[Epidemiologic surveillance of occupational cancer in the light of the new law (DLgs 81/2008)]. / La sorveglianza epidemiologica dei tumori professionali alla luce del nuovo quadro normativo (DLgs 81/2008).

As a result of legislation regarding the surveillance of occupational cancers in Italy three systems for the monitoring of the effects of occupational exposure to carcinogenic agents have been implemented: - theMesothelioma national register (ReNaM), one of the most important experiences in terms of quality of data produced, territorial coverage and scientific reliability of results; - the rino-sinusal national tumor register (ReNaTuns). Today important regional experiences are on going in Piedmont, Lombardy, Tuscany. - OCCAM, a monitoring system based on the linkage of available information. The SIREP system has been implemented to monitor the exposure to carcinogenic agents in the workplace and is available at ISPESL. In the near future, the epidemiology of occupational cancer in Italy will most certainly regard issues such as scientific research, surveillance, compensation and prevention.

[Occupational exposure to wood dust. Health effects and exposure limit values]. / Exposition professionnelle aux poussières de bois. Effets sur la santé et valeurs limites d'exposition.

This article presents a review of the health effects of occupational exposure to wood dusts and of the data that could be used for setting occupational exposure limits for this nuisance. The causal role of wood dust in the onset of sinonasal cancers is solidly established by numerous epidemiological studies, and the magnitude of the risk is particularly high for adenocarcinoma induced by exposure to hardwood dust. However, no current data allows to rule out the carcinogenic role of softwood dusts and, in the view of protecting the health of the workers, it does not seem relevant to distinguish these two types of wood. Various impairments of the lung function have been frequently associated with exposure to both 'allergenic' and 'non-allergenic' wood dusts and may occur at very low concentrations. According to the SUMER 94 and CAREX studies, about 200 000 workers are currently exposed to wood dusts in France (about 1% of the working population between 1990 and 1994). When taking into account full professional careers, the percentage of workers having been occupationally exposed can be estimated to be about 15% for men and 5% for women. Measurements performed in France between 1987 and 2000 show that exposure levels are high, about 50% of the samplings being over 1mg/m(3) (actual TWA in France). Although the studies present limits, particularly for the quantitative assessment of individual exposure levels, it seems that nonmalignant effects are susceptible to arise at the level of 1mg/m(3); a limit value of 0.5mg/m(3) would credibly allow to protect exposed workers from most of the risks of nonmalignant pulmonary effects. However, it is impossible to assure that this value will avoid the induction of sinonasal cancer, even if this level is certainly lower than the levels to which the cases of sinonasal cancers published in the literature were exposed.

Study of ethmoidal mucosa in a population at occupational high risk of sinonasal adenocarcinoma.

The occurrence of nasal adenocarcinomas was first described in 1965. Since 1988 these tumors have been accepted as an occupational disease for woodworkers in Italy. There are several underlying reasons why there is interest in studying the ways in which sinonasal adenocarcinomas occur. Often diagnosed at advanced stages of development because their symptoms are non-specific, these tumors are associated with a high mortality rate. A multidisciplinary study protocol was developed in this investigation. The aim was to identify the factors and conditions that promote sinonasal tumor growth in a population at risk due to occupational exposure to wood dust. Sixty-eight carpenters with a minimum of 10 years exposure to wood dust were studied. The control group comprised 81 volunteers. The patients underwent the following protocol: completion of a case report form, physical examination, evaluation of nasal cavity patency, clinical laboratory tests and histological study of the nasal mucosa. Our study provides significant evidence of the elevated incidence of pavimentous metaplasia in workers occupationally exposed to wood dust. In addition, it underscores a significant deficit of immunoglobulin A in such workers compared to the controls. However, we did not find, as reported elsewhere in the literature, a statistically significant difference between cases and controls as regards nasal symptoms and hyperemia of the nasal mucosa. Our study showed that, even in the absence of evident sinonasal lesions, it is still possible to determine an increased incidence of morphofunctional changes in subjects occupationally exposed to wood dust. Our findings may lead to the identification of occupational groups prone to elevated risk of the disease.

Distant metastases from sinonasal cancer.

Distant metastases from sinonasal malignancy are generally a rare event except in the terminal stages of the diseases and many patients die from recurrence before the secondaries become clinically manifest. Sinonasal neoplasia covers a diverse range of pathologies, some of which have a greater tendency to spread than others, in particular adenoid cystic carcinoma, malignant melanoma and some of the sarcomas. Notwithstanding this, the frequency with which systemic metastases occurs is such that screening at presentation could not be regarded as cost-effective and is consequently only instituted in the presence of specific symptoms.

[Epidemiology of cancers of the nasal cavities and paranasal sinuses]. / Epidémiologie des cancers du massif facial supérieur.

Cancers of nasal cavities and paranasal sinuses represent about 2-3% of cancers of the upper aerodigestive tract, in France. In 20% of these cases, these cancers develop in the ethmoid region, 80% of them being adenocarcinomas. Among the distinctive features of adenocarcinomas, epidemiological data should be emphasized. Indeed, ethmoid adenocarcinomas are mostly linked to wood exposure, mainly hard and exotic woods. However, in synthetic wood, binding agents and glues may also be involved as cocarcinogens. These cancers are often underdeclared by medical professionals leading to possible prejudice to the patient and his entitled beneficiaries. Therefore a detailed professional history of all patients presenting with a cancer of the nasal cavities and/or paranasal sinuses should be undertaken to avoid such a situation.

[Etiological epidemiology of tumors of the nasal cavities and the paranasal sinuses]. / Epidemiologia eziologica dei tumori delle fosse nasali e dei seni paranasali.

Etiologically-oriented epidemiologic studies on cancer of the nasal cavities and paranasal sinuses have been carried out since the beginning of the century. These studies showed that several chemical agents (chromates, nickel compounds, isopropylic alcohol, and mustard gas), and two occupational exposures (wood dust in the furniture industry and exposure to leather in shoe factories) were causally associated with nasal cancer. An increased risk has also been associated with several occupations (i.e. metalworker, textile worker, construction worker, and farmer) even in the apparent absence of causal agents. The first reports of an increased risk of nasal cancer in woodworkers and leather workers in Italy date back to 1980. Subsequent studies have provided estimates of the relative risk, ranging from 3.0 to 11.0 among woodworkers and from 8.1 to 47.1 among leatherworkers. Increased risks have been associated to the metal industry (relative risk ranging from 3.1 to 5.9), the textile industry (ranging from 2.9 to 17.0), the mining and construction industry (ranging from 2.3 to 5.3), and the agricultural industry (ranging from 1.9 to 3.3); all of these estimates are time- and place-specific. Moreover, the estimates are not reliable because of the small sample size, resulting from the low occurrence of the disease. The etiologic fraction for the population, taking into account both verified and suspected carcinogenic exposures, ranges between 50% and 65% in males. Relatively few cases of nasal cancer (all of them occurring in woodworkers) have been notified for workman's compensation; woodworkers with nasal cancer have received monetary compensation in Italy since 1988. Nasal cancer is an often fatal but largely preventable disease. Several verified and suspected occupational exposures are associated with this neoplasm. The reduction of dust and fumes in the air of the above mentioned work environments is recommended for reducing the occurrence of this disease.

Discovery in medicine--chance or science? The case of woodworkers' nasal cancer.

The relative roles of chance and scientific observation in medical discovery are discussed. The emergence of ethmoidal adenocarcinoma as an industrial disease among makers of wooden furniture in an English area is related. Regular monitoring clinics held in the factories are then justified.