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The study was aimed at investigating in a sample of general medicine practitioners the level of epidemiologic and law knowledge as well as the degree of sensitivity to the topic of subjects formerly affected by occupational cancer. From the research, carried out on a sample of 745 practitioners from two northern Italy highly industrialized regions, come out the need for training and information on the problems associated with identification and management of subjects formerly exposed to professional cancer.

European Commission, H2020 [101016167]; Regional Health Authority (Azienda Zero), Veneto Region, Italy; Health Research Institute of Asturias (ISPA), Spain, Porru S, Monaco MGL, Spiteri G, Carta A, Pezzani MD, Lippi G, Gibellini D, Tacconelli E, Dalla Vecchia I, Sala E, Sansone E, De Palma G, Bonfanti C, Lombardo M, Terlenghi L, Pira E, Mansour I, Coggiola M, Ciocan C, Godono A, Tardon A, Rodriguez-Suarez MM, Fernandez-Tardon G, Jimeno-Demuth FJ, Castro-Delgado RV, Iglesias Cabo T, Scapellato ML, Liviero F, Moretto A, Mason P, Pavanello S, Volpin A, Vimercati L, Tafuri S, De Maria L, Sponselli S, Stefanizzi P, Caputi A, Gobba F, Modenese A, Casolari L, Garavini D, D'Elia C, Mariani S, Filon FL, Cegolon L, Negro C, Ronchese F, Rui F, De Michieli P, Murgia N, Dell'Omo M, Muzi G, Fiordi T, Gambelunghe A, Folletti I, Mates D, Calota VC, Neamtu A, Perseca O, Staicu CA, Voinoiu A, Fabiánová E, Bérešová J, Adamčáková ZK, Nedela R, Lesňáková A, Holčíková J, Boffetta P, Abedini M, Ditano G, Asafo SS, Visci G, Violante FS, Zunarelli C, Verlato G

Background There is conflicting evidence on the association between asbestos exposure and prostate cancer (PCa). Two recent meta-analyses have claimed that exposure is associated with increased PCa incidence and mortality, but they suffer from some methodological flaws. Given the potential importance of this research question, we aimed to perform a methodologically sound systematic review and meta-analysis to investigate the association between occupational asbestos exposure and the incidence of and mortality from PCa. Methods We followed PRISMA guidelines to systematically search for pertinent articles in three relevant electronic databases: Pubmed, Scopus, and Embase, from their inception to July 2020. The methodological quality of included articles was evaluated using the US National Institutes of Health tool. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for PCa, as well as respective 95% confidence intervals (CIs), were extracted or calculated for each included cohort. Main and subgroup meta-analyses according to first year of employment, industry, asbestos type, and geographic region were performed. Results Sixty-five articles comprising 68 cohorts were included. PCa incidence and mortality were not significantly associated with occupational asbestos exposure (pooled SIR: 1.06, 95% CI: 1.00-1.13, P = 0.062; pooled SMR: 1.03, 95% CI: 0.99-1.06, P = 0.115). PCa incidence was higher among workers employed after 1960 (SIR: 1.10, 95% CI: 1.01-1.20). Pooled SIR was elevated in European (SIR: 1.09, 95% CI: 1.01-1.18) and UK cohorts (SIR: 1.05, 95% CI: 1.02-1.09). Mortality was elevated in North American cohorts (SMR: 1.06, 95% CI: 1.02-1.10). Studies of lower methodological quality appeared to yield elevated SIRs or SMRs. Conclusions This systematic review and meta-analysis provides evidence that men with occupational asbestos exposure have a PCa incidence and mortality similar to that of the general population. Temporal and geographical variables seem to be related to higher SMR or SIR.

