Drinking water contamination from perfluoroalkyl substances (PFAS): an ecological mortality study in the Veneto Region, Italy.

Background: Perfluoroalkyl substances (PFAS), a heterogeneous group of highly stable man-made chemicals, have been widely used since 1960s and can be detected almost ubiquitously in all environmental matrices. In Italy, on January 2014, drinking water contamination in an area of the Veneto Region was detected mainly due to the drain of fluorinated chemicals by a manufacturing company operating since 1964. Methods: The present ecological mortality study was aimed at comparing mortality for some causes of death selected on the basis of previous reported associations, during the period 1980-2013, in municipalities with PFAS contaminated and uncontaminated drinking water on the basis of the levels indicated by the Italian National Health Institute (ISS). Sex-specific number, standardized mortality rates and rate ratios (RR) for PFAS contaminated and uncontaminated areas were computed for each cause of death through the ENEA epidemiological database. Results: In both sexes, statistically significant RRs were detected for all causes mortality, diabetes, cerebrovascular diseases, myocardial infarction and Alzheimer's disease. In females, RRs significantly higher than 1.0 were also observed for kidney and breast cancer, and Parkinson's disease. Increased risk, although not statistically significant, was observed for bladder cancer in both sexes, and for testicular cancer, pancreatic cancer and leukemia in males only. Conclusions: Higher mortality levels for some causes of death, possibly associated with PFAS exposure, were detected in contaminated municipalities in comparison with uncontaminated ones with similar socioeconomic status and smoking habits. These results warrant further individual level analytic studies to delineate casual associations.

[Rate advancement assessment: a case study]. / Valutare l'anticipazione dell'evento: un caso di studio.

OBJECTIVE: to re-evaluate the meaning of attributable risk assessing the event advancement as an individual effect indicator. DESIGN: mortality descriptive study of cardiovascular and respiratory causes in two populations exposed to different emission levels from a coal-fired power plant. SETTING AND PARTICIPANTS: people residing in 23 Italian municipalities (100,725 subjects) aged 35-84 years observed from 2000 to 2007. MAIN OUTCOME MEASURES: age-specific death rates and death anticipation by age. RESULTS: a higher mortality among the exposed corresponds to a median death anticipation from 25 to 20 months among people aged 65-74 and of 6 months for people aged 75-84. CONCLUSION: for the set of the considered causes of death, a higher mortality among the exposed corresponds to a median anticipation of all deaths occurred among exposed people.

Occupational brain cancer risks in Umbria (Italy), with a particular focus on steel foundry workers.

OBJECTIVES: As a part of the Occupational Cancer Monitoring (OCCAM) project, a routine analysis based on Umbria region cancer registry (RTUP) database in 2002-2008 was performed. Among other results, the incidental finding of brain cancer increased risk in steel foundry workers in Terni province (Italy), lead us to deepen the analysis, focusing on this specific industrial sector. METHODS: A monitoring study, based on Umbria Regional Cancer Registry data, was recently carried out. Brain cancer cases and controls identified within this preliminary study were selected. Therefore, we considered all incident cases (in Umbria region 2002-2008) of brain cancer occurred among workers occupied for at least one year in private companies since 1974 and controls randomly sampled from the same population. Afterwards, taking in to account results from steel foundry in Terni province, we further deepened our analysis, focusing on this productive sector. Odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple logistic regression models, adjusted by age at diagnosis or sampling, sex and province of residence, when appropriate. RESULTS: Statistical analyses were carried out on 14913 subjects, 56 cases and 14857 controls. Significantly increased ORs were observed for garment, mechanical manufacturing and chemical industries. Moreover, the risk estimates were strongly correlated with exposures in iron and steel foundries and a cluster of 14 cases in the same foundry in Terni was observed (OR 9.59, 90% CI 2.76-33.34). CONCLUSIONS: Results of this explorative study showed increased ORs of brain cancer in some productive branches, involving possible exposures to chemical compounds and/or solvents. Moreover, our results pointed out a significantly increased risk in Terni foundry workers, determining an interesting brain cancer cluster (14 cases). Further studies on this industrial sector are needed with improved definitions of tasks and exposures.

Lung cancer risk in the electroplating industry in Lombardy, Italy, using the Italian occupational cancer monitoring (OCCAM) information system.

BACKGROUND: Occupational Cancer Monitoring (OCCAM) is an Italian organization that monitors occupational cancers, by area and industrial sector, by retrieving cases and employment history from official databases. OCCAM previously estimated a relative risk (RR) of lung cancer of about 1.32 among "metal treatment" workers in Lombardy, northern Italy, potentially exposed to chrome and nickel. In the present study, lung cancer risk was estimated among electroplating workers only. METHODS: Lombardy electroplating companies were identified from descriptions in Social Security files. Lung cancer risk was evaluated from 2001 to 2008 incident cases identified from hospital discharge records. RESULTS: The RR for lung cancer among electroplating workers was 2.03 (90% CI 1.33-3.10, 18 cases) for men; 3.00 (90% CI 1.38-9.03, 4 cases) for women. CONCLUSIONS: Electroplaters had higher risks than "metal treatment" workers. Although the risks were due to past exposure, case histories and recent acute effects indicate a present carcinogenic hazard in some Lombardy electroplating factories.

[From research on occupational tumors to interventional prevention: use of the OCCAM method at the ASL in Como]. / Dalla ricerca dei casi di tumore professionale agli interventi di prevenzione: l'utilizzo del metodo OCCAM nell'ASL di Como.

In the framework of "Occupational Cancers" project of the Lombardy Region, estimates of cancer risk by site and by economic activity for the incidence period 2001-2004 have been produced in the Local Health Unit of Como. Using these estimates a set of cancer cases with possible occupational origin has been determined. This has been carried out using the OCCAM approach, a case control study where incident cases are identified by hospital discharge records, controls are sampled from health population files and occupational histories are obtained by automatic link with social security archives. This has been integrated with the knowledge of firms and the workers' awareness of other cancer cases in the workforce of the same firms. Among 45 cases with potential occupational origin, 24 were established as due to occupation. These cases were referred for compensation. Moreover, carcinogenic risks still present in some firms were identified and appropriate interventions were carried out.

Female breast cancer and electrical manufacturing: results of a nested case-control study.

BACKGROUND: A previous explorative record-linkage study suggested a putative role of employment in electrical manufacturing in increasing female breast cancer risk in the Province of Milan (Italy). We deepened the understanding of this possible association in a single large electrical manufacturing plant located in Lombardy in the Province of Milan. METHODS: We carried out a nested case-control study within a cohort of women employed in a large electrical manufacturing plant. All incident cases during 2002 to 2009 of female breast cancer in individuals who worked at least a 1 year in the factory and resided in Lombardy, Italy, were selected. Controls were randomly sampled from all women who worked in the same plant and resided in Lombardy as of December 31, 2005. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated using multiple logistic regression models, taking into consideration only female workers as ever/never exposed to physical/chemical agents and their longest occupational period. ORs were adjusted for several potential confounders, namely, other known risk factors. RESULTS: The ORs for female breast cancer were significantly increased for exposure to chlorinated solvents (OR 1.65, 95% CI 1.04-2.62), and there was a twofold increase (OR 2.10, 95% CI 1.21-3.66) among women exposed for at least 10 years. We found no other significantly increased OR by exposure or job title. CONCLUSIONS: Our results suggest an increased risk of breast cancer after exposure to chlorinated solvents among women employed in the electrical manufacturing industry.