Pleural mesothelioma in a circus worker

Our plain-English summary of Pleural mesothelioma in a circus worker, by C. Mensi, C. Zellino, M. Polonioli, et al (Journal of Occupational Health, 2021).

The study

• Authors: C. Mensi, C. Zellino, M. Polonioli, B. Dallari, A.C. Pesatori, L. Riboldi, D. Consonni
• Journal: Journal of Occupational Health
• Published: 2021;63(1):e12250
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: To describe an unusual occupational asbestos exposure in a patient with mesothelioma.

Methods: Since 2000, the Lombardy Mesothelioma Registry (LMR) collects cases of malignant mesothelioma (MM) occurring among people residing in the Lombardy Region, North-West Italy, with a population of 10 million inhabitants. For each case, clinical records and asbestos exposure are collected. Each case is then classified in agreement with the guidelines of the National Mesothelioma Registry.

Results: We identified a male (86 years old), former smoker, who had been working for 53 years as a circus truck driver and tamer of lions and tigers. The first circumstance of exposure was the use of an asbestos tape that wrapped around the hoop in the feline jumping show with a flaming hoop. The second one was the presence of insulating panels protecting the engine placed inside the trucks.

Conclusion: A new MM case with an occupational etiology has been found in the public entertainment, an occupational sector not usually considered at risk for the presence of asbestos.

© 2021 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.

In plain English

This was a case report from the Lombardy Mesothelioma Registry in northern Italy. It described a man, born in 1931, reported to the registry in 2017 with pleural mesothelioma. He had smoked filter cigarettes from 1951 to 1970. At age 86 he developed worsening breathlessness. A CT scan showed fluid around the right lung; tissue examination showed mesothelioma with sarcomatoid and desmoplastic features. He died in May 2017, surviving 3 months. From 1947 to 2000 he worked in a circus as a handyman and tamer of tigers and lions. In acts where animals jumped through fire hoops, asbestos tape wrapped the hoop. He replaced the tape by hand; the old tape crumbled in his hands. He stopped using it in 1990. Exposure was described as a few hours daily for 43 years. No fiber type was identified for his tape or truck insulation. A second possible source, engine insulation in the trucks he drove, remained uncertain. No exposure outside work was reported. The authors classified the case as occupational mesothelioma and described it as the first reported case in a circus worker.

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 (single patient identified through a population-based mesothelioma registry)
• Who was studied: One man, born in 1931, resident in the Lombardy Region of North-West Italy, reported to the Lombardy Mesothelioma Registry in 2017 at age 86
• Exposure: Asbestos tape wrapped around flaming hoops used in a lion and tiger jumping act, replaced by hand before each show and during daily training, a few hours daily for 43 years (use of the tape stopped in 1990). No fiber type was identified for this worker's tape or truck insulation; the article names chrysotile and crocidolite only when discussing asbestos found in renovated entertainment buildings. A possible second source was insulating panels protecting truck engines inside the driver's cab, but this remained uncertain.
• Main results:
  • The patient had worked in the circus from 1947 to 2000 (53 years) as a handyman and tamer of tigers and lions
  • The removed asbestos tape was damaged and crumbled in the worker's hands
  • Duration of exposure to the asbestos tape was a few hours daily for 43 years
  • The patient smoked filter cigarettes (5 to 6 per day) from 1951 to 1970
  • A chest CT scan showed a right pleural effusion
  • Histology of pleural specimens showed a mesothelioma with sarcomatoid and desmoplastic aspects
  • The patient died in May 2017, surviving 3 months
  • Possible exposure from engine insulation in the trucks he drove remained uncertain
  • No extra-professional exposure (environmental or familial) was reported
  • The case was defined as an occupational mesothelioma
• The authors' conclusion: The authors concluded that this was the first reported case of mesothelioma in a circus worker with direct exposure to asbestos used as lining of fire hoops, and that it shows the need for a thorough examination of occupational history.
• Limitations the authors state:
  • The worker could not report the truck models he drove, so exposure from truck engine insulation could not be confirmed

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, Asbestos Exposure, Mesothelioma, Malignant Mesothelioma, Etiology.

Related studies

• Mesothelioma in Agriculture in Lombardy, Italy: An Unrecognized Risk — C. Mensi, B. Dallari, et al. (2021)
• Asbestos Exposure in Patients with Malignant Pleural Mesothelioma included in the PRIMATE Study, Lombardy, Italy — A. Spinazzè, D. Consonni, et al. (2022)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)
• Impact of an asbestos cement factory on mesothelioma incidence in a community in Italy — D. Consonni, S. De Matteis, et al. (2020)
• Estimate of environmental and occupational components in the spatial distribution of malignant mesothelioma incidence in Lombardy (Italy) — D. Catelan, D. Consonni, et al. (2020)
• Gender differences in pleural mesothelioma occurrence in Lombardy and Piedmont, Italy — D. Consonni, E. Migliore, et al. (2019)

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