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Environmental Exposure to Asbestos and the Exposure–Response Relationship with Mesothelioma M.T

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Environmental Exposure to Asbestos and the Exposure–Response Relationship with Mesothelioma M.T Eastern Mediterranean Health Journal, Vol. 15, No. 1, 2009 25 Environmental exposure to asbestos and the exposure–response relationship with mesothelioma M.T. Madkour,1 M.S. El Bokhary,2 H.I. Awad Allah,2 A.A. Awad3 and H.F. Mahmoud4 ُّالتعرض البيئي لﻷسبستوس والعﻻقة بني ُّالتعرض واﻻستجابة وبني ورم املتوسطة خمتار طه مدكور، حممود رسي البخاري، هاله إبراهيم عوض اهلل، عبد احلميد عوض، حسني فتحي حممود أجرىاخلﻻصة: الباحثون دراسة وبائية وبيئية يف منطقة شربا اخليمة بمدينة القاهرة الكربى، حول العﻻقة بني ُّالتعرض واﻻستجابة لﻷسبستوس )اﻷميانت( وبني ورم املتوسطة َالـج ْن َبوي اخلبيث. وقد أجرى الباحثون ًتنظريا 2913 487 ًشعاعيا لـ ًشخصا َّمعرضني ًمهنيا لﻷسبستوس، و ًشخصا َّمعرضني ًبيئيا له، وجمموعة شاهدة َّمكونة من 979 ًشخصا ليس هلم سوابق ُّتعرض. كام أخذ الباحثون خزعات َج ْن َب َّوية من احلاﻻت َاملشت َبه هبا، وحددوا تركيز ألياف اﻷسبستوس املنقولة باهلواء يف مجيع املناطق. َّوشخصوا 88 حالة من ورم املتوسطة، 87 منها كانت ضمن املجموعة َّاملعرضة. وتبني للباحثني أن اختطار ورم املتوسطة لدى املجموعة َّاملعرضة ً بيئياأعىل من املجموعتني اﻷخريني، كام أن اﻻختطار أعىل لدى اﻹناث منه لدى الذكور. وازداد انتشار ورم املتوسطة مع ازدياد ُّالتعرض التـراكمي لﻷسبستوس. ABSTRACT An epidemiological and environmental study was carried out in Shubra El-Kheima city, greater Cairo, of the exposure–response relationship between asbestos and malignant pleural mes- othelioma. Radiological screening was done for 487 people occupationally exposed to asbestos, 2913 environmentally exposed to asbestos and a control group of 979 with no history of exposure. Pleural bi- opsy was done for suspicious cases. The airborne asbestos fibre concentrations were determined in all areas. There were 88 cases of mesothelioma diagnosed, 87 in the exposed group. The risk of mesothe- lioma was higher in the environmentally exposed group than other groups, and higher in females than males. The prevalence of mesothelioma increased with increased cumulative exposure to asbestos. Exposition environnementale à l’amiante et relation exposition-réponse avec le mésothéliome RÉSUMÉ Une étude épidémiologique et environnementale a été réalisée à Shubra El-Kheima, dans la banlieue du Caire, sur la relation exposition-réponse entre l’amiante et le mésothéliome pleural malin. Un dépistage radiologique a été effectué sur 487 personnes exposées à l’amiante dans le milieu professionnel, 2 913 personnes exposées à l’amiante dans l’environnement et un groupe témoin de 979 personnes n’ayant jamais été exposées. Une biopsie pleurale a été réalisée sur les cas suspects. Les concentrations de fibre d’amiante dans l’air ont été établies dans toutes les zones. Quatre-vingt-huit cas de mésothéliome ont été diagnostiqués, dont 87 dans le groupe exposé. Le risque de mésothéliome était plus élevé dans le groupe soumis à une exposition environnementale que dans les autres groupes, et plus élevé chez les femmes que chez les hommes. La prévalence du mésothéliome augmentait en même temps que l’exposition cumulée à l’amiante. 1Department of Chest Diseases, Faculty of Medicine; 2Department of Medical Sciences, Institute of Environmental Studies and Research, Ain Shams University, Cairo, Egypt (Correspondence to M.T. Madkour: [email protected]). 3Department of Air Pollution, National Research Centre, Cairo, Egypt. 4Abbassia Chest Hospital, Cairo, Egypt. Received: 02/07/06; accepted: 04/12/06 املجلة الصحية لرشق املتوسط، منظمة الصحة العاملية، املجلد اخلامس عرش، العدد 1، ٢٠٠9 26 La Revue de Santé de la Méditerranée orientale, Vol. 15, N° 1, 2009 Introduction peak around 2020 [18]. This reflects in- dustrial exposure to asbestos, which was Malignant pleural mesothelioma (MPM) common up to the 1980s, combined with a is associated with environmental and oc- latent period between exposure to asbestos cupational exposure to asbestos [1]. During and development of mesothelioma averag- the last 4 decades, numerous studies on ing 30–40 years [17]. MPM have been conducted [2,3]. However, Data obtained from the information the natural history of this tumour remains network of the General Organization for ill-defined or scarcely known. Particular Industrialization in Egypt, showed that 14 topics that deserve further investigation asbestos factories were present in Egypt include the proportion of cases attributable in the year 2004 [19]. These factories af- to asbestos, the spectrum of the population fect an area of approximately 5–7 km in at risk, the length of the latency period, the radius, which explains the high incidence impact of mild exposure to asbestos and the of mesothelioma in the neighbourhood of role of cofactors in the development of the these factories. Workers employed since tumour [4]. 