Malignant mesothelioma in the jewelry industry

Our plain-English summary of Malignant mesothelioma in the jewelry industry, by D.G. Kern, K.T. Hanley, V.L. Roggli (American Journal of Industrial Medicine, 1992).

The study

• Authors: D.G. Kern, K.T. Hanley, V.L. Roggli
• Journal: American Journal of Industrial Medicine
• Published: 1992;21(3):409-16
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 004908).

Abstract

We conducted a clinical, environmental, pathologic, and mineral lung burden investigation of a 61-year-old man with malignant mesothelioma. For 35 years, up until three weeks prior to pneumonectomy, the patient made asbestos soldering forms at a costume jewelry production facility. Only chrysotile asbestos was used at the plant during the last decade of the patient's employment, and recent environmental sampling of the work-place identified no other asbestos fiber type. Anticipating that the patient would add to the very small number of cases of mesothelioma attributable solely to chrysotile, we found instead that the patient's lung tissue contained large numbers of both coated and uncoated amosite asbestos fibers but, surprisingly, no chrysotile. We subsequently learned that a distributor of both chrysotile and amosite supplied the company during the first 25 years the patient was fabricating soldering forms. The findings underscore the futility of estimating environmental exposure to chrysotile on the basis of fiber counts in lung tissue. Although we previously described non-neoplastic asbestos-related disease among patients engaged in similar work, this case, to the best of our knowledge, represents the first report of mesothelioma in the commercial jewelry industry. As such, it prompted us to initiate a public health campaign to replace asbestos soldering forms in this industry with readily available, safer alternatives.

In plain English

This case report described a 61-year-old man with malignant pleural mesothelioma. For 35 years at a costume jewelry facility, he hand-mixed asbestos powder with plaster of paris and water to make soldering forms, with no respirator or local exhaust. In his last 10 years there, only Canadian chrysotile was used; a later OSHA inspection found no other asbestos type. For the previous 25 years, the shop's asbestos came from a manufacturer packaging both chrysotile and amosite. His lung tissue held 13,300 asbestos bodies per gram of wet lung; the laboratory's normal range is 0-20. All 20 fibers analyzed chemically, each at least 5 micrometers long, were compatible with amosite; none was chrysotile or tremolite. The authors stated that chrysotile was nonetheless present in his lungs, its nondetection most likely reflecting dilution by the more numerous amphibole fibers and the analysis of only 20 fibers of that length. They concluded that the findings highlight the futility of estimating chrysotile exposure from lung fiber counts, and that this appeared to be the first well-documented reported mesothelioma case in the commercial jewelry industry.

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 (clinical, environmental, pathologic and lung mineral burden investigation of one patient)
• Who was studied: One 61-year-old man who worked at a costume jewelry production facility employing 50 people, from 1950 to December 8, 1989. He had earlier worked 9 months (1944 to 1945) cleaning up after welders at a shipyard, and operated a foot press in jewelry shops from 1945 to 1950.
• Exposure: For 35 years he hand-mixed asbestos powder with plaster of paris and water to make soldering forms, 3 to 4 hours a day, using 200 lb of asbestos powder a year, with no respirator and no local exhaust ventilation. In the last 10 years the only asbestos used was Canadian chrysotile from Quebec. During the previous 25 years the shop's asbestos came from a manufacturer that packaged both chrysotile and amosite. He denied asbestos exposure in his 9-month shipyard job.
• Main results:
  • At thoracotomy, microscopic evaluation was reported to show diffuse epithelial mesothelioma and parietal pleural plaques. The lung specimen analysis described the tumor as consistent with the lymphohistiocytoid variant of malignant mesothelioma.
  • OSHA environmental sampling at the workplace: bulk material from Canada was 65% chrysotile, and the asbestos and plaster of paris mixture was 35% chrysotile. No asbestos type other than chrysotile was detected in any sample. No air sampling was done while soldering forms were being made.
  • OSHA personal air sampling of two employees soldering for 30 minutes found no detectable asbestos for one and an average of 0.43 fibers per cc for the other. Four employees sampled for longer periods while soldering on the forms had time-weighted-average exposures below 0.11 fibers per cc.
  • In the patient's lung tissue, light microscopy found 13,300 asbestos bodies per gram of wet lung tissue, compared with the laboratory's normal range of 0 to 20 per gram.
  • Scanning electron microscopy found 7,630 asbestos bodies and an additional 13,300 uncoated fibers per gram of wet lung tissue.
  • Of 20 fibers 5 micrometers or longer (10 coated, 10 uncoated) analyzed chemically, all were compatible with amosite. No chrysotile or tremolite fibers in this size range were identified in the sample of 20.
  • Despite not detecting it, the authors stated that chrysotile is present in the patient's lungs, noting that even people who never worked with asbestos typically carry chrysotile.
• The authors' conclusion: The authors concluded that the findings highlight the futility of estimating chrysotile exposure from fiber counts in lung tissue. They considered the 9-month shipyard job a very unlikely source of the amosite and presumed the patient was exposed to amosite during the first 25 years (1955 to 1980) of making soldering forms. They stated that the patient appears to be the first well-documented reported case of malignant mesothelioma in the commercial jewelry industry.
• Limitations the authors state:
  • The authors said their failure to detect chrysotile most likely reflected dilution by the more numerous commercial amphibole fibers and their laboratory protocol of chemically analyzing only 20 asbestos fibers 5 micrometers or longer.
  • Only fibers at or above a 5-micrometer length were chemically analyzed.
  • The length of the patient's amosite exposure is unknown and is presumed rather than documented.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pneumonectomy, Chrysotile, Mesothelioma, Amosite, Environmental Exposure.

Related studies

• Asbestos-related disease in the jewelry industry: report of two cases — D.G. Kern, H. Frumkin (1988)
• Asbestos-induced lung injury among Danish jewelry workers — M. Døssing, S.W. Langer (1994)
• Pulmonary mineral fibers after occupational and environmental exposure to asbestos in the Russian chrysotile industry — A. Tossavainen, E. Kovalevsky, et al. (2000)
• South Africa's export trade in asbestos: demise of an industry — J.S. Harington, N.D. McGlashan, et al. (2010)
• "Ain't Necessarily So!": The Brake Industry's Impact on Asbestos Regulation in the 1970s — D. Rosner, G. Markowitz (2017)
• Comprehensive assessment of exposures to elongate mineral particles in the taconite mining industry — J. Hwang, G. Ramachandran, et al. (2013)

Browse more research in American Journal of Industrial Medicine, or return to medical research.