriage construction and maintenance, rail transport, textile industries (mainly rag sorting), electricity production, asbestos cement manufacture, chemical, iron and steel industries and in glass manufacturing. In Tuscany two areas are distinguished for their well-documented and massive use of asbestos: the coastal areas (Livorno and Massa Carrara) for maritime activities, and the areas of Pistoia and Arezzo for railway carriage construction and repair. Mesothelioma incidence rates in these areas are the highest in the whole region.
Further investigation is needed in order to identify unknown asbestos uses and consequent exposure, in particular for females. Uncertainty as regards occurrence of asbestos exposure persists in the textile industries where the mesothelioma epidemics have not yet declined. Research hypotheses are addressed on the re-use of jute bags previously containing asbestos, therefore collection of further information on periods and methods of this recycling activity is essential.
托斯卡纳间皮瘤登记处（ARTMM）记录了托斯卡纳居民的胸膜恶性间皮瘤病例，这些病例通过组织学、细胞学或临床（X线摄影或计算机断层扫描）检查确诊。ARTMM始于1988年，估算托斯卡纳间皮瘤发病率，并收集间皮瘤病例过去石棉暴露的信息。
本文旨在描述托斯卡纳胸膜间皮瘤病例的发病率，并分析其过去可能的石棉暴露情况。
我们研究了1988年至2000年期间ARTMM记录的胸膜间皮瘤病例以及针对这些病例所收集的访谈资料。为了确定患者职业和非职业病史中的过去石棉暴露情况，采用标准化问卷进行访谈。
1988年至2000年期间，ARTMM记录了494例胸膜恶性间皮瘤病例；其中82%为男性。在1988 - 1993年、1994 - 1997年、1998 - 2000年期间，以意大利人口为标准（每10万人）的发病率，男性分别为1.15、1.57、2.58；女性分别为0.29、0.27、0.29。收集了418例间皮瘤患者（占记录病例的85%）的职业病史信息：173例间皮瘤病例直接接受访谈；245例病例通过访谈亲属或同事获取信息。在72%的受访病例（80%的男性；20%的女性）中，职业性石棉暴露被列为确定、可能或疑似。1%的男性和3%的女性被确定有环境和非职业性石棉暴露。在24%的受访病例（15%的男性；74%的女性）中未发现已知的石棉暴露。职业性石棉暴露发生在海上活动（造船厂、码头工作、商船和正规海军）、建筑行业、铁路车辆制造与维修、铁路运输、纺织行业（主要是破布分拣）、电力生产、石棉水泥制造、化工、钢铁行业以及玻璃制造行业。在托斯卡纳，有两个地区因石棉使用记录充分且用量大而闻名：沿海地区（里窝那和马萨·卡拉拉）用于海上活动，皮斯托亚和阿雷佐地区用于铁路车辆制造与维修。这些地区的间皮瘤发病率是整个地区最高的。
需要进一步调查以确定未知的石棉用途及由此导致的暴露情况，特别是针对女性。在间皮瘤流行尚未下降的纺织行业，石棉暴露的发生仍存在不确定性。针对先前装有石棉的黄麻袋的再利用提出了研究假设，因此收集有关这种回收活动的时间和方法的更多信息至关重要。
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