Objective To update the analysis of mortality of a cohort of talc miners and millers in Northern Italy. Methods We analyzed overall mortality and mortality from specific causes of death during 1946–2020 of 1749 male workers in a talc mine where asbestos was not detected (1184 miners and 565 millers) employed during 1946–1995. Results The overall standardized mortality ratio (SMR) was 1.21 (95 % confidence interval [CI] 1.14–1.28); no deaths were observed from pleural cancer. Mortality from lung cancer was not increased (SMR = 1.02 95 % CI 0.82–1.27), while mortality from pneumoconiosis was (SMR 9.55; 95 % CI 7.43–12.08), especially among miners (SMR 12.74; 95 % CI 9.79–16.31). There was a trend in risk of pneumoconiosis with increasing duration of employment in the overall cohort, and the SMR for 25+ years of employment was 15.12 (95 % CI 10.89–20.43). Conclusions This uniquely long-term follow up confirms the results of previous analyses, namely the lack of association between exposure to talc with no detectable level of asbestos and lung cancer and mesothelioma. Increased mortality from pneumoconiosis among miners is related to past exposure to silica.

Background Emotional exhaustion is the most important component of burnout syndrome, which is a threat to nurses' psychological well-being. Objectives The study investigated the impact of job demands - workload, cognitive demands, emotional demands, role conflict - and perceived leader-follower interaction frequency on emotional exhaustion among nurses. Methods This study was conducted at three hospitals in northern Italy through an anonymous self-report questionnaire administered to 560 nurses. Multiple hierarchical regression was performed. Results Workload and role conflict were positively related to emotional exhaustion, whereas cognitive demands and perceived leader-follower interaction frequency were negatively related. Emotional demands displayed a non-significant relationship with emotional exhaustion. Further analyses were performed to comment on the unexpected outcome of cognitive demands. A critical role of the perception of “distance” in leader-follower relationships on burnout was found. Conclusions This study provides novel insights into the relationship between job demands and burnout, and much needed empirical evidence on leader-follower relationships among nurses, pointing to the important role played by leader distance in nurses' well-being at work. Findings highlight the importance of training head nurses in managing their working relationship distance from their followers in order to help them soothing emotional exhaustion.

Objective To investigate the long-term mortality of a cohort of Italian asbestos miners. Methods The cohort included 1056 men employed in a chrysotile mine between 1930 and 1990, who were followed up during 1946-2014, for a total of 37 471 person-years of observation. Expected deaths and SMRs were computed using national and local (after 1980, when available) reference. Results A total of 294 (27.8%) subjects were alive and at the end of follow-up, 722 (68.4%) were dead and 40 (3.8%) were lost to follow-up. The SMR for overall mortality was 1.35 (95%CI 1.25 to 1.45). The SMR for pleural cancer, based on seven observed deaths, was 5.54 (95% CI 2.22 to 11.4) and related to time since first exposure, but not to duration of employment, cumulative exposure or time since last exposure. The SMR for lung cancer was 1.16 (95% CI 0.87 to 1.52; 53 observed deaths), with no excess among workers with cumulative exposure below 100 fibre/mL-years (SMR 0.82; 95% CI 0.44 to 1.40). Conclusions The update of the follow-up of this cohort confirmed an increased mortality from pleural cancer mortality in miners exposed to chrysotile and a lack of significant increase in lung cancer mortality. © Article author(s) 2017 (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Background: Quality of working life has been shown to play a key role in reducing strain inside and outside the workplace, supporting the fulfillment of workers’ wellbeing and increasing workforce productivity. Van Laar et al. in 2007 developed the Work-Related Quality of Life (WRQoL) scale that was applied to several different work environments and translated into nine languages. Objectives: We aimed to test and validate an Italian version of the WRQoL scale. Methods: A cross-sectional design was conducted to collect a sample of healthcare professionals (N=430) in 8 hospitals in the Northwest of Italy. Internal consistency of each scale was tested through Cronbach’s alpha. A Confirmatory factor analysis was performed. Independent samples t-tests and ANOVA were performed to determine whether the scores on the subscales differed according to various socio-demographic variables. Results: A seven factors structure was confirmed (Control at work; General well-being; Home-work interface; Stress at Work; Job and career satisfaction; Working conditions; Employee Engagement; χ2=682.453, p

