Incidence of mesothelioma in young people and causal exposure to asbestos in the Italian national mesothelioma registry (ReNaM).

INTRODUCTION: The epidemiological surveillance of mesothelioma incidence is a crucial key for investigating the occupational and environmental sources of asbestos exposure. The median age at diagnosis is generally high, according to the long latency of the disease. The purposes of this study are to analyse the incidence of mesothelioma in young people and to evaluate the modalities of asbestos exposure. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993-2018 were retrieved from Italian national mesothelioma registry and analysed for gender, incidence period, morphology and exposure. Age-standardised rates have been calculated and the multiple correspondence analysis has been performed. The association between age and asbestos exposure has been tested by χ2 test. RESULTS: From 1993 to 2018, 30 828 incident MM cases have been collected and 1278 (4.1%) presented diagnosis at early age (≤50 years). There is a substantial association between age at diagnosis and the type of asbestos exposure and a significantly lower frequency of cases with occupational exposure to asbestos (497 cases vs 701 expected) in young people has been documented. Paraoccupational and environmental exposure to asbestos have been found more frequent in young MM cases (85 and 93 observed cases vs 52 and 44 expected cases, respectively). CONCLUSIONS: Mesothelioma incidence surveillance at population level and the anamnestic individual research of asbestos exposure is a fundamental tool for monitoring asbestos exposure health effects, supporting the exposure risks prevention policies. Clusters of mesothelioma incident cases in young people are a significant signal of a potential non-occupational exposure to asbestos.

Benzene and cause-specific mortality in an Italian national cohort of exposed workers through a proportions analysis.

BACKGROUND: occupational exposure to benzene represents a threat for the health of a still relevant number of workers. An increased risk of leukaemias has been demonstrated among exposed workers, while a weaker association has been found for other malignancies. OBJECTIVES: to evaluate mortality risk among workers exposed to benzene across economic sectors in Italy. DESIGN: proportionate mortality ratios (PMRs) were calculated linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data. SETTING AND PARTICIPANTS: data from the Italian national registry on occupational exposure to carcinogens (SIREP) in the period 1996-2018 were selected. MAIN OUTCOMES MEASURES: PMRs by cause of death were reported. Specific analyses by cancer site and activity sector, profession, and cumulative exposure were performed. RESULTS: a total of 858 deaths (97% in men) were identified among 38,704 exposed workers (91% men). An excess of deaths from malignant neoplasm of the lung was found among exposed workers, in both genders (PMR 1.27 in men; PMR 3.00 in women). An increased proportion of deaths was also found from leukaemias (leukaemia of unspecified cell type: PMR in men 2.99; 95%CI 1.24-7.19), and multiple myeloma in the chemical industry (PMR in men 2.27; 95%CI 1.08-4.76). CONCLUSIONS: the risk of leukaemia in the petrochemical industry has been confirmed, while an excess risk of lung cancer mortality was highlighted in the retail sale of automotive fuels. Epidemiological surveillance and air and biological monitoring are recommended for workers exposed to benzene to ensure compliance with regulatory requirements and reduce exposure-related deaths.

An occupational health risk index: definition, description and mapping at municipality level.

OBJECTIVES: to develop an occupational health risk index that can help to introduce the occupational risk component into epidemiological studies and assess the level of occupational risk in Italian municipalities useful for supporting prevention measures. DESIGN: defi nition of a municipal index as a combination of occupational and territorial indicators derived from national registers of occupational data and environmental archives. SETTING AND PARTICIPANTS: the index composition is based on data on work injuries, occupational diseases and workers exposed to carcinogens in the years 2015-2019 available at the municipal level, as well as data on municipalities hosting sites of national interest for environmental remediation (SIN) and those in which big industrial facilities (GIE), registered as pollutant emitters, are located. MAIN OUTCOME MEASURES: standardized rates of occupational injuries and occupational diseases occurred in Italian municipalities were calculated from data collected by the Italian National Institute for Insurance against Accidents at Work (Inail) in relation to the working-age population (15-69 and 15+ for injuries and occupational diseases, respectively), estimated by the Italian National Statistical Institute (Istat) in 2018. In addition, data from the National Information System on Occupational Exposure to carcinogens (SIREP) were included, from which raw rates were calculated at municipal level. Finally, two other indicators were included, describing the presence/absence of a SIN and the number of GIEs industrial facilities in each municipality. The index of occupational health risk (INDORS) is calculated by summing standardised values of the above fi ve indicators as a continuous variable and it was also classifi ed by quintiles of population as a categorical variable. The association between cause-specific mortality and INDORS levels was evaluated using data on mortality occurring in 2015. RESULTS: during the observation period 2,011,457, 131,353 and 140,183 events were recorded for injuries, occupational diseases and workers exposed to carcinogens, mainly among male workers. A municipal map of INDORS levels (1-5) shows a strong South-North gradient, in line with the Italian industrial geographical context. The contributions of the SIN and GIE indicators are higher in the hot spot municipalities located in the Southern regions and islands. Among the municipalities analysed 1,099 were classifi ed in the lowest risk level, 1,331 in the low-medium level, 1,619 in the medium level, 2,621 in the medium-high level and 1,284 in the highest risk level. The index shows a direct correlation with accidental mortality and an inverse correlation with all-cause and malignant neoplasm mortality. CONCLUSIONS: the proposed index can be useful to introduce the occupational risk dimension in ecological studies and results as a flexible tool to rank Italian municipalities in terms of occupational risk.

