Twelve Italian cases of mesothelioma (all the cases but one from the Emilia Romagna Region), following exposure to asbestos used in sugar refinery plants, are reported. Eleven cases arose in workers occupationally exposed, and one in the daughter of an exposed worker, following family contact. Eleven of the cases were pleural and one peritoneal. In the 11 cases following occupational exposure the average latency time was 36.0 (range 23-48) years, and the average age at onset was 63.4 years. In the case which followed family contact, the latency time and the age of the onset were 37 years. This represents the largest series of cases of mesothelioma due to the asbestos present in sugar refinery plants reported to date in the scientific literature. While these cases demonstrate the risk of asbestos mesothelioma in the sugar refinery industry, they in no way give the dimension of the pathological effects of asbestos (and man-made mineral fibres) used in this industry. To assess this risk further research is suggested.