The Malignant Mesotheliomas Registry (RMM), Regional Operative Center of the National Registry of Mesotheliomas, pursues the following objectives:
- estimate the incidence of malignant mesothelioma of the pleura and the peritoneum in Piedmont, with temporal and geographical disaggregations, to identify excesses that require in-depth analysis through analytical investigations;
- collect information on work and residential history, by interviewing patients and / or their families, to identify both the situations that may have involved exposure to asbestos and the manner in which this may have occurred.
Further objectives of the RMM are: to favor medical-insurance procedures for the recognition of occupational diseases in favor of people with mesothelioma; study population survival and temporal trends; provide assistance and collaboration to research activities, especially case-control studies of the population on malignant mesothelioma and studies on the mortality of different cohorts.
The registration of malignant mesotheliomas became mandatory in the Member States of the European Union with Council Directive 83/477 / EEC of 19.09.1983, art. 17. The obligation was confirmed by Directive 2003/18 / EC of 27.03.2003. In Italy, the National Registry of Mesotheliomas (ReNaM) was established by Legislative Decree 277 of 15.08.1991, when some regional registers already existed or were underway. These had arisen in Tuscany, Piedmont, Emilia-Romagna, Puglia and Liguria, in response to the epidemic of malignant mesotheliomas that was emerging in those regions and the need to investigate the causes.
During the 1990s the ReNaM was gradually implemented at the Institute for Occupational Prevention and Safety (ISPESL), which has now become an INAIL research area. The collection of cases was based on the activity of the already existing regional registers, which became Regional Operational Centers (COR) ReNaM. The experience was progressively extended to other Italian regions, while Legislative Decree 257 of 25.07.2006 and Legislative Decree no. 8 dated 09.04.2008 confirmed the registration obligations and their modalities.
At present, COR has been set up in 20 regions or autonomous provinces, with coverage of approximately 98% of the Italian population. The relationship between ReNaM and COR and the procedures for registering cases are established by the DPCM 308 of 10.12.2002 and by national guidelines. The RMM is the COR of Piedmont, as established by the Asbestos Regional Plan, approved with DGR n. 51-2180 of 5.02.2001.
Detection and evaluation
The reporting of cases to RMM by health facilities is mandatory, but the Registry also systematically performs their active research. On a weekly basis selected departments and services of the hospitals are contacted, where most of the cases are sent to receive diagnostic confirmation, staging and treatment.
Every week a consultation is made of the archives of all the Pathological Anatomy services in the region. Finally, a search is carried out in the archives of the Hospital Discharge Cards (SDO) to identify cases that have escaped the first two surveys.
The reliability of the diagnosis of mesothelioma is assessed according to the ReNaM guidelines.
When a suspected case is registered, the specialized personnel of the RMM requires an interview necessary to collect information on all the possible circumstances of exposure to asbestos and other mineral fibers, in the workplace and life, through the ReNaM standard questionnaire.
Each questionnaire is examined by experts in occupational and environmental risks, who evaluate and record the probability and degree of exposure. The questionnaires are made available to both the prevention and safety services of the health care work environments (SPRESAL) and, in certain cases, to the judicial authorities requesting it.
Management and data processing: incidence and survival
The RMM data (new cases and evaluation of their exposures) are processed locally and are also periodically transmitted to the ReNaM, where they contribute to the archive and national statistics.
Age-standardized incidence rates are calculated separately for different categories of diagnosis confirmation level (histological confirmation, cytological or clinical-radiological confirmation). The statistics are disaggregated by calendar period, location (pleural, peritoneal, all primitive localizations) and geographical area (whole Region, ASL and district).
Survival time analyzes are conducted periodically to evaluate the effect of determinants such as age and histological type and to describe temporal trends in survival.
RMM receives exclusively public funding. The ordinary activities are part of those carried out in general by the Hospital-University Company. The conduct of specific research programs is made possible by specific funding provided by ASL (mainly that of Casale Monferrato) and by regional or state research funds, such as those for Finalized Health Research, for Applied Scientific Research and of the Center for Disease Control of the Ministry of Health. The Environment Department of the Piedmont Region has financially supported research on the risk due to natural outcrops of asbestiform minerals.
SC Tumor Epidemiology - CRPT U, University Hospital of the Health and Science of Turin, via Santena n. 7 - 10126 Turin. The RMM is located at the San Vito headquarters, in the municipal road San Vito Revigliasco n. 34 - 10133 Turin. Responsible is Franco Merletti, director of the SC, assisted by Enrica Migliore, vicarious manager.
- Registro Nazionale Mesoteliomi
- Mesotelioma - Accogliere, Informare, ConDividere, Assistere, SOllevare, FaciLItare (MAI DA SOLI)