Occupational impact in COVID-19 pandemic according to one year of compensation claims in Italy.

OBJECTIVES: to evaluate the patterns of occupational COVID-19 cases, based on compensation claims applied to the Italian National Institute for Insurance against Accidents at Work (Inail). DESIGN: descriptive analyses of daily time series of compensation claims applications, geographical distributions, and occupations involved. Multivariate analyses have been performed for identifying significant epidemiological pattern. SETTING AND PARTICIPANTS: compensation claims for COVID-19 injuries received by Inail from March 2020 to February 2021 have been analysed. MAIN OUTCOME MEASURES: daily time series of compensation claims applications in the first year of pandemic and comparatively with population data, patterns of occupations majorly involved in time, territorial clusters. RESULTS: in the observed period, Inail has received 155,684 workers' compensation claims with a first peak (more than 1,000 daily compensation claims) in March 2020 and a second peak (more than 1,500) in November 2020. A time dependent geographical pattern was identified, with the Northern regions formerly affected in the first phase, followed by a diffusion in the Central and Southern regions during the summer period. Health technicians (32% and 42% in male and female, respectively) and physicians (15%and 6%) were the most involved workers. The timing of infection was found to depend by job, with physicians, nurses, and health technicians firstly involved with a spread of about 2 weeks with respect to other jobs. Trend in health workers' vaccination has been found in a clear inverse relationship with the decreasing number of compensation claims, remaining, since February 2021, under one hundred daily cases of occupational COVID-19 compensation claims. CONCLUSIONS: different intensities, timing, and characteristics were found among application claims, which address for different pandemic diffusion paths. Health workers are the firstly and most involved impacted by the pandemic. The use of application claims could be useful and effective in monitoring the occupational component of COVID-19 and his trend in time and space. There is a need to establish an epidemiological surveillance system that includes the assessment of work related risk, supporting the effectiveness of public insurance and welfare system, and to harmonize occupational data collection among countries.

Occupational asbestos exposure after the ban: a job exposure matrix developed in Italy.

BACKGROUND: Asbestos is a well-known carcinogen for humans. The aim of this study is to develop a tool to estimate occupational asbestos exposure in Italy after the ban using information collected in a national dataset. METHODS: Data were collected from firm registries of workers exposed to asbestos in the period 1996-2016. Descriptive statistics (arithmetic mean, standard deviation, geometric mean and geometric standard deviation) were calculated for the main exposure-related variables (activity sector, occupational group and exposure period). An estimate of workers potentially exposed to asbestos was also performed. RESULTS: A total of 19 704 airborne measurements of asbestos exposure was selected from the national database of occupational exposures in the sectors of asbestos abatement. Overall, a geometric mean of 7.93 f l-1 was found, and chrysotile was the asbestos type that had more exposures (41%). A total of 46 422 workers was estimated to be potentially at asbestos exposure risk. Exposure data were summarized by calendar period, activity sector and occupational group. CONCLUSIONS: The construction of a job exposure matrix for different occupation/industry combinations may allow the assessment of occupational exposure to asbestos in several removal and disposal activities, and the estimate of the risks associated with asbestos-related diseases in epidemiological studies.

Assessment of exposure to cobalt and its compounds in Italian industrial settings.