On November 9 and 10, 2015, the International Conference on Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group's efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure, biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to asbestos and related mineral fibers. MM is an almost entirely preventable malignancy as it is most often caused by exposure to commercial asbestos or mineral fibers with asbestos-like health effects, such as erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial asbestos, erionite, and other mineral fibers in soil or rock (termed naturally occurring asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood biomarker validated to be effective for use in screening and identifying MM at an early stage in asbestos/NOA-exposed populations is not currently available, novel biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM. © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

Background Formaldehyde, a widely used chemical, is considered a human carcinogen. We report the results of a meta-analyses of studies on the relationship between occupational exposure to formaldehyde and risk of non-Hodgkin lymphoma (NHL). Methods We performed a systematic review and meta-analysis according to international guidelines and we identified 12 reports of occupational populations exposed to formaldehyde. We evaluated inter-study heterogeneity and we applied a random effects model. We conducted a cumulative meta-analysis and a meta-analysis according to estimated average exposure of each study population. Results The meta-analysis resulted in a summary relative risk (RR) for NHL of 0.93 (95% confidence interval 0.83–1.04). The cumulative meta-analysis suggests that higher RRs were detected in studies published before 1986, while studies available after 1986 did not show an association. No differences were found between different levels of occupational exposure. Conclusions Notwithstanding some limitations, the results of this meta-analysis do not support the hypothesis of an association between occupational exposure to formaldehyde and risk of NHL.

We carryied out a meta-analysis of studies on exposure to polychlorinated biphenyls (PCBs) and risk of non-Hodgkin lymphoma (NHL). Through a systematic search of the literature, we identified relative risks (RRs) for PCB exposure and NHL risk in 30 populations (10 occupational exposure, seven high environmental exposure, 13 without special exposure). We performed random effects meta-analyses for exposure to all PCBs, specific PCB congeners and risk of all NHL and NHL subtypes. The meta-RR for studies of occupational exposure, high environmental exposure, and no special exposure were 0.94 [95% confidence interval (CI): 0.84-1.03], 1.05 (95% CI: 0.94-1.16), and 1.03 (95% CI: 0.72-1.34), respectively, and the cumulative meta-RR was 0.96 (95% CI: 0.85-1.07). No positive associations were found for exposure to specific congeners, nor for NHL subtypes. The meta-RR for an increase of 100 ppb serum or fat PCB level was 1.02 (95% CI: 1.00-1.04). There was weak indication of publication bias. Our meta-analysis found no association between PCB exposure and NHL risk, in particular in studies of occupational exposures. We detected a weak dose-response relation; the possibility of residual confounding and other sources of bias cannot be ruled out. PCBs are not likely to cause NHL in humans.

Purpose: A ‘risk reversal’ has been observed for several human carcinogens following cessation of exposure, but it is unclear whether it also exists for asbestos-related mesothelioma. Methods: We conducted a systematic review of the literature and identified nine studies that reported information on risk of mesothelioma after cessation of asbestos exposure, and performed a meta-regression based on random effects models. As comparison we analyzed results on lung cancer risk from four of these studies. Results: A total of six risk estimates from five studies were included in the meta-analysis. The summary relative risk (RR) of mesothelioma for 10-year interval since cessation of exposure was 1.02 [95% confidence interval (CI) 0.87–1.19; p-heterogeneity 0.01]. The corresponding RR of lung cancer was 0.91 (95% CI 0.84–0.98). Conclusions: This analysis provides evidence that the risk of mesothelioma does not decrease after cessation of asbestos exposure, while lung cancer risk does.

