Mesothelioma in a wine cellar man: detailed description of working procedures and past asbestos exposure estimation

Our plain-English summary of Mesothelioma in a wine cellar man: detailed description of working procedures and past asbestos exposure estimation, by A. Nemo, S. Silvestri (The Annals of Occupational Hygiene, 2014).

The study

• Authors: A. Nemo, S. Silvestri
• Journal: The Annals of Occupational Hygiene
• Published: 2014;58(9):1168-74
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A pleural mesothelioma arose in an employee of a wine farm whose work history shows an unusual occupational exposure to asbestos. The information, gathered directly from the case and from a work colleague, clarifies some aspects of the use of asbestos in the process of winemaking which has not been previously reported in such details. The man had worked as a winemaker from 1960 to 1988 in a farm, which in those years produced around 2500 hectoliters of wine per year, mostly white. The wine was filtered to remove impurities; the filter was created by dispersing in the wine asbestos fibers followed by diatomite while the wine was circulating several times and clogging a prefilter made of a dense stainless steel net. Chrysotile asbestos was the sole asbestos mineralogical variety used in these filters and exposure could occur during the phase of mixing dry fibers in the wine and during the filter replacement. A daily and annual time weighted average level of exposure and cumulative dose have been estimated in the absence of airborne asbestos fiber monitoring performed in that workplace. Since 1993, the Italian National Mesothelioma Register, an epidemiological surveillance system, has recorded eight cases with at least one work period spent as winemaker. Four of them never used asbestos filters and presented exposures during other work periods, the other four used asbestos filters but had also other exposures in other industrial divisions. For the information hitherto available, this is the first mesothelioma case with exclusive exposure in the job of winemaking.

© The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

In plain English

This case report described a non-smoker born in 1933, identified through mesothelioma surveillance in Tuscany, Italy, who developed pleural mesothelioma (sarcomatoid type), diagnosed in 2012. He was a farm winemaker from 1960 to 1988, with no other asbestos exposure reported by the authors. Interviews and purchase records showed the farm built wine filters from chrysotile asbestos and diatomite until about 1975. Exposure could occur when he opened bags and scattered fibers onto the wine. No air measurements existed, so the authors estimated exposure from data on other jobs. They estimated a daily average of 0.32 fibers per cubic centimetre (range 0.17 to 0.48) during a filtration season of about 100 days a year, an annual average of about 0.13 (range 0.07 to 0.2), and a cumulative exposure over 15 years of about 2.0 fiber-years per cubic centimetre (upper end 3.0; the lower end is misprinted). Disease began 52 years after first exposure. The authors concluded this was the only case in Italy's national mesothelioma list with exposure solely from wine filtration. They noted their estimates rest on limited, uncertain data.

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 with a retrospective (estimated) reconstruction of past asbestos exposure
• Who was studied: One man, a non-smoker born in 1933, who worked as a winemaker on an Italian wine farm from 1960 to 1988. The farm produced about 2500 hectoliters of wine a year. The case was identified through the Tuscany mesothelioma surveillance system.
• Exposure: Chrysotile asbestos fibers (bought in 1 kg bags) used together with diatomite to build wine filters. He used about 2 kg a day during a filtration season of about four months a year. Exposure came from opening bags and scattering fibers on the wine, and possibly from dried filter residues on the floor. Asbestos use in the filters continued until about 1975. He wore no respiratory protection. He worked as an office clerk in two other periods, with no other asbestos exposure reported.
• Main results:
  • The man developed a right pleural effusion in October 2012. Thoracoscopy showed pleural mesothelioma, which was confirmed by histology as sarcomatoid type.
  • The authors reported that he had no other asbestos exposure during his working life.
  • The authors estimated, from published data on other settings, peak levels of 7.2 to 22 fibers per cubic centimetre while bags were opened and fibers spread. Each operation lasted about 5 minutes, twice a day.
  • His estimated daily time-weighted average exposure on working days was 0.32 fibers per cubic centimetre (range 0.17 to 0.48).
  • Because the filtration work lasted about 100 days a year, with close to no exposure for the rest of the year, his estimated annual time-weighted average exposure was about 0.13 fibers per cubic centimetre (range 0.07 to 0.2).
  • His estimated cumulative exposure over 15 years of work was about 2.0 fiber-years per cubic centimetre. The upper end of the range was 3.0. The lower end is printed as '05' and cannot be read with certainty.
  • The authors applied figures from an earlier published risk analysis (Hodgson and Darnton, 2000). That analysis gave about 5 deaths per 100 000 exposed, with an uncertainty interval of 1 to 20, at 1 fiber-year per millilitre of chrysotile. On that basis, the authors stated that the risk at about 2 fiber-years should be slightly higher.
  • The time between his first exposure and the onset of disease was 52 years.
  • Among 2035 cases in the Tuscany Mesothelioma Registry (1988 to 2013), this was the first case in a winemaker whose exposure could be confirmed and estimated in terms of intensity.
  • The Italian National Mesothelioma Register recorded eight cases from 1993 to 2008 with at least one period of work as a cellar man. Four of these were exposed to asbestos in other periods and not as winemakers. The others were exposed both as winemakers and in other periods.
• The authors' conclusion: The authors concluded that this case is the only one in the Italian national case list with asbestos exposure solely during wine filtration, and that it involved only chrysotile. They also concluded that collecting full work histories directly from patients during surveillance is needed to identify such cases.
• Limitations the authors state:
  • Airborne asbestos was never measured at this workplace. The estimates rely on the few data available in the literature, mostly from other jobs.
  • The authors called the assumed background level inside the cellar arbitrary.
  • The upper exposure estimate might be too low, because the filter fibers were heavily processed and may have dispersed more easily than raw asbestos.
  • The national count of cases among winemakers might be too low, because some cases may have been recorded only as agricultural workers.
  • There are no official figures on how many cellar workers there were, or how many used asbestos, so a reliable risk calculation was not possible.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Pleural Mesothelioma, Work History, Occupational Exposure, Chrysotile, Cumulative Dose.

Related studies

• Pleural mesothelioma after a short interval from first exposure in the wine filter industry — G. Scansetti, F. Mollo, et al. (1984)
• Asbestos fibers in wines: relation to filtration process — A. Gaudichet, M. Bientz, et al. (1978)
• Exposure of UK industrial plumbers to asbestos, Part II: Awareness and responses of plumbers to working with asbestos during a survey in parallel with personal sampling — D. Bard, G. Burdett (2007)
• Airborne fiber size characterization in exposure estimation: Evaluation of a modified transmission electron microcopy protocol for asbestos and potential use for carbon nanotubes and nanofibers — J.M. Dement, E.D. Kuempel, et al. (2015)
• A procedure for the estimation of asbestos collected on membrane filters using transmission electron microscopy (TEM) — A.P. Middleton, E.A. Jackson (1982)
• Estimation of the past and future burden of mortality from mesothelioma in France — A.G. Ilg, J. Bignon, et al. (1998)

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