Lung cancer risk and residence in the neighborhood of a sewage plant in Italy. A case-control study.

AIMS AND BACKGROUND: Environmental pollution originating in sewage and industrial plants can be associated with lung cancer risk, as ecological and case-control studies have indicated. In the present study, the association between lung cancer occurrence and residence near a sewage plant in Prato (Italy) was investigated. A previous geographic study in the same area had shown an increasing trend of lung cancer mortality and incidence with propinquity to the plant. METHODS: A case-control study was carried out in the male population of Prato. Incident cases in the period 1987-1997 were identified from the Tuscan Cancer Registry (no. 918). Controls were randomly extracted from the Registry Office of the Municipality of Prato (no. 1852). For all subjects, the residential history was reconstructed. A weighted average distance from the plant was computed and used as a proxy variable of exposure. Two analyses were performed: on the whole data set and on a subset of subjects for whom information on tobacco exposure and education was obtained through a postal questionnaire (response rate, 41.1%). Logistic regression models were applied to estimate odds ratios and 95% CI. RESULTS: Both analyses showed a significantly elevated lung cancer risk for subjects living within 1.5 km (ORwhole= 1.56, 1.06-2.28; ORsubset= 2.28, 1.06-4.86) and suggested a risk increase with a decrease of weighted average distance from the plant. CONCLUSIONS: The findings highlight a possible role, in lung cancer occurrence, for environmental pollution spread from the plant. Due to drawbacks of the study, further analyses are needed to evidence a noncontroversial etiological conclusion. When environmental data are not available, results of epidemiological studies using residential histories may be useful in preventive policies regarding point source emissions.

Exposure to carcinogens and mortality in a cohort of restoration workers of water-damaged library materials following the River Arno flooding in Florence, 4 November 1966.

BACKGROUND: In Florence, Italy, the Arno River overflowed on 4 November 1966 and the rare library collections of the National Central Library in Florence (FNCL) were flooded. A Restoration Centre was immediately set up. For book restoration many toxic chemicals were used, such as chlorinated solvents, ethylene oxide (EtO), formaldehyde, petroleum distillates, and pesticides. The study's aims were: (I) to document the restoration process, (II) to identify the potential chemical exposures, (III) to evaluate the mortality experience of restorers. METHODS: A small cohort of 168 workers was identified. The restorers were employed in the FNCL's Restoration Centre during the years 1967-1976. We excluded 9 subjects from the analysis because no working period data were available. Mortality from all causes, from all cancers, and from cancers of specific sites was compared with that of the Italian general population. Standardized Mortality Rates (SMRs) and their 95% confidence intervals were estimated. RESULTS: Restorers were exposed to relatively low levels of several carcinogens. A non-significant excess of cancer mortality was found. Significant increases in brain neoplasm among men and in uterine cancer among women were found, CONCLUSIONS: The small cohort size hampers interpretation of the results. Larger epidemiology studies on library material restorers are needed in order to evaluate risks in this activity. Recommendations to improve future studies are given.

Alkylphenol polyethoxylate removal in a pilot-scale reed bed and phenotypic characterization of the aerobic heterotrophic community.

The removal of the non-ionic surfactant Triton X-100, dosed at 30 and 300 mg/L in a pilot-scale subsurface horizontal flow reed bed, and the aerobic heterotrophic cultivable community associated with the roots and with the substrate gravel in both absence and presence of Triton X-100 were investigated. t-Octylphenol (OP) and its mono-, di- and tri-ethoxyl derivatives, among others, were found in the outlet. A mass balance allowed us to calculate that approximately 40% of the Triton X-100 metabolites OP and octylphenol polyethoxylate derivatives flowed out of the reed bed during the dosage and postdosage experiments. More aerobic heterotrophic microorganisms adhered to the roots than to the gravel. The appearance of new strains (Aeromonas, Flavobacterium, and Aquaspirillum) and the increased presence of others (Pseudomonas) during the dosage of Triton may be linked to the capacity of these bacteria to adapt to the presence of the surfactant or to use it as a nourishment.

