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Background: Exposure to air pollution has been proposed as one of the potential risk factors for leukaemia. Work-related formaldehyde exposure is suspected to cause leukaemia., Methods: We conducted a nested register-based case-control study on leukaemia incidence in the Viadana district, an industrial area for particleboard production in Northern Italy. We recruited 115 cases and 496 controls, frequency-matched by age, between 1999 and 2014. We assigned estimated exposures to particulate matter (PM 10 , PM 2.5 ), nitrogen dioxide (NO 2 ), and formaldehyde at residential addresses, averaged over the susceptibility window 3rd to 10th year prior to the index date. We considered potential confounding by sex, age, nationality, socio-economic status, occupational exposures to benzene and formaldehyde, and prior cancer diagnoses., Results: There was no association of exposures to PM 10 , PM 2.5 , and NO 2 with leukaemia incidence. However, an indication of increased risk emerged for formaldehyde, despite wide statistical uncertainty (OR 1.46, 95%CI 0.65-3.25 per IQR-difference of 1.2 μg/m 3 ). Estimated associations for formaldehyde were higher for acute (OR 2.07, 95%CI 0.70-6.12) and myeloid subtypes (OR 1.79, 95%CI 0.64-5.01), and in the 4-km buffer around the industrial facilities (OR 2.78, 95%CI 0.48-16.13), although they remained uncertain., Conclusions: This was the first study investigating the link between ambient formaldehyde exposure and leukaemia incidence in the general population. The evidence presented suggests an association, although it remains inconclusive, and a potential significance of emissions related to industrial activities in the district. Further research is warranted in larger populations incorporating data on other potential risk factors., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alessandro Marcon reports financial support was provided by ATS della Val Padana. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: occupational exposure to benzene represents a threat for the health of a still relevant number of workers. An increased risk of leukaemias has been demonstrated among exposed workers, while a weaker association has been found for other malignancies., Objectives: to evaluate mortality risk among workers exposed to benzene across economic sectors in Italy., Design: proportionate mortality ratios (PMRs) were calculated linking exposure occupational information to national mortality statistics (2005-2018), assuming a Poisson distribution of the data., Setting and Participants: data from the Italian national registry on occupational exposure to carcinogens (SIREP) in the period 1996-2018 were selected., Main Outcomes Measures: PMRs by cause of death were reported. Specific analyses by cancer site and activity sector, profession, and cumulative exposure were performed., Results: a total of 858 deaths (97% in men) were identified among 38,704 exposed workers (91% men). An excess of deaths from malignant neoplasm of the lung was found among exposed workers, in both genders (PMR 1.27 in men; PMR 3.00 in women). An increased proportion of deaths was also found from leukaemias (leukaemia of unspecified cell type: PMR in men 2.99; 95%CI 1.24-7.19), and multiple myeloma in the chemical industry (PMR in men 2.27; 95%CI 1.08-4.76)., Conclusions: the risk of leukaemia in the petrochemical industry has been confirmed, while an excess risk of lung cancer mortality was highlighted in the retail sale of automotive fuels. Epidemiological surveillance and air and biological monitoring are recommended for workers exposed to benzene to ensure compliance with regulatory requirements and reduce exposure-related deaths.

Background: Benzene is a highly flammable, highly volatile liquid aromatic hydrocarbon. It has been used in many industrial processes as a solvent or a starting material. At the beginning of the twentieth century, it was very widely used in the workplace, especially in printing and in the shoe manufacturing and rubber industries. Although benzene was first recognized to cause aplastic anemia, its association with leukemia has been investigated only since the 1930s. In 1963, Italy was one of the first countries in the world to adopt a law to ban benzene as a solvent in work activities., Objectives: This study analyzed the contribution of the Clinica del Lavoro in Milan, Italy, to studies of the relationship between exposure to benzene and leukemia., Methods: Scientific literature and historical sources on benzene and leukemia in the twentieth century were reviewed, and interviews with a first-hand witness of that period were conducted., Results: By 1928, several scholars had reported anecdotal cases of leukemia among workers exposed to benzene. Enrico Vigliani was the first to collect all of these cases and to try to conduct statistical analysis on these data, in order to support the association between benzene and leukemia. In the 1960s, Vigliani and Alessandra Forni showed that benzene could cause chromosome aberrations in the bone marrow that could produce leukemic clones., Conclusions: As a result of these studies and the subsequent regulations which banned benzene, exposure conditions changed in the workplace in the last few decades. The resulting low concentrations have prompted researchers to investigate new exposure biomarkers and to study any related health problems.

