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Anthophyllite Miners Occup Environ Med: First Published As 10.1136/Oem.51.3.212 on 1 March 1994

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Anthophyllite Miners Occup Environ Med: First Published As 10.1136/Oem.51.3.212 on 1 March 1994 212 Occupational and Environmental Medicine 1994;5l:212-215 Four cases of mesothelioma among Finnish anthophyllite miners Occup Environ Med: first published as 10.1136/oem.51.3.212 on 1 March 1994. Downloaded from A Karjalainen, L 0 Meurman, E Pukkala Abstract theless, often constituted a large proportion Four cases of mesothelioma in a cohort of the total fibre burden and could therefore of 999 Finnish anthophyllite miners and not be excluded as a cause of mesothelioma. millers are described. Three deaths were In one of the patients with a reasonably low due to pleural mesothelioma and one to concentration of fibres only anthophyllite was peritoneal mesothelioma among the total detected.5 of 503 male deaths up to 1991. All four In this report we describe four cases of patients with mesothelioma had had long mesothelioma that occurred in the ongoing term (13 to 31 years) exposure in antho- follow up of the cohort of Finnish anthophyl- phyllite mining and milling. The latency lite miners and millers. time from the onset of employment until diagnosis was 39 to 58 years. All four patients were smokers or ex-smokers and Materials and methods had asbestosis. In three of the cases the THE COHORT OF ANTHOPHYLLITE MINERS pulmonary fibre concentration and fibre Two anthophyllite asbestos quarries were type were analysed by transmission elec- worked in Finland during the period tron microscopy. High concentrations 1918-75. They were owned by the same (270 to 1100 million fibreslg dry tissue) of company and located within 10 km of each anthophyllite fibres were detected. The other in a sparsely populated area about 50 anthophyllite fibres were thicker and had km from the nearest city. The workers were lower aspect ratios than the values recruited mainly from the farming population reported for crocidolite fibres retained in living in this area. In the 1950s and 1960s the the lungs ofpatients with mesothelioma. annual output was about 10 000 tonnes. The quarries were combined with a dry hammer (Occup Environ Med 1994;51:212-215) mill, which crushed, ground, and classified the broken rock into asbestos products for various industrial applications. Numerous reports from several countries A fairly complete personnel register was have described cases or series of pleural and kept by the company in the form of salary http://oem.bmj.com/ peritoneal mesotheliomas in relation to occu- lists from 1936. The register contained the pational exposure to various types and mix- names, dates of birth, working periods, and tures of asbestos. In 1960 Wagner and roughly the kind of work done. The series of coworkers described 33 cases of pleural miners and millers included all workers mesotheliomas in the neighbourhood of a employed for three months or longer between crocidolite mine in South Africa.' In later 1 January, 1936 and 1 July, 1967 (miners, studies, mesotheliomas have been found after millers, forestry workers, transportation work- on October 2, 2021 by guest. Protected copyright. occupational exposure to crocidolite, amosite, ers, and office workers). After the exclusion tremolitic material, and chrysotile asbestos.2 of workers who could not be identified, the In Finland, anthophyllite asbestos has been follow up was completed in 999 workers up exceptionally widely used because of its to the end of 1991. The deaths in the cohort domestic production from 1918-75, and spe- were researched through the death files of cial attention has been focused on the role of Statistics Finland. The deaths from cancer anthophyllite asbestos in the aetiology of were based on the files of the Finnish Cancer Institute of Occupational Health, mesothelioma. Anthophyllite fibres have Registry. Helsinki, Finland induced mesotheliomas in animal experi- A Karjalainen ments both after inhalation and intrapleural HISTOLOGICAL VERIFICATION OF THE Department of administration, but epidemiological studies DIAGNOSES Pathology, University ofTurku, Turku, have failed to firmly connect exposure to In all four cases of mesothelioma tissue sam- Finland anthophyllite and mesothelioma in humans. ples taken from the tumour at necropsy or L 0 Meurman In a cohort of about 1000 anthophyllite min- thoracotomy were available for histopatholog- Finnish Cancer ers and millers an increased risk of lung can- ical examination. The diagnoses of mesothe- Registry, Helsinki, cer was found, but no confirmed cases of lioma were confirmed the Finnish Finland by E Pukkala mesothelioma were reported up to 1977.34 In Mesothelioma Panel. Formalin-fixed and a more recent Request for reprints to: study of 29 Finnish patients paraffin embedded tissue blocks were used in Antti Karialainen, Institute with mesothelioma, raised