The assessment of the malignant mesothelioma cases and environmental asbestos exposure in Sivas province, Turkey

Abstract

One of the most significant diseases related to environmental asbestos exposure is malignant mesothelioma (MM). Sivas province is located in the Central Anatolia where asbestos exposure is common. We aimed to study clinical, demographical and epidemiologic features of the patients with MM in Sivas, along with the history of asbestos exposure. In total, 219 patients with MM who were diagnosed in our hospital between 1993 and 2010 were retrospectively analyzed in terms of demographical and clinical features. Rock, soil and house plaster samples were taken from the habitats of those patients and were evaluated with optical microscopy and X-ray diffraction methods. The age of the patients ranged between 18 and 85 years. The male-to-female ratio was 1.4:1. Most of the patients confirmed an asbestos exposure history. The most frequent symptoms of the patients were chest pain (60 %) and dyspnea (50 %). The gap between the start of first symptoms and the diagnosis date was approximately 4 months in average. The plaster materials used in most of the houses were made up of mainly carbonate and silicate minerals and some chrysotile. Ophiolitic units contained fibrous minerals such as serpentine (clino + orthochrysotile) chiefly and pectolite, brucite, hydrotalcite and tremolite/actinolite in smaller amounts. MM is not primarily related to occupational asbestos exposure in our region, and hence, environmental asbestos exposure may be indicted. Yet, single or combined roles and/or interactions of other fibrous and non-fibrous minerals in the etiology of MM are not yet fully understood and remain to be investigated.

Cancer burden in four countries of the Middle East Cancer Consortium (Cyprus; Jordan; Israel; Izmir (Turkey)) with comparison to the United States surveillance; epidemiology and end results program

“…Other epidemiological risk factors, e.g. asbestos-like exposure and high arsenic level in drinking water in Turkey may also play a role in the observed high male lung cancer rate in Turkey [13,14]. However, the high lung cancer rate in men and low rate in women can be explained by the male to female ratios of lung cancer and smoking prevalence presented in Table 3.…”

Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues

“…Environmental exposure from naturally occurring asbestos contamination of the soil has been documented in Turkey, where mesothelioma epidemics due to the presence of tremolite, chrysotile and erionite, belonging to the zeolite family, have been proved 26. In Greece, a high frequency of pleural calcification was found in patients living in places where no industrial use of asbestos was documented in the past, but tremolite fibres have been found in the soil used to make whitewash that was commonly applied to homes in the affected areas 27.…”

Epidemiology of Environmental Exposure and Malignant Mesothelioma

“…3). The geographic locations of the studies included places where asbestos was historically used in industrial/mining activities, such as Wittenoom in West Australia [38][39][40]60 ; the Veneto region, 20,24 the Trieste-Monfalcone area, 18 Naples, 23 and the Lombardy region 28 in Italy; Thetford Mines in Quebec, Canada 58 ; and places where naturally occurring asbestos (NOA) was recognized (such as Sivas, Turkey [31][32][33]37 ; Metsovo, Greece 54 ; New Caledonia 42 ; and Biancavilla in Sicily, Italy 22 ). There are also a few relatively new locations of NOA identified in Southern Nevada 61 and Dunn County, North Dakota 63 in the United States; in Mexico 49,50 ; and in Dayao, Yunnan Province, People's Republic of China.…”

“…44 A higher proportion of MM cases with nonoccupational asbestos exposure was reported in areas where NOA or other types of environmental asbestos exposure are dominant. 22,31,32,45,46 Studies on neighborhood exposures have reported that increased distance from the sources and decreased exposure duration are associated with decreased MM risk. For example, Tarrés et al 57 reported an MM incidence rate ratio (IRR) of 12.92 (95% CI: 10.77-15.33) for those living less than 500 m from an asbestos cement plant in Barcelona, Spain, whereas the ratios decreased to 0.70 and 0.23 for those living 500 to 2000 m or more than 2000 to 10,000 m from the plant, respectively.…”