Leukaemia risk in adult populations exposed to environmental air pollution is poorly investigated. We have carried out a population-based case-control study in an area that included a fossil fuel power plant, a coke oven and two big chemical industries. Information on residential history and several risk factors for leukaemia was obtained from 164 cases, diagnosed between 2002 and 2005, and 279 controls. A higher risk for subjects residing in polluted areas was observed, but statistical significance was not reached (adjusted OR = 1.11 and 1.56 for subjects living in moderately and in heavily polluted zones, respectively, p = 0.190). Results suggest a possible aetiological role of residential air pollution from industrial sites on the risk of developing leukaemia in adult populations. However, the proportion of eligible subjects excluded from the study and the lack of any measure of air pollution prevent definitive conclusions from being drawn.

Benzene, a recognized occupational leukemogen in adults, has been hypothesized to also increase the risk of childhood leukemia. We carried out a population-based case-control study in a northern Italy community involving 83 cases with acute childhood leukemia diagnosed in the years 1998-2009 and 332 matched controls. We assessed residential exposure to benzene and to particulate matter ≤10 μm (PM10) from motorized traffic using geocoded residences and detailed emission and dispersion modeling. Exposure to benzene, and to a lesser extent to PM10, appeared to be independently associated with an excess leukemia risk. When we stratified the study population by age and by leukemia subtype, the relative risk associated with benzene exposure was higher among children aged less than 5 years, and despite small numbers this relation appeared to be considerably stronger for acute myeloid leukemia than for acute lymphoblastic leukemia. Overall, these findings suggest that exposure to low levels of benzene released from motorized traffic may increase the risk of childhood leukemia, and suggest a possible independent effect of PM10, although unmeasured confounding due to other pollutants cannot be ruled out.

Objective: The purpose of the present study is to assess knowledge of and attitudes toward environmental risks as possible determinants of diseases in the general population in Italy., Methods: Parents of 900 children and adolescents received an anonymous self-administered questionnaire., Results: Correct knowledge ranged from 98.4% of those who are aware that tobacco smoking is a risk factor for respiratory disease to 4.0% of those who know that there is no evidence of an increase of risk of childhood leukaemia in those living near mobile phones base stations. Those who are knowledgeable on the effect of an environmental risk factor are significantly more likely to know also about other risk factors., Conclusion: The findings of this survey provide valuable information to researchers and policy makers about public awareness of environmental risks that are to take into account in the implementation of risk communication and protective actions.

This study concerned a group of ex-workers (372 males and 99 females) from a firm situated in Bergamo (Italy) that ceased its activity at the beginning of the Nineties. From an introductory analysis of the results, we found out that there isn't excess in the death-rate for liver and bile ducts cancers among the males of this group. Among them, for what concerns the other tumoral pathologies, such as leukaemia and stomach tumors, the information allowed to verify an excess of mortality. However, this increase hasn't result statistically significant. On the contrary, it came out that there is an excess of risk for intestine tumors: standardized death-rate of 2.58. In accordance with the information collected, for the future it will be necessary to carefully examine the research in order to verify the existence of a direct connection to the exposure at PCB and study the incidence (not only for mortality) of these neoplasms.

