Human biomonitoring studies of populations exposed to incinerator fumes in Emilia Romagna, Italy

1. Human biomonitoring studies of populations exposed to incinerator fumes in Emilia Romagna, Italy Unit 13

3. Maranello

5. Diseases associated with exposure to urban incinerators fumes. • Biomarcatori di esposizione interna: eccessi significativi di rischio in 13 studi (marcatori: PCDD/PCDF, PCB, metalli pesanti, TSH, fitoemoagglutinine, cellule natural killer), a fronte di 3 studi con un rischio inferiore all’atteso e 21 con risultati non significativi; • Mortalità per tutte le cause: eccesso in 1 studio, difetto in 4 studi; • Mortalità per neoplasie: eccesso significativo in 14 studi (polmone, esofago, stomaco, laringe, sistema ematopoietico, tumori infantili), 9 studi con risultato non significativo; • Mortalità per mal. ischemiche: 1 studio con eccesso significativo, 1 non significativo; • Incidenza di tumori: 10 studi con eccesso di incidenza di tumori di diverse sedi (STS, stomaco, LNH, polmone, colon-retto, fegato, vescica, sistema ematopoietico), a fronte di 5 studi con risultati non significativi; • Patologie respiratorie: 3 studi riportano un eccesso di rischio, 4 risultati non significativi; • Malformazioni congenite: 5 studi con eccesso significativo, 3 con risultati non significativi.

6. APPROACH AND METHODOLOGY FOR THE MONITORING OF AIRBORNE POLLUTANTS • This chapter is intended to define the chemical parameters representing the “minimum” basis of choice for the monitoring of the air matrix in areas surrounding incineration plants. • It was decided to monitor the following pollutants: • • Cd, Ni, As, Pb, Zn, Cu, Mn. • • PCDD/F • These parameters are of significant interest for health and environmental issues, and may be ascribable to incinerator emissions. • The study may be broadened to include further parameters of major interest: • • Hg (gas phase) • • Other metals • • Size distribution of air particulate

7. The research aims at evaluating the feasibility of a monitoring approach integrating environmental measures and indexes of human health. The key instrument to reach this objective is the use of biomarkers, in the framework of a molecular epidemiology study. The design of a molecular epidemiology study is particularly complex when exposure to multiple agents is involved. This situation is challenging for scientific problems as well as for the emotional involvement of the exposed populations.

9. Selection of the exposed population There is a number of possible options to select a group of individuals exposed to incinerator fumes, e.g., ballot, lists of residents, outpatients in local hospitals. The selection of a group occupationally exposed to incinerator fumes may not represent the residential exposure in term of intensity and quality of exposure. Furthermore it could be difficult to find a group with homogenous exposure large enough to allow a proper estimate of exposure (especially after stratification for other confounders).

10. Selection of Biomarkers The list of candidate biomarkers should be assembled collecting the information from a literature review searching all published papers on human populations living (or working) near a urban wastes incinerator and using biomarkers. Other main parameters taken into considerations were; 1) biological relevance and sensitivity; 2) cost; 3) expertise of laboratories present in the territory; 4) sampling invasiveness.

12. Imagine that at this point someone from the Ministry of Health calls your telephone to ask you if you can implement these results with that new amazing discipline which is called Molecular Epidemiology

13. People at the Ministry ask you to: • Investigate the presence of genetic damage in the population living in the proximity of the incinerator of Modena. Particular attention to damage in residents is requested. • Quantify the presence of exposure to genotoxic agents in population living near the incinerator. • Identify groups at increased risk

14. To design the study you should: • Identify the exposed population (including size) • Identify control population • Decide what biomarkers are important and must be included in the study • Decide what biological fluid should be sampled and how • Discuss ethical issues concerning the study you propose.

15. In the next hour(s) try to design a study addressing the previous questions. Take into consideration the following issues: • You have enough resources to perform medium size population studies. Forget thousands, may be you can deal with hundreds, surely you can work with dozens !! • Media are heavily involved, and you’ll feel the pressure !! The two areas have contrasting interests, i.e., Molecular epidemiogists should also deal with politics. • As a consequence of the previous point avoid innovative and non validated biomarkers.

16. Continued: • You don’t have time !! People want to know ! One year is the max time allowed !! • Remember that you are a scientist. You should also put together some interesting data to publish in a good journal and get your PhD !! • You are not alone. The other local public services can help you providing information about demographics, population statistics, environmental analyses, water and air pollution, etc.

17. Do your best to face this messy situation ! Be prepared to discuss with the class your choices and proposals, and ......

18. Do your best to face this messy situation ! Be prepared to discuss with the class your choices and proposals, and ...... .... be relaxed, you’ll never be fired for the wrong choice !!