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Umedktoadelbvoro UfntrdJrf "L. 0AWdH VioSah Junwta S* W/towa. half
@006 Med Lav 1905; JW, 5". 478-41
MESOTHELIOMAS FOLLOWING EXPOSURE TO ASBESTOS USED IN SUGAR REFINERIES: REPORT OF 12 ITALIAN CASES
C MALTONI, C, PINTO, D. VALENIX, R. CARNUCCIO, E. AMADUCCI, F. MINARDI
Afesotc//o/n/ da esposlzfone aU'amianto mate negli zucrftBrjficJ: resoconto di 12 ca Italians*. Vengouo riportati 12 cast Italian! di tnesotelionia ftatti tninne uito del Regime Emilia Romagna), insortl in segutto ad esposbtione all'amlanto usato negli atu cherifiti. Undid cosi sono fnsorti in lavoratori esposti professiodalntente, ed uno nel figliadi un tavoratore esposto, In seguito a coniatto farailalre. Undid dei casl erai pieurici, ed uno pcritoncale. Negli 11 casi insorti in seguito ad esposizione lavoratlva, tempo medio di iatenza & stato di 36,4 anni (da 23 a 48 anni), e Feta media di inso gema state di 63,4 anni. Nel caso insorto in seguito a contatto Eamiliare, II tempo Iatenza e FetA di insorgenza sono stati di 37 anni. Si tratta della plA ampla eaalstica nteaoteliomi dovuti. all'amianto presents negli zuccherlfid riferita finora nefla letteratu scieatifica, Mentre quest! ca$j dimostrano il rischio di mesoteliowii da amianto nej zuccherifid, non consentono dl deflnire la dimenstone degli effetti patologi dell'amlanto (e delle fibre mineral! ardfidali) usato in quasta industrla. Per valuta i'entlta diquesto rischio sirendono ncccstaric ulteriori richerche.
Key words! mesothelioma; asbestos;nugur industry
INTRODUCTION
"
The sugar refinery industry has long been widely diffused in Italy, particularly in some regions, and principally in the Emilia Romagna Region, where the pro duction of sugar-beet is largely practised.
European Ktunazzini Foundation of Oncology and Environmental Sciences, and Institute nf Onco logy ofBologna, Bologna (Italy)
This investigation has been performed .within the framework of the oncologic epidemiology pro gramTM of the Ramszzlnl Foundation of Oncology and Environmental Sciences and of (ho Bologna in stitute of Oncology, supported by the Bologna Sec tion of the Italian League for the Fight again*! Cancer
Although in the last years this indust has been gradually declining, on the bar of the available information, in 1993 the were still 29 major sugar refinery plar. scattered In 12 of the 20 Italian regioi 11 of which in the Emilia Romagna R gion alone.
Asbestos, and more recently glass-wo and rock-wool, have been massively us< for the insulation of thermo-hydraulic sj terns (boilers, pipes, etc.) and for the ft naces of sugar refinery plants. Thereto employees working in the sugar refine industry, and particularly those engaged the running and maintenance of therm
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l
Med Uv 1 995; 5:478-483
ASBESTOS EXPOSURE IN SUGAR RKPINRtlRS
@007 479 .
VING USED IN RT OF
,F. MINARDI
wrtfici: rcsoconto di 12 east
ma (tutti franne nno della
alPamianto usato negli 2uc-
'esstonalinente, ed nno nelln
lalre. Undid dei casi erano
> ad espo*iz5one lavorativa, II
inni), e I'cta media di insor-
Mitatto familiare, H tempo di
i della piii ampfa casistica di
ferita iinora nella letteratura
esoteliomi da amianto negli
ne degli effelti patologici
testa industria. Per vatutare
'die.