Objective: The present paper estimates the 1980-2000 trend in exposure to benzene of the population living within the urban area of Modena. An assessment of leukaemia risk is also presented., Design: The 2000 annual means of benzene atmospheric concentrations in 73 sites has been derived using a procedure which integrated data from fixed site stations and passive samplers: on this basis, an annual mean for the whole urban area has been calculated. The population exposure trend for the period 1980-2000 has been estimated using the information on traffic emission changes. The expected annual number of leukaemia cases attributable to benzene has been calculated by using two different approaches., Setting: Residents in the urban area of Modena., Main Outcome Measures: Annual incidence of leukaemia attributable to benzene., Results: In 2000, the mean urban concentration was about 7 microg/m3 and in average the population was exposed to about 9 microg/m3. In the eighties, the population exposure was 5 times higher than the 2000 value, with a maximum of 51 microg/m3 in 1988. The leukaemia risk assessment procedures gave a value of about 4 x 10(-1) with the method based on cumulative exposure and of about 4 x 10(-2) with the method based on weighted exposure., Discussion and Conclusion: This study is one of the few examples of evaluation of both the trend in benzene exposure for a population and assessment of leukaemia risk. Uncertainties in the assessment of health impact derive from inconsistencies in the underlyng methods.

Objectives: The study attempted to add years of follow-up to an earlier study describing excess leukemia among workers exposed to benzene-based glues in a shoe-factory and to conduct a quantitative exposure assessment of the exposure to benzene and the risk of leukemia., Methods: The cohort comprised 1687 persons with complete work histories, at work on 1 January 1950, and followed through 31 December 1999. For each subject, time-specific cumulative exposure (ppm-years) was calculated as the sum of the products of job-specific concentrations of benzene (ppm) and the duration (years) for each job. Standardized mortality ratios (SMR) were estimated using national and regional rates specific for gender, age, and period., Results: The cumulative exposure ranged from 0 to >500 ppm-years. The SMR values for all hematolymphopoietic malignancies and leukemia for the men and women combined were elevated in all but the lowest exposure category. Leukemia risk was significantly elevated in the highest exposure category and the most evident among the men. The SMR values for the men were 1.4 [95% confidence interval (95% CI) 0.2-5.0], 3.7 (95% CI 0.1-20.6), 3.0 (95% CI 0.4-10.9), and 7.0 (95% CI 1.9-18.0) for benzene, the cumulative exposure equaling <40, 40-99, 100-199, and >200 ppm-years, respectively., Conclusions: The results indicate that leukemia mortality is associated with exposure to benzene in this factory and that the risk increases with increasing cumulative exposure. The relevance of these findings for estimating risk at much lower levels is limited because of the small study size.

We conducted a population-based, case-control study on hematolymphopoietic malignancies in 12 areas in Italy to investigate associations between different hematolymphopoietic malignancies and exposure to solvents and pesticides. We collected all incident cases 20-74 years of age from 12 areas, with a combined population of approximately 7 million residents. The control group was formed by a random sample of the study population. Data presented in this paper refer to 2,737 interviewed cases of 3,357 eligible cases and to 1,779 of 2,391 eligible controls. We analyzed risks associated with occupation using job-title information to evaluate disease pattern according to job category. An earlier publication presented results for women; here, we report the findings for men and discuss the overall patterns in both genders. The most consistent overall finding was an approximate doubling in relative risk for all four types of malignancies among male managers and related occupations. Several additional occupations were associated with elevated risk of one or more malignancies among men. These included cooks, waiters, and bartenders, and building caretakers and cleaners, for non-Hodgkin's lymphoma; textile workers and machinery fitters for Hodgkin's lymphoma; metal processors, material handlers, rubber workers, and painters for leukemia; and hairdressers, metal processors, tailors, electrical workers, and plumbers for multiple myeloma. The finding of increased risk of non-Hodgkin's lymphoma among both male and female cooks, waiters, and bartenders has not been previously reported; nor has the elevated risk of leukemia among material handlers. Among people engaged in agriculture, those employed as tractor drivers and as "orchard, vineyard, and related tree and shrub workers" appeared to be at increased risk for hematolymphopoietic malignancies.

This article present the results of the extension of the follow-up of a cohort of workers employed in an Italian oil refinery. 1,583 workers employed in 1949-1982 in a northern Italy oil refinery plant were followed-up for mortality as of May 31, 1991. Environmental measurements documented potential exposure to benzene. Standardized mortality ratios (SMR) and their 95% confidence intervals (95% CI) were calculated using as references national (1949-1968) and regional mortality rates (1969-1991). Elevated mortality from lymphoma (seven deaths, SMR 190, 95% CI 76-391) and leukemia (eight deaths, SMR 225, 95% CI 97-443) was observed. No consistent trends by length of employment or time since first exposure were apparent. Nonetheless, the excess risk was particularly and significantly increased among workers with 15 or more years of employment, and 30 or more years since first employment. The findings of elevated mortality from leukemia and lymphoma are in agreement with those of other oil refinery studies. Chance, confounding, or other biases might have played a marginal, if any, role in determining the results. Exposure to benzene is a biologically plausible explanation.

