I casi di mesotelioma maligno in Italia. Attività e risultati del Registro Nazionale (ReNaM)

The Italian National Mesothelioma Registry (ReNaM) has been set up at the National Institute for Occupational Safety and Health (ISPESL), in order to estimate the incidence of malignant mesothelioma in Italy, to define the modalities of exposures to asbestos, to assess the impact and diffusion of the pathology in the population, and to identify underestimated (or unknown) sources of environmental contamination with asbestos. Regional Operating Centres (COR) have been set up in 16 Italian regions to identify and to investigate all cases of malignant mesothelioma diagnosed in each region, applying national guidelines. Each COR directly collects cases in those care institutions that diagnose and treat mesothelioma cases (anatomo-pathological units, pneumology units and chest surgery wards). Occupational history, lifestyle habits and areas of residence for each case are obtained by direct interview using a standard questionnaire, administered by a trained interviewer. The modalities of exposure are then classified by an industrial hygienist who evaluates whether the subject's work, private life or any particular environmental conditions could have involved exposure to asbestos. The data presented refer to a case series from 12 Italian regions in different periods during the years 1993-2001. 4,961 cases of malignant mesothelioma have been collected: pleural mesothelioma affected 93% of cases and the ratio pleural/peritoneal cases is 14.6:1. The percentage of female cases is remarkable: the gender ratio (M/F) is 2.6:1 over the entire case series. There is a wide variety of occupational exposures, in a large range of sectors, including some already known as high risk sectors and others unexpected. The most common occupational exposures occurred in the building and construction industries, metallurgy and steel, shipbuilding, and railway stock. Categories at high risk such as bricklayers, plumbers, carpenters in the building and construction industries, electricians, welders, installers and maintenance workers in the metallurgy and steel industry, and general labourers, tool makers and painters in shipbuilding repair and demolition and railway rolling stock maintenance have been encountered. Although the work of ReNaM currently suffers from many limitations, the research activity which it conducts regarding the epidemiology of the mesothelioma incident cases and the analysis of the modalities of exposure for each case, using national standardized criteria, is a fundamental tool for the primary prevention of asbestos-related diseases.