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Re: Radiation as a cause of mesothelioma.

Dear Editor

Atkinson et al,[1] reported “particularly among those monitored for plutonium exposure there was a significant excess mortality from cancer of the pleura”.

However, they also note the lack of a trend for radiation dose. The authors’ suggest that these cancers are mostly mesothelioma and that asbestos is the likely causative agent. There is no mention of other agents that can cause mesothelioma; although they elude to other causes (“…are strongly related to exposure to asbestos.”). I would like to point out that others [2-4] reported ionizing radiation as a possible aetiological agent for mesothelioma. This appears to include a case4 involving short- term ionizing radiation exposure. In addition, mesothelioma appears to be caused by a number of other agents (e.g. sugar cane, viruses)[5,6] besides asbestos and radiation. It has been suggested that non-asbestos causes of mesothelioma may be as high as 87%,[7] although a lower percent has been reported (around 13%).[8] Readers need to be aware that there appears to be many agents, including spontaneous events5, which may be responsible for cases of pleural cancer (mesothelioma).

References

1. Atkinson WD., Law DV., Bromley KJ., Inskip HM. Mortality of employees of the United Kingdom atomic energy authority, 1946-87. Occup Environ Med. 2004; 61:577-85.

2. Lerman Y, Learman Y, Schachter P, Herceg B, Lieberman Y, Yellin A. Radiation associated malignant pleural mesothelioma. Thorax. 1991;46:463- 4.

3. Hoffman J, Mintzer D, Warhol MJ. Malignant mesothelioma following radiation therapy. Am J Med. 1994;94:379-92.

4. Mizuki M, Yukishige K, Abe Y, Tsuda T. A case of malignant pleural mesothelioma following exposure to atomic radiation in Nagasaki. Respirology. 1997;2:201-5.

5. Hubbard R. The aethiology of mesothelioma: are risk factors other than asbestos exposure important? Thorax 1997;52:406-7.

6. Lange JH. Other non asbestos causes of mesothelioma besides the SV40 virus. (eletter) Thorax. 2004; http://thorax.bmjjournals.com/cgi/eletters/57/4/353#161

7. Peterson JT, Greenberg SD, Buffler PA. (1984) Non-asbestos-related malignant mesothelioma: a review. Cancer 54:951-60.