As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 from 34 registries covering 48 million residents. The 2008-2017 period, with 20 registries covering 24 million residents, was used for trends and regional comparisons. Net survival was estimated by Pohar-Perme method with life tables by year, sex, residence and calculated using the international standard distribution. Five-year age-standardized net survival for all cancers combined was 66.7 % in females and 62.2 % in males. Females had better survival than males for most cancers, notably acute lymphatic leukaemia (+9 % points (pp)), upper respiratory/digestive (+9 pp), lung (+6 pp), CNS (+5 pp), and stomach (+4 pp). Males had a higher survival for bladder (+4 pp), kidney (+2 pp), and urinary cancers (+5 pp). Best outcomes (>75 %) were documented for prostate, testicular, breast, endometrial, thyroid, melanoma, Hodgkin lymphoma, bladder, and chronic lymphatic leukaemia. Poorest prognosis (<30 %) was for CNS, liver, lung, pancreas, and acute myeloid leukaemias. Survival was age-dependent, highest in younger and lowest in older patients, with > 40 % points gaps in some haematological cancers. From 2008-2017, net survival arose from 65.7 % to 70.7 % in men and from 69.9 % to 74.1 % in women. Improvements were seen for pancreas, lung, and acute leukaemias, mainly in women, while decreases affected bladder, cervical, chronic lymphatic leukaemia in men. Geographical disparities persisted, with higher survival in Northern-Central Italy (64.0 % for men and 68.3 % for women) than in Southern-Islands (58.1 % for men and 63.7 %, for women). Our findings confirmed a better prognosis for younger patients and females than male patients. Survival has continued to improve over time, even at a higher improving rate in the considered period than the past.

Gender differences in cancer burden have been consistently reported worldwide, with men exhibiting higher incidence and mortality rates for most non-sex-specific cancers. However, the extent and patterns of these disparities across cancer sites, age groups, and geographical regions in Italy remain poorly investigated. We analysed data from population-based cancer registries belonging to the AIRTUM network, including 1359,053 cancer cases diagnosed between 2013 and 2017, overall and stratified by age group (0-49, 50-69, ≥70 years) and by geographic macro-areas (North, Centre, South & Islands). Differences in five-year net survival between men and women were also assessed. Overall, cancer incidence was markedly higher in men (male-to-female incidence rate ratio [M/F IRR] 1.38; 95% confidence interval [CI]: 1.38-1.39), and this gap increased when excluding breast cancer (M/F IRR = 1.90; 95% CI: 1.89-1.90). Male predominance was observed in 29 of 30 sites, most notably laryngeal (M/F IRR = 8.74; 95% CI: 8.31-9.19), bladder (5.23; 95% CI: 5.15-5.32), mesothelioma (3.60; 95% CI: 3.40-3.82), and lung (2.92; 95% CI: 2.89-2.95) cancers, while thyroid cancer was more common in women (0.37; 95% CI: 0.36-0.38). Incidence gender gaps were greater in the South & Islands than in the North and Centre. Women showed higher five-year survival rates than men for most major cancers, including colorectal and lung. In Italy, men bear a substantially higher cancer burden than women, with significant geographical variability, while women consistently achieve better survival outcomes. Biological, behavioural, and sociocultural factors likely contribute to these differences. Addressing these disparities requires incorporating a gender perspective into cancer prevention, early detection, and treatment strategies.

BACKGROUND:In Italy, the 1992 asbestos ban prohibited all forms of asbestos production, use and importation. The epidemiological surveillance of mesothelioma mortality and incidence enabled the assessment of the ban's impact and subsequent phases in asbestos exposure patterns. METHODS:To estimate the effects of the ban, a quasi-Poisson generalised linear model was used to fit past asbestos consumption with mesothelioma mortality by gender, using distributed lag non-linear models and different asbestos consumption scenarios with and without ban. Mesothelioma cases in the period 1993-2021 were categorised based on type of asbestos exposure and economic sector of activities involved, to examine their temporal trend and geographical distributions. RESULTS:The avoided number of mesothelioma deaths was estimated to be between 8341 and 21 981 in the period 1992-2020, depending on asbestos use scenario. As for incidence, 37 003 cases were collected between 1993 and 2021. The causal role of direct asbestos use (mining and milling ore and processing asbestos in asbestos-cement and asbestos-textile industry) changed from 11.3% for cases between 1993 and 1996 to 3.2% in the most recent cases (2017-2021). Inversely, cases due to unexpected or atypical exposure to asbestos and in construction increased from 11.3% in 1993-1996 to 17.0% in 2017-2021, and from 12.9% to 21.4%, respectively. CONCLUSIONS:The asbestos ban in Italy has produced substantial health benefits, with many deaths avoided. Countries that still use asbestos should consider evidence of the effects of asbestos bans, as well as the relationship between trends in mesothelioma cases and changing patterns of asbestos exposure.

