Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust

Our plain-English summary of Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust, by S. Yazicioglu, R. Ilçayto, K. Balci, et al (Thorax, 1980).

The study

• Authors: S. Yazicioglu, R. Ilçayto, K. Balci, B.S. Sayli, B. Yorulmaz
• Journal: Thorax
• Published: 1980;35(8):564-9
• Cited by: 104 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002555).

Abstract

Around the town of Cermik in south-east Turkey there are many deposits of asbestiform minerals, some of which are used to make whitewash or stucco. A sample of 7000 of the population revealed 461 (6.5%) with pleural thickening and calcification, of whom 103 (1.47% of the total) had evidence of interstitial pulmonary fibrosis. Forty-one patients with respiratory cancer were admitted to the Diyarbakir Chest Hospital from around Cermik and from a comparable area of equal population (but without asbestos deposits) in 1977-8. Of these 23 were mesotheliomas, 22 coming from around Cermik. In addition, 11 of the 18 primary bronchial cancers came from around Cermik. A similar excess of mesothelioma and bronchial cancer had been admitted from the Cermik area in previous years. The whitewash or stucco material has been shown to contain fibrous tremolite and non-fibrous antigorite/lizardite, chlorite, and talc. A lung biopsy of a patient from Cermik contained large numbers of tremolite fibres, both free and forming asbestos bodies. There were only occasional chrysotile fibres.

In plain English

This 1980 study investigated "Cermik disease" in south-east Turkey. Villagers around the town of Cermik use local fibrous mineral deposits as whitewash or stucco for their houses. Of 7000 adults over 20 X-rayed in three districts (not a random sample), 461 (6.5%) had pleural thickening and calcification and 103 (1.47%) had signs of pulmonary fibrosis. Pleural changes became more frequent with age. In 1977-8 the Diyarbakir Chest Hospital admitted 23 patients with malignant pleural mesothelioma from five asbestos districts and seven comparison districts of similar population. Of these, 22 came from the asbestos districts. Bronchial cancers numbered 11 from asbestos districts versus 7 from comparison districts. That difference was not statistically significant alone but was significant when combined with 1968-76 admissions. Detailed analysis found the fibrous mineral in the stucco was tremolite, not chrysotile as first assumed. One patient's lung biopsy held mostly tremolite with a very small share of chrysotile. The authors concluded the stucco material appeared to cause the pleural changes, lung fibrosis and cancers. They noted only about 5% of the at-risk population had been X-rayed.

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: Chest X-ray survey of a non-random population sample, a comparison of lung and pleural cancer admissions to one hospital from asbestos and non-asbestos districts, and mineral analysis of stucco and one lung biopsy
• Who was studied: About 3700 men and 3300 women (7000 total) over age 20 from the Ergani, Cermik and Cingus districts (population 100 800), south-east Turkey. Also 41 patients with lung or pleural cancer admitted to Diyarbakir Chest Hospital in 1977 and 1978: 33 from five asbestos districts (population about 227 000) and 8 from seven non-asbestos districts (about 217 000).
• Exposure: Lifelong household exposure from birth to locally quarried whitewash or stucco material. The material contained fibrous tremolite (an amphibole) and non-fibrous chlorite, talc and serpentine (antigorite/lizardite). Men quarried it; women ground it to powder and applied it to walls and floors each year.
• Main results:
  • Among the 7000 people X-rayed, 461 (6.5%) had pleural thickening and calcification, and 103 (1.47% of the total) had evidence of interstitial pulmonary fibrosis.
  • Pleural changes showed no significant difference between the sexes but became more frequent with age.
  • Pulmonary changes appeared about 10 years later than the pleural changes and affected about 50% of the surveyed population over age 70.
  • Of the 41 patients with lung or pleural tumours admitted in 1977-8 from the 12 districts compared, 33 came from asbestos districts and 8 from control districts.
  • There were 23 malignant pleural mesotheliomas, of which only one came from the non-asbestos districts. Seventeen came from the three surveyed districts (population 100 000).
  • Among the mesothelioma patients, men and women were affected in equal numbers. The three patients under 40 were all women. All the men smoked cigarettes and none of the women did.
  • Primary bronchial cancer: 11 cases came from asbestos districts and 7 from non-asbestos districts in 1977-8. This difference was not statistically significant, but it was significant when combined with the 1968-76 figures (p less than 0.001).
  • Stucco from Cermik contained tremolite as its fibrous mineral, and its serpentine did not include chrysotile fibres. In the lung biopsy of one patient from Cermik, most fibrous particles were tremolite with a very small percentage of chrysotile. Elemental analysis of tremolite from the stucco and the biopsy was very similar, suggesting a common source.
  • Only six cases of pulmonary tuberculosis were found in the survey, fewer than the authors expected for the region.
• The authors' conclusion: The authors concluded that use of stucco containing a fibrous mineral (tremolite) appears to be the cause of the pleural reactions, pulmonary fibrosis and malignant tumours of the lungs and pleura in the Cermik area. They wrote that perhaps one-third of the bronchial cancers can be attributed to the asbestos exposure.
• Limitations the authors state:
  • The people X-rayed were those who could be persuaded to attend from villages known to use fibrous minerals, not a random sample.
  • The investigation covered about half the area at risk, and only about 5% of the population at risk had been X-rayed.
  • The detailed composition of the stucco material may vary from place to place within the area.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Calcification, Pleural Mesothelioma, Tremolite, Asbestiform, Whitewash, Pleural Thickening, Interstitial, Pulmonary Fibrosis.

Related studies

• Tremolite whitewashing and pleural calcifications — S.H. Constantopoulos, N.A. Saratzis, et al. (1987)
• Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? — S.H. Constantopoulos, Y.A. Dalavanga, et al. (1992)
• Pleural calcification associated with exposure to chrysotile asbestos in southeast Turkey — S. Yazicioglu (1976)
• Prevalence of pleural calcification in persons exposed to asbestos dust, and in the general population in the same district — M. Navrátil, F. Trippé (1972)
• The calcification of fibrous pleural lesions produced in guinea-pigs by the injection of chrysotile asbestos dust — J.M. Davis (1971)
• Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology — S.H. Constantopoulos, J.A. Goudevenos, et al. (1985)

Browse more research in Thorax, or return to medical research.