Asbestos-Related Mesothelioma: Epidemiological Evidence for Asbestos as a Promoter
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Abstract:
A series of 144 cases of mesothelioma among asbestos workers indicated important divergences from the epidemiological pattern shown to exist for asbestos-related lung cancer. Consideration of exposure duration and intensity and the latent period between first exposure and death suggests that asbestos does not act as a complete carcinogen, but as a promoter. A threshold seems probable for both duration and intensity of exposure in the induction of mesothelioma. This threshold may, in part, be related to the passage of fibers from the lungs to the pleura or peritoneum, and would, in any case, be masked in lung cancer by the retention of asbestos in the lungs. Reported cases of mesothelioma in immediate family members indicate the existence of an additional factor in mesothelioma induction, acting earlier in life than the first asbestos exposure.Keywords:
Asbestosis
Unlike most other inhaled dusts, asbestos can produce at least three distinct diseases: asbestosis, lung cancer and mesothelioma of the pleura and peritoneum. Workers with asbestosis are at greater risk of developing lung cancer than their healthy contemporaries and some studies have suggested that asbestos exposure without asbestosis increases the risk of lung cancer. Mesothelioma of the pleura and peritoneum is a rare tumour but it has been found with ever‐increasing frequency in persons exposed to relatively small amounts of asbestos; the latent period between exposure to asbestos dust and development of the tumour usually exceeds 20 years.
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Projections have been made of the number of mesotheliomas, lung cancers, and cases of asbestosis that might occur over the period 1987 to 2020 in former workers at the Wittenoom crocidolite asbestos mine in Western Australia. Predictions were based on the observed mortality to the end of 1986 and modelling of the mesothelioma rate. Elimination of crocidolite from the lungs was included in the model. Between the years 1987 and 2020 it is predicted that between 250 and 680 deaths will occur due to mesothelioma. This wide range is due to uncertainty on the functional form of the relation between mesothelioma rate and time, and insufficient data to estimate the elimination rate of crocidolite from the lungs. The most likely range is the lower half of this total range--that is, between 250 and 500. It is predicted that between 340 and 465 deaths will occur due to lung cancer. About 45% of these deaths would be attributable to exposure to asbestos. It is estimated that currently there are up to 200 cases of undiagnosed asbestosis. Of these about 50 will die of lung cancer or mesothelioma and are therefore also included in the figures above. Up to 60 former workers may develop the first signs of asbestosis in the future but any such cases are likely to progress to more serious disease at a much slower rate than the cases that have already been identified.
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연구배경서론: Malignant peritoneal mesothelioma is a rare disease and usually develops in individuals aged between 50 and 69 years. Exposure to asbestos is reported in 80% of cases of pleural mesothelioma, but in peritoneal type such an exposure is notedin only 8% of cases. Prognosis is poor for mesothelioma with a median survival of <1 year.Here, we report two cases of malignant peritoneal mesothelioma without history of exposure to asbestos.
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Background:The relationship between mesothelioma and exposure to asbestos is well established. As a result, the use of asbestos in buildings, construction sites, and mines, as well as the implications of disease for the workers has received considerable attention. However, asbestos was also used in household equipment and consumer products, including hairdryers.Purpose:To examine one case of peritoneal mesothelioma in a hairdresser and review the relevant literature on asbestos exposure from hairdryers.Methods:The subject’s medical and occupational records were obtained and reviewed and a physical examination was performed.Results:The results indicate that the subject developed peritoneal mesothelioma from her occupational exposure to asbestos containing hairdryers in accordance with the literature.Conclusion:Hairdryers are possible sources of asbestos exposure in patients with mesothelioma, and the asbestos exposure risk is higher for those who use hairdryers occupationally.
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Peritoneal mesothelioma has been recognized for over a half century, but causality with asbestos of different fiber types and the incidence of this fatal tumor in relation to asbestos exposure dose still needs clarification. In order to help bring clarity, the most important studies on peritoneal mesothelioma, including a brief history, relationship to asbestos exposures, diagnostic issues and experimental studies are reviewed including case series, case-control, occupational, and registry epidemiology studies. This review concludes that all types of asbestos, including amphiboles and chrysotile, are causative for peritoneal mesothelioma. Many cases have been found in both males and females from asbestos exposures in occupational and neighborhood settings, shown in differing epidemiology study designs. It is clear that there is a causal relationship between all types of asbestos at all dose levels for peritoneal mesothelioma and no threshold of exposure to asbestos appears safe.
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The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.
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Asbestosis
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A study of 54 autopsies of patients dying with pulmonary asbestosis disclosed 3 cases of peritoneal mesothelioma, one of which was complicated by a mesothelioma of the pleura. In 2 of the 3 patients there was an occupational exposure history of 20 and 34 years in an asbestos textile plant. Although the remaining patient had classical asbestosis of the lungs at autopsy, there was no known history of industrial exposure to asbestos. The authors think asbestos can produce mesothelioma of either peritoneum or pleura; they present 3 cases to support the concept of a causal relationship. The increased utilization of asbestos material and the recent demonstration of asbestos bodies in the lungs of urban dwellers may have significant implications for cancer epidemiology in the future.
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Abstract An analysis of 344 patients with asbestos related conditions seen between June 1988 and December 1993 is reported. Malignant mesothelioma occurred in 42%, asbestosis in 19% and cancer of the lung in 4%. All those suffering from asbestosis had a history of heavy exposure to asbestos dust, whereas many of those with mesothelioma had experienced only relatively light exposures. The experience with mesothelioma has lead to an unreasoning fear of any contact with asbestos and brought about policies resulting in many instances of its unnecessary and expensive removal.
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Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.
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