Turkey Asbestos Control Strategic Plan Final Report

Our plain-English summary of Turkey Asbestos Control Strategic Plan Final Report (Turkish Thoracic Journal, 2015).

The study

• Journal: Turkish Thoracic Journal
• Published: 2015;16(Suppl 2):S27-S52
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

This report presented the Turkey Asbestos Control Strategic Plan. The Plan was prepared by the Turkish Mesothelioma Working Group with the Public Health Institution of Turkey. Its aims were to determine the extent of environmental asbestos exposure in rural Turkey, where asbestos-containing 'white soil' was used for plaster, roofing and insulation, and to estimate future disease. Using a 'from case to the field' method, the authors identified mesothelioma cases coded C45 in hospitals of 30 provinces between 2008 and 2012, verified them against population registers, and traced their birthplaces. Of 7,787 records, 5,617 cases were retained, and 3,738 (66.5%) of these had lived in villages or rural areas. Median survival was 8 months. Trained public health staff collected 2,447 soil samples from house walls, roofs and mounds in villages of 58 provinces. Of these, 1,251 showed fibrous minerals by light microscopy, and 514 were found by X-ray diffraction to contain chrysotile and/or tremolite. These 514 samples came from 379 villages in 41 provinces, with a total population of 158,068. Using published incidence rates, the authors estimated that 571,460 people had been exposed for a risky period. Among them, they projected 15,450 mesothelioma and 5,737 lung cancer cases in 2013-2033. Among people still exposed, they projected 2,511 mesothelioma and 1,322 lung cancer cases. They concluded that rural exposure could be eliminated with low-cost measures such as covering plaster, roofs and mounds.

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In plain English

This is the final report of the Turkey Asbestos Control Strategic Plan, a national project of the Turkish Mesothelioma Working Group. Using a "from case to the field" method, the authors gathered mesothelioma (C45) hospital records for 2008 to 2012 from 30 provinces. Of 7,787 records, 5,617 cases remained after checking. Of these, 3,738 had lived in rural areas; 1,879 (33.5%) had not. Among cases who died, median survival was 8 months (95% confidence interval 7.60 to 8.40). Of 2,447 soil samples from house walls, roofs and mounds in the cases' birth villages, 1,251 showed fibrous minerals on screening; X-ray diffraction found chrysotile, tremolite or both in 514 of these, from 379 villages in 41 provinces with 158,068 residents. Using earlier Turkish incidence rates, the authors projected 15,450 mesothelioma and 5,737 lung cancer cases for 2013 to 2033 among an estimated 571,460 people with past rural exposure. They projected 2,511 more mesothelioma cases among villagers still exposed, if that exposure continued. The authors noted these are projections, not observed cases, and that registered diagnoses were not always histopathological.

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: National public health plan report: a review of hospital mesothelioma records, field soil sampling with mineral analysis of the samples, and projections of future disease
• Who was studied: Mesothelioma cases recorded under code C45 in hospitals in 30 Turkish provinces from 2008 to 2012. There were 7,787 records at first, reduced to 5,617 validated cases (3,241 men, 2,376 women). The project also covered the villages where these cases were born and the people living there.
• Exposure: Environmental exposure in rural areas to asbestos-containing 'white soil'. The soil was used for wall plaster and roof insulation and was also found in natural mounds. Analysis of soil samples identified chrysotile and tremolite.
• Main results:
  • Hospital records coded C45 for 2008 to 2012 in 30 provinces numbered 7,787. After checking, 5,617 cases remained.
  • The ratio of men to women among the 5,617 cases was 1.36.
  • Of the 5,617 cases, 3,738 had lived in villages or rural areas and 1,879 (33.5%) had not.
  • By July 2014, 62.2% of the 5,617 cases had died. The text gives the number of deaths as 3,445, but Table 3 gives 3,495.
  • Among the cases who died, median survival was 8 months (95% confidence interval 7.60 to 8.40).
  • Of 2,447 soil samples, 1,251 showed fibrous minerals on preliminary analysis and were sent for XRD (X-ray diffraction) analysis.
  • Of the 1,251 samples analyzed by XRD, 514 contained chrysotile, tremolite or both. These 514 samples came from 379 villages in 41 provinces.
  • 158,068 people lived in the 379 villages or rural areas where asbestos exposure was detected. When places with populations above 1,000 were excluded, the figure was 98,453.
  • Using mesothelioma incidence rates from an earlier Turkish cohort, the authors estimated that 571,460 people had been exposed in rural areas for a risky period of time.
  • Projection for 2013 to 2033: 15,450 mesothelioma cases among the estimated 571,460 people with past rural exposure.
  • Projection for 2013 to 2033: 2,511 mesothelioma cases among the 158,068 people still exposed, if the exposure continues.
  • Projected lung cancer cases for 2013 to 2033: 5,737 among the 571,460 people with past exposure, and 1,322 attributed to asbestos exposure among the 158,068 people still exposed.
• The authors' conclusion: The authors concluded that at least 158,068 people in Turkey are at risk of asbestos exposure and that at least 98,453 are exposed at a serious level. They also concluded that rural asbestos exposure in Turkey can be fully eliminated.
• Limitations the authors state:
  • Registered mesothelioma diagnoses were not always based on histopathology, and clinical-radiological diagnosis was not always precise.
  • The number of villages with asbestos exposure is probably an undercount, because 218 villages were not sampled.
  • How long residents actually stay in the villages is not known, so individual cumulative exposure doses could not be determined.
  • The disease figures are projections, not observed cases, and the actual numbers may turn out lower or higher.
  • Records on occupational exposure in Turkey are insufficient, so occupational asbestos exposure could not be fully determined.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Median Overall Survival, X-Ray Diffraction (XRD), Chrysotile, Tremolite, Incidence, Lung Cancer.

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