Asbestos textile production linked to malignant peritoneal and pleural mesothelioma in women: Analysis of 28 cases in Southeast China

Our plain-English summary of Asbestos textile production linked to malignant peritoneal and pleural mesothelioma in women: Analysis of 28 cases in Southeast China, by Z. Gao, K. Hiroshima, X. Wu, et al (American Journal of Industrial Medicine, 2015).

The study

• Authors: Z. Gao, K. Hiroshima, X. Wu, J. Zhang, D. Shao, H. Shao, H. Yang, T. Yusa, T. Kiyokawa, M. Kobayashi, Y. Shinohara, O.D. Røe, X. Zhang, K. Morinaga
• Journal: American Journal of Industrial Medicine
• Published: 2015;58(10):1040-9
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Chrysotile had been used in asbestos textile workshops in Southeast China but a clear relation to mesothelioma is lacking.

Methods: All patients diagnosed with mesothelioma from 2003 to 2010 at Yuyao People's Hospital were re-evaluated by multiple expert pathologists with immunohistochemistry and asbestos exposure data were collected.

Results: Of 43 patients with a mesothelioma diagnosis, 19 peritoneal and nine pleural cases were finally diagnosed as mesothelioma. All were females, and the mean age of the patients with peritoneal or pleural mesothelioma was 52.4 and 58.2 years, respectively. All these cases had a history of domestic or occupational exposure to chrysotile. Two-thirds of the patients were from two adjoining towns with multiple small asbestos textile workshops. Contamination of tremolite was estimated to be less than 0.3%.

Conclusions: This is a report of mesothelioma in women exposed to chrysotile asbestos at home and at work, with an over-representation of peritoneal mesothelioma.

© 2015 Wiley Periodicals, Inc.

In plain English

The authors re-examined tissue from all 43 patients recorded with mesothelioma from 2003 to 2010 at Yuyao People's Hospital, Zhejiang Province, China, an area where women hand-spun asbestos in household textile workshops. Expert pathologists re-reviewed the slides using immunohistochemical stains, and exposure histories were collected. The diagnosis was upheld in 19 of 23 suspected peritoneal mesotheliomas (82.6%) and 9 of 20 suspected pleural mesotheliomas (45.0%). All 28 confirmed patients were women, with mean ages of 52.4 years (peritoneal) and 58.2 years (pleural). Of these, 17 of 19 peritoneal and all nine pleural cases had hand-spun asbestos or grown up in a house where it was done. For the other two, no exposure history was obtained. No fibers were measured. The authors judged it unlikely that any asbestos other than chrysotile was used, and, based on other studies, estimated tremolite contamination at less than 0.3%. The authors concluded this was a report of mesothelioma in women exposed to chrysotile at home and at work, with an over-representation of peritoneal mesothelioma. They noted the small retrospective design, incomplete clinical data and the lack of autopsy fiber analysis.

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: Retrospective case series: re-evaluation of hospital mesothelioma diagnoses by expert pathologists using immunohistochemistry, combined with clinical and asbestos exposure data
• Who was studied: 43 patients diagnosed with mesothelioma between 2003 and 2010 at Yuyao People's Hospital, Yuyao, Zhejiang Province, China (38 women). 28 were confirmed as mesothelioma, all women.
• Exposure: Asbestos hand-spinning in household asbestos textile workshops, or being raised in houses where hand-spinning was done. The fiber type was not measured; the authors judged it unlikely that any type other than chrysotile was used.
• Main results:
  • Of 23 cases originally diagnosed as peritoneal mesothelioma, 19 (82.6%) were confirmed (categories 4 and 5). Of these, 15 were epithelioid and 4 biphasic.
  • Of 20 cases originally diagnosed as pleural mesothelioma, 9 (45.0%) were confirmed, all in women. Of these, 7 were epithelioid, 1 biphasic and 1 sarcomatoid.
  • Mean age was 52.4 years for confirmed peritoneal cases and 58.2 years for confirmed pleural cases.
  • 17 of 19 (89%) confirmed peritoneal cases and all nine (100%) confirmed pleural cases had hand-spun asbestos or been raised in houses where hand-spinning was performed. All confirmed peritoneal cases whose occupational history was obtained had been exposed.
  • Among cases not confirmed as mesothelioma, 2 of 4 (50%) suspected peritoneal and 8 of 11 (73%) suspected pleural cases had no history of asbestos exposure.
  • Patients raised in houses where asbestos hand-spinning was performed developed mesothelioma before age 50. The youngest was 38.
  • Tremolite contamination was not measured in this study. Based on published analyses of raw chrysotile by other researchers, the authors estimated it at less than 0.3%.
• The authors' conclusion: The authors concluded that this was a report of mesothelioma in women exposed to chrysotile asbestos at home and at work, with an over-representation of peritoneal mesothelioma.
• Limitations the authors state:
  • Retrospective analysis of a relatively small number of patients
  • Clinical data were incomplete in some cases
  • The amount and type of asbestos fibers in patients' lungs and pleura could not be analyzed because no autopsies were performed
  • Fiber type analysis of workshop air could not be done because the workshops had closed
  • Occupational data were not systematically collected at first, and in a few cases missing information could not be retrieved
  • The rate of pleural mesothelioma may be falsely low, for example because of referral elsewhere or misdiagnosis
  • Needle biopsies for pleural cases yielded only small samples

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chrysotile, Mesothelioma, Immunohistochemistry, Asbestos Exposure, Occupational Exposure, Tremolite, Peritoneal Mesothelioma.

Related studies

• Hand-spinning chrysotile exposure and risk of malignant mesothelioma: A case-control study in Southeastern China — Z. Jiang, T. Chen, et al. (2018)
• Improving the Accuracy of Mesothelioma Diagnosis in China — Z. Guo, M. Carbone, et al. (2017)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)
• Size- and type-specific exposure assessment of an asbestos products factory in China — M.N. Courtice, D.W. Berman, et al. (2016)
• Cancer mortality and asbestosis among workers in an asbestos plant in Chongqing, China — F. Zhong, E. Yano, et al. (2008)
• Lung cancer mortality in North Carolina and South Carolina chrysotile asbestos textile workers — L. Elliott, D. Loomis, et al. (2012)

Browse more research in American Journal of Industrial Medicine, or return to medical research.