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

Abstract

Inhabitants of the Metsovo area, north-west Greece have been exposed since childhood to inhalation of asbestos, from a material containing tremolite, used for whitewashing ("luto soil"). This has resulted in endemic pleural calcifications (47% of adult population) and increased incidence of malignant pleural mesothelioma (MPM). In 1987, we reported that the incidence of MPM between 1981-1985 was around 300 times higher than expected in a nonasbestos exposed population (seven cases in 5 yrs in a population of 4,000-5,000).The present study is an updated report regarding this "mesothelioma epidemic", in conjunction with the diminished use and final abandonment of "luto soil" in the early 1980s.It appears that the incidence of MPM in Metsovo has dropped considerably since our first report. Between 1985-1994, we diagnosed six such cases (incidence rate=1.4 cases per 10,000 person-years), whilst between 1980-1984 eight cases had been diagnosed (incidence rate = 3.7 cases per 10,000 person-years). Although, because of the small number of cases, this did not reach statistical significance (p=0.08), we note that the incidence is now considerably lower than before. Had it remained unchanged, we would have expected 17 cases of MPM instead of six.This drop follows the diminished use of "luto" whitewash (by 92% of the population in 1950 and only 18% in 1980). If we take into account a 30-40 year latency period for mesothelioma, we expect that the "Metsovo mesothelioma epidemic" will fade away by the year 2020-2030, since the material has not been used since 1985.

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

“…Their distribution in 5-and 10-yr intervals is shown in figure 1, which shows the variability of incidence of MM. As previously reported, 14 cases of MM occurred in the first 15 yrs, while between 1995 and 2009, 12 more MM cases from Metsovo (10 pleural and two peritoneal) where diagnosed at our two hospitals, the last two being in 2002 and 2005 [7,8]. Of these 12 patients, three were male and nine female, aged 50-86 yrs, and it was confirmed that they had been using luto during 1950-1970.…”

“…In 1996, we reported that the incidence of MM in the period 1985-1994 declined to one-third compared with the period 1980-1984, and we attributed the reduction to the abandonment of the use of luto. As a result, we concluded that the ''Metsovo mesothelioma epidemic'' would decline by 2020-2030 [8].…”

Mesotelioma maligno: descripción clínica y radiológica de 45 casos con y sin exposición a asbestos

“…Otros agentes considerados como probables inductores de MM son el berilio y la zeolita. [15][16][17] Histológicamente, el MM se divide en tres grupos: epitelial, sarcomatoide y mixto. 1,3,4 El tipo sarcomatoide se asocia con grandes masas tumorales, ausencia o mínimo derrame pleural y mayor frecuencia de metástasis hematógenas.…”

Malignant Pleura Mesothelioma: Clinical Perspectives

“…In Europe there are asbestos deposits in Italy, Greece and Cyprus [4] [ [29][30][31][32][33]. Asbestos is a non-flammable material and has a great mechanical endurance.…”