Alessandro Marinaccio

Ovarian cancer deaths attributable to asbestos exposure in Lombardy (Italy) in 2000–2018

ObjectivesWe aimed to estimate the fraction of deaths from ovarian cancer attributable to asbestos exposure in Lombardy Region, Italy, using a novel approach that exploits the fact that ovarian cancer asbestos exposure is associated with pleural cancer and other risk factors for breast cancer.MethodsThis ecological study is based on the Italian National Institute of Statistics mortality data. We formulate a trivariate Bayesian joint disease model to estimate the attributable fraction (AF) and the number of ovarian cancer deaths attributable to asbestos exposure from the geographic distribution of ovarian, pleural and breast cancer mortality at the municipality level from 2000 to 2018. Expected deaths and standardised mortality ratios were calculated using regional rates.ResultsWe found shared dependencies between ovarian and pleural cancer, which capture risk factors common to the two diseases (asbestos exposure), and a spatially structured clustering component shared between ovarian and breast cancer, capturing other risk factors. Based on 10 462 ovarian cancer deaths, we estimated that 574 (95% credibility interval 388–819) were attributable to asbestos (AF 5.5%; 95% credibility interval 3.7–7.8). AF reaches 34%–47% in some municipalities with known heavy asbestos pollution.ConclusionsThe impact of asbestos on ovarian cancer occurrence can be relevant, particularly in areas with high asbestos exposure. Estimating attributable cases was possible only by using advanced Bayesian modelling to consider other risk factors for ovarian cancer. These findings are instrumental in tailoring public health surveillance programmes and implementing compensation and prevention policies.

Cause specific mortality in an Italian pool of asbestos workers cohorts

AbstractBackgroundAsbestos is a known human carcinogen and is causally associated with malignant mesothelioma, lung, larynx and ovarian cancers.MethodsCancer risk was studied among a pool of formerly asbestos‐exposed workers in Italy. Fifty‐two Italian asbestos cohorts (asbestos‐cement, rolling‐stock, shipbuilding, and other) were pooled and their mortality follow‐up was updated to 2018. Standardized mortality ratios (SMRs) were computed for major causes of death considering duration of exposure and time since first exposure (TSFE), using reference rates by region, age and calendar period.ResultsThe study included 63,502 subjects (57,156 men and 6346 women): 40% who were alive, 58% who died (cause known for 92%), and 2% lost to follow‐up. Mortality was increased for all causes (SMR: men = 1.04, 95% confidence interval [CI] 1.03−1.05; women = 1.15, 95% CI 1.11−1.18), all malignancies (SMR: men = 1.21, 95% CI 1.18−1.23; women = 1.29, 95% CI 1.22−1.37), pleural and peritoneal malignancies (men: SMR = 10.46, 95% CI 9.86−11.09 and 4.29, 95% CI 3.66−5.00; women: SMR = 27.13, 95% CI 23.29−31.42 and 7.51, 95% CI 5.52−9.98), lung (SMR: men = 1.28, 95% CI 1.24−1.32; women = 1.26, 95% CI 1.02−1.53), and ovarian cancer (SMR = 1.42, 95% CI 1.08−1.84). Pleural cancer mortality increased during the first 40 years of TSFE (latency), reaching a plateau thereafter.ConclusionsAnalyses by time‐dependent variables showed that the risk for pleural neoplasms increased with latency and no longer increases at long TSFE, consistent with with asbestos clearance from the lungs. Peritoneal neoplasm risk increased over all observation time.