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The Authors, after a survey of the latest experimental and epidemiological studies concerning the possible role of crystalline silica in lung carcinogenicity, examine the cases acknowledged by the INAIL in Genoa concerning subjects suffering from silicosis who, thereafter, developed a lung cancer in the period 1979 - 2004. Distribution of the degree of disability, of the length of occupational exposure to silica, of the workers' age at the time of death and of the different fields of activity have been tested; smoking habits and histological classification of the neoplasms have also been assessed, when available. Our data seem to agree with the point of view of the Authors who so far have expressed perplexities about the role played by silica in lung carcinogenesis, especially if associated with the exposure to powerful carcinogenic agents such as cigarette smoke. At present we share the opinion of those who think that a final regulation should be delayed up to the time when it will be possible to identify the occupational source of silica with such characteristic as to make it actually carcinogenic.

An epidemiological study on the dockworkers in the Genoa harbour, made after some occupational disease claims, showed an increase of bladder cancer probably caused by skin exposure to carbon black.

The present study compares the data of pleural mesothelioma (PM) patients resident in the province of Genoa (Italy) who, in the period 1994-1996, applied to the Italian National Insurance Institute for Work Accident (INAIL), for workers' compensation for asbestos-related diseases due to occupational exposure, with the dataset of PM patients collected by the Mesothelioma Registry of Liguria (REM) in the same period and in the same area. As PM is a malignant tumor of a prevalently occupational origin, it is recognized and acknowledged as such by INAIL when clinical and etiological characteristics are matched. Objectives of this study were to describe observed PM cases, to evaluate completeness of collected data and differences between those who requested compensation and those who did not. The REM describes the incidence of PM among Ligurian residents, proposing patients with a specific questionnaire to assess occupational, environmental and indoor asbestos exposures. The REM collected 199 new cases of PM among the residents of both the city of Genoa (1994-96) and the province of Genoa (1995-96). In the same period, INAIL received 48 (24%) applications for compensation. Among these, 43 subjects were included in a subgroup of 98 patients registered in the REM as cases with definite diagnosis and ascertained asbestos exposure; 32 were awarded compensation, while 11 are under evaluation. The data collected by REM do not show proven asbestos exposure and/or PM diagnosis for five other subjects (two compensated and three under judgment). This study reveals that: a) only a 24% of the patients with a diagnosis of PM and asbestos exposure apply for compensation; b) an exchange of information among institutions involved in primary prevention, in the evaluation of occupational exposures to carcinogens and in insurance compensation is useful.