Magnani C, Terracini B, Ivaldi C, Botta M, Mancini A, Andrion A
Cancer Epidemiology Unit, Local Health Authority, Torino, Italy.
Occup Environ Med. 1995 Jun;52(6):362-7. doi: 10.1136/oem.52.6.362.
To assess and quantify the occurrence of pleural malignant mesotheliomas in people who neither experienced occupational exposure to asbestos nor were married to (or known to live with) workers exposed to asbestos in the workplace. The study was conducted in the area of the local health authority of Casale Monferrato, in north western Italy, where a large factory that produced asbestos cement was active up to 1985. No other major activities related to asbestos have ever been present in the area.
A retrospective survey covering the period 1980 to 1991 identified 126 incident pleural malignant mesotheliomas histologically diagnosed among residents in the local health authority (population at the 1981 census 98,000). Submission of 83 of 95 cases diagnosed during 1980-9 for revision by a panel of five expert pathologists led to the exclusion of 21. The 31 cases diagnosed in 1990-1 were not submitted for revision. For 64 of the 105 retained cases, information derived from different sources (rosters of the employees in the asbestos cement factory dated back to 1907, list of their spouses, clinical records) did not suggest occupational or paraoccupational exposure to asbestos.
Incidence excludes cases for which there was some suggestion of occupational or paraoccupational exposure to asbestos. Incidence of histologically confirmed malignant mesothelioma among residents in the local health authority (annual x 100,000; age adjusted) was 4.2 in men and 2.3 in women (based on 26 and 18 cases respectively). In both sexes, rates in 1985-9 were higher than in the previous quinquennium. Corresponding estimates for 1990-1 (based on unrevised diagnoses) suggest similar rates in men and women.
Rate ratios which are four to six times those measured by conventional Italian cancer registries can hardly be totally explained by bias produced by lack of recognition of occupational or paraoccupational exposure. The problem of proving this type of negative data is common to other circumstances of alleged cancer clusters of environmental (non occupational) origin.
评估并量化在既未经历职业性石棉暴露，其配偶（或已知与之共同生活的人）也未在工作场所接触石棉的人群中胸膜恶性间皮瘤的发病情况。该研究在意大利西北部卡萨莱蒙费拉托地方卫生当局辖区内进行，直至1985年，当地有一家大型石棉水泥生产厂一直在运营。该地区从未有过与石棉相关的其他重大活动。
一项涵盖1980年至1991年期间的回顾性调查，确定了当地卫生当局辖区居民中126例经组织学诊断的胸膜恶性间皮瘤新发病例（1981年人口普查时人口为98,000）。95例在1980 - 1989年期间诊断的病例中有83例提交给由五名专家病理学家组成的小组进行复查，其中21例被排除。1990 - 1991年诊断的31例病例未提交复查。在保留的105例病例中的64例，来自不同来源（可追溯到1907年的石棉水泥厂员工名册、其配偶名单、临床记录）的信息未显示有职业性或准职业性石棉暴露。
发病率排除了有职业性或准职业性石棉暴露迹象的病例。当地卫生当局辖区居民中经组织学确诊的恶性间皮瘤发病率（每10万人年；年龄调整后）男性为4.2，女性为2.3（分别基于26例和18例）。在男女两性中，1985 - 1989年的发病率均高于前一个五年期。1990 - 1991年的相应估计值（基于未复查的诊断）显示男女发病率相似。
该发病率比意大利传统癌症登记处测得的发病率高出四至六倍，这很难完全用因未识别职业性或准职业性暴露而产生的偏差来解释。在其他所谓环境（非职业）性癌症聚集的情况下，证明这类阴性数据的问题很常见。