The aim of this study was to carry out a meta-analysis of studies on exposure to polychlorinated biphenyls (PCBs) and the risk of malignant melanoma (MM). We searched Scopus, PubMed, and reference lists; among 807 potentially relevant articles, we selected those based on 12 populations. Data were extracted according to a standardized form; the Newcastle-Ottawa Scale was used to assess study quality. Meta-analyses were carried out according to fixed-effect and random-effects models. The fixed-effect summary relative risk (RR) for MM was 0.91 [95% confidence interval (CI): 0.82-1.00]; the random-effects summary RR was 1.05 (95% CI: 0.78-1.32). The random-effects summary RR from eight occupational cohorts was 1.13 (95% CI: 0.91-1.35) and that from four community-based studies was 0.84 (95% CI: 0.36-1.31). The quality of the studies and the methods for PCB exposure assessment did not influence the RR. These results do not support the hypothesis of an association between PCB exposure and the risk of MM. © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Several experimental and clinical studies have shown that a variety of ototoxic agents (such as drugs, industrial chemicals and noise) can cause sensorineural hearing loss. The most common ototoxic drugs used in clinical practice include: aminoglycoside and macrolide antibiotics, quinoline anti-malarials, platinum analog antineoplastics, loop diuretics, and acetylsalicylic acid. Among chemical agents with potential ototoxic properties are: organic solvents, heavy metals, organotins, nitriles, asphyxiants, and pesticides/herbicides. Acoustic exposure to high intensity and/or prolonged noise can also cause permanent threshold shifts in auditory perception. Ototoxic agents can influence auditory function by different mechanisms: RO S overload, inhibition of mitochondrial protein synthesis, DNA/RNA damage, activation of the apoptotic pathways, excessive calcium influx, increase of proinflammatory cytokines, interference with fluid and electrolyte balance of the endolymph, atrophy of the stria vascularis, changes in blood-labyrinth barrier and overstimulation of the stereocilia of the ear cells. Since noise exposure and many drugs or chemical compounds frequently share the same ototoxic mechanisms, this may explain why hearing loss can be potentiated by combined exposure to these agents. However, a great variability in the individual’s response to a given xenobiotic exists and depends on a complex interplay between endogenous and exogenous factors.

Objective: The aim of this study was to update the analysis of mortality of a cohort of talc miners and millers in Northern Italy. Methods: We analyzed the mortality during 1946 to 2013 of 1722 male workers in an asbestos-free talc mine (1166 miners and 556 millers) employed during 1946 to 1995. Results: The overall standardized mortality ratio (SMR) was 1.24 [95% confidence interval (95% CI) 1.17 to 1.32]; no deaths were observed from pleural cancer; mortality from lung cancer was not increased. Mortality from pneumoconiosis was increased (SMR 26.62; 95% CI 20.71 to 33.69), in particular among miners, and was associated with duration of employment and time since first employment. Conclusions: We confirmed the lack of association between exposure to asbestos-free talc, lung cancer, and mesothelioma. Increased mortality from pneumoconiosis among miners is attributable to past exposure to silica. © Copyright 2017 American College of Occupational and Environmental Medicine.

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Objectives: To analyze overall and cause-specific mortality, especially from cancer, among cement production workers. Introduction: Results from some epidemiological studies suggested an increased risk of overall mortality and of stomach cancer associated with employment in the cement production, but the presence of a hazard and, if present, the magnitude of a risk have not been precisely quantified. We conducted a systematic review and meta-analysis of data on mortality from all causes, cardiovascular or respiratory diseases, and cancer among cement workers. Methods: The literature search in PubMed and Scopus up to February 2016 and with appropriate keywords on mortality among cement workers revealed 188 articles which were screened. A total of 117 articles were reviewed in full text and 12 articles, referring to 11 study populations, were found to be relevant and of sufficient quality for further analysis. Meta-analyses were performed using a random-effects model. Results: Eight cohort studies, one proportionate mortality study, and two case–control studies were identified. The summary RRs were 0.89 [95 % confidence interval (CI) 0.76–1.01] for all-cause mortality, 0.94 (95 %, CI 0.80–1.08) for cancer mortality, 1.07 (95 % CI 0.79–1.35) for lung cancer mortality, and 0.93 (95 % CI 0.70–1.17) for stomach cancer mortality, respectively. Significant heterogeneity in results was observed among studies. Conclusion: The present meta-analysis does not provide evidence of increased risk of overall mortality, as well as cancer, cardiovascular or respiratory mortality in relation to employment in cement production. © 2016, Springer-Verlag Berlin Heidelberg.