BACKGROUND: Adverse health effects of occupational exposure to cobalt and its compounds are well-documented. OBJECTIVES: The aim of the study is to evaluate exposures to cobalt in Italian industrial settings. METHODS: Data on cobalt and its compounds were collected from an occupational exposure registry. Statistical analysis was carried out for some exposure-related variables (i.e., cobalt compound, activity sector, occupational group, firm size). The number of workers potentially exposed was estimated for selected industrial sectors. RESULTS: Overall 1,701 measurements were analyzed in the period 1996-2016. The geometric mean of cobalt airborne concentration was 0.33 µg/m3. Most exposures occurred in the manufacture of fabricated metal products (50%) and among metal finishing-, plating- and coating-machine operators (42%). A total of 30,401 workers potentially exposed to cobalt was estimated, over 72% were male. CONCLUSIONS: Identifying professional groups at high-risk of exposure can help to control the most dangerous situations for workers' health. Surveillance systems based on occupational exposure registries contribute to support systematic improvement of working conditions.

The epidemiology of malignant mesothelioma in women: gender differences and modalities of asbestos exposure.

INTRODUCTION: The epidemiology of gender differences for mesothelioma incidence has been rarely discussed in national case lists. In Italy an epidemiological surveillance system (ReNaM) is working by the means of a national register. METHODS: Incident malignant mesothelioma (MM) cases in the period 1993 to 2012 were retrieved from ReNaM. Gender ratio by age class, period of diagnosis, diagnostic certainty, morphology and modalities of asbestos exposure has been analysed using exact tests for proportion. Economic activity sectors, jobs and territorial distribution of mesothelioma cases in women have been described and discussed. To perform international comparative analyses, the gender ratio of mesothelioma deaths was calculated by country from the WHO database and the correlation with the mortality rates estimated. RESULTS: In the period of study a case list of 21 463 MMs has been registered and the modalities of asbestos exposure have been investigated for 16 458 (76.7%) of them. The gender ratio (F/M) was 0.38 and 0.70 (0.14 and 0.30 for occupationally exposed subjects only) for pleural and peritoneal cases respectively. Occupational exposures for female MM cases occurred in the chemical and plastic industry, and mainly in the non-asbestos textile sector. Gender ratio proved to be inversely correlated with mortality rate among countries. CONCLUSIONS: The consistent proportion of mesothelioma cases in women in Italy is mainly due to the relevant role of non-occupational asbestos exposures and the historical presence of the female workforce in several industrial settings. Enhancing the awareness of mesothelioma aetiology in women could support the effectiveness of welfare system and prevention policies.

Gender differences in occupational exposure to carcinogens among Italian workers.

BACKGROUND: Many carcinogenic chemicals are still used or produced in several economic sectors. The aim of this study is to investigate differences in occupational exposure patterns to carcinogens by gender in Italy. METHODS: Information about the most common carcinogens recorded in the Italian occupational exposures database (SIREP) for the period 1996-2015 was retrieved. Descriptive statistics were calculated for exposure-related variables (carcinogenic agent, occupational group, economic activity sector, and workforce size). The chi-square(χ2) test was used to verify differences between genders, and logistic regression analysis was performed to evaluate the association between gender and risk of having higher exposure levels, after adjusting for age. Concurrent exposures to multiple carcinogens were investigated using the two-step cluster analysis. RESULTS: A total of 166,617 exposure measurements were selected for 40 different carcinogens. Exposed workers were only in a small proportion women (9%), and mostly aged 20-44 years (70%) in both genders. Women were more likely to be exposed than men to higher levels for several carcinogens even after correction for age at exposure, and the exposure level was significantly (p < 0.01) associated with occupation, economic sector and workforce size. The five main clusters of co-exposures identified in the entire dataset showed a differential distribution across economic sectors between genders. CONCLUSIONS: The exposures to occupational carcinogens have distinguishing characteristics in women, that are explained in part by work and job segregation. Because of the presence of high-exposed groups of female workers in many industrial sectors, further research and prevention efforts are recommended.

Nickel compounds in the workplaces: Occupations and activities involving high-risk exposures in Italy.