Background and Objective: Patients treated for Hodgkin's disease have an increased risk of developing subsequent acute leukemia. This co-operative study was conducted to assess the relative risk associated with several candidate factors including age, splenectomy, combined modality therapy and cumulative drug dose including alkylating agents and nitrosurea derivatives., Design and Methods: This study evaluated the risk of acute leukemia according to pretreatment variables and therapy modalities among 1659 patients treated for Hodgkin's disease and followed for a median time of 10 years. Both case-control and actuarial risk studies were performed. Median age was 34 years (range: 12-83); 53% of patients were splenectomized. As to the overall therapy, 348 patients (21%) were given radiotherapy (RT) alone, 375 (23%) chemotherapy (CT) alone (including MOPP, MOPP + ABVD or MOPP + ABVD + lomustine); 936 (56%) received both CT and RT, either as primary or salvage treatment., Results: The overall 15-year actuarial risk of leukemia was 4.2%; the hazard function curve showed two peaks of risk at the 3th and the 8th year from the initiation of therapy and no leukemia beyond the 12th year of follow-up. Risk of leukemia was 0.3% after RT alone, 2.8% after CT alone (2.2% after MOPP; 4.4% after MOPP + ABVD + lomustine), and 5.4% in patients given combined modality therapy (10.2% for RT + MOPP; 15.6% for RT + MOPP + lomustine). No leukemia occurred after ABVD alone and the risk was low (0.6%) when neither mechlorethamine nor lomustine were utilized. Patients who had received extended radiotherapy including abdomen and pelvis in addition to MOPP showed a significantly higher risk of leukemia compared to those given limited RT + MOPP (P = 0.01). Case-control analysis indicated advanced stage, type and duration (> 8 months) of CT and extension of RT as significant risk factors for leukemia. Compared to RT alone, the odds ratio was 5.9 after MOPP + extended RT, and 8 when a lomustine-containing regimen was used, as well. Neither age nor splenectomy were independent risk factors for leukemia; splenectomy was influential only when patients had been given MOPP chemotherapy, as well., Interpretations and Conclusions: Both case-control and actuarial analyses indicated that: a) combined modality therapy with MOPP and extensive RT (including abdomen and pelvis), and the use of lomustine added to the leukemogenic risk of MOPP alone; b) programs without mechlorethamine, procarbazine and lomustine were almost devoid of leukemogenic risk.

A multicenter case-control study was conducted in Italy in twelve areas covering a population of 7 million persons with the aim of verifying the hypothesis of an association between exposure to herbicides and to organic solvents and occurrence of lymphoma, leukaemia and multiple myeloma. 3420 cases were recruited in a three-year period (1991-1993), through periodical surveys in the main hospitals in each area. A random sample of the general population (2317 subjects) constitutes the control group. Cases and controls were face to face interviewed by trained personnel. A questionnaire was used asking about personal habits, residential and occupational history, past health status. Preliminary analyses, concerning a total of 1388 cases and 1718 controls, focused risks by occupation. Elevated risks of non Hodgkin's lymphoma (OR: 1.7; IC 95%: 0.92-3.02; based on 28 exposed cases), and of multiple myeloma (OR: 3.6; IC 95%: 1.51-8.63; based on 9 exposed cases) were shown for welders. Among female hairdressers there were elevated risks of non Hodgkin's lymphoma (OR: 1.8; IC 95%: 0.76-4.30; based on 8 exposed cases), multiple myeloma (OR: 3.3; IC 95%: 0.77-14.15; based on 3 exposed cases) and Hodgkin's disease (OR: 2.0; IC 95%: 0.93-4.47; based on 16 exposed cases).

