Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register Alessandro Marinaccio 1 , Alessandra Binazzi 1 , Davide Di Marzio 1 , Alberto Scarselli 1 , Marina Verardo 2 , Dario Mirabelli 3 , Valerio Gennaro 4 , Carolina Mensi 5 , Luciano Riboldi 5 , Enzo Merler 6 , Renata De Zotti 7 , Antonio Romanelli 8 , Elisabetta Chellini 9 , Stefano Silvestri 9 , Cristiana Pascucci 10 , Elisa Romeo 11 , Simona Menegozzo 12 , Marina Musti 13 , Domenica Cavone 13 , Gabriella Cauzillo 14 , Rosario Tumino 15 , Carmela Nicita 15 , Massimo Melis 16 , Sergio Iavicoli 1 and ReNaM Working Group 1 Workers Compensation Authority (INAIL), Research Area ex ISPESL, Occupational Medicine Department, Epidemiology Unit, Rome, Italy 2 Regional Operating Center of Valle d’Aosta (COR Valle d’Aosta), Valle d’Aosta Health Local Unit, Aosta, Italy 3 COR Piedmont, Unit of Cancer Prevention, University of Turin and S. Giovanni Battista Hospital, Torino, Italy 4 COR Liguria, Epidemiology and Prevention Department, National Cancer Research Institute (IST), Genova, Italy 5 COR Lombardy, Department of Preventive Medicine, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico and Universita ` degli Studi, Milano, Italy 6 COR Veneto, Occupational Health Service, Department of Prevention, National Health Service, Padua, Italy 7 COR Friuli-Venezia Giulia, University of Trieste—Trieste General Hospitals, Clinical Unit of Occupational Medicine, Trieste, Italy 8 COR Emilia-Romagna, Health Local Unit, Public Health Department, Reggio Emilia, Italy 9 COR Tuscany, Institute for Cancer Study and Prevention, Epidemiology Unit, Firenze, Italy 10 COR Marche, Hygiene, Environmental and Health Sciences Department, University of Camerino, Camerino, Italy 11 COR Lazio, Department of Experimental Medicine, University La Sapienza, Roma, Italy 12 COR Campania, Experimental Medicine Department, II University of Naples, Napoli, Italy 13 COR Puglia, Department of Internal Medicine and Public Medicine, Section of Occupational Medicine ‘‘B.Ramazzini,’’ University of Bari, Bari, Italy 14 COR Basilicata, Epidemiologic Regional Center, Potenza, Italy 15 COR Sicily, ‘‘Civile - M.P. Arezzo’’ Hospital, Ragusa Cancer Register Unit, Ragusa, Italy 16 COR Sardegna, Regional Epidemiological Center, Cagliari, Italy Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case-list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N 5 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as ‘‘at risk’’ (asbestos-cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all-too-predictable asbestos effects should be transferred to developing countries where asbestos use is spreading. Key words: asbestos, mesothelioma, pleural, national register, Italy ReNaM Working Group: Massari S., Branchi C.; Detragiache E.; Merletti F., Gangemi M., Stura A., Brentisci C., Cammarieri Diglio G., Macerata V., Gilardetti M.; Lazzarotto A., Benfatto L., Bianchelli M., Mazzucco G.; Sieno C., Pesatori A.C.; Gioffre ` F., Bressan V.; De Michieli P.; Mangone L., Storchi C.; Seniori Costantini A., Badiali A.M., Cacciarini V., Giovannetti L., Martini A.; Calisti R.; La Rosa F., Stracci F., D’Alo ` D.; Perucci C.A., Forastiere F., Cavariani F., Ascoli V., Sangalli M.; Trafficante L., Gatta S.; Menegozzo M., Izzo F., Canfora M.L., Santoro M., Viscardi F.; Massaro T.; Convertini L.; Leotta A., Lio S.G.; Dardanoni G., Scondotto S.; Corrias G.A., Angius M.R., Nieddu V. DOI: 10.1002/ijc.26229 History: Received 28 Jan 2011; Accepted 2 May 2011; Online 6 Jun 2011 Correspondence to: Alessandro Marinaccio, INAIL (Italian Workers Compensation Authority), Department of Occupational Medicine, ISPESL area (Italian National Institute for Occupational Safety and Prevention) Epidemiology Unit, via Alessandria 220/E, 00198 Rome, Italy, Tel.: 0039-06-9789-2660, Fax: þ0039-06-9789-2690, E-mail: alessandro.marinaccio@ispesl.it Epidemiology Int. J. Cancer: 000, 000–000 (2011) V C 2011 UICC International Journal of Cancer IJC