A one-generation cluster of malignant mesothelioma within a family reveals exposure to asbestos-contaminated jute bags in Naples, Italy

Our plain-English summary of A one-generation cluster of malignant mesothelioma within a family reveals exposure to asbestos-contaminated jute bags in Naples, Italy, by V. Ascoli, C. Carnovale-Scalzo, F. Nardi, et al (European Journal of Epidemiology, 2003).

The study

• Authors: V. Ascoli, C. Carnovale-Scalzo, F. Nardi, C. Efrati, M. Menegozzo
• Journal: European Journal of Epidemiology
• Published: 2003;18(2):171-4
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Substantial evidence supports the role of asbestos in malignant mesothelioma. Clustering for this malignancy among relatives not only suggests genetic susceptibility as a relevant component but also provides a clue to investigate non-occupational sources of exposure. We identified five cases of malignant mesothelioma within one family with exposure to asbestos experienced during childhood, as 'next door' residents of a workshop recycling asbestos-contaminated jute sacks in Naples, Italy. This cluster discloses the health risk in the reuse of bags that previously had contained asbestos. Furthermore, it emphasizes the role of asbestos in the genetic-environmental interaction issue of malignant mesothelioma.

In plain English

This report described one family in Naples, Italy, in which five siblings of one generation developed malignant mesothelioma. Three cases were pleural (in the lining around the lungs) and two were peritoneal (in the lining of the abdomen). From 1954 to 1963 the siblings lived together in a basso, a small street-level home. The same building's ground floor and basement held a jute sack recycling workshop, which connected to the home through a basement grille. Two sisters had occasionally worked in the workshop as teenagers. The authors had no formal confirmation that the sacks had held asbestos. They considered it very likely that many came from local asbestos cement factories. The article did not identify the asbestos fiber type this family was exposed to. Three of the siblings had pleural plaques. The patients' mean age was 45 years, which the authors took to point to childhood exposure. The family history showed no other cancers, but the authors could not rule out one more sister as a case. The authors concluded that shared asbestos exposure accounted for the cluster. They could not assess whether genetic factors also played a part.

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 of a family cluster (five cases in one family)
• Who was studied: Five siblings (three women, two men) from the third generation of one family, born 1940 to 1954, who were born and grew up in Naples, Italy, and lived together in a basso from 1954 to 1963
• Exposure: Residential exposure from living in the same building as a workshop that recycled jute sacks believed to have contained asbestos, likely from asbestos cement factories in Naples. Two sisters also worked there occasionally as teenagers. The fiber type of this family's exposure is not identified.
• Main results:
  • Of the five cases, three were pleural mesothelioma (all in women) and two were peritoneal mesothelioma (both in men).
  • Pathological and/or radiological signs of prior asbestos exposure (pleural plaques) were found in cases 3, 4 and 5.
  • The mean age of the patients was 45 years, which the authors said points to exposure during childhood.
  • Two sisters (cases 2 and 3) had occasionally worked in the jute sack workshop as teenagers. No other relevant occupations with possible asbestos exposure were found in the family.
  • The family history included no additional cases of cancer. However, the authors could not rule out that the fifth-born sister, who died of HCV-related cirrhosis with atypical mesothelial cells in ascites, was another case of mesothelioma.
  • Constitutional karyotype (chromosome analysis) in one patient (case 5) was normal.
• The authors' conclusion: The authors concluded that shared exposure to asbestos accounted for the mesothelioma cluster in this family. They described the family aggregation as a strong indicator of an unusual type of environmental exposure to asbestos. They said that whether inherited susceptibility interacted with asbestos remains speculative.
• Limitations the authors state:
  • The authors had no formal confirmation that the recycled sacks had actually contained asbestos.
  • The degree of individual exposure was unknown.
  • The authors could not assess whether genetic defects or hereditary cancer susceptibility also contributed to the cluster.
  • Information on other relatives was limited. The authors could not rule out that the fifth-born sister, who died of HCV-related cirrhosis, was another case, because slides were unavailable and no autopsy was done.
  • The authors had no data on whether simian virus 40 (SV40) could be implicated in the cluster.

Topics

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

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

Related studies

• Mesothelioma in blood related subjects: report of 11 clusters among 1954 Italy cases and review of the literature — V. Ascoli, D. Cavone, et al. (2007)
• Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry — M. Corfiati, A. Scarselli, et al. (2015)
• Asbestos reclamation at a disused industrial plant, Bagnoli (Naples, Italy) — G. Cecchetti, A. Fruttero, et al. (2005)
• Well-differentiated papillary mesothelioma: clustering in a Portuguese family with a germline BAP1 mutation — C. Ribeiro, S. Campelos, et al. (2013)
• Malignant mesothelioma in Italy, 1997 — M. Nesti, A. Marinaccio, et al. (2004)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)

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