Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece

Our plain-English summary of Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece, by A. Gogali, E.E. Ntzani, C. Manda-Stachouli, et al (Respiration; International Review of Thoracic Diseases, 2017).

The study

• Authors: A. Gogali, E.E. Ntzani, C. Manda-Stachouli, S. Peristeri, L. Tzarouchi, E. Laiou, A. Konstantinidis, S.H. Constantopoulos, Y. Dalavanga
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2017;94(6):510-517
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Inhabitants of Metsovo, NW Greece, had been domestically exposed to asbestos from a gradually abandoned whitewash ("luto") that resulted in a declining epidemic of malignant mesothelioma.

Objectives: We aimed to evaluate whether other sources of asbestos exposure exist following "luto" abandonment.

Methods: Chest computed tomography (CT) and bronchoalveolar lavage (BAL) were used to evaluate residual asbestos exposure in younger Metsovites through the identification of pleural calcifications and asbestos bodies, respectively. In order to provide a historical universally exposed group for comparison, we used the accumulated chest CTs and chest roentgenograms of our previous studies, performed in Metsovites with confirmed exposure but negative chest roentgenogram. As an additional external comparison group, we also assessed CT scans and chest roentgenograms of Metsovites being older than our target group obtained from the records of the Radiology Department between 2009 and 2011. In order to be able to compare our BAL findings, we sought historical controls among BAL studies performed in Metsovites with known exposure to "luto," in the 1980s-1990s, mainly to evaluate alveolitis. Those belonging to individuals of the same age range were used for further comparison.

Results: Twenty-two Metsovites born between 1960 and 1980 consented to undergo a chest CT scan, while another 14 CTs were retrieved from the records of the Radiology Department (among 86 of all ages), thus increasing the number of individuals studied to 36. Five of the 36 Metsovites studied were former "luto" users for a short period of time. Minimal pleural calcifications were present in 2 of them, while all chest CTs of nonusers were negative. All 8 BAL studies were negative for asbestos bodies.

Conclusion: "Luto" use seems to have been the only source of considerable asbestos exposure in Metsovo.

© 2017 S. Karger AG, Basel.

In plain English

This study looked for signs of continuing asbestos exposure in Metsovo, in northwest Greece. Households there had once used "luto," a whitewash containing tremolite asbestos. The authors examined 36 Metsovites born between 1960 and 1980, after luto use had declined. Twenty-two were volunteers recruited from 2007 to 2011, and 14 were people whose chest CT scans were found in hospital records. The signs of exposure looked for were pleural calcifications on CT and asbestos bodies in fluid washed from the lungs (bronchoalveolar lavage, BAL). Five of the 36 had used luto. Minimal pleural calcifications were found in 2 of them, both exposed until adolescence. The chest CTs of all non-users were negative. All 8 BAL samples were negative for asbestos bodies. By comparison, in older records from luto-exposed Metsovites of a similar age, 6 of 7 BAL samples showed asbestos bodies. The authors concluded that domestic use of luto had been the only source of asbestos exposure in Metsovo. They noted a relatively low enrollment rate, and the people taken from records did not have BAL.

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: Cross-sectional clinical study of younger residents (volunteers given chest CT and BAL, plus a retrospective review of hospital CT records), compared with historical groups of luto-exposed residents
• Who was studied: 36 Metsovites born between 1960 and 1980 (aged 30 to 49). 22 were volunteers and 14 had CTs retrieved from Ioannina University Hospital records for 2009 to 2011. Mean age 40.0 years, median 40.5, 47% male.
• Exposure: Domestic use of "luto," a tremolite-containing whitewash used in Metsovo households
• Main results:
  • 5 of the 36 younger Metsovites (14%) had used luto: 2 until adolescence and 3 only as toddlers
  • Minimal pleural calcifications were seen on CT in 2 of the 5 former luto users; chest CTs of all non-users were negative
  • The 3 people exposed to luto only until age 5 to 6 had no pleural calcifications
  • Chest X-rays were all negative for asbestos exposure in the active surveillance group
  • All 8 BAL studies in the younger volunteers were negative for asbestos bodies
  • In the historical luto-exposed comparison group, asbestos bodies were found in 6 of 7 BAL studies in the same age range, and in 54 of 75 (72%) across all ages
  • In the historical 1980s group, all 18 Metsovites with confirmed luto exposure but a negative chest X-ray had minimal pleural calcifications on CT
  • On 2009 to 2011 hospital CTs of Metsovites over 50, pleural calcifications rose with age: 56% (9/16) at 50 to 59, 85% (11/13) at 60 to 69, 93% (25/27) at 70 to 79, and 100% (10/10) at 80 or above
  • In Metsovites over 50, pleural calcifications were found on 87 of 152 chest X-rays (57%) versus 55 of 66 chest CTs (83%)
• The authors' conclusion: The authors concluded that domestic use of the tremolite-containing whitewash luto had been the only source of asbestos exposure in Metsovo
• Limitations the authors state:
  • Enrollment of volunteers was relatively low, so hospital records were reviewed to add more people
  • For the 14 people taken from hospital records, luto history was obtained retrospectively and BAL was not performed

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Whitewash, Luto, Malignant Mesothelioma, Bronchoalveolar Lavage (BAL), Pleural Calcification, Asbestos Bodies, CT Scan.

Related studies

• Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later — A. Gogali, C. Manda-Stachouli, et al. (2012)
• Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece — S.H. Constantopoulos, P. Theodoracopoulos, et al. (1991)
• 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)
• Additional proteins in BAL fluid of Metsovites environmentally exposed to asbestos: more evidence of "protection" against neoplasia? — V. Galani, S. Constantopoulos, et al. (2002)
• Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? — K. Sakellariou, V. Malamou-Mitsi, et al. (1996)
• Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash — A.M. Langer, R.P. Nolan, et al. (1987)

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