OBJECTIVES:We forecasted the incidence of malignant tumours in Italy in 2025, using the most representative estimates of incidence rates and recent trends in cancer incidence available. A comparison with estimates for 2025 obtained using different assumptions and data sets is also presented. METHODS:34 cancer registries (81 % of the Italian population) were used to estimate incidence rate trends in 2013-2017, by cancer types, sex, and age. The stratified incidence rates were projected until 2025 by applying trends in the same strata, using a linear regression model with the calendar year as an independent variable. RESULTS:We estimated 362,100 new cancer cases in Italy in 2025 (182,300 in men, 179,800 in women). Prostate is the most frequent cancer site in men (31,200 cases; age-standardised incidence rates-ASR=92.3 per 100,000), followed by lung (27,100, ASR=80.9), bladder, and colon-rectum (23,000 cases each; ASR=69.0). 55,900 women were estimated to be diagnosed with breast cancer (ASR=159.0 per 100,000), 18,900 with colorectal (ASR=47.0) and 16,400 with lung cancers (ASR=41.0). CONCLUSIONS:Our estimates were slightly lower than those based on other assumptions and/or different datasets (i.e., ECIS/GLOBOCAN ones). More effective anti-smoking campaigns are needed to halt the predicted increase in smoking-related cancers among women.

BACKGROUND/OBJECTIVES:In Italy, one- and five-year survival of primary liver cancer patients have increased in recent decades and were higher after hepatocellular carcinoma (HCC) than after intrahepatic cholangiocarcinoma (ICC). This study aimed to estimate the complete prevalence and cure indicators (long-term survival) after liver cancer diagnosis by histologic type. METHODS:Data from 31 Italian cancer registries, covering 28,057,000 residents (47% of the population), were included. The complete prevalence was calculated in 2018. The mixture-cure model was used to estimate the cure fraction (CF, proportion of newly diagnosed patients with the same life expectancy as the general population), the cure prevalence (prevalent patients who will not die as a result of cancer) and the life expectancy of fatal cases (LEF). RESULTS:In 2018, 31,723 Italians (53 per 100,000) lived after a liver cancer diagnosis. Among them, the cure prevalence was 23.3% for HCC and 40.3% for ICC. The CF remained <10% for cases diagnosed in recent decades. Higher and rising CF rates were observed between 2005 and 2015 only among patients with HCC aged <45 years (2% of all cases), with an increase from 13% to 22% in men and from 19% to 29% in women, and among patients aged 45-54 years (8% of all cases), with an increase from 7% to 15% in men and from 11% to 19% in women. The LEF for HCC in 2015 was 29 months for both sexes, an 8-month increase since 2005. CONCLUSIONS:No substantial advantage nor favourable trends in the CF was apparent for older patients with HCC as compared to those with ICC, with some progresses for the small age groups of <45 years. A clear-cut increase in CF of patients with HCC aged under 55 years occurred in the 2010s decade, with no changes for older patients. This was accompanied by an increase in the LEF. Although limited by a considerable proportion of liver cancers of unspecified histologic type, the cure indicators presented here may help monitor the long-term effects of therapeutic advances and of surveillance programmes for people with cirrhosis and HCV infection.

