A Critique of Helsinki Criteria for Using Lung Fiber Levels to Determine Causation in Mesothelioma Cases

Abstract

Asbestos is a known human carcinogen and the chief known cause of mesothelioma. In 1997, a group of experts developed the Helsinki Criteria, which established criteria for attribution of mesothelioma to asbestos. The criteria include two methods for causation attribution: 1) a history of significant occupational, domestic, or environmental exposure and/or 2) pathologic evidence of exposure to asbestos. In 2014, the Helsinki Criteria were updated, and these attribution criteria were not changed. However, since the Helsinki Criteria were first released in 1997, some pathologists, cell biologists, and others have claimed that a history of exposure cannot establish causation unless the lung asbestos fiber burden exceeds "the background range for the laboratory in question to attribute mesothelioma cases to exposure to asbestos." This practice ignores the impact on fiber burden of clearance/translocation over time, which in part is why the Helsinki Criteria concluded that a history of exposure to asbestos was independently sufficient to attribute causation to asbestos.

Talc and Malignant Mesothelioma

“…Cosmetic talc is a component of body powders, facial and eye makeups, and some animal flea powders [23]. Although asbestos is a trace impurity of cosmetic talc, concentrations of amphibole asbestos during the application of cosmetic talc powders have been measured at ~2.7-4.5 f/cc, which is orders of magnitude greater than current urban background levels (0.0001 f/cc) [13,16].…”

“…Actinolite is not found in any commercial product other than talc. Tran et all have suggested that finding talc together with tremolite/actinolite/anthophyllite in fiber burden analyses of tissues is prima facie evidence of cosmetic talc use [11].…”