Chest
Volume 143, Issue 1, January 2013, Pages 164-171
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Original Research
Disorders of the Pleura
High Risk of Malignant Mesothelioma and Pleural Plaques in Subjects Born Close to Ophiolites

https://doi.org/10.1378/chest.11-2727Get rights and content

Background

Ophiolites, a special sequence of geologic rock units, are known sources of naturally occurring asbestos. The aim of this study was to test whether the occurrence of malignant mesothelioma (MM) or pleural plaques (PPs) in the province of Sivas, Turkey, is determined by the proximity of the patient's birthplace to ophiolites and, if so, to establish the magnitude of the risk.

Methods

The birthplaces of patients with MM or PPs (cases) and patients with prostate or breast cancer (control subjects), diagnosed between 2000 and 2010 and identified through a mandatory cancer registry or from hospital records (PPs), were located on a geologic map, and the nearest distance to ophiolites was measured. The relation of MM or PPs with distance to ophiolites was analyzed by logistic regression. Samples of soil and house plaster were determined by x-ray diffraction.

Results

Patients with MM (n = 100) or PPs (n = 133) were born significantly nearer to ophiolites (median distance, 4.5 km for men, 0 km for women) than were patients with prostate cancer (n = 161) or breast cancer (n = 139) (median distance, 20 km for both). ORs were 1.6 (men) (P < .001) and 2.0 (women) (P < .001) for every 5-km decrease in the distance of birthplace to ophiolites for MM, compared with prostate and breast cancer, respectively.

Conclusion

In this area without substantial industrial asbestos use, there is an association between the occurrence of mesothelioma (and of PPs) and the proximity of the subject's birthplace to ophiolites.

Section snippets

Materials and Methods

Patients given a diagnosis of MM (International Classification of Diseases [ICD] code C45), breast cancer (ICD code C50), or prostate cancer (ICD code 61) between 2000 and 2010 were identified through the cancer registry of the Provincial Directorate of Health, to which physicians are mandated to declare malignant diseases. Patients given diagnoses of PPs (ICD code J92) made over the same period were identified from the digital databases of the two hospitals with a pulmonology division in Sivas

Results

Two-hundred sixty-one patients with either MM (n = 123) or PPs (n = 138), 178 patients with breast cancer, and 196 patients with prostate cancer were identified. Three patients with MM were excluded because they had been born in Tuzköy, a village in another province about 250 km away from Sivas and known for the presence of erionite.19 Birthplaces could be determined for 100 patients with MM (81%), 133 patients with PPs (96%), 161 patients with prostate cancer (82%), and 139 patients with

Discussion

We demonstrated that two conditions that have been well established to result from exposure to asbestos, namely MM and PPs, were closely related to the proximity of the subject's birthplace to sources of NOA (ophiolites). Having been born close to ophiolites was associated with a substantially increased risk of MM or PPs, compared with two other types of cancer, with women appearing to be at higher risk than men.

The occurrence of MM or PPs in relation to ophiolites in the northwest area of the

Conclusions

Although the industrial use of asbestos has been banned or restricted in many countries, benign and malignant diseases due to asbestos will not disappear for many years, as a result of the presence of asbestos in many buildings and products.33 Even though the incidence of “endemic” MM resulting from the use of NOA fibers for whitewashing houses has been shown to have decreased in some areas,34 our study and our observations in the field suggest that the epidemic will remain present for many

Acknowledgments

Author contributions: Dr Bayram is the guarantor and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Bayram: contributed to the concept and design of the study; acquisition, analysis, and interpretation of data; drafting of the article; and critical revision of the article for important intellectual content.

Dr Dongel: contributed to the acquisition, analysis, and interpretation of data and writing of the article.

Dr Bakan: contributed to the concept

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    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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