Epidemiology of Mesothelioma

Abstract: Since 1973 the International Agency for Research on Cancer has classified asbestos as a certain carcinogen, but today it is still used in several countries. To date, mesothelioma risk is certainly linked not only to occupational exposures but also to environmental exposures. The incidence and mortality are increasing worldwide, especially in developing countries where asbestos is still often used without adequate measures for worker safety. The epidemiological surveillance systems of related asbestos diseases are instruments of public health adopted internationally. The experience and the operating methodology of the Italian mesothelioma registry and the data produced from 1996 to 2015 highlight how in countries where the asbestos ban has been active for over 20 years the risk of asbestos remains present, especially in the construction sector as well as for the environmental exposures of the resident population near companies that used asbestos in their production cycle. Worldwide, it is necessary to introduce the ban on the extraction, processing, and marketing of asbestos as claimed by the international scientific community. Keywords: asbestos; mesothelioma; incidence; mortality; surveillance systems; mesothelioma Registry; public health; review 1. Asbestos: Consumption, Exposure, and Ban Asbestos is a natural mineral, which in all its mineralogical varieties has fibrous morphology (actinolite, amosite, anthophillite, chrysotile, crocidolite, and tremolite). It has been used all over the world and also in Italy, and its use dates back to the time of the ancient Persians, Greeks, and Romans. It is characterized by high resistance to heat, as well as chemical and biological agents, abrasion, and wear. Asbestos is an environmental carcinogen, asbestos fibers, when mechanically disturbed, divide longitudinally, generating even thinner fibers (fibrils), which, when inhaled, may be responsible for fibrotic (asbestosis) or neoplastic processes (mesothelioma, lung cancer). The two historical epidemiological studies that established with certainty the causal role of asbestos in the onset of pulmonary carcinoma and pleural mesothelioma were, respectively, Doll’s 1955 [1] and Wagner’s and collaborators in 1960 [2] In 1964, the world conference on the biological effects of asbestos was held, organized by the New York Academy of Sciences, whose proceedings were published in 1965, the year in which the scientific community reached unanimous agreement on the carcinogenic action of this material [3]. In 1973, the International Agency for Research on Cancer (IARC) classified asbestos (all types: actinolite, amosite, anthophyllite, crocidolite, tremolite, and chrysotile) as certain carcinogens for humans [4]. In a 2012 IARC monograph, [5] asbestos was confirmed as the only certain risk factor for mesothelioma in a series of target organs including the pleura, the peritoneum, the pericardium, and the vaginal tunic of the testicle. The monograph confirms asbestos as a certain carcinogen for lung cancer, and for the first time it defines asbestos as a certain carcinogen for laryngeal and ovarian cancer