It is an aggressive tumor, from which there is no cure: the median survival in population registers is 10-13 months. Let’s talk about mesothelioma pleural, malignant tumor that originates from the pleura and is due to the very fine asbestos fibers that insinuate themselves between the two sheets that make up this membrane, creating inflammation and starting the pathological process. The words of Franco di Mare, Rai correspondent in the theaters of war, who spoke on “Che tempo che fa” on Nove to present his book «Le parole per lo dirlo. The war outside and inside us”, they indignantly said for the “repugnant” silence of the public companybut they have also contributed to shining a spotlight on this occupational disease.
Federica Grosso
«It was very courageous, mesothelioma is a forgotten pathology, which is little talked about, due to the social, political and legal implications, thus raising less awareness compared to other diseases» he reflects Federica Grosso, head of the simple departmental structure Mesothelioma and Rare Cancers of the Santi Antonio e Biagio and Cesare Arrigo University Hospital of Alessandria.
Casale Monferrato is one of the most affected areas of our country, where a cough, a pain in the back or difficulty breathing immediately brings to mind that, the cursed Eternit.
The national register
Mesothelioma affects around two thousand Italians every year. The risk factor is exposure to asbestos, a mineral whose fibers penetrate deep into the respiratory tree. In Italy, a 1992 law – law 257/92– prohibits its extraction, import, export, marketing and production, but certain territories are not free from dust at all. «The closure of a plant, without subsequent reclamation, does not protect citizens who in some areas of the country continue to breathe dust, fall ill and die» explains Federica Grosso. Exposure to asbestos is found in most mesothelioma diagnoses, but it also causes asbestosis, pleural plaques and lung cancer. The National Mesothelioma Registry (ReNaM), established at INAIL, produces a report every three years; the most recent, from 2021, finds that 50% of new cases are registered among residents in Lombardy, Piedmont, Liguria and Emilia-Romagna. The most affected areas are Casale Monferrato, Mestre, Savona and Ancona. This monitoring system is mandatory, it requires the reporting of new cases, but this is not always done. Therefore, explains the specialist, “we can consider the data in our possession an underestimate”.
We keep dying
All types of asbestos are carcinogenic to the lungs, larynx, ovary, peritoneum, pericardium, tunica vaginalis of the testis, colorectal, esophagus, stomach and pharynx. Carcinogenicity is confirmed by WHO, this has been known for at least six decades. Yet some countries still cannot resist pressure from the industry: the United States, for example, banned chrysotile, the most common type, only last March. Then there is the typical latency of the disease, which appears decades after exposure, a time bomb, so much so that cases have not decreased with the 1992 law. «Also due to the presence of asbestos in the environment . Indeed, epidemiology has changed and today we are seeing a greater number of cases due to environmental exposures, compared to a decline in professional ones, typical of workers in the most involved sectors such as construction and heavy industry” comments Grosso. In Piedmont, particularly in the Casale area, there has been an increase in cases among women, who made up a third of the new cases and today are 50%, and also among younger people.
Therapeutic innovation
In addition to the persistence of the poison in the environment and the lack of reclamation, the subject of the great battles for rights and trials for the recognition of responsibilities, there is a problem regarding therapeutic innovation. «Mesothelioma is a rare tumor. The standard of care for the most frequent form of mesothelioma is chemotherapy, but the results are not satisfactory and only 8% are alive 5 years after diagnosis. This is also a tragedy for us clinicians, called to communicate an unfortunate diagnosis by admitting that we have few weapons at our disposal» admits the oncologist Grosso, one of the authors of an important independent non-profit clinical study (not financed by the pharmaceutical industry) published in Lancet That showed that immunotherapy with pembrolizumab in combination with first-line platinum chemotherapy and pemetrexed significantly improved overall survival, reducing the risk of death by 21%. At 3 years, 25% of patients treated with the combination were alive compared to 17% with chemotherapy alone. The study involved centers in Italy, France and Canada and our country recruited half of the 440 subjects. The data on progression-free survival and response are also significant, which is no small feat for patients who are highly symptomatic. «These are encouraging results for clinical practice, we hope the approval will not be too late, given that at the moment immunotherapy is authorized in the most aggressive histological subtypes, the non-epithelioid forms, which constitute only 25% of cases» comments Grosso «We must do something, we cannot let this massacre happen without engaging in the search for a cure».
Let Eternit find the cure
Having established the responsibilities, what is asked of a tormented territory is restorative justice and there is no shortage of appeals to the Swiss entrepreneur who owns Eternit (five factories in Italy: Casale Monferrato, Rubiera, Cavagnolo, Naples Bagnoli e Syracuse) Stephan Ernest Schmidheiny to finance research into a cure. Here therean open letter from the journalist from Casale, widow of asbestos, Silvana Mossanopublished in his blog on the occasion of the World Day of Asbestos Victims on 28 April, which addresses Schmidheiny: «He takes on the entrepreneurial management himself (through a pharmaceutical company) and has the ethics of encouraging research until reaching the shared objective: finding the right “medicine”.
A national network
The first association of Rare Thoracic Tumor Tutor patients was established only in 2017, also due to the need of the families of these very fragile patients to engage first and foremost in the fight for recognition of responsibilities. «Today, we also want to talk more about mesothelioma and provide information and raise awareness» concludes Grosso. «Rare diseases require global management and the patient must be referred to a specialist center with high expertise. This is why we are setting up an Italian network of centers that can coordinate the smaller ones in the territories».
Milan, union protest in front of the Court where the trial for the death of 10 La Scala workers who died from mesothelioma was underway in 2022. Photo La Presse