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.

[Cohort study of mortality among leather tanners in the Lower Valdarno area]. / Studio di coorte di mortalità degli addetti alla concia del cuoio e delle pelli nel territorio dell'azienda USL 11--Zona Valdarno Inferiore.

BACKGROUND: Epidemiological studies of tanners have shown increased risk for a number of cancer sites, namely: lung, bladder, kidney and urinary organs as well as stomach, intestine, pancreas, nose and nasal cavities, together with leukemias and soft tissue sarcomas. OBJECTIVE: To study cause specific mortality of leather tanners in Tuscany (Valdarno Inferiore area). METHODS: The cohort included 4874 workers (4150 males and 724 females) employed in 92 tanneries operating in 1996 (Valdarno Inferiore Tanneries Census) which were also operating on 31-12-1970. Ascertainment of vital status was completed for all individuals on 31-12-1998 (end of follow-up), and the cause of death was known for all deceased subjects. Demographic and work history data were obtained from factory payrolls. Regional mortality rates were used for comparison to calculate SMR (Standardised Mortality Ratio) and 90% Confidence Intervals (CI). In addition to the overall cohort analysis, for men only separate analyses were completed for finishers, chrome tanners and vegetable tanners. RESULTS: The study showed an increased mortality from lung cancer among finishers, Standardised Mortality Ratio (SMR) 145, 19 observed (obs) (90% Confidence Intervals, 90% CI 95-212), from bladder cancer in the overall cohort (SMR 134, 9 obs, 90% CI 70-233) and among finishers (SMR 125, 2 obs, 90% CI 22-393) and from pancreatic cancer among finishers (SMR 120, 2 obs, 90% CI 21-379). Mortality from lymphoemopoietic cancer is above expected, and the increase is mainly due to myeloid leukaemia, both in males (SMR 208, 5 obs, 90% CI 82-437) and females (SMR 599, 2 obs, 90% CI 106-1887). No deaths from soft tissue sarcoma were observed. A new finding of the study was the increased mortality from cancer of the endocrine glands (SMR 566, 4 obs, 90% CI 194-1297), psychiatric disorders (SMR 195, 6 obs, 90% CI 85-385) and blood diseases (SMR 329, 4 obs, IC 90% 112-752). CONCLUSIONS: The observations of increased lung cancer mortality among finishers, of bladder cancer in the overall cohort and among finishers, as well as an increase in pancreatic cancer among the latter, confirm previous epidemiological findings among tanners. The increase in myeloid leukemia mortality for both males and females, and the absence of deaths from cancer of the connective tissue, which includes soft tissue sarcomas, are worthy of note. The results should be valued with caution, given the small number of cases and the novelty of some observations.

[Identification and mortality of Italian emigrants returning to Italy after having worked in the crocidolite mines at Wittenoon Gorge, Western Australia]. / Identificazione e mortalità dei migranti italiani ritornati in Italia dopo aver lavorato alla miniera di crocidolite di Wittenoom Gorge, Western Australia.

The crocidolite mine at Wittenoom Gorge, Western Australia, has been active from 1943 to 1966, and managed by Australian Blue Asbestos Ltd (ABA). Migrants constituted the large majority of workers. The list of workers is composed of 6,911 subjects (6,501 males). In it we identified 1,102 Italians (1,069 males) and completed the follow up for those previously lost, remained in Australia or returned to Italy. Up to 1997, 302 subjects (301 males) definitively resettled in Italy, almost always returning to their community of origin. The median length of work at Wittenoom for those resettled was 17.8 months. The resettled subjects are spread around Italy, and 112 subjects (37%) already died. We compared the mortality rates of those returned to Italy to the rates of the male Italian population. Migrants were subjected to a strong selection before departure and were the target of a surveillance program during work at Wittenoom: however, for those resettled, instead of a healthy migrant effect, we observed an overmortality, mainly due to deaths from penumoconiosis (10 deaths vs 0.38 expected), from respiratory tumours (3 deaths from pleural mesothelioma and 4 from primary peritoneal tumours; an excess of lung cancers, SMR 1.28, 95% CI 0.72-2.11, and an excess of undefined caused of deaths (SMR 6.29, 95% CI 2.52-12.96). The study suggests that asbestos-related diseases and deaths have been observed among those resettled to Italy. In order to increase the precision of the follow up of the Wittenoom cohort, a search outside Australia should be carried out in some European countries for workers whose vital status was unconfirmed. Survivors in Italy are suffering from asbestosis, jeopardizing their life, and are at risk of cancer, but few have received information, actions aimed at reducing the accumulated risk, or compensation. Italy had a multi-million number of migrants for work, and an important percentage of migrants is returned to Italy: the effects of occupational exposures to adverse agents should be expected, but this topic has received up to now little attention.

Colorectal, lung, and breast cancer care during the three years following the diagnosis: a population-based study.

AIMS: We evaluated a number of basic parameters of care during hospitalization that contribute to the total cost of therapy during the 3 years after the first diagnosis of cancer. METHODS: The study examined a sample of cases of cancer of the colon-rectum (164 cases), lung (160 cases) and breast (144 cases) diagnosed in 1987, taken from the data base of the Tuscany Cancer Registry. All the information collected by the Registry was examined and the sample was further validated by reviewing original clinical records. The agreement between the two sources was very high, confirming the adequacy of the Registry as a source of information. The parameters evaluated for each patient were the number of cytohistologic examinations, surgery, hospital admissions and days spent in hospital during the 3 follow-up years. RESULTS: The average number of admittances in 3 years was 1.93 for colorectal, 3.39 for lung and 2.15 for breast cancer. The mean number of days spent in hospital in the 3 follow-up years was 39.9 for colorectal, 50.1 for lung and 21.1 for breast cancer. The parameters differed among subjects still alive, those deceased and those in various stages of the illness. CONCLUSIONS: The costs of the time spent in hospital, based on the number of days during the first 3 years of the illness, were higher in cases of lung cancer than of the other sites, and more so for patients diagnosed in an advanced phase of the disease.

[Chromatid exchanges: a chromosomal index of environmental mutagenicity]. / Gli scambi cromatidici: un indice cromosomico di mutagenicità ambientale.

The induction of exchanges between related chromatids (SCEs) was studied to discover exposure to genotoxic agents. The frequencies of SCEs were recorded in a group of workers exposed to azoic dyes and in a control group. The chromatid exchange test was proved to be a sensitive indicator of chemical mutagenic action. The results on SCE frequency and chromosome aberrations indicate that these workers had been exposed to mutagenic agents.