An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia

Our plain-English summary of An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia, by Y.I. Baris, A.A. Sahin, M. Ozesmi, et al (Thorax, 1978).

The study

• Authors: Y.I. Baris, A.A. Sahin, M. Ozesmi, I. Kerse, E. Ozen, B. Kolacan, M. Altinörs, A. Göktepeli
• Journal: Thorax
• Published: 1978;33(2):181-92
• Cited by: 173 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002112).

Abstract

The 575 inhabitants of the remote Anatolian village of Karain suffered 11 deaths from pleural mesothelioma in 1975/76 and there were five cases of fibrosing pleurisy. In the previous five years there had been 25 cases of mesothelioma. Calcified pleural plaques were common on survey radiography. Asbestos does not occur in the local soil or rock, nor is it handled in the village, but a few fibres were found in the water. Fibres were also found in the pleural tissue of two of five cases examined. Inhabitants of the neighbouring villages are free of mesothelioma.

In plain English

The authors investigated the long-reported cancer problem in Karain, a village of 575 inhabitants in central Anatolia, Turkey. They reviewed village and hospital information up to 1975 and surveyed Karain and neighbouring villages in 1975/76. In 1974 Karain, then with 604 people, had 11 deaths from pleural mesothelioma out of 18 deaths, and none of the other villages compared had any. During 1975 and 1976, 16 new cases of pleural disease were found. Eleven were finally diagnosed as mesothelioma and five as chronic fibrosing pleurisy. No asbestos deposits were found, and soil, rock and dust contained no asbestos fibres. Small quantities of mineral fibres were found in Karain's original piped water and in one old well. Ashed pleural tissue from five patients was examined, and asbestos fibres were found in two. One mesothelioma patient had about 10 chrysotile fibres. One patient with fibrosing pleurisy had chrysotile and 3 × 10^5 amphibole fibres per gram of dry tissue. The authors concluded that these diseases are endemic in Karain and suggested asbestos in water as a possible route, calling for further studies.

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: Descriptive investigation of a disease outbreak in one village: a review of information available up to 1975, plus a 1975/76 field survey of the environment and of villagers' health, with comparison to neighbouring villages
• Who was studied: Inhabitants of Karain (575 people), a village in the Urgup district of Cappadocia, central Anatolia, Turkey, compared with neighbouring villages. Deaths from 1970 to 1976 were reviewed, and new pleural disease cases were studied in 1975 and 1976.
• Exposure: Environmental, non-occupational. The authors found no asbestos deposits or asbestos processing in the area. Soil, rock and dust contained volcanic debris with fine fragments of volcanic glass but no asbestos fibres. Small quantities of mineral fibres, 5 to 70 microns long, were found in Karain's original piped water supply and in one old well.
• Main results:
  • In 1974, Karain (population 604) had 11 pleural mesotheliomas out of a total of 18 deaths.
  • In the 1974 comparison, none of the neighbouring villages had any pleural mesothelioma deaths.
  • During 1975 and 1976, 16 new cases of pleural disease were found among villagers (8 men and 8 women, aged 27 to 65).
  • Of the 16 new cases, 11 received a final diagnosis of mesothelioma.
  • The other 5 of the 16 new cases received a final diagnosis of chronic fibrosing pleurisy.
  • Of the water sources tested, mineral fibres were found only in Karain's original piped supply and in one old well by the river.
  • Soil, rock, stucco and airborne dust contained no asbestos fibres, but did contain a few fine fibre fragments of volcanic glass.
  • Electron microscopy of ashed pleural tissue from five patients found about 10 chrysotile fibres in case 1, a patient with malignant pleural mesothelioma.
  • Case 3, a patient with chronic fibrosing pleurisy, had chrysotile fibres (count unclear in the scanned text) and 3 × 10^5 amphibole asbestos fibres per gram of dry tissue.
  • Asbestos bodies could not be shown by optical microscopy.
  • Three mesothelioma patients had been brought up in Karain and moved away before developing the disease. The authors report that no one brought up elsewhere who moved to Karain developed mesothelioma.
  • Tests of water for nitrosamine were negative, and no significant radioactivity was found.
• The authors' conclusion: The authors concluded that diffuse pleural mesothelioma and chronic fibrous pleurisy are endemic in Karain. They suggested the outbreak may be an example of asbestos reaching the body through water, noting that the only difference between Karain and nearby villages was the drinking water source.
• Limitations the authors state:
  • Identification of individuals in the 1971 radiographic survey was incomplete, so the 1975 repeat survey was not an individual follow-up.
  • Case records were kept only after a health institute was established in the village. Earlier information came from elderly residents and the village headman.
  • Five patients refused thoracotomy and some other investigations, so their diagnoses rested on clinical and radiological evidence.
  • The histological diagnosis in case 7 was uncertain. The authors suspected chronic fibrosing pleurisy rather than mesothelioma.
  • The physical properties and concentration of volcanic glass and other fibres in the local soil were not studied analytically.
  • Further studies were needed, including exact measurement of fibre dimensions and composition, and experiments testing whether Karain's water induces disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleurisy, Karain, Mesothelioma, Pleural Plaques.

Related studies

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• How useful is GLUT-1 in differentiating mesothelial hyperplasia and fibrosing pleuritis from epithelioid and sarcomatoid mesotheliomas? An international collaborative study — A.N. Husain, M.K. Mirza, et al. (2014)
• Fibrosing pleuritis with extrathoracic extension — B.I. Hoffbrand, M.R. Hetzel, et al. (1985)
• Evidence of a role for mesothelial cell-derived interleukin 8 in the pathogenesis of asbestos-induced pleurisy in rabbits — A.M. Boylan, C. Rüegg, et al. (1992)
• Respiratory function changes after asbestos pleurisy — P.H. Wright, A. Hanson, et al. (1980)
• Ventilatory failure due to asbestos pleurisy — A. Miller, A.S. Teirstein, et al. (1983)

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