Background and Objective: The number of allogeneic transplants of peripheral blood stem cells (PBSC) is rapidly increasing. Collection of PBSC in healthy subjects currently implies the administration of G-CSF or GM-CSF and, of course, the use of apheretic devices. These procedures involve potential risks, in particular the risk of leukemia secondary to growth-factor treatment. To evaluate the current practice of PBSC mobilization and collection, and initially assess the short-term side effects and efficiency of procedures, the GITMO (Gruppo Italiano Trapianti di Midollo Osseo) promoted a retrospective cooperative study among the Italian centers., Methods: Seventy-six healthy individuals donating to their HLA-identical or partially matched sibling recipients in seven Italian centers form the basis of the present analysis. The data were retrospectively collected by proper forms, pooled and analyzed by means of a commercially available statistical soft package., Results: All donors received G-CSF as mobilizing agent with different schedules according to each single center policy. A median of 2.5 (range 1-4) aphereses per donor were run. The most frequent side effect was bone pain. In no case did the medium term follow-up reveal subjective complaints or laboratory modifications. After G-CSF mobilization, WBC and lymphocytes counts increased to a maximum of (mean +/- SD) 48.1 +/- 15.6 x 10(9)/L and 4.2 +/- 1.5 x 10(9)/L, respectively. The peak was reached on day 5 in both cases. Platelets decreased after the apheretic procedures, reaching a minimum of (mean +/- SD) 77 +/- 26 x 10(9)/L on day 8 and returning to normal values on day 11. Overall, the apheretic collection yielded (mean +/- SD) 18.6 +/- 19.2 x 10(8)/kg donor body weight MNC; 10.4 +/- 5.7 x 10(6)/kg CD34+ cells; 90.6 +/- 75.9 x 10(4)/kg CFU-GM and 4.3 +/- 1.8 x 10(8)/kg CD3+ cells. The target dose of 4 x 10(6)/kg CD34+ cells was harvested in 51.3% donors after a single apheresis, in 85.5% after the second, and in nearly 100% after a maximum of 3 aphereses., Interpretation and Conclusions: These data demonstrate that collection of adequate numbers of circulating progenitors is feasible and well tolerated in healthy donors. However, only careful monitoring of donors and international cooperation will help to definitively assess the long-term safety of G-CSF for mobilization of PBSC.

Objectives: To examine the cancer risk of shoe manufacturing workers and evaluate whether the risk was associated with exposure to leather dust and solvents., Methods: Data from two historical cohort studies of shoe workers were expanded and analysed in parallel. A total of 4215 shoemakers from England contributing 103 726 person-years at risk and 2008 shoemakers from Florence, Italy, contributing 54,395 person-years at risk were included in the analysis. Exposure to leather dusts and solvents from glues was evaluated on the basis of job title information. Standardised mortality ratios (SMR) were calculated as ratios of observed deaths (Obs) over expected derived from national mortalities., Results: Overall mortality was lower than expected in both cohorts (English cohort: Obs 3314, SMR 81, 95% confidence interval (95% CI) 78-84; Florence cohort: Obs 333, SMR 87, 95% CI 78-97). An increased risk of nasal cancer was found (English cohort: Obs 12, SMR 741; Florence cohort: Obs 1, SMR 909). 10 of the 13 cases occurred among English workers employed in the manufacture of welted boots (SMR 926, 95% CI 444-1703), a sector of the industry thought to have had the highest exposure to leather dust. Mortality from leukaemia was not increased in the English cohort (Obs 16, SMR 89), but was increased in the Florence cohort (Obs 8, SMR 214, 95% CI 92-421); and the highest risk was found among shoe workers in Florence who were first exposed between 1950 and 1959 when exposure to benzene was substantial (Obs 3, SMR 536, 95% CI 111-1566). Some evidence for an excess risk of stomach, bladder, and kidney cancer, as well as multiple myeloma and non-Hodgkin's lymphoma was also found in the Florence cohort only among workers employed in jobs with the highest exposure to solvents., Conclusions: These findings confirm the associations between exposure to leather dust and nasal cancer and between exposure to benzene and leukaemia in the shoe manufacturing industry and suggest that the risk of other cancers may be increased among workers exposed to solvents or glues.