Background: Increased cancer risk has been reported among workers in the rubber manufacturing industry employed before the 1960s. It is unclear whether risk remains increased among workers hired subsequently. The present study focused on risk of cancer mortality for rubber workers first employed since 1975 in 64 factories. Patients and methods: Anonymized data from cohorts of rubber workers employed for at least 1 year from Germany, Italy, Poland, Sweden, and the UK were pooled. Standardized mortality ratios (SMRs), based on country-specific death rates, were reported for bladder and lung cancer (primary outcomes of interest), for other selected cancer sites, and for cancer sites with a minimum of 10 deaths in men or women. Analyses stratified by type of industry, period, and duration of employment were carried out. Results: A total of 38 457 individuals (29 768 men; 8689 women) contributed to 949 370 person-years. No increased risk of bladder cancer was observed [SMR = 0.80, 95% confidence interval (CI) 0.46; 1.38]. The risk of lung cancer death was reduced (SMR = 0.81, 95% CI 0.70; 0.94). No statistically significant increased risk was observed for any other cause of death. A reduced risk was evident for total cancer mortality (SMR = 0.81, 95% CI 0.76; 0.87). Risks were lower for workers in the tyre industry compared with workers in the general rubber goods sector. Analysis by employment duration showed a negative trend with SMRs decreasing with increasing duration of employment. In an analysis of secondary end points, when stratified by type of industry and period of first employment, excess risks of myeloma and gastric cancer were observed each due, essentially, to results from one centre. Conclusion: No consistent increased risk of cancer death was observed among rubber workers first employed since 1975, no overall analysis of the pooled cohort produced significantly increased risk. Continued surveillance of the present cohorts is required to confirm the absence of long-term risk. © The Author 2016.

A high risk of neoplastic transformation of nasal and paranasal sinuses mucosa is related to the occupational exposure to wood dust, however no conclusive data have been reported up to now about morphological precursors of these tumors, mechanisms of carcinogenesis and role of p53 gene. Immunohistochemical overexpression of protein p53 (DO7 clone) by epithelial cells of ethmoidal mucosa was investigated on 60 woodworkers occupationally exposed for a minimum of 10 years, on 50 functional and/or esthetic nasal surgery patients (control group) and on 15 cases of intestinal-type adenocarcinoma, 10 of these involving subjects who had a longtime exposure to wood dust. In almost all the woodworkers (92%) the normal ciliated epithelium showed tracts of squamous metaplasia. The mean percentage of p53-positive cells in woodworkers and in controls was 28.6 and 7.97%, respectively, in metaplastic epithelium (P0.001), 11.7 and 2.08% in ciliated epithelium (P0.001), 12.46 and 1.03% (P0.001) in the sero-mucous glands of the nasal stroma. Both in tracts of metaplastic epithelium and in those of ciliated epithelium, positive cells were distributed in basal and suprabasal layers. A high number of p53-positive cells was also observed in the normal ciliated epithelium close to the neoplastic cells, of intestinal-type adenocarcinomas affecting subjects with longtime exposure to wood dust. Moreover, a higher number of p53 positive neoplastic cells was showed by the cases occurring in occupationally exposed patients than by the others. The following conclusions can be drawn: (1) in the ethmoidal mucosa, a region at high risk of carcinogenesis in subjects exposed to wood dust, epithelial cells overexpress p53 protein, and this may be linked to the presence of p53 gene mutations; malignant transformation, as at other head and neck sites, may thus occur through this pathway; (2) the presence of p53 overexpression in sero-mucous glands is in keeping with the histogenesis of some tumors from these structures; (3) since tumors of nose and paranasal sinuses, mainly adenocarcinoma, are recognized as occupational neoplasias, immunohistochemical evaluation of p53, perhaps combined with molecular methods, could be the first step to detect subjects at high risk of carcinogenesis among woodworkers.

