Conclusions
We found some excesses of cancer mortality among residents in areas with the highest predicted concentration of heavy metals. These findings might be possibly related to pollutants released from the incinerators over the past decades. This study contributes to the controversy over the possible health effects of waste management. However, future research into the health risks of waste management needs an accurate characterization of individual exposure, an improved knowledge of chemical and toxicological data of specific compounds, multi-site studies of large populations to increase statistical power, approaches based on individuals rather than communities and a better control of confounding factors. In this view, an ongoing multi-site project over the entire Emilia-Romagna region is investigating possible health effects due to exposure to all eight incinerators operating in the region.