A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report

Our plain-English summary of A case from India of pleural malignant mesothelioma probably due to domestic and environmental asbestos exposure: a posthumous report, by V. Muralidhar, P. Raghav, P. Das, et al (BMJ Case Reports, 2019).

The study

• Authors: V. Muralidhar, P. Raghav, P. Das, A. Goel
• Journal: BMJ Case Reports
• Published: 2019;12(3)
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

India is the largest consumer of asbestos in the world. There is no report from India of mesothelioma related to asbestos. The case is a 42-year-old man who died of pleural mesothelioma. He was exposed to asbestos domestically and from the environment since birth. Two of his close family members worked in a factory that used asbestos. The living quarter of the family was within the premises of the factory. Asbestos waste was strewn on the grounds surrounding the quarters. After decades of legal battles by workers and families exposed to asbestos, Indian courts have ordered remedial measures and compensation to people, who are exposed to asbestos at work and the environment. Mesothelioma, currently in epidemic proportions in the west where asbestos production was banned in the 1990s, could rise to alarming levels in the next decades in India if the legal remedial measures are not implemented soon.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This is a case report, written after the patient's death, about one man in India with pleural mesothelioma (a cancer of the lining around the lungs). The authors linked it probably to asbestos exposure at home and in his surroundings. He was 42, did not smoke, and worked as a security guard with no history of asbestos exposure at work. His father and brother were maintenance workers at a factory that used asbestos in sheets, insulation pipes and cement. They came home in their work clothes, his mother washed their clothes with his, and the family lived in a workers' colony on the factory grounds. People who lived there described widespread asbestos contamination. The authors counted 42 years of exposure. His mother had asbestosis. A biopsy confirmed epithelioid pleural mesothelioma. Despite chemotherapy, surgery and radiotherapy, he died 23 months after his first symptoms. The authors said no asbestos-related mesothelioma had yet been reported from India, the world's largest asbestos consumer. They warned that cases there could rise to alarming levels by the middle of the 21st century unless court-ordered measures are implemented.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (published after the patient's death)
• Who was studied: one 42-year-old man in India, a non-smoker who worked as a security guard, who died of pleural mesothelioma
• Exposure: Household exposure from his father and brother, maintenance workers at a factory that used asbestos in sheets, insulation pipes and cement (they came home in work clothes and his mother washed their clothes with his), plus environmental exposure from living in the workers' colony on the factory premises. The article does not name a fiber type. The authors gave a cumulative exposure period of 42 years.
• Main results:
  • The patient had no history of asbestos exposure at his workplace.
  • The patient's mother had asbestosis, which the authors attributed to secondary exposure (ILO grading 1/1, s/s). His father, brother and wife did not have asbestos-related lung disease.
  • In the patient, a chest X-ray taken after the pleural fluid was drained showed changes graded ILO s/t, 1/1, which the figure caption labels parenchymal asbestosis.
  • A pleural biopsy confirmed epithelioid mesothelioma of the pleura.
  • After one cycle of chemotherapy, the tumour had shrunk by about 50% of its former volume.
  • At surgery, 9 of the 13 lymph nodes removed contained tumour. The stage was T3, N1, M0, stage III.
  • The disease spread to the abdomen, bone and the other side of the chest. He died 15 months after surgery and 23 months after his first symptoms.
  • Because other household members did not develop mesothelioma, the authors suggested the patient may have had an added genetic susceptibility. They illustrated this with two genes, drawing on other researchers' animal and laboratory studies.
• The authors' conclusion: The authors concluded that India is the world's largest asbestos consumer but no asbestos-related mesothelioma had yet been reported there. They concluded that mesothelioma could rise to alarming proportions in India by the middle of the 21st century if court-ordered remedial measures are not urgently implemented.
• Limitations the authors state:
  • The authors described the evidence of widespread asbestos contamination in the workers' colony as anecdotal, coming from people who lived there.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Asbestos Exposure, Mesothelioma, Pleural Mesothelioma.

Related studies

• An environmental survey in chrysotile asbestos milling processes in India — A.K. Mukherjee, H.R. Rajmohan, et al. (1992)
• Assessment of environmental and domestic exposure to tremolite in New Caledonia — D. Luce, M.A. Billon-Galland, et al. (2004)
• Monitoring and identification of airborne asbestos in unorganized sectors, India — F.A. Ansari, I. Ahmad, et al. (2007)
• Assessment of the future mesothelioma disease burden from past exposure to asbestos in ship recycling yards in India — R. Singh, J.W. Cherrie, et al. (2020)
• Risk assessment due to environmental exposures to fibrous particulates associated with taconite ore — R. Wilson, E.E. McConnell, et al. (2008)
• Bilateral environmental and occupational health program with India — M. Allred, S. Campolucci, et al. (2003)

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