Malignant mesothelioma in Pilbara Aborigines

Abstract: Malignant mesothelioma occurred in a female Aborigine after environmental exposure to asbestos. All known cases of the disease in Aborigines in Western Australia were reviewed; all occurred in Pilbara residents. Most were exposed while involved in the transport of asbestos from the Wittenoom crocidolite operation. Based on recent estimates of the size of the Aboriginal population in the Pilbara region, their incidence of this disease (250 per million for ages 15 and over) is one of the highest population-based rates recorded.     

Malignant mesothelioma in the jewelry industry.

We conducted a clinical, environmental, pathologic, and mineral lung burden investigation of a 61-year-old man with malignant mesothelioma. For 35 years, up until three weeks prior to pneumonectomy, the patient made asbestos soldering forms at a costume jewelry production facility. Only chrysotile asbestos was used at the plant during the last decade of the patient's employment, and recent environmental sampling of the work-place identified no other asbestos fiber type. Anticipating that the patient would add to the very small number of cases of mesothelioma attributable solely to chrysotile, we found instead that the patient's lung tissue contained large numbers of both coated and uncoated amosite asbestos fibers but, surprisingly, no chrysotile. We subsequently learned that a distributor of both chrysotile and amosite supplied the company during the first 25 years the patient was fabricating soldering forms. The findings underscore the futility of estimating environmental exposure to chrysotile on the basis of fiber counts in lung tissue. Although we previously described non-neoplastic asbestos-related disease among patients engaged in similar work, this case, to the best of our knowledge, represents the first report of mesothelioma in the commercial jewelry industry. As such, it prompted us to initiate a public health campaign to replace asbestos soldering forms in this industry with readily available, safer alternatives.     

Malignant mesothelioma in Italy, 1997

BACKGROUND: The Italian National Mesothelioma Register (ReNaM) was set up at the Istituto Superiore Prevenzione e Sicurezza Lavoro (ISPESL), in Rome, in accordance with Art. 36 of Italian Legislative Decree No. 277 [1991]. METHODS: Five Italian regions, Piedmont, Liguria, Emilia-Romagna, Tuscany, and Apulia, agreed to record mesothelioma cases according to guidelines established by ISPESL, to define exposure to asbestos and transmit the data systematically to ISPESL. RESULTS: Four hundred and twenty-nine mesothelioma cases, diagnosed in 1997, are recorded. The standardized annual incidence rate for definite pleural mesothelioma is 1.51 per 100,000 inhabitants (2.26 for males and 0.79 for females). Exposure was defined for 198 mesotheliomas with a histological diagnosis: 125 (63%) refer to occupational exposure, 10 (5%) to environmental exposure, and 5 (2.5%) to household exposure. CONCLUSIONS: Despite the ReNaM's work, many limitations still have to be overcome. Clear-cut information on asbestos exposure is available for a limited number of cases; and differing regional procedures in collecting and evaluating mesotheloma cases exist. At this stage the identification and evaluation of a large number of cases of mesothelioma is a worthwhile result. This epidemiological surveillance, currently being extended to other regions, will enable us to better assess the impact and diffusion of this disease in future, and to monitor more closely the effects of ceasing asbestos use in 1992, and the efficacy of preventive measures since mid '70s. Am. J. Ind. Med. 45:55-62, 2004.     

Malignant mesothelioma in garment sewing-machine workers

BACKGROUND: Due to poor information collected through patient interviews, a considerable number of malignant mesothelioma (MM) cases still remain classified as "unknown" asbestos exposure in the Italian Mesotelioma Registry (Re.Na.M). At the same time, some occupational asbestos exposures, which were previously unknown, have been demonstrated in certain types of work, i.e., in agriculture and in the textile industry. OBJECTIVES: The aim of this research was to investigate the possible past occupational exposure to asbestos in clothing workers using sewing-machines. METHODS: The MM cases were collected from the Mesothelioma Registry of Brescia. Work histories were obtained via a standardized questionnaire. Investigations were conducted in sewing-machine maintenance workshop in order to collect information regarding the possible use of asbestos parts. In addition, the use of asbestos friction materials and the use of insulated asbestos materials was checked in the clothing divisions by interviewing the management and maintenance workers of two companies where cases of MM were observed. RESULTS: The Mesothelioma Registry of Brescia identified and collected 10 MM cases with past work in the clothing industry: 6 used sewing-machines and 4 were self-employed tailors. The search for asbestos materials gave positive results as the use of friction materials had been widespread since the 1950's in all types of sewing-machines; in addition, asbestos materials were used to insulate some parts of the ironing equipment and the steam pipelines. CONCLUSION: The results of this investigation suggest assigning at least "possible occupational asbestos exposure" to those cases employed in clothing manufacture since the 1950's, who used sewing-machines or pressing machines, according to the Re.Na.M guidelines. Other possible occupational exposures to asbestos in this working sector cannot be excluded; when the simple interview of patients does not reveal such exposures further investigations are needed in order to demonstrate all the possible circumstances of exposure.     