1948 by the Egyptian asbestos company Epidemiological studies have linked Sigwart at the mills in greater Cairo (El occupational exposure to asbestos with Maasara and Shubra El-Kheima) had an in- mesothelioma [5–10]. Cohort studies have creased risk of mesothelioma, as did former found increased incidence of and mortality residents of Shubra El-Kheima who were from mesothelioma among asbestos workers not directly employed in the milling of employed in mining [5], textile manufactur- asbestos. In 2002, a high prevalence of ing [6], insulation [7] and asbestos cement pleuropulmonary disorders due to environ- factories [8]. Exposure has been assessed by mental asbestos exposure was reported in a variety of methods, but all studies reach the immediate vicinity, 0.5–1.5 km, from an the conclusion that the rate of mesothelioma asbestos plant in south Cairo [20]. In Egypt, increases as the level of exposure increases the ministerial council decided to ban asbes- [10]. Non-occupational or environmental tos imports in 2004 and the Sigwart plants exposure to asbestos is also associated with were closed in November 2004. Therefore, an increased risk of mesothelioma [11]. the predicted incidence of mesothelioma Exposure is experienced by individuals in Egypt will reach its peak around 2040. living with asbestos workers [12] and those However, no previous Egyptian study of living near asbestos mines and mills [13] or environmental exposure to asbestos and factories manufacturing asbestos products the risk of mesothelioma has been able to [14]. The development of the disease has a utilize exposure levels to derive quantitative long latency, with cases arising more than exposure–response relationships. 10 years after first exposure, and numbers The aims of this study were: to evaluate continue to rise exponentially with time the prevalence of MPM due to occupational since first exposure [15]. and environmental (non-occupational) Since other factors such as level of ex- exposure to asbestos among persons who had posure also determine the risk of mesotheli- worked in the asbestos manufacturing plant oma [16], it is important to analyse all these and in persons living in an area nearby the factors to disentangle their separate effects. plant with potentially significant population The prevalence of mesothelioma has been exposure and to estimate the exposure– increasing throughout the industrialized world [17]. The incidence is predicted to املجلة الصحية لرشق املتوسط، منظمة الصحة العاملية، املجلد اخلامس عرش، العدد 1، ٢٠٠9 Eastern Mediterranean Health Journal, Vol. 15, No. 1, 2009 27 response relationship between environmental the 2000 census population data were ob- exposure to asbestos and MPM. tained from the Egyptian Central Agency for Public Mobilization and Statistics. All sampling sites were located within 2 km of Methods the asbestos plant. El-Wehda El-Arabia area Location This epidemiological and environmental 2.5 km study was carried out in Shubra El-Kheima city, greater Cairo, to evaluate the preva- lence of MPM. Shubra El-Kheima is an industrial city at the northern boundary of Cairo, just upwind from downtown Cairo. It has an area of about 30 km2. This city was considered the focal point of the highest environmental exposure to ambient asbes- tos fibres due to the operation of a large asbestos manufacturing plant (the Sigwart Company plant) (Figure 1). The Sigwart plant is an asbestos manufacturing plant us- ing chrysotile asbestos. It was constructed in 1948 and its main products were asbestos cement pipes and reinforced concrete prod- ucts. The study included 6 areas in the near vicinity of Sigwart plant, and these areas were mapped according to the distance from the asbestos plant and the airborne asbestos fibre concentrations. Sample The people working in the plant were desig- nated the occupationally exposed group and the population living in the 6 areas near the plant were defined as the environmentally exposed group. Sampling areas of airborne asbestos fibres and the wind direction and speed are shown in Figure 1. Environmentally exposed group The 6 areas which were defined in the near Figure 1 Map of Shubra El-Kheima city vicinity of Sigwart plant included El-Wehda with superimposed direction and speed of El-Arabia, Manshiyat El-Gadida, Manshiyat wind. Sampling areas: (1) Asbestos plant El-Horriya, Ezbet Osman, Manshiyat Abdel (Sigwart store); (2) El-Wehda El-Arabia; (3) Moneim Riad and Ezbet Rostom. For the Manshiyat El-Horriya; (4) Ezbet Rostom; (5) purpose of calculating population statistics, Ezbet Osman; (6) Manshiyat El-Gadida; (7) Manshiyat Abdel Moneim Riad املجلة الصحية لرشق املتوسط، منظمة الصحة العاملية، املجلد اخلامس عرش، العدد 1، ٢٠٠9 28 La Revue de Santé de la Méditerranée orientale, Vol. 15, N° 1, 2009 includes 56 228 people and lies about 100 m industrial shops, administration, asbestos walking distance of the asbestos plant. Man- waste site and the gate of the plant. The shiyat El-Gadida includes 20 000 people, study was done during working hours in Manshiyat El-Horriya includes 67 832 peo- the presence of the whole workforce of the ple, Ezbet Osman includes 25 000 people, plant. All the staff inside the asbestos plant Manshiyat Abdel Moneim Riad includes were exposed to the hazards of asbestos as 128 215 people, finally, Ezbet Rostom in- there were contiguous rooms for all staff cludes 24 834 people. A total of 322 109 inside the different sections of the plant and people are still living in these areas and are clerks delivered circulars from the adminis- still exposed to asbestos.
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