:
1 the last years this industry .ually declining, on the basis e information, in 1993 there major sugar refinery plants 2 of the 20 Italian regions, in the Emilia Romagna Re
nd more recently glass-wool I, have been massively used ion of thermo-hydraulic syspipes, etc.) and for the fur r refinery plants. Therefore >rfclng In the sugar refinery particularly those engaged in nd maintenance of theimo-
hydraulic systems, have been potentially Given the more recent use of man-made
exposed to asbestos for a tong time, and mineral fibres in these workplace, it is too
to other mineral fibres. The exposure to early to expect the onset of neoplastic pa
these fibres, however, is not limited to thologies related to these fibres.
these workers. More recently, after the
Between 1983 and 1985, 7 cases of
closing of several sugar refinery plants, mesothelioma among sugar refinery wor
workers engaged in the dismantling of the kers were reported In Sweden, all among
plants have also been exposed, and prob people potentially exposed to asbestos (6,
ably even more heavily- Moreover, family 7, 12) (table 1). Since 1991 we have re
members of sugar refinery industry wor ported several cases of mesothelioma
kers and people living in areas neighbour among people of our country, who had
ing the sugar refinery plants must also be been exposed to asbestos used in sugar re
considered potentially exposed to asbe finery plants (1-5, 8-11). With this report
stos, as well as to other mineral fibres.
we are referring the foil series of the 12
The number of people potentially ex Italian mesothelioma cases observed to
posed to asbestos in sugar refineries in date. To our knowledge, this is at present
Italy is very large. One must consider the the largest series of cases of mesothelio
number of workers employed simulta mas caused by asbestos in sugar refinery
neously in each factory (in many cases plants reported in the scientific literature.
hundreds), the Jong historical period of
sugar refinery activity, the particularly high turnover of the working population, the employment of, seasonal workers
Table 1 - The 7 mesothelioma coses observed amongsugar refinery workers tn Sweden (1)
usually engaged for a few months for only 1- The 7 cases were included In the Swedish
one, two or three years, and lately the workers engaged in dismantling. Tct those
people occupationally exposed, one must add the very large number of workers' family members, and the population sur
- Canccr-EUVironmental Registry, which gives
Information) on the economic activity of all
cases of career in Sweden, notified in 1960-
1979
' ................... :
2. The cases were observed In a cohort of 2954
men aged 29-69 years working in sugar re
rounding the plants, whose exposure has been recently increasing, in relation to the dismantling of the plants.
For Italy, and especially for the Emilia
finery plantxinj 960 . . 3. All the cases'were observed among men, and
all were pleural 4. AH 7 men were strongly suspected to have
been heavily exposed to asbestos:
Romagna Region, the exposure to asbe stos and mineral fibres used in sugar re finery plants represents a crucial problem of public health, as well as for other coun
-- 3 worked full-time with n machine: -- 1 worked with insulation, who, as was re
ported, "dug by hand tn sacks containing asbestos* -- l was a blacksmith;
tries In the world, where the sugar indus
-- 1 was a foreman, who, as was reported,
try is active and has entailed use of asbe stos and other mineral fibres.
The relevance of this problem is at present demonstrated by early reports of mesothelioma cases among people ex
"took part in the dismantling of machines which had asbestos as Insulation": and -- 1 was an unskilled worker, who "was ex posed over about two years when he
helped to take down a complete factory eight years before h ebecame III"
posed to asbestos in sugar refinery plants. (1) From: Sleineck (l2), 1983
"TM
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4 BO
MAL.TON] ST AL
| THEITALIANMESOTHELIOMA CASES average age of diagnosis of the 11 occupa
ij tional cases was 63.4 years; the average
All the mesotheliomas herein reported age at death of the 10 deceased cases was
were diagnosed in our Institute. All the di 66.3 years.
agnoses of cases were based on pathologi
cal evidence. These series of cases is not
the result of a systematic epidemiological investigation (based on Cancer Registry DISCUSSION
data or cohort studies), but simply the
outcome of observations deriving from
The reported cases demonstrate the
our everyday clinical practice. The cases risk of asbestos diseases (and specifically
were detected in a period from 1986 to of mesothelioma) among people exposed
1995. The data regarding plant location, to asbestos used in sugar refinery plants,
sex, exposure scenario (job, family situ following occupational exposure or 1 ation), site and latency time of the neopla through family contact. The risk must be
sia, age of the patient at diagnosis and foreseen for all the people exposed in
death, and year of diagnosis and death, these scenarios in all parts of the world.
are given in table 2.
