Lung Cancer in an Orthoprosthetist Using Vermiculite

Our plain-English summary of Lung Cancer in an Orthoprosthetist Using Vermiculite, by Q. Durand-Moreau, M. Dezutter, G. Quéré, et al (The International Journal of Occupational and Environmental Medicine, 2017).

The study

• Authors: Q. Durand-Moreau, M. Dezutter, G. Quéré, G. Robinet, P.Y. Le Roux, B. Loddé, J.D. Dewitte
• Journal: The International Journal of Occupational and Environmental Medicine
• Published: 2017;8(4):241-243
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Occupational exposure to certain substances would cause cancer. Herein, we report on a case of a 58-year-old former orthoprostethist who died from a lung adenocarcinoma. He had a 3 pack-year history of smoking and a single exposure to asbestos during his professional career. Between 1979 and 2010, he used vermiculite plaques daily to build medical prostheses, using no personal protective equipment. Contamination of vermiculite with amphibole asbestos has been described in Libby, Montana. Expert opinion on this case has raised the hypothesis of the use of this kind of vermiculite during this period and the occupational etiology of this cancer. It seems important to point out the possibility of vermiculite-related lung cancers in unusual occupations in order to better document such cases in the future.

In plain English

This case report, written by doctors at the University Hospital of Brest, France, described one man who had worked as an orthoprosthetist. He was diagnosed with adenocarcinoma of the right lung in April 2016, at age 58, and had a three pack-year smoking history. From 1979 to 2010 he broke vermiculite plaques and mixed them with plaster powder several times a day to build prostheses. This generated dust, and he used no personal protective equipment. In 1995 he also spent 10 days renovating his workshop, during which he removed asbestos heat insulation himself while wearing a simple cartridge mask. At diagnosis the cancer had spread to both lungs, the left adrenal gland and multiple bones. A pneumoconiosis specialist found no silicosis on his CT scans. Immunotherapy and then chemotherapy brought no response, and he died in November 2016. The authors noted that other studies have described vermiculite from Libby, Montana, as contaminated with amphibole asbestos. They had no strong evidence that this patient was exposed to it, and no mineral analysis was done. They considered the cancer possibly related to his vermiculite exposure.

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: case report (one patient)
• Who was studied: One 58-year-old man with a three pack-year smoking history, a former orthoprosthetist, diagnosed with right lung adenocarcinoma in April 2016; reported by the Occupational Diseases Center, University Hospital of Brest, France
• Exposure: From 1979 to 2010, the patient broke vermiculite plaques and mixed them with plaster powder several times a day to build prostheses such as corsets. The task generated dust and he used no personal protective equipment. He also had one short exposure to asbestos: in 1995 he spent 10 days renovating his workshop and removed asbestos heat insulation himself using a simple cartridge mask. The fiber type of this asbestos was not stated.
• Main results:
  • At diagnosis the cancer had multiple metastases, visible on FDG PET/CT scan, in both lungs, the left adrenal gland and multiple bones
  • The immunostains (anti-WT1, anti-calretinine, TTFI, Ber-ep4) were all negative, as were the biomarkers Kras, EGFR, ALK, cMET and ROS1
  • A pneumoconiosis specialist who reviewed the CT scans did not identify any silicosis
  • Immunotherapy with durvalumab and tremelimumab, followed by chemotherapy with carboplatin and pemetrexed, produced no response; the patient died in November 2016 from progression of the cancer
  • The authors considered the cancer possibly related to his occupational vermiculite exposure and asked the social insurance for compensation
• The authors' conclusion: The authors concluded that it seems important to point out the possibility of vermiculite-related lung cancers so that such cases can be better documented in the future, and that mineral analysis at the time of diagnosis could be helpful
• Limitations the authors state:
  • There was no strong evidence that the patient was ever exposed to vermiculite from Libby, Montana
  • The patient's business had closed, so no mineral analysis of any material could be performed, and none was done
  • The hypothesis of asbestos-contaminated vermiculite was raised only six months after the diagnosis
  • The patient also smoked a small amount of tobacco and had one short exposure to pure asbestos

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, vermiculite, Occupational Exposure, Lung Adenocarcinoma, Amphibole Asbestos, Etiology.

Related studies

• Radiographic abnormalities and exposure to asbestos-contaminated vermiculite in the community of Libby, Montana, USA — L.A. Peipins, M. Lewin, et al. (2003)
• Cohort study of mortality of vermiculite miners exposed to tremolite — J.C. McDonald, A.D. McDonald, et al. (1986)
• Vermiculite, respiratory disease, and asbestos exposure in Libby, Montana: update of a cohort mortality study — P.A. Sullivan (2007)
• The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part II. Mortality — H.E. Amandus, R. Wheeler (1987)
• Mortality in a cohort of vermiculite miners exposed to fibrous amphibole in Libby, Montana — J.C. McDonald, J. Harris, et al. (2004)
• Pulmonary changes after exposure to vermiculite contaminated with fibrous tremolite — J.E. Lockey, S.M. Brooks, et al. (1984)

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