Malignant pleural mesothelioma in Turkey, 2000-2002

Our plain-English summary of Malignant pleural mesothelioma in Turkey, 2000-2002, by S. Emri, A.U. Demir (Lung Cancer, 2004).

The study

• Authors: S. Emri, A.U. Demir
• Journal: Lung Cancer
• Published: 2004;45 Suppl 1:S17-20
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Both asbestos and erionite related malignant pleural mesothelioma (MPM) is a serious health problem in Turkey. Erionite has a higher potency in the lung than asbestos and familial clustering of malignant mesothelioma suggests a genetic predisposition to this cancer among affected individuals. Neither Simian virus 40 (SV40) nor human herpes virus 8 (HHV-8) are co-factors in the pathenogenesis of environmentally induced mesothelioma. A survival advantage has been demonstrated in patients with asbestos-induced mesothelioma compared with erionite-induced mesothelioma. This together with the proliferation index (PI) can be used as an independent prognostic factor for patients with malignant pleural mesothelioma. It is envisaged that the application of these prognostic approaches together with the new TNM staging system will allow investigations to be more precisely carried out and evaluated.

In plain English

This short article was a review rather than a new study. The authors summarised earlier research, largely by their own group, on malignant pleural mesothelioma in Turkey linked to environmental exposure to asbestos and to erionite, a non-asbestos fibrous zeolite found in building stone in Cappadocian villages. They described rural use of whitewash or stucco contaminated mainly with tremolite. They estimated that about 16 million people in rural Anatolia had been environmentally exposed to mineral fibre. A cited survey reported 506 new mesothelioma cases (464 pleural, 42 peritoneal) for 2000, with no history of occupational exposure obtained in any of them; 30 of the 506 came from erionite villages. Other cited studies reported shorter survival in erionite-exposed than in asbestos-exposed patients (median 13.5 versus 21.5 months in one study; 8 versus 14 months, not significant, in another). They also reported family clustering of mesothelioma in erionite villages, and that SV40 (in Turkey) and HHV-8 were not co-factors in environmentally induced mesothelioma. The authors concluded that the new TNM staging system and prognostic groups would let investigations be carried out and evaluated more precisely.

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: Narrative review summarising earlier published and conference research on mesothelioma in Turkey, much of it by the authors' group; no new study methods are described
• Who was studied: Rural populations of Anatolia, Turkey, environmentally exposed to asbestos or erionite, and mesothelioma patients described in the cited studies; the authors estimated about 16 million people exposed
• Exposure: Environmental (non-occupational) exposure in two forms. The first was asbestos in locally used whitewash or stucco, mainly tremolite, plus chrysotile and, in certain districts, anthophyllite. The second was erionite, a non-asbestos fibrous zeolite in volcanic tuff building stone in three Cappadocian villages.
• Main results:
  • A cited survey reported 506 new mesothelioma cases in Turkey for the year 2000: 464 pleural and 42 peritoneal
  • In the cited 2000 survey, no history of occupational exposure to asbestos or erionite was obtained in any case, and 30 of the 506 cases were from the erionite villages
  • A cited mortality study of the erionite villages and nearby villages for 1994 to 1997 found that 53 of 64 reported mesothelioma deaths were from the three erionite villages
  • A cited retrospective study (Selcuk et al.) reported a median survival after diagnosis of 13.5 months for erionite-exposed patients and 21.5 months for asbestos-exposed patients with malignant pleural mesothelioma (P less than 0.01)
  • In another cited study, overall median survival was 10 months; survival was 8 months for erionite-related cases versus 14 months for asbestos-related cases, a difference that was not significant
  • The authors reported that they had found the proliferation index to be an independent prognostic factor for malignant pleural mesothelioma (in a cited earlier study)
  • A cited genetic-epidemiologic study found some families in the erionite villages with clustering of malignant mesothelioma cases, which suggested a genetic predisposition
  • A cited study concluded that Simian virus 40 was not a co-factor in environmental malignant mesothelioma in Turkey; the article notes that other studies had suggested SV40 may be a co-factor in human mesotheliomas
  • A cited study concluded that environmentally induced mesothelioma was not related to HHV-8
  • Cited experimental studies in which fibres were given by the intrapleural route found erionite to have 300 to 800 times more carcinogenic potency than chrysotile and 100 to 500 times more than crocidolite
  • The authors noted two of their own malignant pleural mesothelioma patients who survived over 4 and 10 years without any treatment
• The authors' conclusion: The authors concluded that applying the new TNM staging system and distinguishing prognostic groups would allow investigations to be carried out and evaluated more precisely

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, erionite, Malignant Mesothelioma, SV40, Mesothelioma, TNM Staging.

Related studies

• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Genetic predisposition to fiber carcinogenesis causes a mesothelioma epidemic in Turkey — A.U. Dogan, Y.I. Baris, et al. (2006)
• Erionite exposure in North Dakota and Turkish villages with mesothelioma — M. Carbone, Y.I. Baris, et al. (2011)
• Endemic malignant mesothelioma: exposure to erionite is more important than genetic factors — M. Metintas, G. Hillerdal, et al. (2010)
• Erionite series minerals: mineralogical and carcinogenic properties — A.U. Dogan, M. Dogan, et al. (2008)

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