| Occupational cancer and national mesothelioma register |
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The regional laws DGR n. 438/ 18.07.2006 and DGR n. 177/ 27.03.2009 have established the C.O.R. (Regional Operative Centre) of the Lazio Region at the Department of Epidemiology of the Regional Health Service - ASL Rome E for the management of the Regional Register of malignant mesothelioma (MM).
The COR carries out the surveillance of the incidence of cases of malignant mesothelioma (MM) in the Lazio Region since 2001 and the attribution of exposure and, like the other regional CORs do, supplies its data to the National Mesothelioma Register (ReNaM), established at the INAIL (former ISPESL) through Decree n. 308/2002. The following institutions cooperate with the COR: the Department of Anatomy and Histopathology of the University of Rome La Sapienza (Department of Radiological, Oncological and Anatomical-pathological Sciences), the Laboratory of Industrial Hygiene - Regional Asbestos Centre (CRA) of the ASL Viterbo, and the Departments for Prevention and Safety in Workplaces (Presal) of the various ASL of the Lazio Region. The latest report on the activities of the Regional Mesothelioma Register of the Lazio Region referring to the year 2011 (full version attached below by clicking on the link “2011 Report on the activities of the Regional Mesothelioma Register”) shows the results of the activities of the Register, concerning cases of mesothelioma during the past decade in the Region (from January 1, 2001 to November 30, 2011): 716 cases are diagnosed as malignant mesothelioma (71% in men and 29% in women): of these, 535 were confirmed as certain cases, 69 as probable and 112 as possible. The most common site for the disease is the pleura with 659 cases, while 56 relate to the peritoneum and the only one case to the pericardium. For all cases diagnosed in the Lazio Region in the period from 2001-2010 the place of residence at diagnosis was analyzed, with particular attention to the municipalities in which there were at least three cases. Municipalities with the highest incidence are: Colleferro, Civitavecchia, Pomezia, and Ardea. The whole of the municipality of Rome has an incidence of 1.2 cases per 100,000 inhabitants with higher values in the districts VI, II and XII. For 426 cases, we collected information on the anamnesis as well as personal and professional information and such on the living and working conditions. Based on this background we proceeded to the assessment of exposure to asbestos, using the expertise of the panel of experts belonging to the Regional Asbestos Centre. In cases where it was possible to recognize a previous exposure to asbestos at work (223 cases), the construction sector was the most frequently individuated workplace category (33%), followed by engineering industry (15%), shipping (6 %), rail transport (6%) and national defense (6%). According to the data as to the third report of the National Mesothelioma Register, the incidence rates for mesothelioma cases in the Lazio Region from 2001-2010 were lower (compared to those calculated for Italy in the period from 1993-2004). This result is explained by the absence of large industrial complexes and building sites in the Lazio Region. Regarding the mesothelioma cases after workplace exposure, the spatial distribution of the cases shows the highest rates in the municipalities of Colleferro and Civitavecchia, which is explained by occupational exposures in those areas, i.e. the industrial complex of Colleferro and the energy production plants as well as the maritime transport sector in Civitavecchia, both already known since the early 90s. In addition to these situations, the following other industries with occupational exposure to asbestos have been identified: construction, national defense, and rail and maritime transport. There is also a high frequency of cases with unknown source of exposure to asbestos among persons who have worked in public administration. The construction sector has produced the highest number of cases with occupational exposure (only in men), with a frequency twice the national average (33% vs. 18%). This finding, already reported in previous studies regarding the Lazio Region, is due to the possible presence of asbestos in building materials and the large distribution of this sector in the Region compared to other sectors.
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