Is risk of pleural mesothelioma an environmental risk outside Turkey? A study on immigrants to Sweden

Our plain-English summary of Is risk of pleural mesothelioma an environmental risk outside Turkey? A study on immigrants to Sweden, by S.M. Mousavi, J. Sundquist, K. Hemminki (Lung Cancer, 2010).

The study

• Authors: S.M. Mousavi, J. Sundquist, K. Hemminki
• Journal: Lung Cancer
• Published: 2010;68(1):125-6
• Type of article: Letter
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter asked whether the high risk of malignant pleural mesothelioma known among people from Cappadocia, Turkey, where villagers are environmentally exposed to erionite and tremolite asbestos, also appears among immigrants from other countries. The authors used the nationwide Swedish Family-Cancer Database (2008 update) to study first-generation immigrants to Sweden from 63 countries or country groups. Follow-up ran from 1958 to the end of 2006. They calculated standardized incidence ratios (SIRs) with 95% confidence intervals, using the native Swedish population as the reference and adjusting for 5-year age group, sex and time period. There were 2128 mesothelioma cases among native Swedes and 188 among immigrants. Compared with native Swedes, risk was significantly increased in Turkish men (SIR 2.82) and Turkish women (SIR 23.76), Danish men (SIR 1.64) and women from Benelux (SIR 8.93). No significant risk difference was found among the large immigrant groups. Among Turkish immigrants the male-to-female ratio was 1.1, and more than two decades on average had passed between immigration and diagnosis. The authors suggested that environmental exposure was similar for both sexes and that early-life exposure may have been responsible, although genetic predisposition could also explain the excess. They considered the borderline Danish and Benelux results possibly due to occupational or passive exposure, or chance. They concluded that high risk was confirmed in Turkish immigrants only and called for study of second-generation immigrants.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the editor reported a registry-based study using the nationwide Swedish Family-Cancer Database. The authors compared rates of malignant pleural mesothelioma among first-generation immigrants to Sweden, grouped by 63 countries or country groups of birth, with rates among native Swedes, from 1958 to 2006. Results were given as standardized incidence ratios (SIRs), where 1.00 equals the native Swedish rate. The database held 2128 cases among native Swedes and 188 among immigrants. Turkish-born immigrants had raised rates: men SIR 2.82 (95% CI 1.22 to 5.56, 8 cases), women 23.76 (10.86 to 45.11, 9 cases). Rates were also raised for Danish-born men (1.64; 1.01 to 2.51) and Benelux-born women (8.93; 1.08 to 32.24, 2 cases). The authors called these two increases borderline and said they could reflect occupational or passive exposures or chance. For all immigrants together the SIR was 1.08 (0.93 to 1.25). The authors concluded that the high risk was confirmed in Turkish immigrants only. They suggested early-life environmental exposure to erionite or tremolite asbestos as one explanation, but said the finding may equally point to genetic predisposition.

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: Registry-based study of a national cancer database comparing immigrant groups with native Swedes using standardized incidence ratios, published as a letter to the editor
• Who was studied: First-generation immigrants to Sweden from 63 countries or country groups, compared with the native Swedish population, followed from 1958 to December 31, 2006. There were 2128 mesothelioma cases among native Swedes and 188 among immigrants.
• Exposure: Country or region of birth. Exposures were not measured. The authors discussed environmental erionite and tremolite asbestos as possible causes in Turkish immigrants, and occupational or passive exposures as possible causes in Danish and Benelux immigrants.
• Main results:
  • Turkish-born immigrants: men SIR 2.82 (95% CI 1.22 to 5.56, 8 cases); women SIR 23.76 (95% CI 10.86 to 45.11, 9 cases); both sexes SIR 5.29 (95% CI 3.08 to 8.47, 17 cases)
  • Danish-born immigrants: men SIR 1.64 (95% CI 1.01 to 2.51, 21 cases); women SIR 2.04 (95% CI 0.55 to 5.21, 4 cases); both sexes SIR 1.69 (95% CI 1.10 to 2.50, 25 cases)
  • Benelux-born immigrants: women SIR 8.93 (95% CI 1.08 to 32.24, 2 cases); men SIR 1.05 (95% CI 0.13 to 3.80, 2 cases)
  • All immigrants combined: SIR 1.08 (95% CI 0.93 to 1.25, 188 cases); immigrant men 0.99 (0.84 to 1.17, 144 cases); immigrant women 1.54 (1.12 to 2.06, 44 cases)
  • Among the large immigrant groups, the authors found no significant difference in risk compared with native Swedes
  • Turkish immigrants: median age at immigration and at diagnosis were 26 and 57 for men, and 33 and 55 for women
  • The authors reported a male to female ratio of mesothelioma of 1.1 in Turkish immigrants. They described this as equal to the Cappadocian experience.
• The authors' conclusion: The authors concluded that their study confirmed a high risk of mesothelioma in Turkish immigrants, and only in Turkish immigrants. They considered it reassuring that the results did not show evidence of mesothelioma risk in other immigrant populations. They said a study of second-generation immigrants might define the role of genetic predisposition.
• Limitations the authors state:
  • The raised risk in Turkish immigrants may reflect genetic predisposition rather than environmental exposure. The authors said second-generation data would be needed to sort this out.
  • The borderline increases in Danish and Benelux immigrants may be chance findings

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Cappadocia, erionite, Tremolite, Standardized Incidence Ratio (SIR), confidence interval, Mesothelioma, Environmental Exposure.

Related studies

• Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden — M. Ozesmi, G. Hillerdal, et al. (1990)
• The role of environmental and occupational exposures in Turkish immigrants with fibre-related disease — P. Dumortier, A. Göcmen, et al. (2001)
• Environmental asbestos exposure in rural Turkey and risk of lung cancer — S. Metintas, M. Metintas, et al. (2012)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Determination of environmental exposure to asbestos (tremolite) and mesothelioma risks in the southeastern region of Turkey — A. Senyigit, A. Dalgic, et al. (2004)
• Environmental mesothelioma associated with tremolite asbestos: lessons from the experiences of Turkey, Greece, Corsica, New Caledonia and Cyprus — S.H. Constantopoulos (2008)

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