Di Lorenzo Giuseppe, Federico Piera, De Placido Sabino, Buonerba Carlo
Università degli Studi Federico II, Dipartimento ad Attività Integrata di Medicina Clinica, Napoli, Italy.
IOS (Istituto Ospedaliero del Sud) SrL & Coleman SPA, Napoli, Italy.
Crit Rev Oncol Hematol. 2015 Dec;96(3):534-41. doi: 10.1016/j.critrevonc.2015.07.004. Epub 2015 Jul 20.
During the past three decades, large areas of the Naples and the Caserta provinces of the Campania region in Italy have been extensively contaminated by the widespread burial and open-air dumping and incineration of industrial toxic waste. On the basis of the finding that the incidence of bladder cancer appears remarkably high in the Naples province with respect to the rest of Europe and of a potential causative role of environmental contaminants, we sought associations between exposure to toxic agents and increased mortality/incidence of bladder cancer by performing a systematic search of epidemiology and human biomonitoring studies conducted in the provinces of Naples and Caserta. The data show that the incidence of bladder cancer is higher than expected on the basis of regional data in the province of Naples and in certain areas of the province of Caserta, even after accounting for social deprivation, with two clusters of increased mortality rate located in the north-western part of Naples province and in the south-eastern part of the Caserta province. The biomonitoring studies conducted focused on the levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs), which are generated by the uncontrolled combustion of refuse abandoned in the territory and have been shown to enter the food chain. While the average values of PCDD/F and PCBs reported in blood serum and human milk of the area population are in accordance with those expected on the basis of studies conducted at a national and international level, five municipalities assessed in the province of Naples, that is Brusciano, Caivano, Giugliano, Mugnano, and Qualiano-Villaricca were clearly characterized by the presence of arsenic, with 62% samples showing serum arsenic levels higher than the 95th percentile of the national distribution. The potential negative synergism of social deprivation, environmental pressure and arsenic contamination may account for the higher than expected bladder cancer incidence and mortality in certain areas of the Campania region and remains to be elucidated via the conduction of ad hoc population-based studies.
在过去三十年中，意大利坎帕尼亚大区那不勒斯省和卡塞塔省的大片地区受到广泛污染，原因是工业有毒废物被广泛掩埋、露天倾倒和焚烧。基于那不勒斯省膀胱癌发病率相对于欧洲其他地区明显较高这一发现以及环境污染物的潜在致病作用，我们通过系统检索在那不勒斯省和卡塞塔省开展的流行病学和人体生物监测研究，探寻接触有毒物质与膀胱癌死亡率/发病率增加之间的关联。数据显示，即使在考虑了社会剥夺因素之后，那不勒斯省以及卡塞塔省某些地区的膀胱癌发病率仍高于基于区域数据的预期，在那不勒斯省西北部和卡塞塔省东南部有两个死亡率上升的聚集区。所开展的生物监测研究聚焦于多氯二苯并对二恶英和二苯并呋喃（PCDD/Fs）以及多氯联苯（PCBs）的水平，这些物质是由遗弃在该地区的垃圾的无控制燃烧产生的，并且已被证明会进入食物链。虽然该地区人群血清和母乳中报告的PCDD/F和PCBs的平均值与在国家和国际层面开展的研究预期值相符，但在那不勒斯省评估的五个市镇，即布鲁西亚诺、卡伊瓦诺、朱利亚诺、穆尼亚诺和夸利亚诺 - 维拉里卡，明显存在砷污染，62%的样本血清砷水平高于全国分布的第95百分位数。社会剥夺、环境压力和砷污染的潜在负面协同作用可能是坎帕尼亚大区某些地区膀胱癌发病率和死亡率高于预期的原因，这仍有待通过开展专门的基于人群的研究来阐明。
