Post-occupational health surveillance of asbestos workers.

BACKGROUND: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. OBJECTIVES: To develop an updated evidence-based methodology for an appropriate health surveillance programme. METHODS: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. RESULTS: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). CONCLUSIONS: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

Increasing incidence of malignant mesothelioma after exposure to asbestos during home maintenance and renovation.

OBJECTIVE: To determine trends in incidence of malignant mesothelioma (MM) caused by exposure to asbestos during home maintenance and renovation. DESIGN, SETTING AND PARTICIPANTS: Using the Western Australian Mesothelioma Register, we reviewed all cases of MM diagnosed in WA from 1960 to the end of 2008, and determined the primary source of exposure to asbestos. Categories of exposure were collapsed into seven groups: asbestos miners and millers from Wittenoom; all other asbestos workers; residents from Wittenoom; home maintenance/renovators; other people exposed but not through their occupation; and people with unknown asbestos exposure; or no known asbestos exposure. Latency periods and age at diagnosis for each group were calculated and compared. RESULTS: In WA, 1631 people (1408 men, 223 women) were diagnosed with MM between 1960 and 2008. Since 1981, there have been 87 cases (55 in men) of MM attributed to asbestos exposure during home maintenance and renovation, and an increasing trend in such cases, in both men and women. In the last 4 years of the study (2005-2008), home renovators accounted for 8.4% of all men and 35.7% of all women diagnosed with MM. After controlling for sex and both year and age at diagnosis, the latency period for people exposed to asbestos during home renovation was significantly shorter than that for all other exposure groups, but the shorter follow-up and difficulty recalling when exposure first occurred in this group may partly explain this. CONCLUSIONS: MM after exposure to asbestos during home renovation is an increasing problem in WA, and these cases seem to have a shorter latency period than other types of exposure. MM cases related to renovation will probably continue to increase because of the many homes that have contained, and still contain, asbestos building products.

[Algorithm for assessment of exposure to asbestos]. / Proposta di algoritmo per la valutazione stimata dell'esposizione lavorativa ad amianto.

There is no universally approved method in the scientific literature to identify subjects exposed to asbestos and divide them in classes according to intensity of exposure. The aim of our work is to study and develope an algorithm based on the findings of occupational anamnestical information provided by a large group of workers. The algorithm allows to discriminate, in a probabilistic way, the risk of exposure by the attribution of a code for each worker (ELSA Code--work estimated exposure to asbestos). The ELSA code has been obtained through a synthesis of information that the international scientific literature identifies as the most predictive for the onset of asbestos-related abnormalities. Four dimensions are analyzed and described: 1) present and/or past occupation; 2) type of materials and equipment used in performing working activity; 3) environment where these activities are carried out; 4) period of time when activities are performed. Although it is possible to have informations in a subjective manner, the decisional procedure is objective and is based on the systematic evaluation of asbestos exposure. From the combination of the four identified dimensions it is possible to have 108 ELSA codes divided in three typological profiles of estimated risk of exposure. The application of the algorithm offers some advantages compared to other methods used for identifying individuals exposed to asbestos: 1) it can be computed both in case of present and past exposure to asbestos; 2) the classification of workers exposed to asbestos using ELSA code is more detailed than the one we have obtained with Job Exposure Matrix (JEM) because the ELSA Code takes in account other indicators of risk besides those considered in the JEM. This algorithm was developed for a project sponsored by the Italian Armed Forces and is also adaptable to other work conditions for in which it could be necessary to assess risk for asbestos exposure.

La prevención de las patologías del asbesto: perspectivas operativas de la cooperación italiana con los países de América Latina / Preventing asbestos-related diseases: operative action for Italian cooperation with Latin-American countries