In the last five decades, the epidemiology of cancer in Italy has been characterised by a north-south gradient in cancer incidence, mortality, and survival. Recently, this pattern has been changing, making it important to analyse the three indicators together to understand the underlying dynamics and to identify successes and failures in cancer control. Herein, data from 20 accredited Italian population-based cancer registries were used to examine age-standardised trends in incidence, five-year net survival, and mortality rates, for all cancers and 18 major cancer types, between 2008 and 2017. Data from the national pool were compared with macro-areas ones from north-centre and south-islands. We classified trends according to a 5-category model, ranging from 'Optimal Progress' (decreasing incidence and mortality, increasing survival) to 'Worsening' (increase of both incidence and mortality). At the national level we found progress in all indicators for all cancers combined: incidence and mortality rates declined, on average, by 2.5% and 5.5% annually, while survival increased by 2.5 % points. Similar optimal progress was shown, in men, by all cancers and lung cancer and, in both sexes, by liver cancer, and non-Hodgkin lymphoma. Conversely, evidence of worsening emerged for lung cancer in women, with incidence and mortality rates increasing, on average, by 6.5% and 4% annually. Contrasting trends emerged from north to south for colorectal, pancreatic, and kidney cancers. Trends were homogeneous, but improvements were stronger in the north-centre for all cancers, all cancers in men, male lung, prostate and bladder cancers, non-Hodgkin lymphoma, and for breast cancer mortality. For female lung cancer and breast cancer incidence, we documented a stronger burden increase in the south-islands. The advantage in cancer incidence and mortality risk shown decades ago by the south-islands macro area is being lost, and, if these trends remain stable, in near future the north-south gradient is expected to be reversed for many cancers.

Although a worldwide health crisis, the COVID-19 pandemic affected several geographical areas in Italy in very different ways in terms of infection rate, morbidity, and death. In the present work, we carefully studied the incidence rate in several Italian provinces and propose a complete data analysis strategy to explore, preprocess, and analyse the time series of COVID-19 positive and hospitalised cases with a daily cadency. We applied a new procedure, developed for unevenly sampled data (Discrete Correlation Function), to perform the cross-correlation analysis looking at possible correlation between COVID-19 positive and hospitalised cases with the air quality during the first pandemic wave. It is a completely new approach, that makes use of techniques used in transversal fields, such as signal processing and astronomy. The study suggests some plausible correlations between COVID-19 time series and NO related air pollutants. Instead, differently from what often has been reported, we did not find any specific correlation between COVID-19 infection and PM[Formula: see text] air pollutant. We further corroborate the results using a Machine Learning approach that uses Random Forest and the Permutation Feature Importance Analysis to include a wider set of possible risk factors, founding the same dependence between COVID-19 cases and NO related air pollutants.

Background: Mesothelioma of the tunica vaginalis testis (MTVT) is an exceedingly rare tumor. We performed a registry-based study on MTVT patient management and survival in Italy. Methods: Cases were extracted from the dataset of the Italian National Mesothelioma Registry. A descriptive analysis of patient characteristics, including asbestos exposure, clinical presentation, diagnostic work-up and therapeutic management, was performed. Overall survival was evaluated. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for selected variables by fitting univariate and multivariable Cox models. Results: Overall, 104 patients with MTVT were included. Median age was 72 years (range 17–92). Epithelioid histotype was the most frequent. Previous asbestos exposure was identified in two thirds of cases. Data on diagnostic and therapeutic management were available for 74 patients (71%). The most frequent presentations were scrotal swelling/mass, hydrocele and inguinal pain. All patients underwent surgery, mostly with orchi-funicolectomy. Adjuvant therapy was administered to 15 patients (20%). Overall median survival was 26.2 months (95% CI 22.1–52.1); 3-, 5- and 10-year survival was 49%, 30% and 18%. Older age at diagnosis and presence of distant metastasis (HR 1.91, CI: 0.85–4.26) were negative prognostic factors. Adjuvant therapy was associated with higher mortality (HR 2.54, CI: 1.25–5.15), indicating a more advanced stage at diagnosis. Conclusions: Surgery remains the mainstay of treatment for MTVT; adjuvant therapy in our study did not improve outcome. Data from cancer registries are essential for rare cancers, but they should be integrated routinely with additional diagnostic and therapeutic information.

Italy, home to one of the world's oldest populations, has traditionally shown geographic differences in cancer incidence, with rates decreasing from north to south. The cancer registries that have been accredited by the Italian Cancer Registry Network (AIRTUM), during the last 20 years altogether cover the 90 % of the Italian population, aiming to improve data quality, standardize procedures, and promote research. This study presents the methodological approaches used for data collection, quality control, and analysis to describe current patterns of cancer incidence, mortality, and survival across Italy's three macro-areas (North, Central, South). Estimates of incidence rates and case numbers for 2025 were also produced. Data from 34 accredited cancer registries were analyzed, comprising over 4.6 million cases from 1981 to 2020, with a detailed focus on the 2008-2017 period, which includes over 3 million cases. Cancer incidence and mortality data were collected according to ICD-O-3 and ICD-10 classifications and processed for statistical analysis using tools such as SEERPrep, SEERStat, and the Joinpoint Regression Program. Age-standardized rates were calculated, and incidence and mortality trends from 2013 to 2017 were modeled. Five-year cumulative net survival was estimated using the Pohar-Perme method to adjust for competing risks. Survival trends were analyzed by geographic areas and cancer sites, revealing regional disparities in cancer outcomes.