Background: The purpose of this study is to evaluate whether demographics, lifestyle habits, clinical data and alcohol dehydrogenase polymorphisms rs1229984 and rs1573496 associated with first primary head and neck (HNC) are associated with overall survival, recurrence, and second primary cancer (SPC). Methods: We conducted a follow-up study in five centres including 801 cases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for overall survival, recurrence and SPC. Results: Five-years overall survival was 62% for HNC cases, 55% for oral cavity, 53% for oropharynx, 41% for hypopharynx, and 71% for larynx. Predictors of survival were older ages (HR. =. 1.18 for 5 years increase; CI: 1.07-1.30), higher tumour stage (HR. =. 4.16; CI: 2.49-6.96), and high alcohol consumption (HR. =. 3.93; CI: 1.79-8.63). A combined therapy (HR. =. 3.29; CI: 1.18-9.13) was associated with a worst prognosis for oral cavity cancer. The only predictor was higher tumour stage (HR. =. 2.25; CI: 1.26-4.03) for recurrence, and duration of smoking (HR. =. 1.91; CI: 1.00-3.68) for SPC. ADH1B rs1229984 polymorphism HRs for HNC and oesophageal cancer death and for alcohol related cancer death were 0.67 (95% CI: 0.42-1.08), and 0.64 (95% CI: 0.40-1.03), respectively. Conclusions: The survival expectation differs among HNC sites. Increasing age and stage, and high alcohol consumption were unfavourable predictors of HNC survival overall. Duration of tobacco consumption before the first primary tumour was a risk factor for SPC.

Some excess of non-Hodgkin lymphomas (NHL) and soft tissue sarcomas (STS) was reported in the literature among agricultural workers, mainly in relation to exposure to phenoxyacids and chlorophenols. In this study, information was analyzed for a cohort of rice growers that comprised 1,493 subjects, and for a follow-up that was more than 99% complete with regard to both traced subjects and known causes of deaths. A total of 960 subjects (65%) died during the observation period (1957–1992). Lower than expected standardized mortality ratios (SMRs) were found for all causes, for cardiovascular diseases (especially ischemic heart disease) and for all cancers. Slightly increased SMRs were found for some cancer sites (oral cavity, esophagus, liver, intestines, pancreas, bladder, STS, and NHL), although none of these was statistically significant in the overall analysis. An excess risk of close to statistical significance was found for NHL among workers with longer exposure during the period when phenoxyacid herbicide was in use (1950–1992). Thus, a prolonged follow-up is advisable. At present the study should be evaluated in the context of the data set suggesting a tendency toward an increased risk of NHL among farmers. Am. J. Ind. Med. 31:435–441, 1997. © 1997 Wiley-Liss, Inc.

Objective: To investigate mortality among workers of an Italian rubber tire factory employed between 1954 and 2008. Methods: This cohort study included 6246 men, totaling 190,512 man-years of observation. Employment data were obtained from personnel records, whereas vital status and causes of death were ascertained from local authorities. We computed standardized mortality ratios (SMRs) using national and regional death certification rates. Results: Mortality was significantly lower than expected for all cancers (SMR = 79) and all causes (SMR = 85). The SMRs were 99 for cancer of stomach, 78 for lung, 121 for urinary bladder, 116 for lymphoma, and 89 for leukemia, none being significant. Decreased mortality emerged for cancers of the oral cavity and pharynx (SMR = 45), esophagus (SMR = 29), colorectum (SMR = 71), liver (SMR = 57), and kidney (SMR = 33). Conclusions: This study shows no excess cancer risk among male rubber tire workers employed after 1954.

Objectives: To provide further information on mortality from cancer and other causes among chrysotile asbestos miners several years after exposure ceased, we updated the analyses from the Balangero mine worker cohort with follow-up to the end of 2003. Methods: The cohort included 1056 men, for a total of 34 432 man-years of observation. We obtained employment data from factory personnel records, and ascertained vital status and causes of death through population registers and death certificates from municipal registration offices. We computed expected numbers of deaths and standardised mortality ratios (SMRs) for relevant causes using the province of Turin and national death rates, for each 5-year calendar period and age group. Results: We found a significant excess mortality from pleural cancer only (4 deaths, SMR 4.67) and pleural and peritoneal cancers combined (5 deaths, SMR 3.16). All pleural and peritoneal cancer deaths occurred 30 or more years after first exposure. The SMRs were 1.27 for lung cancer (45 deaths), 1.82 for laryngeal cancer (8 deaths) and 1.12 for all cancers (142 deaths). Cumulative dust exposure and the various time factors considered did not show a clear pattern of risk associated with mortality from lung cancer. There were 57 deaths from cirrhosis (SMR 2.94) and 54 from accidents and violence (SMR 1.88). Overall, we observed a total of 590 deaths as compared to 412.9 expected (SMR 1.43). Conclusions: This updated analysis, with almost 60% of the cohort having died, confirmed the excess mortality from pleural and peritoneal cancers and from several alcohol-related causes.

