Unusually high incidence of malignant pleural mesothelioma in a town of eastern Sicily: an epidemiological and environmental study

Our plain-English summary of Unusually high incidence of malignant pleural mesothelioma in a town of eastern Sicily: an epidemiological and environmental study, by L. Paoletti, D. Batisti, C. Bruno, et al (Archives of Environmental Health, 2000).

The study

• Authors: L. Paoletti, D. Batisti, C. Bruno, M. Di Paola, A. Gianfagna, M. Mastrantonio, M. Nesti, P. Comba
• Journal: Archives of Environmental Health
• Published: 2000;55(6):392-8
• Type of article: Case report
• Cited by: 79 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In a recent epidemiological study, researchers investigated mortality from malignant pleural neoplasms in Italy, and they detected some geographic clusters of cases of this disease. We found a town located in a volcanic area of eastern Sicily to be of special interest. The residents, some of whom were diagnosed with pleural mesothelioma, had never had any relevant exposure to asbestos during their professional lives. The results of an environmental survey suggested that a possible cause of asbestos exposure was the stone quarries near the town. The products of the quarries contain fibrous amphiboles, which are used widely in the local building industry. These fibrous amphiboles were identified as intermediate phases between tremolite and actinolite. Samples were collected from buildings in the town, and concentrations of amphibole fibers were evaluated. Fibrous phases were detected in 71% of the samples, and fiber concentrations ranged from a few thousand to more than 4 x 10(4) fibers/mg of material. In addition, we conducted a study on the mineral fiber lung burden in a pleural mesothelioma case. Many mineral fibers that were classified as the same tremolite-actinolite fibrous amphibole found in the quarries and in the building materials were detected in the lung tissue. The results suggest that the inhabitants of the town we studied had been exposed for several decades to asbestos fibers that were present in the material extracted from the local stone quarries. The material was subsequently used in the building industry, and this has caused an increased risk of pleural mesothelioma in the area.

In plain English

The authors studied Biancavilla, a town of about 23,000 people in a volcanic area of eastern Sicily. Comparing residents' deaths in 1980 to 1993 with Sicilian rates, they found 9 deaths from malignant pleural cancer against 2.31 expected (SMR 390, 95% CI 178 to 740), with a stronger excess among women. Lung cancer deaths matched expectations. A raised figure for peritoneal cancer in women was not statistically significant. The authors detected no increase in ovarian cancer deaths (2 observed, 6.03 expected). Of 17 pleural mesothelioma cases identified, 9 had no evidence of occupational asbestos exposure. Material from the nearby Monte Calvario stone quarries contained fibrous amphibole intermediate between tremolite and actinolite. This amphibole was found in 18 of 25 sand and plaster samples and in 27 of 38 samples from buildings. Lung tissue from an 86-year-old housewife who died with pleural mesothelioma contained the same fibers. The authors concluded that residents had been exposed for decades to these fibers through quarry material used in local building, and that this had raised the risk of pleural mesothelioma.

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: Combined epidemiological and environmental study: a mortality analysis (standardized mortality ratios against Sicilian rates), a case series of pleural mesothelioma with exposure interviews, mineralogical analysis of quarry material, sampling of building materials, and lung fiber analysis in one case
• Who was studied: Residents of Biancavilla, eastern Sicily, Italy (population approximately 23,000), studied for mortality from 1980 through 1993; 17 pleural mesothelioma cases listed; one 86-year-old woman for lung fiber analysis
• Exposure: Fibrous amphibole intermediate between tremolite and actinolite (classified as Na-F-tremolite and Na-F-actinolite) in material from the Monte Calvario stone quarries, used in local building materials such as sand and plaster
• Main results:
  • Residents, 1980 to 1993, all ages: 9 observed deaths from malignant pleural neoplasms against 2.31 expected, SMR 390 (95% CI 178, 740). The increase was relatively stronger among women, in people 65 or younger, and in the most recent years.
  • Women, 1980 to 1993, all ages: 5 observed deaths from malignant pleural neoplasms against 0.74 expected, SMR 676 (95% CI 219, 1,577)
  • Lung cancer, all residents: 80 observed against 81.21 expected deaths, SMR 99 (95% CI 78, 123)
  • Peritoneal malignant tumor among women: 4 observed against 1.30 expected, SMR 308 (95% CI 84, 788). This was not statistically significant.
  • Ovarian cancer mortality among women: 2 observed against 6.03 expected deaths, SMR 33. The authors were unable to detect any increased mortality.
  • Of the 17 pleural mesothelioma cases listed, occupational exposure to asbestos was probable for 2 and could not be ruled out for 5. There was no evidence of it for 9, and it could not be assessed for 1.
  • Based on 8 cases in the most recent 5 years in about 23,000 people, the authors estimated an annual incidence of approximately 7.0 per 100,000, about 10 times the average rate in Italy
  • X-ray analysis of quarry samples identified mineral phases intermediate between tremolite and actinolite
  • First set of building samples: amphibole fibrous phases were found in 18 of 25 samples (72%): 9 of 13 sands (69%) and 9 of 12 plasters (75%)
  • Second set, from buildings with known construction dates: fibrous phases were found in 27 of 38 samples (71%), at concentrations from a few thousand to more than 4 x 10 to the 4th fibers per mg of material
  • Lung tissue from an 86-year-old woman who died with pleural mesothelioma (a housewife married to a farm laborer who had always lived in Biancavilla) contained several fibers identified as the Monte Calvario tremolite-actinolite amphibole. The fibers were 12 to 40 micrometers long and 0.4 to 1 micrometer in diameter.
• The authors' conclusion: The authors concluded that Biancavilla residents had been exposed for several decades to asbestos fibers in material from the local quarries used in building, and that this caused an increased risk of pleural mesothelioma in the area. They considered the exposure environmental rather than occupational.
• Limitations the authors state:
  • The increase in peritoneal neoplasms rested on only a few cases
  • The relationship between ovarian cancer and asbestos exposure is controversial
  • The case series was considered adequately complete only for the most recent five-year period

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, Neoplasm, Asbestos Exposure, Amphibole Group, Tremolite, Actinolite, Mineral Fiber.

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