Cancer survivors have been considered individuals who have completed anti-tumor treatment and are in “remission”. However, the definition is increasingly seen as insufficient due to a significant number of patients living with chronic or stable disease, as a result of advanced therapies, and according to a recent definition, “survivors” are all people living with and beyond cancer. Breast, prostate, lung and colorectal cancers are the most frequent tumors diagnosed in Europe with an increasing population of survivors. The longer life expectancy has made it necessary to assess the health status, comorbidities, and complications in cancer patients, mainly in the age range of 20–50 years. In particular, the long-lasting hormonal therapies in hormone-sensitive tumors and the immunotherapies, that are changing the cancer clinical scenario, have opened a broad landscape of late endocrine/metabolic toxicities. The aim of the present manuscript is to evaluate the late endocrine-metabolic complications in survivors of young adult or adult-onset cancers in the most prevalent tumors, analyzing risk factors for endocrine/metabolic disease, attempting to provide a indications for long-term surveillance and treatment strategies. This paper highlights the importance of recognizing endocrine and metabolic complications, as well as identifying key risk factors that can suggest a more effective surveillance and management.

BACKGROUND:Clostridioides difficile (C. difficile) Infection (CDI) is a major public health concern, causing a range of gastrointestinal diseases with increasing global incidence. In Italy, epidemiologic data on Clostridioides difficile CDI, particularly on community-acquired cases, are limited. This study aimed to provide population-based incidence data for CDI in Umbria, Italy, from 2014 to 2022, analyzing trends, demographics, recurrence rates, and 30-day all-cause mortality. METHODS:We used laboratory data from all regional public hospitals and local health units. CDI cases were C. difficile strains growing in culture and with toxin genes. The presence of toxin genes was confirmed by Xpert C. difficile Binary Toxin testing. Cases were categorized into hospital-acquired (HA-CDI) or community-acquired (CA-CDI). Incidence rates per 100,000 inhabitants per year were calculated. We analyzed incidence and 30-day mortality trends over a nine-year period. Logistic regression assessed predictors of 30-day mortality. RESULTS:5955 CDI cases were identified (57.7 % female). Overall incidence increased from 48.1 cases per 100,000 inhabitants in 2014-88 cases in 2022 (CA-CDI rose from 25.2 to 39 and HA-CDI from 22.9 to 49.2). The 30-day mortality risk was 17.6 % (1045 deaths). In multivariable analysis, adjusted 30-day all-cause mortality risk was higher among HA-CDI patients compared to CA-CDI (OR 1.8, 95 % CI 1.6-2.1). 30-day mortality risk was also higher for elderly patients and male gender. Moreover, the mortality risk was stable over time. Recurrence occurred in 655 (11 %) of patients. CONCLUSIONS:The worrisome finding of increasing incidence of CDI in all settings, including hospital, indicates the urgency of establishing a stable surveillance system for CDIs. Considering the unfavorable trend and high mortality, measures to reduce the risk of CDI would be indicated, particularly in hospital and elderly home care settings where vulnerable patients concentrate.

We outline the history and role of cancer registration in Italy. Since the '70s, local population-based registries were established, representing up to nowadays a valuable national surveillance network. In this framework, the Italian Association of Cancer Registries (AIRTUM) has been playing a central role, ensuring high data quality standards and supporting cancer registry-based research. Over the years, difficulties for cancer registration arose due to a strict and non-uniform application of data protection rules, to the gap in digitalization of health data primary sources, which feed population-based cancer registries (PBCRs), and, more recently, to the impact of COVID-19 pandemic. Indeed, the COVID-19 pandemic in Italy affected not only cancer surveillance but also cancer screening and access to care. Despite the above-mentioned limitations, an unprecedented coverage of cancer surveillance on the Italian population (about 80 %) was reached for the present study, representing a substantial contribution in the perspective of the long-lasting establishment of a national cancer registry. This commentary introduces a series of manuscripts updating the landscape of descriptive cancer epidemiology, highlighting at the same time the challenges of cancer registration, in Italy.

