Impact of asbestos on public health: a retrospective study on a series of subjects with occupational and non-occupational exposure to asbestos during the activity of Fibronit plant (Broni Italy)

摘要

The goal of this study is to understand more about the role of asbestos in causing human diseases, first of all mesothelioma, by investigating a large series of deaths due to asbestos-related diseases (ARDs). The main aim is to clarify if even very low amounts of asbestos can cause mesothelioma and other ARDs, as well as to find out if a different individual vulnerability can be important. This retrospective study included 188 subjects who died from asbestos related diseases in 2000-2017 in the area around Broni, Italy, where an important asbestos cement factory had been active from 1932 until 1993. In each case, a forensic autopsy has been performed. In order to perform the present study, the records were retrieved, including the clinical files, the autopsy, and the histological report. The statistical analysis performed showed that there was a significant relation between the cause of death (mesothelioma, lung cancer or asbestosis) and the kind of exposure (occupational, neighborhood or household), showing that all the subjects not exposed occupationally (and, therefore, exposed to lower amounts of asbestos) died from mesothelioma, whereas the individuals who used to work at the plant died also from other caused (asbestosis, lung cancer). Significant differences were highlighted examining the distribution of the causes of death according to the smoking habits. Moreover, among the mesothelioma patients, the survival time was shorter in the subjects with a neighborhood or household exposure than in the occupationally exposed individuals. The study provided meaningful data about the role of asbestos in causing human pathologies. In particular, the present data appear to support the hypothesis that even an exposure to a very little amount of asbestos can cause mesothelioma in hypersusceptible subjects (probably, on a genetic basis).Significance for public healthThe widespread production and use of asbestos have caused unprecedented human suffering and still represents a major public health problem all over the world. The particularly prolonged latency of the disease has led to the onset of a catastrophic epidemics affecting people who suffered exposure even decades ago. Even though the use of asbestos has been banned in Europe, as well as in the US, in many countries it is still allowed (e.g. Russia, Kazakhstan, Brazil, China). Asbestos is still widely used for insulation, house construction and shipbuilding, and still represents a big business. The diseases caused by asbestos can be divided in two main groups: the non-neoplastic diseases, such as the benign manifestation known as pleuric plaques and, on the other hand, asbestosis, related to the absorption of high amounts of asbestos fibers. The second group includes the malignant neoplastic diseases: lung cancer and mesothelioma. Mesothelioma has to be considered of particular importance, even though its incidence is extremely low in general population, causing, on a global scale, about the 1% of deaths due to tumors. The extreme relevance of this disease, and consequently the great need of research in this field, is owed to its known relationship with a well-defined trigger (asbestos) and its exceptionally poor prognosis.