Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053"

Our plain-English summary of Reply to Mirabelli et al. Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on "Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053", by S.D. Visonà, S. Capella, S. Bodini, et al (International Journal of Environmental Research and Public Health, 2021).

The study

• Authors: S.D. Visonà, S. Capella, S. Bodini, P. Borrelli, S. Villani, E. Crespi, A. Frontini, C. Colosio, R. Vigliaturo, E. Belluso
• Journal: International Journal of Environmental Research and Public Health
• Published: 2021;18(13)
• Type of article: Comment
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We appreciate very much the interest of Mirabelli et al. [...].

In plain English

This is a letter, not a new study. The authors replied to a comment by Mirabelli and colleagues on their earlier autopsy study of lung fiber burden in people with occupational and/or environmental asbestos exposure in Broni, northern Italy, which used scanning electron microscopy (SEM-EDS). They defended how they had cited other researchers' work, which they said showed inconsistent links between lung asbestos levels and malignant mesothelioma. They restated findings from their earlier study of 72 people. Mesothelioma cases had fewer fibers and fewer asbestos bodies than asbestosis patients, some mesothelioma patients had no asbestos in their lungs, and no chrysotile was found. They argued that chrysotile was absent rather than missed, pointing to their methods and to the 8 to 44 years between last exposure and death. They reported that preliminary, unpublished electron microscopy work had so far confirmed no chrysotile, while amphibole fibers were found. The authors stated that their findings do not question asbestos as a cause of mesothelioma. They noted that the fiber burden found in the lungs does not exactly reflect what was inhaled.

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: Reply letter (commentary) responding to a published comment on the authors' earlier autopsy lung fiber burden study; no new study is reported
• Who was studied: Refers to the 72 deceased subjects of the authors' earlier study in Broni (Pavia, Northern Italy); the time between last exposure and death was 8–44 years
• Exposure: Occupational and/or environmental asbestos exposure; the earlier study compared people who died of malignant mesothelioma with people who died of asbestosis, both exposed in similar settings
• Main results:
  • In the earlier study (restated here), among the 72 individuals, malignant mesothelioma cases had fewer fibers and fewer asbestos bodies than asbestosis patients
  • In the earlier study, no asbestos was found in some mesothelioma patients, and no chrysotile was found at all
  • The authors stated that a non-negligible proportion of mesothelioma patients showed no asbestos in their lungs
  • Fibers shorter than 5 µm were left out of the study's fiber counts under the standard fiber definition, but they were also examined. Short fibers identified as asbestos were present in about 40% of cases, and none of them were chrysotile/asbestiform antigorite
  • Preliminary, unpublished TEM-EDS and SAED analyses of some of the samples had so far confirmed the absence of chrysotile, while amphibole fibers were found
• The authors' conclusion: The authors concluded that their findings do not question the role of asbestos in causing mesothelioma, but allow new considerations beyond what is known. They suggested, as possibilities, that chrysotile degraded in the lung might play a role, and that coating of fibers in asbestosis patients might be protective
• Limitations the authors state:
  • The mineral type of fibers inside asbestos bodies could not be determined with SEM-EDS
  • The fiber burden detected in the lungs is not an exact reflection of the fibers that were inhaled
  • Asbestosis patients cannot be regarded as controls, because they died of an asbestos-related disease

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.

Related studies

• Is Mesothelioma Unrelated to the Lung Asbestos Burden? Comment on Visonà et al. Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples. Int. J. Environ. Res. Public Health 2021, 18, 2053 — D. Mirabelli, A. Angelini, et al. (2021)
• Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples — S.D. Visonà, S. Capella, et al. (2021)
• Evaluation of Deposition and Clearance of Asbestos (Detected by SEM-EDS) in Lungs of Deceased Subjects Environmentally and/or Occupationally Exposed in Broni (Pavia, Northern Italy) — S.D. Visonà, S. Capella, et al. (2021)
• Reply to Comment on Małgorzata Krówczyńska and Ewa Wilk. Environmental and Occupational Exposure to Asbestos as a Result of Consumption and Use in Poland. Int. J. Environ. Res. Public Health 2019, 16, 2611 — M. Krówczyńska, E. Wilk (2020)
• Asbestos burden in lungs of non-occupationally exposed women from Broni (Pavia, Italy): a postmortem SEM-EDS study — S.D. Visonà, S. Capella, et al. (2023)
• Impact of asbestos on public health: a retrospective study on a series of subjects with occupational and non-occupational exposure to asbestos during the activity of Fibronit plant (Broni, Italy) — S.D. Visonà, S. Villani, et al. (2018)

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