Malignant mesothelioma of the pleura among women

BACKGROUND: The epidemiological features of mesothelioma among women differ from those observed among men. OBJECTIVES: To trace the outline of pleural mesothelioma among women in the Monfalcone area, Italy. METHODS: Thirty-three malignant mesotheliomas of the pleura observed in female patients at the Hospital of Monfalcone, Italy, in the period 1979-2002 were reviewed. The diagnosis was based on/or confirmed by necropsy findings in 30 cases. Occupational and social histories were obtained from the patients themselves or from their relatives by personal or telephone interviews. In 29 necropsy cases thoracic cavities were examined for the presence of pleural plaques. Routine lung section were examined for asbestos bodies in 30 cases. In 21 cases asbestos bodies were isolated and counted after chemical digestion of lung tissue. RESULTS: The age of the patients ranged between 48 and 89 years (mean 72.85, median 73.00). All the patients had histories of exposure to asbestos, single in 25 cases and mixed in 8. Exposure at home due to cleaning of work clothes was the most frequent type of exposure. Various patients had been exposed in non-asbestos text industries (cotton mills). Unusual types of exposure occurred in some cases (distillery, small sodium carbonate factory, starch factory). The latency periods (time intervals elapsed between first exposure to asbestos and diagnosis of the tumour), calculated in 23 cases, ranged from 34 to 62 years. Pleural plaques were found in 21 cases. Twelve patients showed asbestos bodies on routine lung sections. The asbestos body burden ranged between only a few bodies and 92,000/g dried tissue. CONCLUSIONS: In contrast with other series of mesothelioma among women, all the present cases were attributable to asbestos. The detection of objective signs of exposure (pleural plaques, lung asbestos bodies) played a key role in attribution.     

Malignant mesothelioma of the pleura among seafarers

BACKGROUND: A large amount of data indicates that seafarers are at risk for asbestos disease. Objectives: To trace the outlines of pleural mesothelioma among seafarers. METHODS: Pleural mesotheliomas diagnosed among seamen in the Trieste-Monfalcone area, Italy, in the period 1973-2003, were reviewed. RESULTS: The series comprised 50 men aged between 53 and 91 years (mean age 75.7 years). The diagnosis of mesothelioma was confirmed by necropsy in 38 cases. The patients had served in the Italian Navy (24 persons), in the merchant navy (17 persons), or in both (9 persons). The trades were various including engine room as well as deck personnel. Asbestos bodies were detected on routine lung sections in 55% of the necropsy cases. Asbestos bodies isolated from the lungs in three cases ranged between 2100 and 7000 bodies per gram of dried tissue. Latency periods ranged between 33 and 72 years (mean 56.1 years). CONCLUSIONS: When compared with shipyard workers, the seamen with mesothelioma show signs of less intense exposure to asbestos, and longer latency periods. Mesothelioma in seamen should be considered as an occupational disease.     

Malignant mesothelioma of the pleura in a truck driver

BACKGROUND: Among the responsibilities of the health operators in the occupational health and safety services of the local health units in Lombardy (Italy) is the administration of standardized questionnaires for the investigation of possible occupational exposure to asbestos fibres in subjects diagnosed with malignant mesothelioma. OBJECTIVES: To describe a case of malignant mesothelioma in a truck driver suspected of being occupationally exposed to asbestos during the course of administration of the questionnaire. METHODS: Analysis of the literature regarding asbestos contamination of truck cabs. Some years ago Italian authors described a case of asbestosis in a truck-driver and findings of pollution by asbestos fibres in the cabs of some models of trucks. RESULTS: The subject had worked for more than 30 years as a truck driver operating on long distances on truck models described in literature as contaminated by asbestos fibres. He had not transported materials made of asbestos, and had not carried out maintenance on the trucks, nor had he any non-occupational sources of exposure to asbestos. Thus the mesothelioma was related to occupational exposure and procedures were initiated for reporting a suspected occupational disease.     

Malignant mesothelioma of the pleura in Trieste, Italy.

One hundred and seventy malignant pleural mesotheliomas seen at necropsy at the Institute of Pathological Anatomy of the Trieste University during the period 1968-1987 were reviewed. The series included 153 men and 17 women, aged between 33 and 92 years (median 70 years). Lifetime work histories were obtained from the patients' relatives by personal or telephone interviews in 162 cases. A majority of the male subjects had been employed in "naval" work, 99 people having worked in the ship-building industry, 19 in the navy and merchant marine, and 7 in docks. A variety of trades appeared in the remaining histories. Work histories were indicative of occupational exposure to asbestos in 150 cases. A further 5 patients with negative or insufficient data showed asbestos bodies in routine lung sections and 5 women had a history of domestic exposure. A majority of the patients had had their first exposure before 1950. The intervals between first exposure and death ranged from 14 to 71 years (median 48 years).     

