Mesothelioma and asbestos, fifty years of evidence: Chris Wagner and the contribution of the Italian occupational medicine community

Background: One of the first studies that "convincingly" described the relationship between pleural mesothelioma and asbestos was made by Wagner, Sleggs and Marchard in 1960. This article, published fifty years ago, contains much of what we still know to-day about malignant mesothelioma. Objectives: The aims of this article were to analyze the historical and scientific developments that led to the publication of Wagner's paper, to critically examine its contents and to consider the contribution to the international debate on the carcinogenesis of asbestos fibres made by occupational medicine in Italy in that period. Methods: A thorough analysis of scientific and historical literature on the relationship between asbestos exposure and tumours was conducted, with special regard to the articles by Italian authors in the 1960s. Results: The decisive role of Wagner's paper in understanding the aetiopathogenetic mechanisms of asbestos-related tumours is inconfutable. In particular, his article clearly demonstrated the existence of a typical cancer of the mesothelium, expressing three fundamental principles of the epidemiology of occupational cancer: association with the carcinogen, latency and individual susceptibility. Enrico Vigliani, then director of the "Clinica del Lavoro" in Milan, made important contributions to this debate, also through the collection of data regarding mortality among Italian asbestos workers. Conclusions: Wagner's 1960 paper can be considered as a milestone not only in the history of occupational and environmental health, but also in the evolution of other medical disciplines such as epidemiology, pathology and oncology. A re-appraisal of the Italian contributions to the international debate on this subject should be considered.