Epidemic of mesothelioma in Egypt

Our plain-English summary of Epidemic of mesothelioma in Egypt, by R.M. Gaafar, N.H. Eldin (Lung Cancer, 2005).

The study

• Authors: R.M. Gaafar, N.H. Eldin
• Journal: Lung Cancer
• Published: 2005;49 Suppl 1:S17-20
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos has been recognized in Egypt since a long time as ancient Egyptians were using it in mummification. Mesothelioma in Egypt is mainly attributed to environmental origin with a high incidence of women and young adults affected. The incidence of mesothelioma is rising in Egypt. Epidemiological data for 635 malignant mesothelioma (MM) patients over 4 years in the third Millennium were collected from the National Cancer Institute (NCI), Cairo University and Abbassia Chest hospital. This number is more than four times the number diagnosed in the previous 11 years at NCI. A clinicopathological study was done for 100 malignant pleural mesothelioma (MPM) patients and showed that asbestos exposure and SV40 positivity were evident in 67% and 60% of cases, respectively. The median survival was 14.3 months and the 1 and 2 year survival rates were 60% and 27%, respectively. Evaluation of p53 and pRb immunohistochemically showed that pRb alteration was related to poor survival. Other biological prognostic factors such as EGFR, HER-2, glutathione S transferase (GST) and MDR were evaluated in 50 cases. Overexpression of EGFR was correlated with lack of clinical benefit and poor survival. GST potentiated the effect of EGFR on survival. The use of EGFR inhibitors may have a role in the treatment of MM. Asbestos in Cairo is a silent killer and measures toward eliminating it entirely or at least strictly controlling human contact with this dangerous carcinogen have to be taken in order to combat the coming epidemic of mesothelioma in Egypt.

In plain English

This short overview from the National Cancer Institute (NCI), Cairo University, described asbestos and malignant mesothelioma in Egypt, using hospital data and earlier studies. From 2000 to 2003, 635 mesothelioma cases were diagnosed at NCI and Abbassia Chest Hospital, Cairo. That was more than four times the 148 cases seen at NCI from 1989 to 1999. These patients had a median age of 53 and a male to female ratio of 1.6, and 64.7% had residential exposure, mainly in Shobra El-Khaymah and the Helwan and El-Maasara areas. In a study of 100 patients with malignant pleural mesothelioma, 67% were counted as asbestos exposed because they lived in endemic areas. SV40 was detected in 60%, median survival was 14.3 months, and altered pRb was related to poor survival. In a study of 50 such patients, 70% overexpressed EGFR, which was associated with lower survival and lack of clinical benefit. The authors concluded that there was a clear need for measures to eliminate asbestos entirely, or at least strictly control human contact with it, to combat a coming mesothelioma epidemic in Egypt, and that EGFR inhibitors may have a role in treatment.

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 overview article on asbestos and mesothelioma in Egypt. It combines hospital-based case counts with summaries of earlier studies, including two studies from the authors' institution (one of 100 and one of 50 malignant pleural mesothelioma patients) that are cited to separate reports.
• Who was studied: 635 mesothelioma cases diagnosed at NCI and Abbassia Chest Hospital, Cairo, in 2000 to 2003, compared with 148 cases at NCI in 1989 to 1999. Also 100 malignant pleural mesothelioma patients aged 19 to 76 seen in 2000 to 2002, and 50 malignant pleural mesothelioma patients enrolled at NCI between April 2001 and July 2002.
• Exposure: Mainly residential (environmental) asbestos exposure near asbestos factories in Cairo that make asbestos cement pipes and corrugated roofing panels. Occupational exposure also occurred. No fiber type is named.
• Main results:
  • The 635 cases diagnosed in 2000 to 2003 were more than four times the 148 cases diagnosed at NCI in 1989 to 1999.
  • Among the 635 cases, the median age was 53 (range 19 to 90 years) and the male to female ratio was 1.6.
  • Among the 635 cases, residential exposure was evidenced in 64.7% (Shobra El-Khaymah 35.6%; Helwan, El-Maasara and surrounding areas 23.6%).
  • Among the 635 cases, tumor types were mainly epithelial (78%), then mixed (12.3%), sarcomatous (7.4%), fibrous (1%) and others (1.3%).
  • In the 100 malignant pleural mesothelioma patients, asbestos exposure was reported in 67% because they lived in endemic areas.
  • In the same 100 patients, SV40 was detected in 60%, and 83% of those SV40-positive patients had evident asbestos exposure.
  • In the 100 malignant pleural mesothelioma patients, median survival was 14.3 months, and the 1-year and 2-year survival rates were 60% and 27%.
  • In the 100 malignant pleural mesothelioma patients, altered pRb expression was found in 85% and was related to poor survival (p = 0.02).
  • In the 50 malignant pleural mesothelioma patients, 70% overexpressed EGFR. EGFR overexpression was associated with lower survival (p = 0.05) and with lack of clinical benefit (p = 0.02).
  • In the 50 malignant pleural mesothelioma patients, HER-2 was graded 2+ or 3+ in only 8%.
• The authors' conclusion: The authors concluded that there was a clear need for measures to eliminate asbestos entirely, or at least strictly control human contact with it, to combat the coming epidemic of mesothelioma in Egypt. They also concluded that EGFR inhibitors may have a role in treating malignant mesothelioma.

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, Malignant Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, SV40, Median Survival, EGFR, Glutathione (GSH).

Related studies

• The European mesothelioma epidemic — J. Peto, A. Decarli, et al. (1999)
• The asbestos cancer epidemic — J. LaDou (2004)
• Malignant mesothelioma--the rising epidemic — D. Ferguson (1989)
• An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgüp in Anatolia — Y.I. Baris, A.A. Sahin, et al. (1978)
• Environmental mesothelioma associated with tremolite asbestos: lessons from the experiences of Turkey, Greece, Corsica, New Caledonia and Cyprus — S.H. Constantopoulos (2008)
• Monitor. Mesothelioma deaths in Great Britain — M. Kinoulty (2004)

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