BACKGROUND:Population-based cancer registries are crucial to monitor health system performance, inform policy makers and allocate resources effectively. We updated Italian survival estimates for children and adolescents, analysing temporal and geographical differences to evaluate improvements. METHODS:Cases were from the Association of Italian Cancer Registries and codified according to the International Classification of Childhood Cancer, 3rd edition. Thirty-one cancer registries provided 9142 incident cases (2013-2017) and 15 cancer registries contributed data for 12,447 incident cases (1998-2017) for trend analysis. We used the period approach to estimate survival in children (0-14 years) and adolescents (15-19 years) during the period 2013-2017. Survival was estimated by age, sex and geographical area of residence. RESULTS:Survival improved over time in both children and adolescents. Among children, significant progress was observed for acute myeloid leukaemia, non-Hodgkin lymphomas, ependymomas, Ewing sarcoma, and acute lymphoid leukaemia. For adolescents, notable improvements were found in non-Hodgkin lymphomas and skin melanomas. However, disparities emerged across Italy, with major differences observed for central nervous system neoplasms and osteosarcoma in children, as well as for acute lymphatic leukaemia and soft tissue sarcomas in adolescents. CONCLUSION:Increased survival was observed in many Italian children and adolescents with tumours and differences emerged across Italian regions. We will investigate the reasons for these discrepancies in collaboration with clinicians.

Background: The increasing incidence, rapidly evolving classification, rarity and heterogeneity of neuroendocrine neoplasms (NENs) pose challenges to NEN registration including difficulty in distinguishing neuroendocrine carcinoma (NEC) and neuroendocrine tumours (NETs). Thus, in Italy a higher NEC incidence was reported. Focusing on gastroenteropancreatic (GEP) NEN, we aimed to review GEP NEN, and in particular cases of neuroendocrine carcinoma, not otherwise specified (NOS) and estimate the incidence of NEN, NET and NEC of the GEP. Methods We launched a pilot study examining cases of neuroendocrine carcinomas NOS (ICD-O3 code 8246) of GEP incidents in the years 2012-2020. Cancer registries (CRs) reviewed information included in the pathology report regarding differentiation and tumour cells proliferation to decide whether to confirm the case as neuroendocrine carcinoma NOS or register it as NET or NEC. After the review, we estimated the GEP NEN, NET and NEC incidence. Results: Nine CRs contributed to the pilot study. After review, in all CRs, only 31% of GEP NOS neuroendocrine carcinomas were confirmed; 50% were recoded as NETs, and approximately 17% of cases were non-NENs. The IR of GEP NENs was 2.99/100,000, and the incidence of NETs was higher than that of NECs. Conclusion: After the review, the incidence of GEP NEN, NET and NEC in the eight Italian CRs involved was comparable to that reported in other European countries. Impact: Our results confirmed that heterogeneity of cancer registries in the registration of NEN requires collaborative work to define and promote a standard definition to be extended to all Italian registries.

Background/Objectives: The increasing incidence of cancer during pregnancy is a growing public health concern, driven by delayed parenthood and rising maternal age. Pregnancy-associated cancer (PAC) presents complex clinical challenges, necessitating a balance between maternal cancer treatment and fetal safety. Historically considered incompatible with favorable pregnancy outcomes, evidence now suggests that pregnancy can often proceed without affecting cancer prognosis. A 2022 study in Italy provided the first population-based PAC estimates by linking cancer registries (CRs) and hospital discharge records (HDRs). This study aimed to update PAC estimates to 2019, covering 30% of the Italian population and addressing prior data limitations. Methods: A retrospective longitudinal analysis was conducted on women aged 15-49 diagnosed with malignant cancers between 2003 and 2019. Data from 21 Italian CRs were linked with HDRs to identify PAC cases, defined as obstetric hospitalizations occurring for women diagnosed with cancer in our study cohort in the period spanning from one year before to two years after a cancer diagnosis. All malignant cancers, excluding non-melanoma skin cancers, were analyzed. PAC rates were calculated per 1000 pregnancies, and trends were assessed using log-linear and JoinPoint regression models. Results: Among 131,774 women diagnosed with cancer, 6329 PAC cases were identified, with a PAC rate of 1.43 per 1000 pregnancies, consistent with global estimates. Thyroid (24.4%) and breast cancer (23.2%) were the most common. Analyzing the PAC rate by pregnancy outcome, in the period 2015-2019, this increased for both childbirths and miscarriages but decreased for voluntary terminations. Most hospitalizations (54%) occurred pre-diagnosis, peaking at diagnosis, especially for breast cancer (69%). Conclusions: PAC incidence is rising, particularly for live births and miscarriages, underscoring the need for multidisciplinary care and robust epidemiological insights to guide clinical management.