Malignant mesothelioma in Turkish immigrants residing in Sweden

Mesothelioma is a rare neoplasm in the general population, but it is strongly associated with previous asbestos exposure. The endemic occurrence of this disease in two villages in central Turkey has raised the question of whether the inhalation of naturally occurring zeolite dust may also be a factor in the development of mesothelioma. During the past few years a large portion of the inhabitants of one of the two villages of concern has immigrated to Sweden. This report presents three cases of malignant pleural mesothelioma and the results of a chest radiographic survey among these immigrants. Mineralogical analysis of lung tissue specimens from two of the cases revealed the presence of both zeolite and asbestos minerals and therefore suggested a synergistic effect involving both types of minerals. The importance of close medical surveillance of this high-risk population is emphasized, as is the possibility that similar cases appear in other countries because of increased migration.     

Malignant mesothelioma in non-asbestos textile workers in Florence

By means of a review of histological diagnosis in the Pathology Department of the University of Florence, suspected cases of malignant mesothelioma, diagnosed in the period 1979-1984, were identified. Study of histological specimens permitted the selection of 13 cases of malignant mesothelioma resident in the Province of Florence. To these cases, referents were matched for age, sex, and year of hospital admission, with residence weighted for the general population of the Province. Both cases and referents (or their next of kin) completed an occupational questionnaire detailing possible occupational exposures. Out of the 13 cases of mesothelioma, 6 were textile workers and 5 of these were "rag-sorters". There were only 5 textile workers among the 52 controls. No asbestos cloth production plants have been in operation in the area from which the cases and referents are derived. Possible sources of exposure to asbestos in the textile industry of this area are discussed.     

Malignant mesothelioma in Australia, 1945-2000

BACKGROUND: Australia has maintained a total national malignant mesothelioma case register since 1980. There has been a marked increase in the incidence of mesothelioma in the last 20 years. Currently 450-600 cases are notified annually in a population of 20 million. While the history of the Wittenoom (Western Australia) crocidolite mine and its aftermath is well known, these cases comprise only 5% of the total. This study describes the incidence of mesothelioma in Australia from 1945 to 2000. METHODS: Using register data, time trends in mesothelioma incidence were calculated. Analyses of incidence are reported by age, sex, anatomical site, and state of notification. Associations with occupational and environmental asbestos exposure histories are described. Lung fiber content measurements were made on a subset of cases. RESULTS: Australia has had 6,329 cases of mesothelioma from 1 January 1945 to 31 December 2000. (A further 620 cases were notified in the period from 1 January 2001 to 31 October 2001.) Annual incidence rates for Australia per million population > or = 20 years (1997) were: male, 59.8; female, 10.9; total, 35.4. Incidence rates have been continually increasing and are the highest reported national rates in the world. While Western Australia has the highest rate (1997 total rate, 52.8), most cases arise from the two most populous eastern states, New South Wales and Victoria. In 88% (male 90%, female 61%) of cases, a history of asbestos exposure was obtained. Exposures occurred in a wide variety of occupational and environmental circumstances. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length per gm dry lung were obtained, suggesting unrecognized exposure. CONCLUSIONS: Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of occupational and environmental settings. The number of cases in total is expected to be about 18,000 by 2020, with about 11,000 yet to appear.     

Malignant mesothelioma in Australia, 1945-2002

Using register data, time trends in mesothelioma incidence in Australia from 1945 to 2002 were calculated. Incidences are reported by age, sex, anatomic site, and state of notification. Associations with occupational and environmental asbestos exposure histories and lifetime risks in different exposure categories were investigated. Lung-fiber content was measured in a subset of cases. Australia had 7,027 cases from 1945 to 2001, with 488 more in January 2002 through June 2003. Incidence rates for Australia per million population > or = 20 years old (1999) were: male 53.3; female 10.2; total 31.8. Rates have continually increased and are the highest reported national rates in the world. Western Australia had the highest rate (1999 total 47.7), but most cases arose from the two most populous eastern states, New South Wales and Victoria. In 88% of cases (male 90%, female 61%), histories of asbestos exposures were obtained. In 80% of cases with no history of exposure, TEM lung asbestos fiber counts > 200,000 fibers > 2 microm length/g dry lung were obtained, suggesting unrecognized exposure. Australia's high incidence of mesothelioma is related to high past asbestos use, of all fiber types, in a wide variety of settings. The number of cases is expected to be about 18,000 by 2020, with about 11,000 yet to appear.