Environmental mesothelioma in Turkey

Our plain-English summary of Environmental mesothelioma in Turkey, by Y.I. Bariş, M. Artvinli, A.A. Sahin (Annals of the New York Academy of Sciences, 1979).

The study

• Authors: Y.I. Bariş, M. Artvinli, A.A. Sahin
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:423-32
• Cited by: 81 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003996).

Summary of the article

The authors, from the Chest Diseases Division of Hacettepe University, Ankara, summarized their studies of environmental (non-occupational) asbestos-related and fiber-related diseases in rural Turkey. Mass chest photofluorography and radiographic surveys of villages in several regions found endemic calcified pleural plaques (CPP). Rates were 5-10% in some villages near Mihaliççik, 5.2% in two villages near Ilgaz, and close to 25% CPP and/or chronic fibrosing pleuritis (CFP) in Bedirli-Yeşilova. Villages nearby with similar living conditions had few or no cases. Villagers in several areas used soil containing asbestos as white stucco. In the village of Karain (Nevşehir), 11 of 18 deaths in 1974 were from malignant pleural mesothelioma (MPM). Twenty-seven patients were added between January 1975 and May 1978. In Tuzköy, among 312 randomly selected residents over 25 years old, 53 (17%) had CPP and 33 (10.5%) had pleural thickening. There were no asbestos deposits near Karain or Tuzköy. Respirable erionite-type zeolite fibers were found in rock and soil samples from both villages but not in control villages. Such fibers were also found in the lung tissue of a Tuzköy patient with CFP. The authors described 148 MPM cases (92 male, 56 female) and 20 CFP cases, mostly in rural peasants. They concluded that CPP, CFP and MPM may be related to fibers other than asbestos. They also concluded that tumor induction by asbestos in drinking water was highly improbable.

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In plain English

This 1979 paper by the Chest Diseases Division of Hacettepe University in Ankara briefly described the group's own studies of environmental, non-occupational fiber-related disease in villages of Anatolia, Turkey. Chest X-ray surveys found calcified pleural plaques in many villages. The incidence was between 5 and 10% in Sorgun, Cardak and Gozeler and 5.2% in Hacihasan and Beyköy, while some nearby villages with similar living conditions had few or no cases. In Karain, a village with no asbestos deposit, 11 of 18 deaths in 1974 were due to malignant pleural mesothelioma. The authors also described 148 cases of malignant pleural mesothelioma and 20 cases of chronic fibrous pleuritis seen in Turkey. Later work with British scientists found erionite-type zeolite fibers of respirable size in rock and soil from Karain and Tuzköy but not in control villages. Such fibers were also found in the lung tissue of a Tuzköy man with chronic fibrous pleuritis. The authors concluded that these diseases may be related to fibers other than asbestos. They had earlier considered swallowed asbestos from Karain's drinking water a possible source, but after the zeolite findings they judged this highly improbable.

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: Descriptive overview of the authors' own studies: mass chest X-ray surveys of villages, retrospective death records and a prospective case series in Karain, mineral analyses, and case series of patients with malignant pleural mesothelioma and chronic fibrous pleuritis
• Who was studied: Villagers (mostly peasants) in several regions of Anatolia, Turkey: Mihalliccik-Eskisehir, Ilgaz-Cankiri, Eregli-Konya, southeastern Turkey, Nevsehir (including Karain and Tuzköy) and Yesilova-Burdur. Karain had 604 inhabitants in 1974. The authors also described 148 patients with malignant pleural mesothelioma (92 males, 56 females) and 20 patients with chronic fibrous pleuritis.
• Exposure: Environmental exposure to natural mineral fibers. In some regions this was asbestos: chrysotile, tremolite, actinolite and anthophyllite around Mihalliccik, and mainly tremolite in the white stucco used to plaster houses in southeastern Turkey. In Karain and Tuzköy, where no asbestos was found, it was erionite-type zeolite fibers in rock and soil.
• Main results:
  • In the villages of Sorgun, Cardak and Gozeler (Mihalliccik-Eskisehir region), the incidence of calcified pleural plaques was between 5 and 10%.
  • Peasants of two villages in the Ilgaz-Cankiri region, Hacihasan and Beyköy, had a 5.2% incidence of calcified pleural plaques. Nearby villages had negligible or zero incidence.
  • In the town of Maden (southeastern Turkey), 86 (64%) of 134 peasants with calcified pleural plaques showed diffuse pulmonary fibrosis.
  • In Karain in 1974, 11 of 18 deaths were due to malignant pleural mesothelioma, in a village of 604 inhabitants.
  • In the village of Redirli-Yesilova, close to 25% of peasants above the age of 25 had calcified pleural plaques and/or chronic fibrous pleuritis.
  • Clumps of asbestiform fibers were found in the water of Karain's old wells. Later work found erionite-type zeolite fibers of respirable size in rock and soil samples of Karain, but not in control villages 4 and 7 km up the valley.
  • When asbestiform fibers were found in Karain's drinking water, the authors had considered the possibility of asbestos ingestion. After the erionite findings, they wrote that ingestion of fibers may not explain their findings, and that induction by asbestos contamination of the drinking water was highly improbable.
  • Erionite-type zeolite fibers were found in the lung tissue of a patient from Tuzköy diagnosed with chronic fibrous pleuritis.
  • Among 312 randomly selected persons above 25 years old in Tuzköy, 53 (17%) had calcified pleural plaques on chest X-ray.
  • Of the 20 patients with chronic fibrous pleuritis, 17 were male, aged 27 to 67 years with a mean of 45. Only two had been employed: one as a plumber and one as a road construction worker.
• The authors' conclusion: The authors concluded that calcified pleural plaques, chronic fibrous pleuritis and malignant pleural mesothelioma may be related to fibers other than asbestos, and regarded these diseases as endemic in some Anatolian villages with or without asbestos deposits.
• Limitations the authors state:
  • The authors stated they had no explanation for why some villages with similar living conditions had rare or no disease.
  • The epidemiologic study in Tuzköy was not yet complete when the paper was written.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Environmental Mesothelioma, Endemic, Pleural Plaques, Karain, Pleural Mesothelioma, Pleural Thickening, erionite, Zeolite.

Related studies

• Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases — Z.T. Selçuk, L. Cöplü, et al. (1992)
• Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients — A.A. Sahin, L. Cöplü, et al. (1993)
• Lung diseases due to environmental exposures to erionite and asbestos in Turkey — S. Emri, A. Demir, et al. (2002)
• High-resolution computed tomography in cases with environmental exposure to asbestos in Turkey — F. Topçu, H. Bayram, et al. (2000)
• Environmental exposure to asbestos in eastern Turkey — H.C. Hasanoğlu, M. Gokirmak, et al. (2003)
• Environmental asbestos-related pleural plaque in southeast of Turkey — G. Ates, T. Yildiz, et al. (2010)

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