[Geographical study on lung cancer mortality among residents in the neighbourhood of the coke plant in Piombino]. / Studio geografico sulla mortalità per tumore del polmone nei residenti a Piombino attorno alla locale cokeria.

OBJECTIVES: To evaluate a possible risk of lung cancer related to environmental pollutants in the population living in Piombino, Italy in the neighborhood of the local coke plant. DESIGN: Geographical study. SETTING AND PARTICIPANTS: Lung cancer deaths occurred in 1986-2000 in residents in Piombino were included in the study. MAIN OUTCOME MEASURES: Observed and expected number of cases for each census unit were computed using 4 different case distributions by residence in the area: at the time of death, 10 years before death, 15 years before death, and the longer residence in Piombino. For each census unit, the expected cases of male lung cancer death in 1986-2000 were calculated using the cause-, sex- and age-specific mortality rates of the entire area, obtained with the four case distributions. Data was analyzed and adjusted for an index ofsocial deprivation, using the Stone conditional test. RESULTS: A significant excess risk of lung cancer mortality, decreasing with distance from the plant, was observed only when the cases experiencing their longer residence in Piombino were included in the analysis. CONCLUSIONS: Smoking habits and occupation are the most important risk factors, nevertheless environmental pollutants might have played an additional role in the causation of the excess risk observed.

Italian general practitioners and smoking cessation strategies.

AIMS AND BACKGROUND: General practitioners (GPs) are in a key position to intervene with patients who smoke. The cornerstone of a smoking cessation strategy should be the routine provision of brief advice and follow-up in primary care. However, it seems GPs do not often take action against smoking, at least in Italy as shown by previous reports. The survey was planned, in the context of the "GPs Empowerment Project", a collaborative project involving Denmark, France, Greece, Italy and Portugal, under the ENSP contract with the European Commission (Health & Consumer protection Directorate-General), to evaluate the general attitude, knowledge and behavior of GPs regarding smoking cessation methods. METHODS: A total of 729 family doctors, 409 in Northern and 320 in Southern Italy, were interviewed by phone in the period July-October 2000 regarding their personal smoking habits and their approach with patients on the topic. Prevalence rates were computed using the Epi INFO 6.0 software and were presented as the unadjusted percentage prevalence. RESULTS: The percentage of current smokers among GPs included in the survey was 28.3%, with a higher prevalence in the south (33.3%). Most of the GPs believe that it is their duty to give information about smoking cessation (96.8%) and consider giving information about smoking cessation to their patients an important intervention (98.5%), but only about 49% think their patients will accept their advice. Most GPs (87.3%) declared having discussed about tobacco use with their patients during the month preceding the interview, and 83.5% would like to be trained on smoking cessation strategies. CONCLUSIONS: The results show that, in order to implement primary prevention in clinical practice in Italy, it appears essential to reduce the number of GPs who smoke and to improve GP training on smoking cessation procedures.

Prediction of mesothelioma and lung cancer in a cohort of asbestos exposed workers.

BACKGROUND: Several papers have reported state-wide projections of mesothelioma deaths, but few have computed these predictions in selected exposed groups. OBJECTIVE: To predict the future deaths attributable to asbestos in a cohort of railway rolling stock workers. METHODS: The future mortality of the 1,146 living workers has been computed in term of individual probability of dying for three different risks: baseline mortality, lung cancer excess, mesothelioma mortality. Lung cancer mortality attributable to asbestos was calculated assuming the excess risk as stable or with a decrease after a period of time since first exposure. Mesothelioma mortality was based on cumulative exposure and time since first exposure, with the inclusion of a term for clearance of asbestos fibres from the lung. RESULTS: The most likely range of the number of deaths attributable to asbestos in the period 2005-2050 was 15-30 for excess of lung cancer, and 23-35 for mesothelioma. CONCLUSION: This study provides predictions of asbestos-related mortality even in a selected cohort of exposed subjects, using previous knowledge about exposure-response relationship. The inclusion of individual information in the projection model helps reduce misclassification and improves the results. The method could be extended in other selected cohorts.