An environmental and epidemiological study has been carried out in Central Cappadocia, Turkey, aiming at investigating the relationship between exposure to naturally occurring erionite fibres and the reported high incidence of malignant mesotheliomas. Airborne fibre levels are generally low but show a higher proportion of erionite fibres in the villages affected by malignant disease than in a control village. The same pattern is confirmed by analysis of the fibre content in lung tissues of sheep from several villages, both affected and unaffected by malignant disease. The 3 villages with the highest proportion of erionite fibres have high rates of malignant pleural mesothelioma, malignant peritoneal mesothelioma and lung cancer. No case of malignancy for the same sites has been reported during the study period from the control village. The relationships between these findings and their consistency with the results from experimental studies indicate erionite fibres as a carcinogenic agent, although some aspects of the exposure are not fully clarified.
Environmental or domestic exposure to asbestos fibers originating from local soil is responsible for a high incidence of diseases in large rural areas of Turkey. Bronchoalveolar lavage fluids (BALF) were obtained for 65 Turkish subjects originating from these areas and for 42 Turkish controls. Asbestos bodies (ABs) and uncovered fibers (UFs) were quantified by phase contrast light microscopy. Total fiber burden was determined by transmission electron microscopy. The main asbestos types disclosed were tremolite and to a lesser extent chrysotile. AB and fiber concentrations were higher in environmentally exposed subjects (geometric mean [geometric standard deviation]: 5.20 [6.22] AB/ml, 444 [11.6] tremolite fibers/ml) than in control subjects (0.22 [1.45] AB/ml, 12.0 [15.4] tremolite fibers/ml) (p < 0.001). In subjects environmentally exposed in Turkey, AB burdens on tremolite were in the same range as those on commercial amphiboles in subjects occupationally exposed in Belgium. In Turkish subjects, values above either 1 AB/ml, 3 uncovered fiber/ml in light microscopy, or 300 fibers/ml in electron microscopy indicated usually an abnormal alveolar retention reflecting a significant cumulative exposure from environmental or domestic origin. These observations are probably valid for other areas in the world where diseases associated with environmental exposure to soil- derived asbestos fibers occur and for immigrants originating from these areas.
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