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Lung Cancer and Mesothelioma in Towns with Environmental Exposure to Asbestos in Eastern Anatolia

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Lung Cancer and Mesothelioma in Towns with Environmental Exposure to Asbestos in Eastern Anatolia Int Arch Occup Environ Health (2006) 79: 89–91 DOI 10.1007/s00420-005-0010-6 SHORT COMMUNICATION Hatice Canan Hasanoglu Æ Zeki Yildirim Æ Hilal Ermis Talat Kilic Æ Nurhan Koksal Lung cancer and mesothelioma in towns with environmental exposure to asbestos in Eastern Anatolia Received: 14 October 2004 / Accepted: 23 May 2005 / Published online: 30 August 2005 Ó Springer-Verlag 2005 Abstract Objective: Our previous study demonstrated the Keywords Asbestos Æ Environmental exposure Æ Lung presence of environmental tremolite and chrysotile cancer Æ Mesothelioma asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma. Introduction Method: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in It has long been confirmed that environmental exposure the towns of Malatya were retrospectively analyzed. The to asbestos through the use of asbestos-contaminated Incidences of lung cancer and mesothelioma were cal- soil mixture causes a high risk of malignant pleural culated. Results: The incidences of lung cancer and mesothelioma in rural areas of Turkey (Barıs 1987; mesothelioma were 3.39/100,000 and 0.21/100,000, Yazıcıog˘ lu 1976; Yazıcıog˘ lu et al. 1973). However, few respectively, for the whole population of Malatya; while reports exist about the lung cancer incidence in these they were 8.23/100,000 and 1.45/100,000 in Hekimhan. areas (Coplu et al. 1996; Martuzzi et al. 1998). The The incidences were strikingly high (22.39/100,000 for asbestos deposits are mostly found in some rural parts of lung cancer and 7.46/100,000 for mesothelioma) in Ar- central and southeast Anatolia in Turkey. guvan, another town in Malatya where an analysis for Malatya province is located in the eastern part of asbestos could not be performed. The overall incidence Turkey. Within the province lie the towns of Hekimhan in Turkey was reported as 5.9/100,000 by the Health and Guzelyurt (Fig. 1) where we have previously re- Ministry in 1994. The incidences of lung cancer were ported environmental tremolite exposure (Fig. 2) (Ha- nearly 1.3-fold higher in Hekimhan and fourfold higher sanoglu et al. 2003). Our clinic is a department of the in Arguvan then in the general population of Turkey. Medical Faculty of Inonu University in the center of Conclusion: The incidences of mesothelioma and lung Malatya province. Most patients from the province, carcinoma in Hekimhan were higher than those of the including Hekimhan and other cities, are admitted to general population in Turkey, suggesting a role of our Hospital. Although an increased incidence of environmental asbestos exposure in lung cancer and mesothelioma in some parts of rural Turkey was docu- mesothelioma. mented in several papers, there was no report related to increased incidences of mesothelioma and lung cancer in Malatya. The purpose of the present study was to determine the incidence of mesothelioma and lung can- H. C. Hasanoglu cer in Hekimhan town and other parts of Malatya. Ataturk Education and Research Hospital, Bilkent, Ankara, Turkey Z. Yildirim (&) Æ H. Ermis Æ T. Kilic Materials and methods Department of Pulmonary Medicine, Medical Faculty, Inonu University, 44069, Malatya, Turkey The charts of 200 patients with lung cancer and meso- E-mail: [email protected] Tel.: +90-422-3410785 thelioma that were admitted to our hospital between Fax: +80-422-3410728 1997 and 2001 were the study materials. The history of N. Koksal the patients revealed that they had no occupational Department of Pulmonary Diseases, Sutcu Imam University, exposure to asbestos. Mesothelioma and lung cancer Faculty of Medicine, Kahramanmaras, Turkey were diagnosed by histology and histochemical tests 90 mesothelioma between 1997 and 2001. As shown in Table 1, 51 patients were from places outside Malatya. The mean age of 149 patients (126 male, 23 female) was 62.34±10.2 (35–86 years). None of the patients had occupational asbestos exposure. One hundred and twenty-one male patients were smokers. Twenty-eight patients of the 36 patients from Arguvan and Hekimhan towns were smokers. Of the 113 patients from other places without environmental asbestos exposure, 93 were smokers. Pleural plaques and other asbestos-asso- ciated pulmonary and pleural lesions were not observed in patients with lung cancer. However, extensive pleural plaques were observed in a patient with mesothelioma. Lung cancer was mostly seen in men (124 men, 16 women) while mesothelioma was mostly seen in women (2 men, 7 women). The distribution of the patients with lung cancer and mesothelioma admitted to the hospital from Malatya and its towns are shown in