To evaluate the role of agricultural exposures in the development of lymphatic and haemopoietic tumors a population-based case-referent study has been carried out in three health districts of Southern Italy. All incident cases of leukemia, lymphoma and myeloma from 1 July 1987 to 30 June 1989, aged 14 years or more, have been identified (71 subjects). The control group is formed by subjects with other neoplasms. A Job Exposure Matrix, specific to 10 areas, to 6 major crops and to 4 calendar periods, was built for assessing pesticide exposure. To date 100 interviews (to the index subject or to proxies) have been carried out (26 cases and 74 referents). The odds ratio (OR) of hematologic malignancies for agricultural workers was 1.63 [95% Confidence Intervals (95% CI): 0.69-4.34] in the whole sample and 6.00 (95% CI: 1.21-25.52) in the female group. Significative increased risks have been observed for exposure to DDT and creolin (OR = 4.11; 95% CI: 1.16-14.55) and, for leukemia, for cattle breeders (OR = 6.38; 95% CI: 1.46-27.83).

The study is a population-based case-control study on hematolymphopoietic tumors, conducted in west Liguria with high prevalence of exposure to chemicals suspected (about 10%) of increasing the risk of leukaemias or lymphomas and multiple myeloma (pesticides). Cases and control were identified and confirmed during the period 1/1/1990 through 31/12/1993. Cases are identified through periodic contacts with the Pathology, or Hematology or other relevant Department of the Hospitals of west Liguria and Genoa town or University of Genoa where patients living in these area are referred for hematolymphopoietic malignancies. Controls are a random sample of the general population living in each area (using the demographic health archives). The range of the age is 20-74. After identification each case or control is contacted to have his consent to the interview near the home. Informations collected using a most completed questionnaire regard drinking and smoking habit, the addresses and the conditions of the homes where spending the life, particularly hobbies about exposure of pesticides and/or solvents, more important pathological events on the life and the occupational exposure. Actually we are in the phase of identification of cases and controls.

A case-control study was carried out to examine the relation of three subtypes of leukemia cells and refractory anemia with excess of blasts to selected behavioral and environmental factors. Cases aged 15 years or older were recruited in three hospitals located in Rome, Bologna, and Pavia, respectively. Outpatients who were either normal or had nonneoplastic hematologic disorders and were seen in the same hospitals as the cases were enrolled as controls. Two hundred fifty-two patients with acute myeloid leukemia, 100 with acute lymphocytic leukemia, 111 with refractory anemia with excess of blasts, 156 with chronic myeloid leukemia, and 1,161 controls were included in the study. Refractory anemia with excess of blasts and chronic myeloid leukemia were included because they are regarded as forms of pre-leukemia. Odds ratio estimates were generally imprecise, but associations were suggested between specific case subtypes and exposure to dark hair dye, selected occupations (shoemaker, painter, electrician, child care), residence in houses built with tuff, and smoking. Although the exploratory nature of the study and its limited statistical power preclude firm conclusions, its results are consistent with those of previous studies, and are in general biologically plausible.

Exposures to organic solvents (including benzene), ionizing radiation and low frequency electromagnetic fields have been suggested as risk factors for leukemias in adults. Exposure to herbicides of the phenoxyacid variety (2, 4, 5-T; 2, 4-D) has been reported to be associated with an increased risk of non-Hodgkin's lymphomas. In addition several studies have suggested that agricultural workers have an excess risk of hematolymphopoietic malignancies, although no specific agent has yet been identified. Italy is particularly attractive for investigating further these associations, because: a) there is a high prevalence of exposure to solvents in industrial areas (estimated to be 10-16% in the province of Torino, Varese and Florence), and a high prevalence of exposure to herbicides (including phenoxyacides) in agricultural areas; b) there is also considerable extra-occupational exposure to solvents and pesticides; c) competent groups of hematologists exist in several towns, using advanced diagnostic techniques including cytogenetics. We propose therefore to conduct a multicenter population-based case-control study in 11 italian areas, chosen on the basis of a high exposure prevalence. In three years, we intend to interview approximately 1100 cases of leukemia, 1900 cases of lymphoma (Hodgkin and non-Hodgkin) and 400 cases of myeloma; 1900 randomly selected individuals, residents of the same areas, will serve as a population control group. Cases will be all those occurring in the study period among residents of the 11 areas, newly diagnosed. Particular care will be dedicated to diagnostic aspects, including B- and T- cell characterization. Cases and controls will be blindly interviewed by trained personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzene is a well documented carcinogen for the hematic and lymphopoietic system, and experimental research confirms its carcinogenicity for tumors of other sites. This report presents the results of a historical cohort study in a shoe manufacturing plant in Florence where cases of aplastic anemia and leukemia were reported in the 1960s. A total of 1008 men and 1005 women were considered eligible members of the cohort. For total mortality, comparing the rates of the cohort with the national rates, the standardized mortality ratio (SMR) was 79 for the women and 95 for the men. For the men excesses of risk for aplastic anemia [SMR 1566; 95% confidence interval (95% CI) 547-3264] and leukemia (SMR 400, 95% CI 146-870) were observed. The increased risk occurred among workers first employed during the period in which benzene was used, but the expected number of cases in the subsequent period was too small to evaluate whether any reduction in risk had occurred. No increasing pattern with duration of employment was discernible.

