Malignant mesothelioma. A cluster in a native American pueblo

Our plain-English summary of Malignant mesothelioma. A cluster in a native American pueblo, by R.J. Driscoll, W.J. Mulligan, D. Schultz, et al (The New England Journal of Medicine, 1988).

The study

• Authors: R.J. Driscoll, W.J. Mulligan, D. Schultz, A. Candelaria
• Journal: The New England Journal of Medicine
• Published: 1988;318(22):1437-8
• Cited by: 20 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. 000901).

In plain English

This report described a malignant mesothelioma cluster in a New Mexico Native American pueblo of about 2000 people. Three patients were diagnosed at the Public Health Service Hospital in Santa Fe from April 1984 to September 1985. The state tumor registry added two cases from 1970 to 1982. All five (three men, two women) were from the same pueblo. Average age at diagnosis was 65; average survival was 3.8 months. Occurrence was 1000 times the expected one, the authors reported. After interviews, they collected 14 items from patients' homes and silversmiths' workrooms. Ten of these contained mixed-fiber asbestos; chrysotile, amosite and crocidolite were found. Silversmiths used asbestos mats on worktables, and dancers used asbestos to whiten leggings and moccasins. Four patients were silversmiths; all five routinely danced and so were known to use asbestos as a whitener. Elders traced the asbestos first to waste insulation from a 1930s railroad serving a brick plant; later, tribe members salvaged it from construction sites and neighboring tribes' members peddled it. The authors concluded that cultural customs, together with an industrial plant, exposed this population to asbestos.

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: investigation of a disease cluster (report of five cases with an epidemiologic investigation)
• Who was studied: Five patients with malignant mesothelioma (three men, two women), all from one Native American pueblo of approximately 2000 persons near Santa Fe, New Mexico. Three were diagnosed between April 1984 and September 1985, and two were found in the state tumor registry for 1970 to 1982.
• Exposure: Asbestos used in making silver jewelry (asbestos mats called pounding boards, used to insulate worktables) and in whitening leather leggings and moccasins worn for ceremonial dances. Samples contained chrysotile, amosite and crocidolite.
• Main results:
  • Five cases of malignant mesothelioma (three men and two women), all from the same pueblo.
  • The patients' average age at diagnosis was 65, and their average survival from diagnosis to death was 3.8 months.
  • Occurrence of mesothelioma in the pueblo was 1000 times the expected one (expected incidence calculated from Surveillance, Epidemiology, and End Results data).
  • Polarized light microscopy identified 10 of the 14 samples collected from patients' homes and silversmiths' workrooms as containing mixed-fiber asbestos.
  • Chrysotile was found in concentrations above 33 percent in 55 percent of the samples. Amosite was found in 30 percent of the samples and crocidolite in 20 percent.
  • Of the five patients, four were silversmiths. All five routinely participated in ceremonial dances at the pueblo and so were known to use asbestos as a whitener for their leggings and moccasins.
  • Pueblo elders traced the original asbestos to a 1930s brick-manufacturing plant whose private railroad had a steam locomotive insulated with asbestos. Waste asbestos discarded at trackside was collected by tribe members.
  • The railroad proved to be a limited supplier. Tribe members who worked in construction then salvaged asbestos from job sites, and more recently members of neighboring tribes peddled it door to door.
• The authors' conclusion: The authors concluded that a unique juxtaposition of cultural customs with the presence of an industrial plant exposed this population to asbestos.

Topics

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

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

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