Chest
Volume 92, Issue 4, October 1987, Pages 709-712
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Clinical Investigations
Tremolite Whitewashing and Pleural Calcifications

https://doi.org/10.1378/chest.92.4.709Get rights and content

Radiologic screening of 688 inhabitants of the Metsovo area in Northwest Greece revealed that 323 (46.9 percent) had pleural calcifications. The percentage of positive examinations rose with age. Calcifications were observed in all four villages of the area where a material (“luto” soil) had been extensively used for whitewashing until 1940 to 1950. In four other villages in the immediate vicinity, where “luto” had never been used, pleural calcifications were not observed. Results suggest that Metsovo tremolite may have caused pleural calcifications to all individuals born in Metsovo before 1940. This is the first study indicating that environmental asbestos exposure can cause abnormalities in everyone exposed to it.

Section snippets

METHODS

Chest roentgenograms of 688 inhabitants of Metsovo, Milea, Anilio, and Votonossi were evaluated for PCs. The extent of involvement was graded from 1 to 4 as previously described.1 In the occupational/environmental questionnaire used in our first study, we added questions as to the use of “luto.” From those questioned, 240 were able to answer whether they had used or still use it and when its use was discontinued. From these 240, we selected a group of 118 who had stopped using “luto” around 20

RESULTS

From the 688 roentgenograms, 323 (46.9 percent) revealed PCs (Fig 1). They increased from 4.5 percent in the 25 to 39 year group to 71.5 percent in the group 70 + years old. Also increasing with age was the extent of PCs (Fig 1). The decline of the use of “luto” is shown in Figure 2. It was used by virtually all households until 1940. Since then, modern materials, plastic colors, etc, have displaced “luto,” and it is now used by less than 10 percent of those questioned. Figure 3 shows the

DISCUSSION

The results of this study suggest that there is a causal relationship between tremolite used for whitewashing (“luto”) and PCs observed in the Metsovo area. Our research was facilitated by the fact that we were dealing with two neighboring populations with similar life-style, similar professions, and similar housing, but with one difference: one used “luto” for whitewashing. “Luto” had been used by virtually all inhabitants of four villages and never used in the other four. Another point that

ACKNOWLEDGMENT

We wish to thank Professor H. M. Moutsopoulos for his valuable comments and Ms. E. E. Papanikolaou for excellent secretarial assistance.

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Manuscript received November 19; revision accepted February 11.

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