The fact that II of the 12 cases here
All the reported cases but one, belong reported are located in the Emilia Ro
to the Emilia Romagna Region. Eleven of magna Region is probably due to two fac
the mesotheliomas were pleural, and one tors: the highest concentration of Italian
t peritoneal
sugar refinery plants in this region, and
Eleven cases arose among male wor the specific scientific interest of our In
kers: the job of all these workers entailed stitution in occupational cancer.
exposure to asbestos: Asbestos bodies The presented results, while demon
could be detected in: the sputum. One strating the carcinogenic risk of asbestos
pleural mesothelioma (base 12 of table 2) used in sugar refinery plants; in no way
was found in a 37 year old woman, fol provide the real dimension of the risk.
lowing familial exposure (figure 1, 2, 3). Our series of cases includes, in fact, only
This woman lived with her father, who, anecdotal, clinical observations of meso
over the whole period from her birth until thelioma. In order to provide, in quantita
she reached 31 years of age, worked in tive terms, the total burden of the prob
i
two sugar refinery plants, and took his lem, one must promote systematic and working clothes home. The careful recon diligent analytical, epidemiological investi
struction of the personal history of this gations on defined and representative oc
woman excluded any occupational expo cupational cohorts and on their family
sure to asbestos.
members, dealing with all causes of death,
The average latency period of the 11 with particular regard to those related to
occupational cases was 36.0 years (the asbestos exposure, and then one must try
shortest 23 and the longest 48). It is of in to collect as much data as possible ou the
j terest to note that the latency period of number of workers occupationally ex mesothelioma following familial exposure posed to asbestos used in sugar refinery
i (37.0 years), falls within the average plants, at the national level and world latency period of occupational cases. The wide.
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f diagnosis of the II occupawas 63.4 years; the average df the 10 deceased cases was
V
ted cases demonstrate the tos diseases (and specifically >ma) among people exposed ised in sugar refinery plants, ccnpational exposure or ly contact The Hsk must be all the people exposed in >s in all parts of the world, hat 11 of the 12 cases here
located in the Emilia Ro ll is probably due to two facicst concentration of Italian y plants in this region, and scientific interest of our Incupational cancer, nted results, while demon-
remogenic risk of asbestos sfinery plants, in no way
-al dimension of the risk. ` cases includes, in fact, only nical observations of meso>rder to provide, in quantita te total burden of the probist promote systematic and tical, epidemiological investi ffined and representative ocjhorts and on their family ding with all causes of death, ir regard to those related to sure, and then one must try nuch data as possible on the workers occupationally cx* estos used in sugar refinery i national level and world
ASBESTOS EXPOSURE IN SUCAk REFINERIES
4S1 '
Table 2 - The 12 mesothelioma coses observed among people exposed to asbestos used in sugar re* fineryplants in Italy____________________________________________________________ _________
Cm Initials Site of sugar Sea Exposure scenario
Na[l)
refinery plant
gob, degree of (relationship)
Site of the Latency Age at Yearof Age at Year of neoplasia time (2) diagnosis diagnosis death death
(yean)
I.CasHftdkrwingoKunationalacposun:
