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Mortality for Mesothelioma and Lung Cancer in a Cohort of Asbestos Cement Workers in BARI (Italy)

Time Related Aspects of Exposure

Cuccaro, Francesco, MD, PhD; Nannavecchia, Anna Maria, MSc; Silvestri, Stefano, MSc; Angelini, Alessia, BEng; Coviello, Vincenzo, MD; Bisceglia, Lucia, MD, PhD; Magnani, Corrado, MD

Journal of Occupational and Environmental Medicine: May 2019 - Volume 61 - Issue 5 - p 410–416
doi: 10.1097/JOM.0000000000001580

Objective: In this cohort mortality study we used an exposure index to evaluate individual cumulative exposure as proxy of asbestos dose and we evaluated change in cancer mortality pattern after long time since the end of exposure.

Methods: We calculated standardized mortality ratios (SMRs) for several causes of death stratified by latency, cumulative exposure, and time since last exposure (TSLE).

Results: Latency: we observed a peak and then a decrease in SMR for lung, pleural, and peritoneal cancer. Cumulative Exposure: We observed a peak and then a decrease in SMR for lung and pleural cancer, not for peritoneal cancer. TSLE: Pleural cancer SMR peaked at 20 to 29 years, then decreased, peritoneal cancer SMR reached a plateau after 20 years and lung cancer mortality was in excess in each class.

Conclusions: We found different patterns in mortality in the main asbestos-related tumors.

Unit of Statistics and Epidemiology, Local Health Unit Barletta – Andria – Trani, Barletta (Drs Cuccaro, Coviello); Regional Strategic Agency for Health and Social of Puglia, Bari (Ms Nannavecchia, Dr Bisceglia); (previously) Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence (Mr Silvestri, Ms Angelini); Department of Translational Medicine, Unit of Medical Statistics and Epidemiology, University of Eastern Piedmont (Dr Magnani); and CPO-Piemonte, Novara (Dr Magnani), Italy.

Address correspondence to: Francesco Cuccaro, MD, PhD, Unit of Statistics and Epidemiology, Local Health Unit Barletta – Andria – Trani, Piazza Principe Umberto 1 – 76121, Barletta (BT), Italy (

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The following authors reported that they served as expert witness for the public prosecutor in court trials on asbestos related diseases: C.M., S.S.

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Copyright © 2019 by the American College of Occupational and Environmental Medicine