We analysed data from a cohort of 1966 subjects (889 men and 1,077 women) employed by an Italian asbestos (mainly textile) company in the period 1946-1984, who were followed-up to 2004. A total of 62,025 person-years of observation were recorded. We computed standardised mortality ratios (SMR) for all causes and selected cancer sites using national death rates for each 5-year calendar period and age group. There were 68 deaths from mesothelioma (25 men and 43 women, 39 pleural and 29 peritoneal) vs 1.6 expected (SMR=4,159), and 109 from lung cancer vs 35.1 expected (SMR=310). The SMRs of pleural/peritoneal cancer were 6661 for subjects exposed only before 30 years of age, 8,019 for those first exposed before 30 and still employed at 30-39 years of age and 5,786 for those first exposed before 30 and still employed at 40 or more years of age. The corresponding SMRs for lung cancer were 227, 446 and 562. The SMR of mesothelioma was strongly related to time since first exposure. The SMR of lung cancer, but not of mesothelioma, appeared to be related to subsequent exposures.

A cohort of 889 men and 1077 women employed for at least 1 month between 1946 and 1984 by a former Italian leading asbestos ( mainly textile) company, characterised by extremely heavy exposures often for short durations, was followed up to 1996, for a total of 53 024 person- years of observation. Employment data were obtained from factory personnel records, while vital status and causes of death were ascertained through municipality registers and local health units. We observed 222 cancer deaths compared with 116.4 expected ( standardized mortality ratio, SMR = 191). The highest ratios were found for pleural ( SMR = 4105), peritoneal ( SMR = 1817) and lung ( SMR = 282) cancers. We observed direct relationships with duration of employment for lung and peritoneal cancer, and with time since first employment for lung cancer and mesothelioma. Pleural cancer risk was independent from duration ( SMR = 3428 for employment < 1 year, 7659 for 1 - 4 years, 2979 for 5 - 9 years and 2130 for &GE; 10 years). Corresponding SMRs for lung cancer were 139, 251, 233 and 531. Nonsignificantly increased ratios were found for ovarian ( SMR = 261), laryngeal ( SMR = 238) and oro- pharyngeal ( SMR = 226) cancers. This study confirms and further quantifies the central role of latency in pleural mesothelioma and of cumulative exposure in lung cancer.

In this paper we have defined the new biomarkers of exposure (NBE) as those biomarkers discovered in the last five years and, among previously validated biomarkers, also those applied in different ranges of doses or those determined in biological matrices which differ from matrices originally considered. We examined the results from the surveys carried out by the main Italian research units involved in biological monitoring, i.e. those from the Universities of Brescia, Milan, Naples, Padua, Parma, Pavia, Turin and Verona. The data were collected using a standardized model and included the following: type of element or organic compound, type of biomarker, analytical technique and method, their relationship with environmental monitoring data, their relationship with effect indicators or effects in general, improvement with respect to old biomarkers, reference values. Twenty two NBEs were identified: 14 elements and chemical compounds as such or as metabolites, 4 examples of mixtures, 3 of new matrices, one of speciation. Among the others, aspects such as interest in requiring NBE, quality assurance, availability, cost-benefit ratio were discussed. We conclude that development of this specific field of research appears to be a crucial point for future improvement in risk assessment and health surveillance procedures.

