Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Italy, 2000-2021

Our plain-English summary of Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Italy, 2000-2021, by D. Consonni, E. Migliore, M. Gangemi, et al (Occupational and Environmental Medicine, 2025).

The study

• Authors: D. Consonni, E. Migliore, M. Gangemi, D. Cavone, L. Vimercati, S. Piro, L. Giovannetti, V. Zabeo, V. Comiati, S. Curti, S. Mattioli, M.T. Landi, C. Gioscia, S. Eccher, S. Murano, F. D'Agostin, C. Genova, R. Perduri, I. Grappasonni, F. Stracci, I. Cozzi, T. Staniscia, F. Calista, I.F. Angelillo, R. Galasso, F. Tallarigo, G. Cascone, M. Melis, S. Peters, H. Kromhout, A. Binazzi, A. Marinaccio, C. Mensi, ReNaM Working Group
• Journal: Occupational and Environmental Medicine
• Published: 2025;82(10):495-503
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Using a case-control design, we examined the association between occupational asbestos exposure and risk of peritoneal mesothelioma in the general population in Italy.

Methods: From the National Mesothelioma Registry, we selected cases (2000-2021) with life-time occupational history. Controls were 3045 from three case-control studies (region-sex-age-matched, performed in six regions), one in 2002-2004 (2116 population controls) and two in 2012-2016 (718 population and 211 hospital controls). For all subjects, exposure assignment was based on a quantitative job-exposure matrix (SYN-JEM). Qualitative expert-based evaluation was available for all cases, but only in 2012-2016 for 929 controls. We estimated ORs and 90% CIs using logistic regression models adjusted for residence, gender, period and age.

Results: In complete analyses (1591 cases, all years/regions), the OR for ever exposure was 3.66 (CI 3.21 to 4.18, 45.4% cases and 27.8% controls exposed). Among the exposed, median cumulative exposure (fibres/mL-years) was 1.4 (max 20.0) in cases and 1.1 (max 10.9) in controls. The OR was 1.55 (1.48 to 1.62) per log10-transformed cumulative exposure. In analyses restricted to 290 cases (same years/regions of controls), ORs were 3.35 (2.57 to 4.37, 43.8% cases exposed) for ever exposure and 1.52 (1.39 to 1.65) for cumulative exposure. ORs for ever asbestos exposure using expert-based evaluation were particularly high, 4.32 (3.50 to 5.34, 53.9% cases and 26.4% controls exposed) in complete analyses (778 cases) and 6.35 (4.58 to 8.81, 57.1% cases exposed) in restricted analyses (245 cases), but are known to be more prone to bias.

Conclusions: Peritoneal mesothelioma showed clear associations with asbestos exposure using different exposure assessment methods.

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

In plain English

This Italian population-based case-control study examined occupational asbestos exposure and peritoneal mesothelioma. Cases were 1591 people recorded in the National Mesothelioma Registry, diagnosed 2000–2021; controls were 3045 people from three earlier studies. Exposure was estimated with a job-exposure matrix, which assigns asbestos levels by job; results were not given by fibre type. Using the matrix, 45.4% of cases and 27.8% of controls had ever been exposed (odds ratio 3.66, 90% CI 3.21 to 4.18). Restricted to 290 cases from the controls' years and regions, it was 3.35 (2.57 to 4.37). The authors reported positive trends with duration and cumulative exposure. Expert assessments from interviews (cases from 2011–2021, 929 controls) gave higher odds ratios: 4.32 (3.50 to 5.34) for 778 cases in the complete analysis and 6.35 (4.58 to 8.81) for 245 cases in the restricted analysis. The authors noted this assessment was unblinded and possibly biased. They concluded that peritoneal mesothelioma showed clear associations with asbestos exposure. They noted that controls covered short periods in only six regions and that participation may have differed between cases and controls.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based case-control study ('control-initiated'), combining registry cases with controls taken from three earlier Italian studies
• Who was studied: 1591 peritoneal mesothelioma cases (965 men, 626 women) diagnosed 2000–2021 from Italy's National Mesothelioma Registry (ReNaM), of whom 290 were used in a restricted analysis. There were 3045 controls (2210 men, 835 women): 2116 from the EAGLE study (Lombardy, 2002–2004), 718 from the MISEM study and 211 hospital controls from the CARA study (2012–2016).
• Exposure: Lifetime occupational asbestos exposure, reported as asbestos overall with no results by fibre type. It was estimated for all subjects with a quantitative job-exposure matrix (SYN-JEM) as ever/never, duration, time since first exposure and cumulative exposure in fibres/mL-years. Expert-based evaluation of occupational and extra-occupational (para-occupational, environmental, home-related) exposure was available for all cases but only for MISEM/CARA controls.
• Main results:
  • Complete analysis (1591 cases, job-exposure matrix): the odds ratio for ever exposure was 3.66 (90% CI 3.21 to 4.18); 45.4% of cases and 27.8% of controls were exposed.
  • Restricted analysis (290 cases from the same years and regions as controls): the odds ratio was 3.35 (2.57 to 4.37) for ever exposure, with 43.8% of cases exposed. The odds ratio for cumulative exposure was 1.52 (1.39 to 1.65).
  • In the complete analysis, odds ratios were elevated in every category of duration and cumulative exposure, with positive trends. The odds ratio was 1.55 (1.48 to 1.62) per log10-transformed cumulative exposure.
  • The odds ratio did not increase beyond 60 years after first exposure.
  • By gender (complete analysis, ever exposure): the odds ratio was 3.35 in men, with 60.1% of cases exposed, and 4.56 in women, with 22.7% of cases exposed.
  • Expert-based assessment (cases 2011–2021 and 929 MISEM/CARA controls): the odds ratio for occupational exposure was 4.32 (3.50 to 5.34) in the complete analysis of 778 cases (53.9% of cases and 26.4% of controls exposed). It was 6.35 (4.58 to 8.81) in the restricted analysis of 245 cases (57.1% of cases exposed).
  • The authors reported evidence of a positive association for para-occupational exposure in the restricted analysis. In women, they reported an elevated odds ratio for para-occupational exposure.
  • When the analysis was limited to blue-collar workers, odds ratios were generally lower but still showed strong associations with all exposure measures.
  • Agreement between the job-exposure matrix and expert assessment was moderate (overall Cohen's kappa 0.48), and higher for cases than for controls.
• The authors' conclusion: The authors concluded that peritoneal mesothelioma showed clear associations with several indices of occupational asbestos exposure. They found higher risks with expert-based assessment, though this method may involve differential misclassification. In the authors' view, people with peritoneal mesothelioma should be eligible for compensation regardless of the sector in which they were exposed.
• Limitations the authors state:
  • Controls were recruited over short time periods (2002–2004 and 2012–2016) and in only six regions.
  • Study participation might have differed between cases and controls.
  • Expert evaluation was not done blind to case or control status. The authors said this could indicate some differential misclassification due to recall, reporting, interviewer or assessor biases.
  • Coding errors and the use of a crosswalk to translate cases' job codes may have weakened (attenuated) the job-exposure matrix odds ratios.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Case-Control Study, Mesothelioma, Occupational History, Cumulative Exposure.

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• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)
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