Magnani C, Bianchi C, Chellini E, Consonni D, Fubini B, Gennaro V, Marinaccio A, Menegozzo M, Mirabelli D, Merler E, Merletti F, Musti M, Oddone E, Romanelli A, Terracini B, Zona A, Zocchetti C, Alessi M, Baldassarre A, Dianzani I, Maule M, Mensi C, Silvestri S
Dipartimento di Medicina Traslazionale - Università del Piemonte Orientale.
Med Lav. 2015 Sep 9;106(5):325-32.
The III Italian Consensus Conference on Pleural Mesothelioma (MM) convened on January 29th 2015. This report presents the conclusions of the 'Epidemiology, Public Health and Occupational Medicine' section. MM incidence in 2011 in Italy was 3.64 per 100,000 person/years in men and 1.32 in women. Incidence trends are starting to level off. Ten percent of cases are due to non-occupational exposure. Incidence among women is very high in Italy, because of both non-occupational and occupational exposure. The removal of asbestos in place is proceeding slowly, with remaining exposure. Recent literature confirms the causal role of chrysotile. Fibrous fluoro-edenite was classified as carcinogenic by IARC (Group 1) on the basis of MM data. A specific type (MWCNT-7) of Carbon Nanotubes was classified 2B. For pleural MM, after about 45 years since first exposure, the incidence trend slowed down; with more studies needed. Cumulative exposure is a proxy of the relevant exposure, but does not allow to distinguish if duration or intensity may possibly play a prominent role, neither to evaluate the temporal sequence of exposures. Studies showed that duration and intensity are independent determinants of MM. Blood related MM are less than 2.5%. The role of BAP1 germline mutations is limited to the BAP1 cancer syndrome, but negligible for sporadic cases. Correct MM diagnosis is baseline; guidelines agree on the importance of the tumor gross appearance and of the hematoxylin-eosin-based histology. Immunohistochemical markers contribute to diagnostic confirmation: the selection depends on morphology, location, and differential diagnosis. The WG suggested that 1) General Cancer Registries and ReNaM Regional Operational Centres (COR) interact and systematically compare MM cases; 2) ReNaM should report results presenting the diagnostic certainty codes and the diagnostic basis, separately; 3) General Cancer Registries and COR should interact with pathologists to assure the up-to-date methodology; 4) Necroscopy should be practiced for validation. Expert referral centres could contribute to the definition of uncertain cases. Health surveillance should aim to all asbestos effects. No diagnostic test is recommended for MM screening. Health surveillance should provide information on risks, medical perspective, and smoking cessation. The economic burden associated to MM was estimated in 250,000 Euro per case.
第三届意大利胸膜间皮瘤（MM）共识会议于2015年1月29日召开。本报告介绍了“流行病学、公共卫生与职业医学”部分的结论。2011年意大利男性MM发病率为每10万人年3.64例，女性为1.32例。发病率趋势开始趋于平稳。10%的病例归因于非职业性暴露。由于非职业性和职业性暴露，意大利女性中的发病率非常高。原地石棉清除工作进展缓慢，仍存在暴露情况。近期文献证实了温石棉的致病作用。纤维氟闪石根据MM数据被国际癌症研究机构（IARC）列为致癌物（第1组）。一种特定类型（MWCNT - 7）的碳纳米管被列为2B类。对于胸膜MM，首次暴露约45年后，发病率趋势放缓；仍需要更多研究。累积暴露是相关暴露的一个指标，但无法区分持续时间或强度是否可能起主要作用，也无法评估暴露的时间顺序。研究表明，持续时间和强度是MM的独立决定因素。血液相关的MM不到2.5%。BAP1种系突变的作用仅限于BAP1癌症综合征，但对散发病例可忽略不计。正确的MM诊断是基础；指南一致认为肿瘤大体外观和苏木精 - 伊红染色组织学很重要。免疫组织化学标志物有助于确诊：选择取决于形态、位置和鉴别诊断。工作组建议：1）一般癌症登记处和ReNaM区域运营中心（COR）相互协作并系统比较MM病例；2）ReNaM应分别报告呈现诊断确定性代码和诊断依据的结果；3）一般癌症登记处和COR应与病理学家协作以确保采用最新方法；4）应进行尸检以进行验证。专家转诊中心可有助于确定不确定病例。健康监测应针对所有石棉影响。不建议进行MM筛查的诊断测试。健康监测应提供有关风险、医学观点和戒烟的信息。MM相关的经济负担估计为每例25万欧元。