The demographic transition, together with changes in lifestyles and the exposure to other risk factors, contributed to a rising burden of chronic degenerative diseases, including cancer, in Italy. We provided updated figures on cancer incidence and mortality in Italy during the period 2013-2017, using data provided by 34 population-based cancer registries from the AIRTUM network. Age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 were estimated, stratified by sex, cancer site or type, and macroarea. The cumulative risk (number of individuals who need to be followed over a lifetime for one to develop cancer), stratified by cancer site and sex, was estimated. Overall, 1,359,053 incident cancer cases (52.8 % in men) were registered during the surveillance period. The ASR for all malignant tumours was 657.1 per 100,000 among men and 475.5 per 100,000 among women. We documented the highest ASRs for all cancer sites in both sexes (males: 685.7 per 100,000, females: 496.1 per 100,000) in the North, followed by the Center (males: 646.6 per 100,000, females: 488.1 per 100,000), and the South and Islands (males: 626.7 per 100,000, females: 435.4 per 100,000). Mortality rates are less than half that of incidence rates (SMR was 331.8 per 100,000 men and 188.8 per 100,000 women), with negligible differences among Italian areas. One man out of two and 1 women out of three may develop a cancer in their lifetime. Despite incidence and mortality figures in Italy were almost aligned with the ones documented in Europe, our findings recalled the importance for policy-makers to implement national policies and community-based prevention strategies aimed at reducing the cancer burden.

We report the results of the quality assessment on data collected by cancer registries belonging to the Italian network of Cancer Registries (AIRTUM). For all malignant cancers diagnosed in 2013-2017, overall percentages of cases known from the death certificate only (DCO), and those of cases with cyto-histological confirmation (MV), were provided. The overall percentage of DCOs was small (1.2 %). The percentage of microscopic verification was overall high (87.6 %), with some variations among registries. DCO proportion varied from 0.1 % for cutaneous melanoma to 3.8 % for liver and pancreatic tumours. Differences across sites in MV proportion were linked to the different diagnostics. The rate of cases lost to follow-up was on average very low (0.7 %). This quality evaluation confirmed that data provided by the Italian cancer registries were affordable.

OBJECTIVES:Using a case-control design, we examined the association between occupational asbestos exposure and risk of peritoneal mesothelioma in the general population in Italy. METHODS:From the National Mesothelioma Registry, we selected cases (2000-2021) with life-time occupational history. Controls were 3045 from three case-control studies (region-sex-age-matched, performed in six regions), one in 2002-2004 (2116 population controls) and two in 2012-2016 (718 population and 211 hospital controls). For all subjects, exposure assignment was based on a quantitative job-exposure matrix (SYN-JEM). Qualitative expert-based evaluation was available for all cases, but only in 2012-2016 for 929 controls. We estimated ORs and 90% CIs using logistic regression models adjusted for residence, gender, period and age. RESULTS:In complete analyses (1591 cases, all years/regions), the OR for ever exposure was 3.66 (CI 3.21 to 4.18, 45.4% cases and 27.8% controls exposed). Among the exposed, median cumulative exposure (fibres/mL-years) was 1.4 (max 20.0) in cases and 1.1 (max 10.9) in controls. The OR was 1.55 (1.48 to 1.62) per log10-transformed cumulative exposure. In analyses restricted to 290 cases (same years/regions of controls), ORs were 3.35 (2.57 to 4.37, 43.8% cases exposed) for ever exposure and 1.52 (1.39 to 1.65) for cumulative exposure. ORs for ever asbestos exposure using expert-based evaluation were particularly high, 4.32 (3.50 to 5.34, 53.9% cases and 26.4% controls exposed) in complete analyses (778 cases) and 6.35 (4.58 to 8.81, 57.1% cases exposed) in restricted analyses (245 cases), but are known to be more prone to bias. CONCLUSIONS:Peritoneal mesothelioma showed clear associations with asbestos exposure using different exposure assessment methods.