Background While talc containing asbestiform fibers is considered a human carcinogen, only limited animal and human data are available on non-asbestiform talc. To provide further evaluation on the issue, we updated the analysis of an Italian cohort of talc miners and millers in Val Chisone; talc found here is free from asbestiform fibers. Methods The cohort was comprised of 1, 795 men who had worked for at least I year in the mine and/or in the factory between 1946 and 1995. Vital status and death certificates were obtained from registration offices in the municipality of death or of birth. Employment, termination of employment, and detailed job history were obtained from personnel records at the plant. Results No excess was found for total cancer mortality, nor mortality for lung cancer No case of mesothelioma was reported There was a significant excess mortality from non-neoplastic respiratory diseases (SMR 228.2, 95% CI 190.2-271.5). Mortality excess for non-neoplastic respiratory diseases was mainly due to silicosis. Conclusions This study provides additional support for an association between talc in mining and milling and non-neoplastic respiratory diseases, while showing no significant excess risk for lung cancer and mesothelioma. The results also provide additional information of interest to evaluate the potential association between silica and lung cancer (C) 2003 Wiley-Liss, Inc.

The mortality experience of a cohort of chrysotile miners employed since 1946 in Balangero, northern Italy was updated to the end of 1987 giving a total of 427 deaths out of 27,010 man-years at risk. A substantial excess mortality for all causes (standardised mortality ratio (SMR) = 149) was found, mainly because of high rates for some alcohol related deaths (hepatic cirrhosis, accidents). For mortality from cancer, however, the number of observed deaths (82) was close to that expected (76.2). The SMR was raised for oral cancer (SMR 231 based on six deaths), cancer of the larynx (SMR 267 based on eight deaths), and pleura (SMR 667 based on two deaths), although the excess only reached statistical significance for cancer of the larynx. Rates were not increased for lung, stomach, or any other type of cancer. No consistent association was seen with duration or cumulative dust exposure (fibre-years) for oral cancer, but the greatest risks for laryngeal and pleural cancer were in the highest category of duration and degree of exposure to fibres. Although part of the excess mortality from laryngeal cancer is probably attributable to high alcohol consumption in this group of workers, the data suggest that exposure to chrysotile asbestos (or to the fibre balangeroite that accounts for 0.2-0.5% of total mass in the mine) is associated with some, however moderate, excess risk of laryngeal cancer and pleural mesothelioma. The absence of excess mortality from lung cancer in this cohort is difficult to interpret.

A case-control study was carried out on 145 male lung-cancer patients diagnosed at autopsy and 178 controls, in order to investigate the relationship between asbestos exposure and the cell type of pulmonary carcinoma. Adenocarcinomas (AD) were individually matched with other cell types and with controls. The relative risk (RR) of developing AD in relation with lung asbestos body (AB) content as the exposure indicator was calculated by using logistic-regression analysis for matched sets. Two cutoff levels, 1,000 and 10,000 asbestos bodies per gram dry weight (AB/gdw), were used in the analysis. In addition, AB counts were treated as a continuous variable (log AB + I). A significant association was found between AD and asbestos exposure, using levers and logarithmic transformation. However, an association of asbestos exposure with cell types other than AD could not be ruled out. (C) 1995 Wiley-Liss, Inc.

An analysis of the mortality of a cohort of 6629 workers employed from 1906 to 1981 in a rubber tyre factory in northern Italy (978 deaths and over 133,000 man-years at risk) showed that the all cause mortality ratio was slightly lower than expected (0.91). Overall cancer mortality was close to expected (275 v 259.4) but there were significant excess rates for two cancer sites: pleura (9 observed v 0.8 expected, which may be due to the use of fibre containing talc) and bladder (16 observed v 8.8 expected). Death rates were not raised for other sites previously associated with employment in the rubber industry, such as cancers of the lung and brain, leukaemias, or lymphomas. The substantially reduced relative risk of pleural cancer among workers first employed after 1940 (RR = 0.05 compared with before 1940) probably reflected improvements in working conditions over more recent periods. For cancer of the bladder, the relative risk was also lower for workers first engaged after 1940. Thus no appreciable risk for any disease was apparent for workers employed over the past four decades. Analysis for each of the 27 job categories showed a substantial excess for cancer of the pleura in the mechanical maintenance workers (4 observed v 0.17 expected); an excess of cancer of the lung (21 v 13.48) was also present in this job category.