El propósito del presente estudio es el de valorar la tesis de que el impacto a la salud de la exposición a fibras de asbesto presentes en los lugares de trabajo y en el ambiente requiere contramedidas basadas en la evidencia científica y la cooperación internacional. La evidencia científica adquirida a nivel internacional sobre el asbesto, la experiencia pluridecenal madurada en Italia sobre este tema, así como la conciencia de que la adaptación de medidas para combatir los efectos en la salud causados por la exposición a asbesto debe ser verificada considerando la especificidad de los diversos contextos nacionales y locales en América Latina, constituyen la base para la identificación de las cuatro principales directrices de intervención (Promoción del acceso a la documentación sobre el asbesto - Realización de intervenciones para reducir la exposición al asbesto - Vigilancia sanitaria de los sujetos expuestos - Detección del mesotelioma) - que pueden ser desarrolladas en el ámbito de la cooperación técnico-científica entre Italia y los países de América Latina. La integración de las capacidades de los investigadores colombianos e italianos podrá permitir conseguir estos resultados, contribuyendo al proceso de eliminación del asbesto ya en curso en América Latina.

The present paper was aimed at promoting countermeasures based on scientific evidence and international cooperation for evaluating the impact on health caused by exposure to asbestos fibres in the workplace and the environment. Scientific evidence regarding asbestos made available by the international scientific community, decades of experience gained in Italy on this issue and being aware that adopting measures to combat the health effects caused by asbestos exposure should be verified considering the specificity of various national and local contexts in Latin-America form the basis for identifying four main areas for intervention which may be developed in the field of technical and scientific cooperation between Italy and Latin-America countries: promoting access to information about asbestos, interventions for reducing exposure to asbestos, health surveillance of exposed subjects and mesothelioma detection. Integrating Colombian and Italian researchers' abilities may lead to such results being achieved, thereby contributing to banning asbestos, which is already underway in Latin-America.

[Preventing asbestos-related diseases: operative action for Italian cooperation with Latin-American countries]. / La prevención de las patologías del asbesto: perspectivas operativas de la cooperación italiana con los países de América Latina.

The present paper was aimed at promoting countermeasures based on scientific evidence and international cooperation for evaluating the impact on health caused by exposure to asbestos fibres in the workplace and the environment. Scientific evidence regarding asbestos made available by the international scientific community, decades of experience gained in Italy on this issue and being aware that adopting measures to combat the health effects caused by asbestos exposure should be verified considering the specificity of various national and local contexts in Latin-America form the basis for identifying four main areas for intervention which may be developed in the field of technical and scientific cooperation between Italy and Latin-America countries: promoting access to information about asbestos, interventions for reducing exposure to asbestos, health surveillance of exposed subjects and mesothelioma detection. Integrating Colombian and Italian researchers' abilities may lead to such results being achieved, thereby contributing to banning asbestos, which is already underway in Latin-America.

Assessment of biomarkers in asbestos-exposed workers as indicators of cancer risk.

Epidemiological studies have shown that mortality from malignant mesothelioma (MM) and lung cancer have increased with increasing cumulative exposure to asbestos. To investigate whether tumour-related biomarkers can contribute towards the evaluation of the carcinogenic risk in populations exposed to asbestos, the DNA adduct 8-hydroxy-2'-deoxyguanosine (80HdG), interleukine-6 (IL-6), platelet-derived growth factor (PDGF-BB), hepatocyte growth factor (HGF), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGFbeta) and soluble mesothelin-related peptides (SMRPs) were analysed in a cohort of workers differently exposed to asbestos fibres at the workplace. To document biomarker levels in an unexposed population, 54 age-matched subjects were enrolled. A total of 119 subjects with a history of occupational exposure to asbestos underwent clinical examination and were interviewed by trained personnel, responding to a detailed questionnaire related to duration of asbestos exposure, smoking, and occupational task. According to the occupational tasks, asbestos-exposed subjects were analysed for their asbestos cumulative dose and the association with the biomarkers was evaluated. Among the occupational groups, maintenance workers, pipe fitters and electricians were exposed to a higher cumulative dose of asbestos fibres. Exposure to asbestos significantly increased the steady-state content of 80HdG in DNA. Elevated levels of 80HdG and IL-6 best reflected a high level of SMRPs, which is related to cell transformation. Subjects heavily exposed to asbestos [> 60(ff/cm3) x years] showed also a higher level of angiogenic factors. A combination of angiogenic biomarkers with a specific mesothelioma-biomarker such as SMRPs could be used for close surveillance of workers with a history of asbestos exposure.