Association of Metsovo Lung and Pleural Mesothelioma With Exposure to Tremolite-Containing Whitewash

Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic?

“…On the other hand, we have discovered PCs in Metsovites who left Metsovo at a very early age (3-5 yrs of age) [3]. Therefore, we speculated that the exposure started at a very early age when women in incidence rate appears too abrupt to be attributed only to the diminished use of "luto", but then one or two cases missed or simply not occurring exactly at the "expected year" could make all the difference.…”

“…In Metsovo, we have documented that the increased incidence of mesothelioma and endemic pleural calcifications are a result of asbestos exposure; more specifically tremolite used for whitewashing [1][2][3][4]. This is a rather unique exposure, differing in several aspects from the "usual" occupational exposure.…”

“…We attributed this, as well as the endemic occurrence of pleural calcifications (PCs) in the same area (47% of adult population), to the use of tremolitecontaining whitewash [2][3][4]. Until then, the inhabitants were unaware of the nature of this material ("luto" soil in the local dialect).…”

Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later: Figure 1–

“…In 1987, we reported on the very high incidence, 300 times higher than expected, of MM in the area of Metsovo, a complex of small villages in the prefecture of Ioannina in northwest Greece [4]. This, in conjunction with the previously noted very frequent pleural calcifications among Metsovites [5], led to the discovery of the culprit, a tremolite asbestos-containing whitewash (''luto'' in the local dialect) [6]. The material was used by practically all households until [1940][1941][1942][1943][1944][1945][1946][1947][1948][1949][1950].…”

“…However, since the 1960s, it has been known that some patient groups, particularly those with chronic obstructive pulmonary disease (COPD), are especially vulnerable to uncontrolled oxygen therapy and a recent randomised study showed that mortality in this patient group was doubled when high-concentration oxygen was used compared with controlled oxygen therapy [1][2][3][4]. It has also been demonstrated that hyperoxaemia is associated with increased mortality in patients with stroke, and in survivors of cardiac resuscitation and critically ill patients in the intensive care unit (ICU) [5][6][7]. The British Thoracic Society (BTS) guidelines for emergency oxygen use recommend a target oxygen saturation range of 94-98% for most emergency medical patients and a lower target range of 88-92% for those at risk of hypercapnic respiratory failure [8].…”