[Considerations about the epidemiologic surveillance system on mesothelioma in Tuscany (Italy) after 25 years of activity]. / Considerazioni sul sistema di sorveglianza epidemiologica del mesotelioma maligno in Toscana nel 25° anno di attività

OBJECTIVE AND DESIGN: To present problems and opportunities related to the operating procedures developed by the Tuscan epidemiological surveillance system on mesothelioma during its 25 years of activity. SETTING AND PARTICIPANTS: All 1,224 mesotheliomas, registered up to 31.12. 2011, diagnosed in Tuscan residents during 1988-2009 by the Tuscan Operating Centre of the Italian registry, have been considered. MAIN OUTCOME MEASURES: In order to evaluate accuracy and completeness of cases, the following indicators by period are used for pleural mesotheliomas diagnosed during 1988-2009: the distribution of the sources of cases' diagnosis and report to the regional registry, the latency time between diagnosis and report, the age and sex specific rates, the ratio between standardized mortality and incidence rates. The distribution of type of interview and exposure classification by period for all cases were used to evaluate the collected and classified exposure information. RESULTS: Histology with immunohistochemistry became the chosen method (97.4% of histological cases in 2005- 2009). Since the second half of the Nineties, other Italian regional Operating Centres and, more recently, the Workers Compensation Authority (INAIL) became new important sources of case report. Nowadays, the mortality/incidence ratio is closer to 1. The latency time between diagnosis and case report have been reducing with a consequent increase in direct interviews to cases (from 20.3% in 1988-1993 to 71.4% in 2005-2009) and in exposure information and classification quality. CONCLUSION: The regional network with the effective cooperation of the Local Health Authorities produced relevant improvements in the quality of the epidemiological surveillance system. It is hoped that the new revision of the national Guidelines will succeed in taking into consideration all the improvements made by the surveillance system in order to get over the difficulties observed in defining and classifying cases and their asbestos exposure.

[Solar ultraviolet radiation risk in outdoor workers: a specific project of Tuscany Region (Italy)]. / Rischio da radiazione solare ultravioletta nei lavoratori outdoor: piano mirato della Regione Toscana.

OBJECTIVE: The aims of Tuscany Regional project were: to study the sun protection attitude of outdoor workers; to measure solar ultraviolet (UV) exposure in work environment; to describe the frequency of photoaging, precancerous lesions, and skin cancers in outdoor workers; to collect information on solar ultraviolet radiation exposure from incident cases of Non-Melanoma Skin Cancer (NMSC) recruited from Tuscany Cancer Registry. DESIGN: Outdoor workers completed a questionnaire devoted to collect information on sun protection attitudes during a typical summer working week. Environmental and personal measurements were carried out. Expert dermatologists examined outdoor workers to assess the frequency of photoaging, precancerous lesions, and skin cancer. A structured questionnaire was mailed to incident cases of NMSC. Information were collected on personal habits and working history, focusing on solar ultraviolet radiation exposure. SETTING AND PARTICIPANTS: Agriculture, construction, quarrying and fishing activities were considered: 292 employees responded to questions about the type of clothing used in the morning and in the afternoon,while working outdoors; 637 outdoor workers underwent skin examination. We contacted 743 cases of NMSC occurred in 2004; 498 subjects accepted to participate in this study. RESULTS: The clothing worn by surveyed subjects was often inadequate compared to the high level of exposure to UV. The skin examination of 637 outdoor workers highlighted 2 melanomas, 7 epitheliomas and 35 actinic keratoses. Among the 498 cases of NMSC, 135 (27%) were diagnosed in outdoor workers. Most represented economic activity sectors were: agriculture, construction, transport, sports. CONCLUSION: The characterization of outside workers revealed unsatisfactory sun protection behaviours. Moreover, previously undetected skin cancers were diagnosed. The study on MNSC confirms the complexity of studying the exposure to UV radiation. The Tuscany Regional project provided useful information on the risk of solar ultraviolet radiation in outdoor workers. Prevention programs are needed.