Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program

Abstract

Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP). The aim of this study was to analyze the results of the TUNMES-EAECP. Patients diagnosed with MM (code C45.0–C45.9) between 2008 and 2012 were identified. The “from case to the field” method was used to determine the villages with current or previous asbestos exposure. Special public health teams took soil samples from these villages, which were then examined using an X-ray diffractometer. Direct Standardized Average Annual Mesothelioma Incidence Rate (AMIR) and relative risk (RR) of MM were calculated. Finally, a projection on the incidence of MM between 2013 and 2033 was made. The number of confirmed MM cases was 5617 with a male to female ratio of 1.36. Mean age was 61.7 ± 13.4 (20–96) years. The median survival was eight (95% CI 7.6–8.4) months. Asbestos exposure continues in 379 villages, with 158,068 people still living in high risk areas. The standardized AMIR was 2.33/100,000 per year. The risk of MM was higher in males, in both sexes over the age of 40, in asbestos-containing provinces, and in those where the TUNMES was organized. Among the population with continuing asbestos exposure in rural areas, the number of MM cases between 2013 and 2033 was estimated as 2511. As such, the incidence of MM in Turkey is as high as in industrialized countries. Asbestos exposure in rural areas continues to be a serious problem in Turkey, which obviates the necessity for effective preventive measures.

Occurrence of asbestos in soils: state of the art

“…Chrysotile Indirect (Vicinity to Asbestos cement factory) PCOM Subramanian et al, 2005;Trivedi et al, 2011Trivedi et al, , 2013Musthapa et al, 2003 Italy (Basilicata) Tremolite Direct (Natural occurrences) Case -report; OM, SEM-EDS, TEM-EDS XRPD, XRF, DTG, DSC Bernardini et al, 2003;Pasetto et al, 2004;Bloise et al, 2016Bloise et al, , 2018Punturo et al, 2018Punturo et al, , 2019 Italy ( Metintas et al, 2002Metintas et al, , 2017 Turkey (Cappadocia) Erionite Indirect (Dirt roads, brick) Case -control study Baris et al, 1987 United Kingdom Amosite, Crocidolite Indirect (Asbestos removal operations) PCOM quantitative study Davies et al, 1996 (Table 4). Instead, Punturo et al 2018 conducted a detailed mineralogical and geochemical investigation of both rocks and soil collected in the Basilicata region, with the aim to understand their potential contribution to human health caused by asbestos exposure.…”

“…In the other two countries, fibrous amphiboles and chrysotile are the main fibres detected. In particular, a total of 1251 soil samples in Anatolia region (Turkey) were collected and analyzed by Metintas et al, 2017 (Fig. 3a).…”

1923’den Günümüze Türki̇ye’de Zehi̇rlenme Oranlari Ve Nedenleri̇ni̇n Anali̇zi̇

“…Another important poison factor in Turkey is asbestos. As of 2012, asbestos-containing soil was used in 473 villages and approximately 1,000,000 people lived in contact with asbestos in rural areas, of which 32,600 developed asbestos-related diseases (13,14). In a study using the data of TACSP, 5617 mesothelioma cases between 2008 and 2012 were examined.…”

HMGB1 as a Potential Biomarker and Therapeutic Target for Malignant Mesothelioma

“…MM is mostly induced by occupational asbestos fibers. However, in some regions such as Turkey, MM is also due to environmental exposure to asbestos fibrous rock or erionite mines, materials that were used for building houses and paving roads [4, 5]. Chronic inflammation caused by long-term asbestos exposure is thought to be an important cause of MM, which is reported to occur in some organic mesothelial layers, such as the peritoneum, pleura, and pericardium, and even in the tunica vaginalis of the testis.…”