BACKGROUND: Nickel (Ni) compounds have been classified as carcinogenic to humans. The aim of the study is to evaluate exposures to Ni at workplaces in Italy. METHODS: Data on Ni compounds were collected from an occupational exposure registry. Statistical analysis was carried out for exposure-related variables. The number of workers potentially exposed was estimated for selected industrial sectors. Concurrent exposures with other occupational carcinogens were investigated using two-step cluster analysis. RESULTS: Overall 10 083 measurements were analyzed during 1996-2016, having a geometric mean of 2.93 µg/m3 . Most exposures occurred in manufacture of metal products (50%) and among metal finishing machine operators (46%). A total of 56 046 workers potentially exposed to Ni was estimated. Concurrent exposures were frequently detected, mainly with chromium VI and cobalt compounds. CONCLUSIONS: Systematic recording of occupational exposures provides a data source that allows recognition of high risk situations for workers' health and helps improve exposure assessment in epidemiologic studies.

Occupational exposure in the removal and disposal of asbestos-containing materials in Italy.

PURPOSE: A great variety of asbestos-containing materials are present in both residential and work settings because of the widespread use made in the past, and many occupational activities still entail the risk of asbestos exposure in Italy, more than 2 decades after the total national ban, mainly those involved in the removal and disposal of asbestos. The aim of the study was to evaluate the level and extent of asbestos exposure in Italy between the years 1996-2013 in the sector of asbestos abatement. METHODS: Data were collected from firm registries of asbestos-exposed workers and descriptive statistics were calculated for exposure-related variables. RESULTS: Overall, 15,860 measurements of asbestos exposure were selected from the national database of registries, mostly referring to the construction sector (N = 11,353). Despite the mean exposure levels are low, the air concentration of asbestos fibers measured during these activities may overcome the action level established by the Italian legislation and, in a limited number of cases, can exceed even the occupational limit value. Among occupations at higher risk, there are also garbage collectors and insulation workers. CONCLUSIONS: Starting from the analysis of the Italian database of occupational exposure registries, this study outlines the current levels of asbestos exposure in abatement-related sectors, discussing their possible implications for public health policies and surveillance programs.

Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry.

BACKGROUND: Previous ecological spatial studies of malignant mesothelioma cases, mostly based on mortality data, lack reliable data on individual exposure to asbestos, thus failing to assess the contribution of different occupational and environmental sources in the determination of risk excess in specific areas. This study aims to identify territorial clusters of malignant mesothelioma through a Bayesian spatial analysis and to characterize them by the integrated use of asbestos exposure information retrieved from the Italian national mesothelioma registry (ReNaM). METHODS: In the period 1993 to 2008, 15,322 incident cases of all-site malignant mesothelioma were recorded and 11,852 occupational, residential and familial histories were obtained by individual interviews. Observed cases were assigned to the municipality of residence at the time of diagnosis and compared to those expected based on the age-specific rates of the respective geographical area. A spatial cluster analysis was performed for each area applying a Bayesian hierarchical model. Information about modalities and economic sectors of asbestos exposure was analyzed for each cluster. RESULTS: Thirty-two clusters of malignant mesothelioma were identified and characterized using the exposure data. Asbestos cement manufacturing industries and shipbuilding and repair facilities represented the main sources of asbestos exposure, but a major contribution to asbestos exposure was also provided by sectors with no direct use of asbestos, such as non-asbestos textile industries, metal engineering and construction. A high proportion of cases with environmental exposure was found in clusters where asbestos cement plants were located or a natural source of asbestos (or asbestos-like) fibers was identifiable. Differences in type and sources of exposure can also explain the varying percentage of cases occurring in women among clusters. CONCLUSIONS: Our study demonstrates shared exposure patterns in territorial clusters of malignant mesothelioma due to single or multiple industrial sources, with major implications for public health policies, health surveillance, compensation procedures and site remediation programs.

Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues.

INTRODUCTION: Italy produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160,000 tons/year. The National Register of Mesotheliomas (ReNaM, "Registro Nazionale dei Mesoteliomi" in Italian), a surveillance system of mesothelioma incidence, has been active since 2002, operating through a regional structure. METHODS: The Operating Regional Center (COR) actively researches cases and defines asbestos exposure on the basis of national guidelines. Diagnostic, demographic and exposure characteristics of non-occupationally exposed cases are analysed and described with respect to occupationally exposed cases. RESULTS: Standardised incidence rates for pleural mesothelioma in 2008 were 3.84 (per 100,000) for men and 1.45 for women, respectively. Among the 15,845 mesothelioma cases registered between 1993 and 2008, exposure to asbestos fibres was investigated for 12,065 individuals (76.1%), identifying 530 (4.4%) with familial exposure (they lived with an occupationally exposed cohabitant), 514 (4.3%) with environmental exposure to asbestos (they lived near sources of asbestos pollution and were never occupationally exposed) and 188 (1.6%) exposed through hobby-related or other leisure activities. Clusters of cases due to environmental exposure are mainly related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova) and soil contamination (Biancavilla in Sicily). CONCLUSIONS: Asbestos pollution outside the workplace contributes significantly to the burden of asbestos-related diseases, suggesting the need to prevent exposures and to discuss how to deal with compensation rights for malignant mesothelioma cases induced by non-occupational exposure to asbestos.

