Adverse health effects of fluoro-edenitic fibers: epidemiological evidence and public health priorities

Our plain-English summary of Adverse health effects of fluoro-edenitic fibers: epidemiological evidence and public health priorities, by C. Bruno, P. Comba, A. Zona (Annals of the New York Academy of Sciences, 2006).

The study

• Authors: C. Bruno, P. Comba, A. Zona
• Journal: Annals of the New York Academy of Sciences
• Published: 2006;1076:778-83
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Subsequent to the detection of a cluster of mesothelioma cases in the Sicilian town of Biancavilla, located at the slopes of Etna volcano, ad hoc epidemiological studies and environmental monitoring suggested an etiological role of an asbestiform fiber present in a stone quarry. The fiber was shown to constitute a new mineral species named fluoro-edenite. Fluoro-edenitic fibers were found in the materials extracted from the quarry and used in the local building industry, as well as in soils. Besides the risk of mesothelioma, residents in Biancavilla showed a significantly increased mortality from chronic obstructive pulmonary disease, which was particularly evident among women. In the light of these findings, Biancavilla was defined a site of national interest for environmental reclamation. The first preventive action involved termination of quarrying activity, covering with asphalt of roads previously paved with local soil materials, and removal of sources of dust in the urban area. Concurrent to the implementation of environmental cleanup, some specific "second generation" studies are now being designed and performed, namely morbidity surveys based on hospital discharge cards, monitoring of fibers in sputum and health surveillance in selected population groups. In this frame, special emphasis is given to the issue of communication, both to the general public and to target groups like family doctors, teachers, and media professionals. This experience could represent a useful basis for the elaboration of a strategy to approach similar environmental issues.

In plain English

This article reviewed earlier studies, many by the authors' own group, on health effects in Biancavilla, a Sicilian town on the slopes of Etna where no asbestos-related industry had operated. A cited study of residents' deaths in 1980–1993 found 9 deaths from malignant pleural neoplasms against 2.31 expected (SMR 390, 95% CI 178–740). Among women there were 5 against 0.74 expected (SMR 676, 95% CI 219–1577). Of 17 pleural mesothelioma cases found between 1980 and 1997, 9 had no evidence of occupational exposure. A fibrous amphibole from a local stone quarry, whose material was used in local building, was later identified as a new mineral, fluoro-edenite. A pilot study found the fiber in at least one sputum sample from 6 of 12 subjects. An ecological study of 36 Etna municipalities found a significant association between COPD deaths and pleural neoplasm deaths among women. The authors concluded that Biancavilla is experiencing an epidemic of pleural mesothelioma caused by fluoro-edenitic fibers, and an increase in nonmalignant respiratory diseases that deserves further investigation.

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: Review and overview of earlier epidemiological, environmental, mineralogical and public health work on Biancavilla. It reports the results of cited studies, not a new study.
• Who was studied: Residents of Biancavilla, a town in a volcanic area of eastern Sicily, Italy. The cited mortality study covered 1980–1993, and the case search covered 1980–1997.
• Exposure: Environmental exposure to a fibrous amphibole from the Monte Calvario stone quarry. It was first described as a tremolitic amphibole with phases between actinolite and tremolite, and was finally identified as the new mineral fluoro-edenite. Quarry material was used in the local building industry.
• Main results:
  • In the cited first study, residents of Biancavilla in 1980–1993 had 9 observed deaths from malignant pleural neoplasms against 2.31 expected, based on Sicily's rates (SMR 390, 95% CI 178–740).
  • Among women in the same study there were 5 observed deaths against 0.74 expected (SMR 676, 95% CI 219–1577).
  • An active search identified 17 cases of pleural mesothelioma between 1980 and 1997 (7 females, 10 males).
  • Of those cases, 9 had no evidence of occupational exposure. Exposure was possible for 2, and could not be excluded for 5 others.
  • In the first set of building samples (25 specimens), 72% showed the same amphibole phases found in the Monte Calvario quarry.
  • In the second set of building samples (38 specimens), fibrous phases were identified in 71%.
  • Autopsy lung tissue from one 86-year-old woman who died of pleural mesothelioma contained the same tremolite–actinolite fibrous amphibole found in the quarries.
  • In a cited pilot study using sputum as an exposure indicator, 6 out of 12 Biancavilla subjects had at least one sample positive for the fiber.
  • In a cited ecological study of 36 municipalities in the Etna volcanic area, COPD mortality was significantly associated with pleural neoplasm mortality among women.
• The authors' conclusion: The authors concluded that Biancavilla is experiencing an epidemic of pleural mesothelioma as a consequence of fluoro-edenitic fibers, and an increase in nonmalignant respiratory diseases that deserves further investigation.
• Limitations the authors state:
  • The authors stated that no explanation had been found for the increase in cardiovascular diseases reported in a cited regional study, and that it deserves further investigation.
  • The authors noted that acute respiratory diseases could be caused by other irritant materials often present in volcanic areas.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Biancavilla, Asbestiform, fluoro-edenite, Sputum.

Related studies

• Asbestos-related diseases in Italy: epidemiologic evidences and public health issues — P. Comba, E. Merler, et al. (2005)
• Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues — A. Marinaccio, A. Binazzi, et al. (2015)
• Fluoro-edenitic fibres in the sputum of subjects from Biancavilla (Sicily): a pilot study — M.G. Putzu, C. Bruno, et al. (2006)
• Asbestos in the air of public buildings: a public health risk? — J. Whysner, V.T. Covello, et al. (1994)
• Unusually high incidence of malignant pleural mesothelioma in a town of eastern Sicily: an epidemiological and environmental study — L. Paoletti, D. Batisti, et al. (2000)
• Is there a public health function? — A. Wolman (1986)

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