Asbestos exposure and gestational trophoblastic disease: a hypothesis

Our plain-English summary of Asbestos exposure and gestational trophoblastic disease: a hypothesis, by A. Reid, J. Heyworth, N. de Klerk, et al (Cancer Epidemiology, Biomarkers & Prevention, 2009).

The study

• Authors: A. Reid, J. Heyworth, N. de Klerk, A.W. Musk
• Journal: Cancer Epidemiology, Biomarkers & Prevention
• Published: 2009;18(11):2895-8
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Among 2,968 women and girls exposed to crocidolite (blue asbestos) at Wittenoom, three cases of choriocarcinoma and three cases of hydatidiform mole have been identified (crude incidence rate of 9.9 per 1000 women and 1.7 per 1000 deliveries for choriocarcinoma and hydatidiform mole, respectively). The women with choriocarcinoma were resident at Wittenoom at the time of disease development, whereas hydatidiform mole occurred much later in women who had first been exposed to asbestos as young girls. Four of the six cases were known to have lived with asbestos company workers who brought their dusty work-clothes home for washing. Asbestos fibers have been reported in the lung, the pleural and peritoneal mesothelium, and the human ovary. They have also been detected in placental digests of live and stillborn infants. This cluster of gestational trophoblastic diseases has some biological plausibility for asbestos causation. Taking an occupational and residential history and examining pathologic specimens for asbestos fibers or bodies may prove useful in patients with gestational trophoblastic disease.

In plain English

This short report described a possible cluster of gestational trophoblastic disease (from hydatidiform mole to choriocarcinoma, a cancer of the placenta) among women and girls exposed to crocidolite (blue asbestos) at Wittenoom, a mining and milling town in Western Australia. Three choriocarcinoma cases, in women living at Wittenoom and working for the asbestos company, were reported from early 1963. A survivor told the authors of her case and two others, and documentary evidence was found for only one case. Two of these women died. Among 302 women of reproductive age there that year, the crude rate was 9.9 per 1,000. Compared with Australian women of reproductive age, the age-adjusted ratio was 258.9 (95% confidence interval, 53 to 757). Western Australian hospital records from 1970 to 2005 covered only the 63% of women known to have lived in that state after leaving Wittenoom. They showed three hydatidiform moles among 1,741 deliveries, or 1.7 per 1,000. All three of these women had been born at Wittenoom. The authors judged asbestos unlikely to have caused one of the choriocarcinomas. Tissue was not tested for asbestos fibers. The authors concluded that the cluster warrants further research.

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: Short report describing a possible disease cluster (case series with crude incidence rates)
• Who was studied: About 3,000 women and girls who lived or worked at Wittenoom, Western Australia, between 1936 and 1992. This included 2,552 town residents who did not work for the asbestos company (Australian Blue Asbestos, ABA) and 416 ABA employees. Six cases of gestational trophoblastic disease were described.
• Exposure: Crocidolite (blue asbestos) from living and working in a mining and milling town. The cases also had family members who worked for ABA.
• Main results:
  • Three choriocarcinoma cases came to the authors' attention through a survivor, who described her own case and two other Wittenoom women treated at the same hospital at the same time. Table 1 lists all three as diagnosed in early 1963. All three women were living at Wittenoom and worked for ABA. Two of them died from the condition.
  • The crude choriocarcinoma incidence among the 302 Wittenoom women of reproductive age (15-54 years) in 1963 was 3/302, which is 9.9 per 1,000 women.
  • Applying the Wittenoom 1963 age-adjusted rates to the Australian female population of reproductive age gave an age-adjusted comparable incidence ratio of 258.9 (95% confidence interval, 53-757).
  • Linkage to Western Australian hospital records (1970 to 2005) covered the 63% of women known to have resided in Western Australia after leaving Wittenoom. It found 3 hydatidiform moles among 1,741 deliveries at Western Australian hospitals to these women, which is 1.7 per 1,000 deliveries.
  • All three women with hydatidiform mole had been born at Wittenoom. Time since first exposure was shorter for the choriocarcinoma cases than for the hydatidiform mole cases.
  • One choriocarcinoma specimen showed a gonadoblastoma component. The authors judged that asbestos was unlikely to have caused that particular choriocarcinoma.
  • The authors described the Wittenoom hydatidiform mole rate of 1.7 per 1,000 deliveries as somewhat greater than the 1.04 per 1,000 confinements reported in an earlier Sydney study (1950-1966).
• The authors' conclusion: The authors concluded that this cluster of gestational trophoblastic disease, with some rationale for asbestos causation, warrants further research.
• Limitations the authors state:
  • Documentary evidence could be obtained for only one of the three choriocarcinoma cases. The treating hospital had destroyed records from before 1966.
  • The search for hydatidiform mole was restricted to women still living in, or admitted to hospital in, Western Australia. This could underestimate incidence.
  • The specimens from the Wittenoom women could not be examined for asbestos fibers or bodies.
  • The choriocarcinoma rate comparison used a different denominator (women) from the earlier Sydney study (confinements).
  • Only limited anecdotal information was available on one choriocarcinoma case (case 3).

Mines named here

Asbestos mines this study is about. Each mine's page says who ran it, when it worked, and what it produced.

• Wittenoom, Western Australia

All asbestos mines

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Crocidolite, Wittenoom, Incidence, Mesothelium, Biological Plausibility, Causation.

Related studies

• Asbestos, carbon nanotubes and the pleural mesothelium: a review of the hypothesis regarding the role of long fibre retention in the parietal pleura, inflammation and mesothelioma — K. Donaldson, F.A. Murphy, et al. (2010)
• Comparison of measures of exposure to asbestos in former crocidolite workers from Wittenoom Gorge, W. Australia — N.H. de Klerk, A.W. Musk, et al. (1996)
• Early life exposure to environmental tobacco smoke alters immune response to asbestos via a shift in inflammatory phenotype resulting in increased disease development — T.A. Brown, A. Holian, et al. (2016)
• Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis — A. Reid, N.H. de Klerk, et al. (2014)
• Are children more vulnerable to mesothelioma than adults? A comparison of mesothelioma risk among children and adults exposed non-occupationally to blue asbestos at Wittenoom — A. Reid, P. Franklin, et al. (2018)
• The epidemiology of asbestos-related diseases — J. Niklinski, W. Niklinska, et al. (2004)

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