Endemic pleural calcification and mesothelioma

Our plain-English summary of Endemic pleural calcification and mesothelioma (JAMA, 1988).

The study

• Journal: JAMA
• Published: 1988;259(4):520
• Type of article: Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000911).

In plain English

These are two JAMA letters to the editor, not a research study. Both responded to a report by Sichletidis and colleagues of malignant pleural mesothelioma in a woman from Metsovo, Greece, where pleural calcification was endemic. Michael Huncharek wrote that personal and family occupational history would have helped, since asbestos contact often goes unrecognized. The writer cautioned against assuming a direct link between the calcifications and the mesothelioma, and called asbestos the primary cause of this tumor. Mark Germine examined Metsovo whitewash by optical microscopy. It was mostly tremolite, intergrown with talc and chlorite. Fiber length-to-width ratios were typically 5:1 to 15:1; 15:1 to 50:1 was not uncommon. The writer described Korean commercial tremolite asbestos, used in rat inhalation studies, as identical in description to typical Metsovo tremolite, except that it lacked a subpopulation of fine fibrillar fibers. The writer concluded that this supports the hypothesis that Metsovo tremolite is a cause of mesothelioma. Under the working mineralogical definition of tremolite asbestos then in use, the writer noted, neither tremolite would have been regulated as asbestos in crushed stone products.

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: Letters to the editor (correspondence) commenting on a published case report; one letter includes an optical microscopy examination of whitewash samples
• Who was studied: No study population. The letters discuss one previously published case of mesothelioma in a woman from Metsovo, Greece, an area of endemic pleural calcification. The second letter examined samples of whitewash used in Metsovo; the number of samples is not given.
• Exposure: Tremolite-rich whitewash used in Metsovo, compared with Korean commercial tremolite asbestos used in rat inhalation studies; the first letter also raises possible unrecognized occupational or secondary asbestos exposure
• Main results:
  • First letter (Huncharek): personal and family occupational history would have been helpful in the reported case
  • First letter: in the reported case, one must be cautious in assuming a direct link between the pleural calcifications and the development of mesothelioma
  • Second letter (Germine): the Metsovo whitewash examined was composed mostly of tremolite, intergrown with talc and chlorite
  • Second letter: tremolite fiber aspect ratios in the whitewash were typically 5:1 to 15:1, with 15:1 to 50:1 not uncommon
  • Second letter: Korean commercial tremolite asbestos used in rat inhalation studies was of identical description to the typical tremolite fiber in Metsovo whitewash
  • Second letter: the Korean tremolite differed in that it did not contain the smaller subpopulation of Metsovo fibers with fine fibrillar structure
  • Second letter: neither tremolite would be regulated as asbestos in crushed stone products under the working mineralogical definition of tremolite asbestos that was in use when the letter was written
• The authors' conclusion: Huncharek stated that asbestos must be considered the primary cause of mesothelioma. Germine concluded that the similarity between the two tremolites supports the hypothesis that the typical Metsovo tremolite is an etiologic agent in mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening, Tremolite.

Medical terms in this study, explained in our Lexicon: Endemic, Pleural Calcification, Mesothelioma.

Related studies

• Tremolite whitewashing and pleural calcifications — S.H. Constantopoulos, N.A. Saratzis, et al. (1987)
• Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece — S.H. Constantopoulos, P. Theodoracopoulos, et al. (1991)
• Pleural effects of tremolite in north-west Greece — T. Bazas (1987)
• Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash — A.M. Langer, R.P. Nolan, et al. (1987)
• An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos — Y.I. Baris, N. Bilir, et al. (1988)
• Radiological survey of past and present vermiculite miners exposed to tremolite — J.C. McDonald, P. Sebastien, et al. (1986)

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