Cohort study of workers employed in an Italian tire manufacturing plant, 1962-2004.

PURPOSE: To investigate mortality and bladder cancer incidence among workers of a tire manufacturing plant where antioxidants severely contaminated by beta-naphthylamine were never used. METHODS: Mortality follow-up was performed of 9,501 workers first hired between 1962 when the plant started operations and 2000. Person-years of observation from 1962 to 2004, expected deaths, and standardized mortality ratios (SMR) were calculated. Follow-up for bladder cancer incidence from 1988 to 2003 was carried out, and standardized incidence ratios (SIR) were calculated. Multivariable (Poisson) analyses of bladder cancer incidence and mortality by duration of employment (DOE) and time since first employment (TSFE) were performed. RESULTS: Among men, SMRs were significantly reduced for all causes, all cancers, lung cancer, cardiovascular, and ischemic heart diseases. Bladder cancer mortality and leukemia mortality were close to expectation but increased with TSFE. Seventy-two incident cases of bladder cancer were observed (SIR = 1.15; 95 % confidence interval 0.90-1.44), and multivariable analysis suggested a possible increase in rate ratios with DOE. Among women, mortality was close to expectation, but the limited number of observed deaths prevented detailed analyses. CONCLUSIONS: No significant cancer excess was observed. A suggestion of increased risks of bladder cancer and leukemias after extended TSFE was present in men, deserving consideration as exposure to carcinogens possibly occurred early in plant operation. Furthermore, this cohort of workers is still relatively young and less than 10 % have died. There was, thus, limited power to detect small increases in risk at rare cancer sites. Further epidemiological surveillance of this cohort is planned.

[Cardiovascular disease prevention: results from Programma FASEN - H San Raffaele]. / La prevenzione delle malattie cardiovascolari: l'esperienza del Programma FASEN - H San Raffaele.

We studied 9145 workers allocated among Italian country employed in the same factory. Most of them were male, mean age 47,6 (20,2

Confounders and confusion: Dealing with cancer cases of occupational origin.

BACKGROUND: The recognition of occupational cancers is often hampered by confusion between the individual determinants of the disease and effects at the group level. METHODS: Here we propose an approach, based on the evaluation of the attributable risk at the group level, that provides quantitative estimates of the roles of multiple causes in individuals affected of cancer within a population exposed to occupational risk. RESULTS: The estimate of individual probability can be easily obtained computing the attributable risk. This can be often achieved by using the existing information available in the literature. CONCLUSIONS: Dismissing the occupation as a cause of a cancer in an exposed subject on the sole basis of potential confounding is erroneous and should be withdrawn from medical practice.

[The active search for occupational cancers]. / La ricerca attiva dei tumori di origine professionale.

The active search for occupational neoplasms has been implemented only in Italy. This search can be carried out with two modalities: the in-hospital face-to-face interview of selected cancer cases, and the linkage of available information (OCCAM). Both were supported by a special project on occupational carcinogenesis of the Lombardy Region. The active search for occupational neoplasms is a moderate-cost activity and is important for the safeguard of the workforce and of the population as a whole.

[The active search for occupational cancer cases: bladder cancer in Lombardy Region]. / La ricerca attiva dei tumori di origine professionale: il caso del tumore della vescica nella Regione Lombardia.

OBJECTIVE: A study called OCCAM (OCcupational CAncer Monitoring) has been carried out in order to establish a nationwide surveillance system for occupational cancer. This project consists of population-based case control studies where information on past occupations are automatically gathered National Institute for Social Security's archive, cancer cases are obtained from Cancer Registries (CR) and controls are sampled from population files of the National Health Service. As previous results obtained using CR were encouraging, we tried to use regional hospital discharge records as a source of incident cases. DESIGN: We have conducted a population based case-control study with 1568 male bladder cancer cases occurred in the years 1999 and 2000 and 18818 controls randomly sampled from resident population in Lombardy region (Italy). RESULTS: Despite the limits of this approach the following industries were found at increased risk of bladder cancer: leather and shoes industry (OR=1.83; CI 90%: 1.01-3.33; observed: 10); transports (OR=1.28; CI 90%: 0.94-1.76; observed: 37), rubber industry (OR=1.22 CI 90% 0.80-1.85; observed: 19) and printing industry (OR=1.5 CI 90%: 1.10-2.05; observed: 38). CONCLUSION: The ability of OCCAM surveillance system to find known associations using routinely available data offers new opportunities to detect cancer cases likely to be of occupational origin.

[Mortality from malignant pleural neoplasms in Broni (Pavia), 1980-1997]. / La mortalità per tumore maligno della pleura a Broni (Pavia), 1980-1997.

Mortality for malignant pleural neoplasms (1980-97) was studied in Broni (Pavia) and in the surrounding area in order to update previous studies indicating a high incidence of pleural mesothelioma, due to the presence of an asbestos-cement factory. Observed mortality for pleural neoplasms was compared to expected figures derived from mortality rates of the population resident in Province of Pavia. A significant increase was found in Broni (SMR 825, CI 95%: 604-1, 100, 46 observed). An increased risk of death from malignant pleural neoplasms was evident in both genders, especially in the most recent years, and in younger age groups; this increase in pleural neoplasm mortality also involves some neighbouring municipalities.

[Mortality study of asbestos cement workers in Emilia-Romagna]. / Studio di mortalità degli addetti alla produzione di manufatti in cemento amianto in Emilia-Romagna.

OBJECTIVE: The present study updates to 06/30/1998 the cohort mortality study of 3358 workers employed in 10 asbestos cement production plants in the Italian region Emilia-Romagna. PARTICIPANTS: The cohort includes 2712 males and 646 females. RESULTS: Overall mortality was significantly increased (SMR=131, IC95%:108-127). Excess mortality has been observed for all malignant neoplasms (SMR=131, IC95%: 115-149, 250 observed) and for respiratory diseases (SMR=153, IC: 105-216, 32 observed), 3 deaths due to asbestosis. Mortality for all respiratory tract neoplasms (SMR=179, IC: 148-215, 114 observed), pulmonary cancer (SMR=157, IC: 126-192, 90 observed) and pleural cancer (SMR=1922, IC: 1139-3038, 18 observed) are significantly increased. DISCUSSION: This study confirms the previous cohort study observation of increased mortality for all causes, all neoplasm and cancer affecting lungs and pleura.

The Italian surveillance system for occupational cancers: characteristics, initial results, and future prospects.

BACKGROUND: Occupational cancer monitoring is important for cancer prevention and public health protection. A surveillance system for identifying occupational cancer risks and cancer cases in Italy that are likely to be of occupational origin using information available in the Italian Social Security archives was created and assessed. Persons employed in the private sector, the employing company, its industrial sector, and years of employment are available in these archives. METHODS: A method to find known occupational hazards was first tested using a case-control approach. Cases were from six Italian cancer registries (CRs) and controls were sampled from source populations and as "exposure" the economic sector of the employing company was used. The potential of using hospital discharge records as case sources was subsequently assessed: these cover larger populations and are available more quickly than CR case series. RESULTS: In the CR-based study many known occupational cancer risks related to specific industrial sectors were identified. By using cases from hospital discharge records many industries at risk were identified, as well as cases of recent diagnosis likely to be of occupational origin. However, for some industrial sectors (e.g., the chemical industry) the approach was unable to detect any excess risk. Furthermore, information on employees in important areas like agriculture, self-employment, and the public sector is not available in the Social Security archives. CONCLUSIONS: This approach appears to be a promising low-cost method for occupational cancer surveillance, at least for some industries, and can be easily implemented in other countries.