Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study

Our plain-English summary of Environmental fiber-induced pleuro-pulmonary diseases in an Anatolian village: an epidemiologic study, by M. Artvinli, Y.I. Baris (Archives of Environmental Health, 1982).

The study

• Authors: M. Artvinli, Y.I. Baris
• Journal: Archives of Environmental Health
• Published: 1982;37(3):177-81
• Cited by: 37 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000657).

Abstract

This study was designed to determine the prevalence of pleural mesothelioma and other malignancies in the Anatolian village of Tuzköy, where neither asbestos nor any environmental carcinogen has been detected. Another village (Kizilköy) located 12 km from Tuzköy was selected as a control. Three hundred twelve subjects from Tuzköy who were at least 25 yr of age and 95 subjects from Kizilköy were studied. Analysis of X-rays of the Tuzköy group revealed that subjects had calcified pleural plaques (17%), pleural thickening (10.5%), obscured costophrenic angles (15%), and diffuse interstitial pulmonary fibrosis (12.1%). Sixty-seven deaths were records in Tuzköy during the previous 3 yr, 41 of which resulted from malignant diseases. There were no X-ray abnormalities or deaths resulting from malignancies in the control group. Because of the high incidence of mesothelioma and lung cancer which usually results from asbestos exposure, the presence of asbestos in Tuzköy was investigated, but none was detected in spite to Tuzköy's volcanic location. Nevertheless, zeolite, an asbestiform mineral, was detected in the stones of buildings and in the village soil, as well as in the lung and pleura of the patients during biopsy. Thus, this mineral was considered to be responsible for the fiber-induced pleuro-pulmonary diseases in Tuzköy. No zeolite was found in the soil and stones of the control village.

In plain English

This study surveyed two villages in Cappadocia, Turkey: Tuzköy and, as a control, Kizilköy, 12 km away. The authors examined and X-rayed 312 Tuzköy residents and 95 Kizilköy residents aged 25 or older, and recorded deaths over the previous three years. In the Tuzköy group, X-rays showed calcified pleural plaques in 17%, pleural thickening in 33 (10.5%), obscured costophrenic angles in 47 (15%) and diffuse interstitial pulmonary fibrosis in 38 (12.1%). None of these appeared in the control group. In Tuzköy, plaques became more common with age, reaching 50% in the oldest group. Of 1,780 Tuzköy residents aged 15 or older, 67 died. Forty-one of those deaths were from cancers, including 15 pleural mesotheliomas, 12 peritoneal mesotheliomas and 8 lung cancers. In Kizilköy, 2 of 325 died, both from non-cancer diseases. No asbestos was found. Fibers of erionite, a zeolite mineral, were found in Tuzköy soil and building stones and in patients' lung and pleura biopsies. The authors concluded that zeolite was the responsible agent, or played the most important role. They noted that portable X-ray equipment lowered film quality.

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: Epidemiologic survey of two villages, comparing an affected village with a control village. It used questionnaires, physical examination, spirometry and chest X-rays, a 3-year death record, and mineral analysis of soil, stones, water and biopsy tissue.
• Who was studied: Residents aged at least 25, chosen by stratified sampling. Tuzköy, near Nevsehir in Cappadocia, Turkey (population 2919): 312 people (145 males, 167 females). Control village Kizilköy, 12 km south (population 631): 95 people (45 males, 50 females). Deaths were recorded among people aged 15 or older from January 1, 1978, to December 3, 1980.
• Exposure: Environmental (non-occupational) exposure to mineral fibers in a volcanic area. No asbestos was detected. Fibers 30 to 40 micrometers long and 1 to 2 micrometers in diameter, identified as erionite (a zeolite mineral), were found in Tuzköy road and field soil and in building stones. Some subjects worked in a salt mine 1 km from Tuzköy.
• Main results:
  • Tuzköy group: calcified pleural plaques were seen in 17% of subjects.
  • Tuzköy group: pleural thickening on 33 (10.5%) of X-rays.
  • Tuzköy group: obscured costophrenic angles on 47 (15%) of X-rays.
  • Tuzköy group: diffuse interstitial pulmonary fibrosis on 38 (12.1%) of X-rays.
  • Kizilköy control group: none of these X-ray abnormalities were present.
  • Tuzköy group: calcified pleural plaques increased with age, reaching 50% in the oldest group (over 70 years).
  • Tuzköy group: all abnormal X-ray findings except interstitial pulmonary fibrosis were significantly less common in housewives than in other occupational groups (p less than .001).
  • Tuzköy group: all abnormal findings except diffuse interstitial pulmonary fibrosis were more common in smokers than in nonsmokers.
  • Tuzköy: 67 of 1,780 individuals aged at least 15 died during the previous 3 years. Forty-one of these deaths were from malignant diseases.
  • Tuzköy causes of death: pleural mesothelioma (15), peritoneal mesothelioma (12), lung cancer (8), gastric cancer (2), colon cancer (2), laryngeal cancer (1) and leukemia (1). Of the other 26, 19 died of nonmalignant diseases and 7 had no definite diagnosis.
  • Tuzköy: five patients firmly diagnosed with pleural mesothelioma were alive at the time of the study.
  • Kizilköy: 2 of 325 individuals aged at least 15 died in the previous 3 years, both from nonmalignant diseases. No malignancies were found among living residents.
  • The same fibrous minerals were detected in lung and pleura biopsies taken from patients during thoracotomy.
  • No fibrous mineral was found in water samples from either village.
  • No zeolite was found in the soil and stones of the control village.
• The authors' conclusion: The authors concluded that zeolite is the responsible agent for the malignancies in Tuzköy, or plays the most important role in their development. They reported that relocation of the village had been considered necessary.
• Limitations the authors state:
  • Oblique chest views were not obtained; the authors stated the rate of abnormal findings would have been higher if they had been.
  • Reliance on a portable X-ray machine and technical difficulties in film processing reduced film quality.
  • Poor-quality films, especially from overweight individuals, were read as normal to avoid overdiagnosing diffuse interstitial pulmonary fibrosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Plaques, Pleural Thickening, Costophrenic angle, Interstitial, Pulmonary Fibrosis, Mesothelioma, Lung Cancer.

Related studies

• An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos — Y.I. Baris, N. Bilir, et al. (1988)
• Non-occupational asbestos related chest diseases in a small Anatolian village — Y.I. Bariş, M. Artvinli, et al. (1988)
• Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology — S.H. Constantopoulos, J.A. Goudevenos, et al. (1985)
• Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases — Z.T. Selçuk, L. Cöplü, et al. (1992)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Asbestos related diseases from environmental exposure to crocidolite in Da-yao, China. I. Review of exposure and epidemiological data — S. Luo, X. Liu, et al. (2003)

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