concentrations of light microscopical histopathological, and of Occupational Health, Topeliuksenkatu 41 a A, anthophyllite fibres often occurred in their immunohistochemical examination. In one of SF-00250 Helsinki, Finland. lungs, but usually together with other types of the cases (case 2 in table 1) a morphologically Accepted 28 June 1993 asbestos fibres. Anthophyllite fibres, never- typical pleural mesothelioma with sarcoma- Four cases ofmesothelioma among Finnish anthophyllite miners 213 Table 1 Age, tumour type, exposure, and lungfibre concentration in thefour cases ofmesothelioma among Finnish anthophyllite miners Fibre concentration Age at Tumour Year of in lung tissue Fibre types Occup Environ Med: first published as 10.1136/oem.51.3.212 on 1 March 1994. Downloaded from Case No diagnosis Tumour type location diagnosis Years in mining (million fibresig) detected 1 82 Epithelial Peritoneal 1989 31, 1936-67 1100 Anthophyllite 2 75 Sarcomatous Pleural 1987 13, 1929-56 270 Anthophyllite 3 57 Sarcomatous Pleural 1986 28, 1947-75 1100 Anthophyllite 4 62 Epithelial Pleural 1991 23, 1950-75 -= No sample tous histology remained negative in cytoker- were used. All inorganic particles having atin staining and a sarcoma could not be roughly parallel sides and a length to width completely excluded. ratio greater than three were defined as fibres and counted. The dimensions of the fibres ANALYSES BY ELECTRON MICROSCOPY were measured directly on the screen with In three cases a sample of lung tissue was magnifications up to 100 000. The dimen- available for analysis of the retained mineral sions of 100 fibres per sample were measured. fibres by electron microscopy. In one of these An energy dispersive x ray microanalyser cases (case 2 in table 1) the tissue was stored (Tracor TN 5500) was used to identify the in 4% formalin. In the two other cases the mineral type of each fibre. The intensity specimens were embedded in paraffin, which ratios of Si, Mg, Fe, Ca, and Na were used in was subsequently dissolved with xylene. As the identification by comparing the spectra the tissue weight is known to decrease during peak ratios to standard spectra. Four hundred the process of embedding due to the extrac- fibres per sample were identified. This gave tion of lipids,6 the fibre concentrations of the an analytical sensitivity of <0-25% for fibre paraffin embedded samples were corrected types other than anthophyllite. According to assuming a dry weight loss of 20%. Poisson statistics this equals a detection limit A piece of tissue of about 100 mg wet of <1 0% (four times the analytical sensitiv- weight was taken for the fibre analysis. The ity). samples were prepared according to a previ- ously described method,5 which included low temperature ashing of the lung tissue and fil- Results tration of the remaining ash on polycarbonate In a recent follow up of 999 anthophyllite filters. The filters were further coated with miners and millers, a total of 593 deaths (503 carbon and placed on electron microscopy men and 90 women) were noted up to the grids. The filter material was dissolved with end of 1991; 72 of these were were due to chloroform in a modified Jaffe washer. The lung cancer, four to mesothelioma, and 31 to fibres were counted with a JEOL 100 CX- asbestosis. The diagnosis of asbestosis was ASID4D electron microscope in STEM mentioned in 20% of all death certificates. A mode on a CRT screen. An acceleration volt- detailed report on the incidence of cancer in http://oem.bmj.com/ age of 100 kV and a magnification of 15 000 this cohort is under preparation. Table 1 presents the pathological charac- teristics of the four mesotheliomas and the Table 2 Dimensions ofanthophyllitefibres in the lungs of three cases of mesothelioma among Finnish anthophyllite exposure data of the patients. Three of the miners workers had pleural and one had peritoneal mesothelioma (one of the pleural mesothe- Case No 1 2 3 liomas had also invaded the abdominal cav- Fibre length (pm): All four were male smokers or on October 2, 2021 by guest. Protected copyright. Range 0-80-27 0 70-44 0-80-31 ity). Mean 6-1 7.9 7-3 ex-smokers and had asbestosis. The three Median 4-1 3.9 5-1 cases with available tissue had a Distribution of lung samples fibre length (%): very high concentration of anthophyllite <1*0 4 2 4 fibres in their about 1% of the fibres 1-04-9 50 55 44 lungs; 5 0-9 9 26 14 29 were coated asbestos bodies. When 400 fibres >10 20 29 23 per sample were identified, only anthophyllite Fibre width (um): fibres were detected. Numerous talc particles Range 0-05-1 1 0-06-1-5 0-05-1-5 were also detected in the Mean 035 040 0-45 samples. Median 030 035 0-35 All four patients had had long term (13 to Distribution of 31 years) exposure in the mining of asbestos fibre width (%): <0-1 13 8 9 (see table 1). The occupational histories indi- 0-1-0-49 56 62 56 cated no to asbestos other than in 0-5{)-99 30 27 25 exposure )1.0 1 3 10 the Paakkila mine.
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