1 LS Crevalaore
M Worker engaged
(Bologna)
Inthe running
ofcentrifugesand
in the maintenance
ofrefinery planla
2 TL Codlgoro
M Variotisjobs
(Ffltrara)
(seasonal)
3 FG Bondeno (Ferrara)
M Variotujobs (hismain placed
workwasnndera
boiler) (seasonal)
4 BD Molkella (Bologna)
M Pipefitter
5 GB Bondeno
M Pipefitter
(Ferrara) 6 DU Classe
(Ravenna)
M Maintenanceworker
Pipefitter
Responsiblefor
themne system
1 CG Molinella
M Pointer
(Bologna)
Engagedin the ' heating of sugar-
beetsauee
8 BA Crevalcoie (Bologna)
M Mason engaged inthe maintenance
and repair offurnaces
9 RF Molinetla
M Porter '
(Bologna)
10 MA Bologna
M Responsible for
11 GA taODtecosaio
thermic system M Boileroperator
Scalo (seasonal)
(Macerate)
Mean
Pleura 29
61 1986 62 1987
Pleura Pleura
31 2S
49 1986 49 1986 44 1989 49 1994
Pleura Pleura Pleura
41 34 41
63 1991 66 1992 54 1991 56 1993 62 1992 63 1993
Pleura 43 '.78 / 1993 78 1993
Pleura 37
77,; ,1993 78 1994
Peritoneum '41 ' no; 1994 80 1994
Pleura 4S ->82.,- .1994, 82 1994
Pleura 23 45 1993
Living
36.0 63.4
66.3(3)
11, Case Mowing fumiMexposure 12 NF Workingplaces F Daughter of fetterMinndola(Modeiia)
iDdCrcvaleore
_________ (Bologna)
Pleura 37 '
37 1988 43 1995 -
(1) Accordingto year of diagnosis
(2) Period of lime elapsed between ihe start of the exposure and the enact of the first symptoms
andsigns ofthe neoplasia (3) Referred to the 10 cases already deceased
T
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Si 010
482 wai;jon! wr *i.
In the meanwhile, prevention measures must be undertaken in the sugar refinery industry, both in normal working condi tions, and also in the course of dismanttling, with reference not only to asbestos but also to other mineral fibres. Moreover, medical surveillance should be performed on exposed workers who are still active and also on those who have retired.
SUMMARY
Figure 1 - Pleural mesothelioma in the daughter pi a
sugar refiners' plant worker, following asbestos expo sure by family contact. Mesothelioma cells in pleural effusion. Pap. x 320
Twelve Italian cases of mesothelioma (all the cases but one from the Emilia Ro magna Region), following exposure to as
bestos used in sugar refinery plants, are re
ported. Eleven cases arose in workers oc
cupationally exposed, and one in the
daughter of an exposed worker, following
family contact. Eleven of the cases were
pleural and one peritoneal. In the 11 cases
following occupational exposure the aver
age latency time was 3(5.0 (range 23-48)
years, and the average age at onset was
63.4 years- In the case which followed fam
ily contact, the latency time and the age of
Figure 2 - Pleural mesothelioma In ihe daughter of a sugar refinery plant worker. following asbestos expo-'
- the
onset
were
37
years.
This
represents
sure by family contact Mesothelioma cells in pleural the Largest series of eases of mesothelioma
effusion. H.E.* 1280
due to die asbestos present in sugar re-
fineiy plants reported to date in the scien
tific literature. "While these cases demon
strate the risk of asbestos mesothelioma in
the sugar refinery Industry, they in no way
give the dimension of the pathological ef
fects of asbestos (and man-made mineral
fibres) used in this industry. To assess this
risk further research is suggested-
Figure 3 - Pleural mesothelioma In the daughter of a
sugar refinery plant worker, following asbestos expo sure by family contact. Pleural biopsy: epithellomcK* phis mesothelioma. H.E.x 320
REFERENCES
1. Maltoni C, Fini A, Pinto C, c coll; Mesotelloma pleurlco da wbesto in figlia di operaio di zucchefifiri dell'EmlHa Romagna. Acta Oncol 1994;/J: 149-154
.