A group of 304 subjects admitted to the Institutes of Occupational Health of Milan and Pavia (Italy) between 1951 and 1970 for suspected benzene intoxication were retrieved from hospital records and their mortality experience was examined up to 31 December, 1986. The aims of the study were: 1) to estimate, in quantitative terms, the risk associated with benzene exposure in that area in the time period considered (these risks had already been reported, but merely as case reports); 2) to investigate the possibility of an increased frequency of neoplasms other than leukaemia; and 3) to further investigate the exposure history of these subjects. In the absence of data on the population at risk, mortality was analysed via the mortality odds ratio (MOR) method. A local population mortality experience was used as reference. Twenty-eight malignant neoplasms were observed (MOR = 2.2; 95% confidence interval = 1.3-3.7), 15 of which were haematologic neoplasms (MOR = 13.3; 95% confidence interval = 8.0-22.2). No odds ratio increases were observed for any of the other tumour sites or types. Eleven observed blood diseases represented a large numerical increase in the odds ratio. For all the haematologic neoplasms there had been an estimated exposure to airborne benzene concentrations above 20 ppm. However, no conclusions on dose-response relationships can be drawn from these data because of the approximate evaluation of individual exposure and, especially, because the study group most probably consisted of a highly selected sample of the exposed population.(ABSTRACT TRUNCATED AT 250 WORDS)

Until recently, the incidence of benzene carcinogenicity was based only on the association between benzene occupational exposure and human leukemia, with many limited case reports and scanty epidemiological data. Available experimental studies up to 1976 on animals were rare, fragmentary, and inadequate, and had failed to prove the carcinogenic effects of benzenes. However, an integrated project of long-term carcinogenicity bioassays, begun in our laboratory in 1976 and still continuing, has shown that benzene produces a variety of tumors in rats including Zymbal gland carcinomas, carcinomas of the oral cavity, hepatocarcinomas, and possibly mammary carcinomas, lymphoreticular neoplasias, and other malignancies. Some of the tumors caused by benzene are uncommon or unusual in the breed of rats studied. Therefore benzene must be considered, under the studied experimental conditions, a strong multipotential carcinogen. The need for more experimental research is emphasized, particularly to assess the carcinogenic effects of low doses. Also recommended are more comprehensive epidemiological investigations, extended to all types of malignancies, and the application of adequate measures for primary prevention.

Aggressive, multimodal treatment of Hodgkin's disease has led to dramatic increases in survival but not without significant early toxicity and late complications. The most serious late complication is the development of a secondary neoplasm. These secondary cancers include acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, and various solid tumors.

First admissions to the hospital among 25,945 men living in southern Piedmont and holding a license authorizing them to use pesticides were analyzed in a study of the cancer risk related to exposure to pesticides. Standardized incidence ratios significantly higher than one were encountered for malignant skin cancers and lymphomas. The risk of lymphoma was particularly high in predominantly arable areas. The standardized incidence ratios for tumors of the nervous system and hematopoietic tissue showed an interesting age-related pattern and a higher risk in areas primarily devoted to forest tree plantation, but did not reach significance. Certain hypotheses are advanced to explain these findings.