[Active research, registration, and prevention of tumors of professional origin]. / Ricerca attiva, registrazione e prevenzione dei tumori di origine professionale.

Occupational cancer is an important public health concern in Italy and in many industrialized countries. The difficulties in monitoring and the complexity in retrieving occupational cancer cases have required the enrolment of a national epidemiologic sureveillance system at national scale with active search methods. A structured system for the registration of occupational cancer cases is normed by the Decree No. 81/2008, that accounts for the previous legislative procedures and experiences. Research activities and prevention of occupational cancer should be integrated with insurance policies to the purpose of an efficient protection of workers health.

Estimating number of workers potentially at risk of exposure to hardwood dust in certain industrial sectors in Italy using a national register.

BACKGROUND: Hardwood dust is a well-known human carcinogen and its use is common in several economic activities. OBJECTIVES: The aim of this study was to assess the extent of occupational exposure to hardwood dust in certain sectors of Italian industry. METHODS: Information on occupational exposures was collected from enterprise exposure registers that must by law be reported to the National Workers' Compensation Authority, as at 31 December 2011. Data stored in the database included economic activity sector, work force size and exposed workers. The number of workers potentially exposed was estimated for some of the industrial sectors from national occupational statistics in Italy. RESULTS: The economic sector with the highest number of potentially exposed workers to hardwood dust was that classified as the manufacture of other wooden furniture with 15,760 men and 2,771 women, while the highest percentage of enterprises that had sent data (according to the ISTAT 2001 census) was in building and repair of non-metallic ships (21%). CONCLUSIONS: The systematic recording of occupational exposures is a source of data that permits recognition of high risk situations and aids exposure assessment for epidemiological studies.

Occupational carcinogens in Italy: an overview on exposure to cadmium and its compounds.

Given the recognized carcinogenicity of cadmium, several regulatory interventions have been carried out over the years to protect exposed workers. The aim of the study is to investigate the prevalence and extent of exposure to cadmium among Italian workers. Data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2022). Gender-specific statistical analysis was carried out for some exposure-related variables (cadmium compound, activity sector, occupational group, firm size). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Overall 4,264 measurements were analyzed. Four industrial sectors were found to be most involved by cadmium exposure: base metal manufacturing, fabricated metal products, machinery and equipment, and other transport equipment (55% of measurements). Jewellery/precious-metal workers, and glass/ceramic plant operators were found to be most at exposure risk. A total of 26,470 workers potentially exposed was estimated (69% men). Concurrent exposures to other occupational carcinogens were detected quite frequently (52% of workers). Several situations of exposure and co-exposure to cadmium deserve attention and awareness in order to minimize the risks associated with workers' health. Recognition of potentially hazardous exposure conditions is an important step in prevention strategies to better protect workers against cancer-causing agents.

The burden of mortality with costs in productivity loss from occupational cancer in Italy.

BACKGROUND: The costs of productivity loss due to occupational cancer mortality are rarely investigated. An estimate of occupational cancer deaths in Italy in 2006 and an approximation of the resultant costs from medical and non-medical expenditures together with figures of remuneration lost are provided. METHODS: Occupational cancer deaths, obtained from the application of the attributable fraction (AF) to mortality data (source: Italian National Institute of Statistics), were used to calculate the Potential Years of Life Lost (PYLLs), the Potential Years of Working Life Lost (PYWLLs) and the costs of the loss of productive life. The health care costs for any cancer was applied to the estimated number of occupational cancer cases to obtain the total cost. RESULTS: Around 8,000-8,500 deaths/year from occupational cancer are estimated to occur in Italy, corresponding to 170,000 PYLLs and more than 16,000 PYWLLs, leading to around 360,000,000 euros in indirect economic loss. Health care costs of occupational cancer are estimated at 456,000,000 euros. CONCLUSIONS: Occupational cancer is of major concern in terms of mortality and economic productivity loss. Preventive efforts in evaluating ongoing risks and current exposures are strongly recommended to health policy-makers.