Table 2. Three patients were diagnosed with mesothelioma Fig. 1 The map shows the towns of Malatya province and its location in Turkey at the right bottom. The well-known areas of and 17 patients with lung cancer from Hekimhan environmental asbestos exposure in Guzelyurt are labeled in bold inhabitants in a period of 5 years. Four of them were female and 17 were smokers. Arguvan town located east of Hekimhan also had high incidences of lung cancer and mesothelioma. The other towns, Kuluncak, Arap- gir, Doganyol, Darende, and Malatya center, had gen- erally low incidences. Discussion This study shows a high incidence of lung cancer and mesothelioma in some towns of Malatya, probably due to environmental asbestos exposure as has been reported from other parts of Anatolia. Villagers use asbestos- containing white stucco on the house walls. The raw material is gathered from the mountains by men and applied to the house wall by women. It is also used as a substitute for baby powder, and on roofs for insulation and prevention of water leakage (Gennaro et al. 2000; Fig. 2 Scanning electron micrograph of tremolite asbestos taken Seaton 2002; Yazıcıog˘ lu et al. 1973). Thus, those living from the wall of a house (2,000· maginification) in houses are chronically exposed to the dust, and chil- dren grow up in houses with asbestos-contaminated air. Asbestos exposure was shown to occur in Hekimhan in our previous study (Hasanoglu et al. 2003), but no such as periodic acide-Schif and Alcian blue stain. mineralogical study has been performed in Arguvan. Immunohistochemical examination was performed with However, this town is a close neighbor to Hekimhan and carcinoembryonic antigen and epithelial membrane the inhabitants gave the same history of using white soil antigen for the differentiation of mesothelioma and mainly for whitewashing of houses. metastatic adenocarcinoma, if needed. The incidences of lung cancer and mesothelioma in each town and village were computed and incidence rates were expressed per Table 1 Distribution of our patients with mesothelioma and lung 100,000 people. cancer from Malatya province and places outside Malatya between 1997 and 2001 Mesothelioma Lung cancer Total Percentage Results Malatya 9 140 149 74.5 Other cities 7 44 51 25.5 Of the 200 patients evaluated, 149 from the Malatya Total 16 184 200 100 province were diagnosed as cases of lung cancer and 91 Table 2 Distribution of 149 patients with lung cancer and mesothelioma in Malatya province and its towns Population Mesothelioma Cases per 100,000a Lung Ca Cases per 100,000a MF MF Arguvan 10,716 – 4 7.46 12 – 22.39 Hekimhan 41,288 2 1 1.45 14 3 8.23 Puturge 26,539 – – – 9 – 6.78 Battalgazi 25,790 – – – 8 – 6.20 Akc¸adag 44,954 – – – 9 4 5.78 Kale 8,470 – – – 2 – 4.73 Yazıhan 18,980 – – – 3 1 4.21 Yesilyurt 39,729 – – – 11 – 5.53 Darende 44,917 – – – 6 1 3.11 Dogansehir 56,685 – 1 0.35 12 1 4.58 Doganyol 9,847 – – – 1 – 2.03 Arapgir 17,482 – – – 1 – 1.14 Kuluncak 16,858 – – – – – – Malatya Center 461,266 – 1 0.043 36 6 1.82 Total 823,521 2 7 0.21 124 16 3.39 aAnnual cases per 100,000 inhabitants is calculated by division of number of patients diagnosed between 1997 and 2001 The main cause of lung cancer is smoking. The and mesothelioma in the Malatya province even though smoking habits of the patients from Arguvan and He- they are minimum figures. kimhan and of those from the other places were similar. In conclusion, this study demonstrated for the first Another known cause of lung cancer is exposure to time that soil contaminated with asbestos may be related asbestos. One year of heavy or 5–10 years of moderate to high incidences of lung cancer and mesothelioma in exposure may increase the lung cancer risk twofold or some rural areas of Malatya province located in eastern more (Mossman and Churg 1998). The annual inci- Turkey. dences of lung cancer in Arguvan and Hekimhan were calculated as 22.39 and 8.23 per 100,000, respectively. The overall annual incidence of lung cancer in Turkey References was estimated to be 5.9 per 100,000 by the Health Ministry in 1994 (Cancer statistics in western Turkey Barıs YI (1987) Asbestos and erionite related chest diseases. Semih 1996). Thus, the incidence rates of lung cancer are Ofset Mat Ltd Co, Ankara, Turkey, pp 3–67 Cancer statistics in western Turkey (1996) 1992–1996. Izmir,_ Tur- approximately fourfold higher in Arguvan and 1.3-fold key: Izmir_ Cancer Registry-KIDEM higher in Hekimhan than in the general population of Coplu L, Dumortier P, Demir AU, Selcuk ZT, Kalyoncu F, Kis- Turkey, and this is probably related to the environ- acik G, DeVuyst P, Sahin AA, Baris YI. (1996) An epidemio- mental exposure to asbestos. logical study in an Anatolian village in Turkey environmentally Malignant pleural mesothelioma can develop even exposed to tremolite asbestos.
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