Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053

Our plain-English summary of Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053, by D. Mirabelli, A. Angelini, P.G. Barbieri, et al (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: D. Mirabelli, A. Angelini, P.G. Barbieri, R. Calisti, F. Capacci, P. Girardi, S. Silvestri, A.B. Somigliana
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(13)
• Type of article: Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We read with interest the report by Visonà and coworkers on the lung asbestos fiber burden in an autopsy series of decedents from mesothelioma (MM: 59 cases) and individuals who "suffered from asbestosis and died of its complications" (13 cases) [...].

In plain English

This article was a short published comment on an earlier study by Visonà and colleagues. It was not new research and reported no data of its own. The earlier study had measured asbestos fibers in lung tissue taken at autopsy from 59 people who died of mesothelioma and 13 people who had asbestosis and died of its complications, in Broni, northern Italy. The commenting authors disagreed with that study's conclusions. They argued that Visonà et al. misquoted earlier research, including studies that, according to the commenters, found higher lung asbestos levels and a dose–response trend in mesothelioma risk. They were concerned that the counting method used may have missed thin fibers, especially chrysotile. Their main point was that the mesothelioma deaths were compared with asbestosis deaths rather than with a suitable control group. In their view, this made the finding of less lung asbestos in mesothelioma cases uninformative, and it also ruled out a dose–response analysis. The authors concluded that Visonà et al.'s conclusions disagreed with the literature and were unwarranted.

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: Published comment (letter) criticizing another study; no new data
• Who was studied: No population of its own. The comment concerns Visonà et al.'s autopsy series from Broni (Pavia, northern Italy): 59 people who died of mesothelioma and 13 people who suffered from asbestosis and died of its complications.
• Exposure: Lung asbestos fiber burden after occupational and/or environmental asbestos exposure, as measured in the Visonà et al. study. The comment discusses how fibers, including chrysotile, were counted.
• Main results:
  • The commenters argued that Visonà et al. misquoted earlier studies. According to the commenters, those studies found higher lung asbestos concentrations in mesothelioma cases or in asbestos workers, and some showed a dose–response trend in mesothelioma risk.
  • The commenters suggested that environmental exposures in Casale Monferrato and Broni in the 1950s to 1980s may have led to life-long exposures comparable to those from some, but not all, occupations.
  • The commenters argued that Visonà et al. counted only fibers longer than 5 micrometres at 2000 times magnification using backscattered electrons. In their view, this may have prevented identification of fibers with a diameter less than 0.5 micrometres, so many fibers, especially chrysotile, may have gone undetected. They also criticized the asbestos body counting procedure.
  • The commenters' main point was about the comparison group. They said Visonà et al. compared mesothelioma deaths with asbestosis deaths, not with deaths from other causes or with an appropriate control series. In their view, the lower lung asbestos burden found in mesothelioma cases was therefore an uninformative and rather obvious finding.
  • The commenters said Visonà et al. could not carry out a dose–response analysis because there was no suitable control series.
• The authors' conclusion: The authors concluded that Visonà et al.'s conclusions were not just in disagreement with the literature but unwarranted, given the limitations of that study.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Fiber Burden, Autopsy.

Related studies

• Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053" — S.D. Visonà, S. Capella, et al. (2021)
• Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples — S.D. Visonà, S. Capella, et al. (2021)
• Evaluation of Deposition and Clearance of Asbestos (Detected by SEM-EDS) in Lungs of Deceased Subjects Environmentally and/or Occupationally Exposed in Broni (Pavia, Northern Italy) — S.D. Visonà, S. Capella, et al. (2021)
• Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611 — B. Świątkowska, W. Hanke (2020)
• Reply to Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611 — M. Krówczyńska, E. Wilk (2020)
• Impact of asbestos on public health: a retrospective study on a series of subjects with occupational and non-occupational exposure to asbestos during the activity of Fibronit plant (Broni, Italy) — S.D. Visonà, S. Villani, et al. (2018)

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