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I
ASBESTOS EXPOSURE IN SUGAR JlEFINHKiFiS
@011 483 .
tiwhile, prevention measures Ttaken in the sugar refinery i in normal working condid in the course of dismanttsrence not only to asbestos ter mineral fibres. Moreover, illance should be performed workers who are still active sse who have retired.
Han cases of mesothelioma Tut one from the Emilia Roi), following exposure to assugai refinery plants, are rei cases arose in workers ocexposed, and one in the a exposed worker, following t. Eleven of the cases were ie peritoneal. In the 11 cases rpatlonal exposure the averme was 36.0 (range 23-48) & average age at onset was the case which followed fam-
tency time and the age of 37 years. This represents ies of cases of mesothelioma ibestos present in sugar feepoited to date in the scien, While these cases demonof asbestos mesothelioma in i*ry industry, they in no way ision of the pathological eftOS (and man-made mineral . this industry. To assess this learchis suggested.
S
Fini A, Pinto C, c coll: Mcruiico da asbesto in figlia dl lccherifici dell'Emilia Romagna, 994; /5:149-154
1. Maltoni C, Pinto C, Sinirai.oi C, e coll:
Setdmo caso di mcsotelioma da asbesto fra
lavorutori di auceberifici, nella Casbtiea
dcll'lsthuto di Oncologla di Bologna. Acta
Oncol 1994; 15:149-154
3. Mai-ton: C, Pinto C, Loti P, e coll: Tre
nuovi cast di mesotelioma plcurico tra operai
addetta alia instailazionc, manuienzlone e de-
moUzloae di Implant! Idraulld e- lentio-
idraulici (terzo, quarto e quinto ease dalla
casistica dellTstituto di Oncologla ;dl Bo
logna). Acta Oncol 1992; 195-215'
4. Maltoni C, Pinto C, Sinibaldi C,' c colb
Casistica deltTatituto di Oncologla 'di Bo
logna: quarto caso di mesotelioma plcurico in
pperalo dl auocherlftoto esposto ad asbesto,
Acta Oncol 1992; I3i 817-830
5. Maltoni C, Pinto C, Valenti D,. e coll;
Scsfo caso di mesotelioma pleurico da esbe-
$to fra lavomtorl dl zuccherifici ndla casi
stica di mesoteliomi dellTstituto di Oncologla
di Bologna. Acta Oncol 1993; 14; 311-316
6. Malksr HR, Malice* BK, Blot WJ: Meso
thelioma among sugar refinery workers. Lan
cet 1983; t. 858
'
7. Mamcer HR, Me LaUC-hlin -JK, Malker
SK, el' ul; Occupational risks for pleural
mesothelioma in Sweden, 1961-79. J Natl
Cancer Insl 1985; 74:61-66
8. Pinto C, Sinibaldi C, Lattes C, a coll: Mcsotdioma pleurico in lavoratore di zuc-
cherificio esposto ad asbesto (quinto caso di mesotelioma plcurico fra lavoraiorf dl zuc-
chertfid nella casistica dell'Istftuio di Oncologia di Bologna). Ada Oncol 1993; /4 89 100
9. Pinto C, Valenti D, Maltoni C: Mcsotclioma pleurico in eperaio di zticcherificio esposto ad ashesto (e a lana dl roccia), Acta Oncol 1992; /J: 425-433
10. Pinto C, Valenti D, Sinibaldi C, e coll; Ottavo, nono e dectmo caso di mesotelioma da asbesto tra lavoratori dl zuccherificl dell'Emilifl Romagna. Acta Oncol 1994; f3: 3S5-369
11. Sinibaldi C, Lodi P, Roncdne L, e coll;
Mesotelioma pleurico da asbesto in operaio addetto alllnstallaaionc e alia manutenzionc dcli'impianto tcimo-idxaulico di uno zuccherlficlo. Acta Oncol 1991; 12\ 569 576 12. Steineck G, Carstensen J, Wiklund K, Eklund G: Mesothelioma among sugar re , finery workers.Lancet 1983; 2; 1503
i