Response to the "Letter to the Editor" by Gabor Mezei et al., Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register"

Our plain-English summary of Response to the "Letter to the Editor" by Gabor Mezei et al., Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register", by L. Vimercati, D. Cavone, M.C. Delfino, et al (Environmental Health, 2019).

The study

• Authors: L. Vimercati, D. Cavone, M.C. Delfino, L. De Maria, A. Caputi, G.M. Ferri, G. Serio
• Journal: Environmental Health
• Published: 2019;18(1):112
• Type of article: Letter
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

In this letter, which presented no new data, the authors replied to criticism by Gabor Mezei and colleagues of their own 2019 systematic review and Apulia (southern Italy) mesothelioma register report on malignant mesothelioma of the tunica vaginalis testis (MMTVT), a rare cancer. The authors accepted that their review had wrongly cited the 2012 IARC Monograph as supporting asbestos as an established cause of MMTVT. They disagreed that only heavy workplace exposure could cause MMTVT. They also argued that asbestos exposure in published cases had often not been investigated, rather than having been found absent. They cited other work. One was an Italian national register report in which 78% of 68 MMTVT cases had ascertained asbestos exposure. Another was a set of preliminary, unpublished case-control results for occupational asbestos exposure (odds ratio 7.940; 95% CI 3.01–18.2). They stated that their own register cases had ascertained exposure and an average latency of 47 years. They agreed that the causes of MMTVT remained poorly understood. The authors concluded that, while not definitive evidence of causation, the available data strongly suggested that asbestos exposure increases MMTVT risk.

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: Letter to the editor (authors' reply to criticism of their earlier systematic review); no new data
• Who was studied: No study population; the letter responds to a letter by Gabor Mezei et al. about the authors' 2019 review and Apulia mesothelioma register cases of malignant mesothelioma of the tunica vaginalis testis
• Exposure: Asbestos exposure (no fiber types named) as a possible cause of malignant mesothelioma of the tunica vaginalis testis
• Main results:
  • The authors accepted the criticism that their review incorrectly cited the 2012 IARC Monograph as supporting asbestos as an established cause of MMTVT
  • The authors disagreed that only heavy workplace asbestos exposure may induce MMTVT
  • Citing earlier studies on 289 MMTVT cases (from their review), the authors stated that 47.6% of cases in which asbestos exposure was investigated were positive, while for 42% of cases the data were not available because exposure had not been investigated
  • Citing Marinaccio et al. 2010, the authors noted that 50% of MMTVT cases were reported in sectors such as construction, steel, and transport construction and maintenance
  • Citing the sixth report of the Italian National Mesothelioma Register (ReNaM), the authors stated that 78% of 68 MMTVT cases recorded in 1993 to 2015 had ascertained asbestos exposure
  • The authors stated that radiation-related mesothelioma reports concerned pericardial mesothelioma, not MMTVT, and noted that Mezei et al. 2017 reported no prior radiation therapy history for tunica vaginalis testis mesothelioma
  • The authors stated that their own register cases had ascertained asbestos exposure and an average latency period of 47 years
  • Preliminary results of a case-control study from the Italian mesothelioma registry (Marinaccio et al., personal communication) were reported to show occupational asbestos exposure significantly associated with MMTVT: OR = 7.940; 95% CI 3.01–18.2
  • The authors agreed that the aetiology of MMTVT is inadequately researched and poorly understood
• The authors' conclusion: The authors concluded that the weight of evidence from currently available data strongly suggests that asbestos exposure increases mesothelioma risk in the tunica vaginalis testis, while acknowledging that this is not definitive evidence of causality and that further work is needed
• Limitations the authors state:
  • The authors acknowledged that the evidence is not definitive proof of causality
  • The authors agreed that little is known about the epidemiology of MMTVT and that information on potential confounders is limited

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Malignant Mesothelioma, Tunica Vaginalis, Systematic Review, Mesothelioma.

Related studies

• Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register" — G. Mezei, E.T. Chang, et al. (2019)
• Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register — L. Vimercati, D. Cavone, et al. (2019)
• Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy — L. Vimercati, D. Cavone, et al. (2019)
• Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis" — A. Marinaccio, D. Consonni, et al. (2021)
• Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation — L. Vimercati, D. Cavone, et al. (2018)
• Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2021)

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