Assessment of work-related exposure to polycyclic aromatic hydrocarbons in Italy.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are generally present in the workplace environment as complex mixtures and often difficult to identify a priori. OBJECTIVES: The aim of this study is to evaluate the level and coverage of occupational exposure to PAHs in Italy. METHODS: Data were collected from exposure registries of companies with mandatory reporting to the National Workers' Compensation Authority. Statistical analyses were carried out on the retrieved information and the number of workers potentially exposed was estimated for some industrial sectors. RESULTS: Overall 12,849 measurements of exposure levels to individual PAHs were selected from the database of registries in the period 1996-2010. Most exposures occurred in the manufacture of chemicals (N = 5,383, 51%), and the occupational group most frequently measured was chemical-processing-plant operator (N = 3,930, 31%). Measurements were associated to various PAHs, including benzo[a]pyrene, benzo[a]anthracene, benzo[b]fluoranthene, benzo[k]fluoranthene, dibenz[a,h]anthracene, and benzo[j]fluoranthene. Overall, 39,230 workers were estimated as potentially at risk of exposure to PAHs in the selected industrial sectors. CONCLUSIONS: This study summarized data recorded in the Italian occupational exposure database and identified specific exposure patterns to PAHs. The systematic recording of occupational exposures is a source of data that allows the recognition, control, and prevention of high-risk situations for workers' health.

[Epidemiologic surveillance of mesothelioma for the prevention of asbestos exposure also in non-traditional settings]. / Sorveglianza epidemiologica dei mesoteliomi per la prevenzione dell'esposizione ad amianto anche in attività non tradizionalmente coinvolte.

OBJECTIVE: To show how malignant mesothelioma (MM) surveillance not only identifies settings of exposure representing past industrial history, but it may also detect conditions of current exposure relevant for the prevention, if the wide spectrum of asbestos uses is considered. DESIGN: Active search of MM cases and exposure assessment at individual level through a questionnaire; identification of exposure circumstances relevant for prevention. SETTING AND PARTICIPANTS: Italy, all the Regions where a Regional Operating Centre (COR) is established to identify all MM cases diagnosed in the population and analyze their occupational, residential, household and environmental histories. Period of diagnosis: 1993-2008. MAIN OUTCOME MEASURES: Descriptive analysis of MM cases and of asbestos exposures. RESULTS: ReNaM includes 15,845 cases of MM diagnosed between 1993 and 2008.The male/female ratio is 2.5. Mean age at diagnosis is 69 years. Pleural MMs represent 93% of all cases. Exposures have been investigated in 12,065 cases (76%). The median latency time is 46 years. In addition to clusters of MM cases in activities well known to entail asbestos use, different current exposure circumstances requiring intervention have been evidenced. CONCLUSIONS: On the basis of this experience, epidemiological surveillance of all occupational cancers should be implemented to foster synergies with the compensation system and the Local Health Authorities' occupational safety and health services, as required by the Italian Legislative Decree N. 81/2008.

Occupational exposure register-based cohort study on mortality among asbestos-related workers in Italy after the ban.

OBJECTIVE: Asbestos is a human carcinogen and can cause some types of cancer, including mesothelioma. A relevant number of workers are still engaged in asbestos removal and disposal activities, whose actual risk of asbestos-related diseases is still scarcely recognized. The main objective of this study is to assess the cause-specific mortality among workers involved in asbestos removal and disposal after the ban in Italy. METHODS: Data from the Information System on Occupational Exposure to carcinogens (SIREP) in the period 1996-2018 were selected. Proportionate mortality ratios (PMRs) by cause of death were calculated by linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data. RESULTS: A total of 142 deaths (all men) were identified among 13 715 asbestos removal and disposal workers. A significant excess ( P < 0.05) of mesothelioma deaths was found among male workers, about five-fold the expected. A significant increase in the mortality ratio was also found for malignant melanoma of skin. CONCLUSIONS: A risk of mesothelioma has been found among workers involved in asbestos removal and disposal. Epidemiological surveillance and promotion of prevention action plans are highly recommended for workers engaged in asbestos removal and disposal activities, to ensure compliance with regulatory requirements and reduce the still relevant risk of contracting the related tumor pathology.