ASBESTOS-RELATED DISEASE SURVEILLANCE AND ENVIRONMENTAL EXPOSURE: COMPARATIVE INSIGHTS FROM CASALE MONFERRATO (ITALY) AND SIBATÉ (COLOMBIA)

Asbestos are mineral fibers with special physicochemical properties and extensively used in construction, automotive, and textile industries. However, all asbestos types have been classified by the International Agency for Research on Cancer (IARC) as carcinogenic to humans. Decades of asbestos production and use have left a massive environmental and health legacy in many industrial towns, including Casale Monferrato, Italy, and Sibaté, Colombia — both sites of major Eternit asbestos-cement factories. While Italy banned asbestos in 1992 and implemented national and regional mesothelioma surveillance systems, enabling over 35 years of data collection and exposure assessment, Colombia only banned asbestos in 2019, with implementation starting in 2021. The absence of mesothelioma registries means that the true burden of the disease and the extent of environmental exposure remain largely unknown in Colombia. The aim of this thesis is to transfer over four decades of Italian experience in asbestos surveillance and contaminated site management to the Colombian context. The thesis includes three main chapters: (1) Time trend analysis (1992-2021) and projections to 2042 of pleural malignant mesothelioma incidence rates in the SIN (Sito di Interesse Nazionale, site of national environmental and health concern) of Casale Monferrato, using data from the Piedmont Mesothelioma Registry; (2) Reconstruction of the industrial process and environmental records of the asbestos-cement facility in Sibaté to identify occupational and environmental exposure pathways in Sibaté; (3) Pilot study to assess asbestos exposure for agricultural workers near the El Muña reservoir in Sibaté — an area contaminated with asbestos for more than 38 years. The findings of this thesis reaffirm the persistence of asbestos health and environmental impact and highlight the urgent need for systematic disease surveillance and environmental monitoring in Colombia. In Casale Monferrato, despite decades of intervention, the mesothelioma epidemic is projected to decline only around the middle of this century, reflecting the long latency of asbestos-related diseases. In contrast, in Sibaté, both the actual number of mesothelioma cases and active sources of asbestos exposure remain largely unknown. Lessons from Italy provide a roadmap for prevention strategies, policy development, and international collaboration to address effectively the risks associated with asbestos