Nonpulmonary outcomes of asbestos exposure.

The adverse pulmonary effects of asbestos are well accepted in scientific circles. However, the extrapulmonary consequences of asbestos exposure are not as clearly defined. In this review the potential for asbestos to produce diseases of the peritoneum, immune, gastrointestinal (GIT), and reproductive systems are explored as evidenced in published, peer-reviewed literature. Several hundred epidemiological, in vivo, and in vitro publications analyzing the extrapulmonary effects of asbestos were used as sources to arrive at the conclusions and to establish areas needing further study. In order to be considered, each study had to monitor extrapulmonary outcomes following exposure to asbestos. The literature supports a strong association between asbestos exposure and peritoneal neoplasms. Correlations between asbestos exposure and immune-related disease are less conclusive; nevertheless, it was concluded from the combined autoimmune studies that there is a possibility for a higher-than-expected risk of systemic autoimmune disease among asbestos-exposed populations. In general, the GIT effects of asbestos exposure appear to be minimal, with the most likely outcome being development of stomach cancer. However, IARC recently concluded the evidence to support asbestos-induced stomach cancer to be "limited." The strongest evidence for reproductive disease due to asbestos is in regard to ovarian cancer. Unfortunately, effects on fertility and the developing fetus are under-studied. The possibility of other asbestos-induced health effects does exist. These include brain-related tumors, blood disorders due to the mutagenic and hemolytic properties of asbestos, and peritoneal fibrosis. It is clear from the literature that the adverse properties of asbestos are not confined to the pulmonary system.

Non-response bias in a surveillance program for asbestos-related lung cancer.

OBJECTIVES: In a cohort study non-response might lead to a biased selection of cohort members and may affect the validity and reliability of the study outcome. To detect the possible effects of a non-response bias on study results, we evaluated the reasons for non-participation and the differences of respondents and non-respondents in a health surveillance program for power industry workers, formerly exposed to asbestos. METHODS: A cohort of former power plant workers was formed to participate in an early detection program for lung cancer. We evaluated the results of 1,019 individuals (mean age 66 yr), of which 839 took part in at least one examination, 180 refused to participate or did not respond. To obtain the reasons for non-response, we interviewed the cohort members by telephone or we requested them by mail to complete and return a brief questionnaire. Further sources of information were the communal registration offices and local health offices. RESULTS: The main reasons for non-participation were refusal (35%), illness (23.3%), death (16.7%) and difficulties with traveling (13.3%). It was impossible to make contact with or obtain an explanation from 11.7%. In a logistic regression model we demonstrated that advanced age and a long travel distance from the study center negatively affected the participation rate (p<0.001). There was no difference between respondents and non-respondents regarding prevalence (p=0.559) and incidence of lung cancer (p=0.882). CONCLUSION: We concluded that in our cohort non-participation did not cause a selection bias in terms of lung cancer rates.

[Occupation related thoracic tumors]. / Berufsbedingte Thoraxtumoren.

It is estimated that about 4% of cancer mortality is attributed to occupational risk factors. Due to long latency periods it is often difficult to establish causal relationships. Thoracal cancer accounts for about 88% of all compensated occupational cancers in Germany. Most important exposures and diseases are asbestos-related lung cancer, asbestos-related malignant mesothelioma and radiation induced lung cancer (by Radon and its decay products). Lung cancer caused by nickel compounds, hexavalent chromium, arsenic and its compounds, coke oven gases and polycyclic aromatic hydrocarbons are rare. Silica-dust induced lung cancer can be compensated as occupational disease if a silicosis is present. In Germany every physician is obliged to notify a suspected occupational cancer as well as other occupational diseases.

SV40 and the pathogenesis of mesothelioma.

Malignant mesothelioma, a tumor of the pleura, pericardium, and peritoneum, is presently a worldwide problem. Current therapy is ineffective in slowing the course of the disease, and median survival from the time of diagnosis is rarely greater than 1 year. While the tumor was almost unknown prior to the second half of the twentieth century, it is presently responsible for more than 2000 deaths per year in the US alone. Mesothelioma is frequently associated with exposure to asbestos, but the incidence of cases involving individuals with low levels of asbestos exposure is increasing. For this reason, there has been much interest in studying whether there are alternative factors that act alone or in conjunction with asbestos in producing this malignancy. In the last decade, simian virus 40 (SV40) has become the most notable suspected agent.

Mesotelioma maligno en la región inguinal de origen incierto / Malignant mesothelioma of unknown origin in the inguinal region

Se presenta un caso de mesotelioma maligno en una paciente joven, localizado en la región inguinal y sin aparente relación con ningún saco herniario ni cavidad peritoneal. Se revisa la bibliografía existente, sin encontrar ninguna otra forma igual de mesotelioma (AU)

Mesotelioma pleural maligno: experiencia del Instituto Nacional de Cancerología (1935-1954)

Introducción: El mesotelioma pleural maligno (MPM) es una neoplasia casi invariablemente fatal, relaciónada la gran mayoría de las veces con la exposición a asbesto. La frecuencia de aparición de MPM es creciente en el mundo entero y, en nuestro país su aumento es alarmante. Sin embargo, hay pocos estudios que describan la experiencia con esta entidad en nuestro medio. Objetivo: Presentar la experiencia del Instituto Nacional de Cancerología de Santafé de Bogotá en MPM. Diseño: estudio observacional descriptivo (serie de casos) Pacientes y Métodos: se revisaron los registros de pacientes con diagnóstico de MPM entre 1935 y 1994. Se escogieron 32 que tuvieron la información requerida. Las variables seleccionadas fueron analizadas estadísticamente por los métods de chi cuadrado, T de student, Kaplan-Meier, Log-Rank-Test y Cox. Resultados: Se diagnósticaron 32 pacientes con Mesotelioma Pleural Maligno. Veintidós (69 por ciento), consultaron en los últimos 6 años; fueron 24 hombres y 8 mujeres (relación 3:1), con edad promedio de 46,5 años (rango 6-76 años). El tiempo promedio de evolución de los síntomas fue de 8 meses (rango 1-72 meses). Se presentó disnea en 22 (69 por ciento) pacientes, dolor torácico en 21 (66 por ciento)y tos en 17 (53 por ciento). Todos presentaron alteraciones radiológicas: 27 derrames pleurales, 24 engrosamientos pleurales y 9 masas. Se definió, si hubo o no exposición a asbesto en 18 pacientes; 14 estuvieron expuestos (78 por ciento). La broncospía y citología del líquido pleural nunca confirmaron el diagnóstico. La biopsia pleural ciega detectó malignidad, pero sólo confirmó el diagnóstico en 2 de 21 pacientes (9,5 por ciento). Las biopsias por toracoscopia o cirugía, siempre permitieron el diagnóstico. Histológicamente fueron 16 epiteliales (51,6 por ciento) 8 mixtos (25.8 por ciento) y 7 sarcomatosos (22,6 por ciento); Veintiocho (90,3 por ciento) fueron difusos. Diez pacientes se consideraron en estado I (34,5 por ciento) y 14 en estado II (48,3 por ciento). Cirugía radical se realizó en 11, con una mortalidad operatoria de 2 (8 por ciento), y una morbilidad de 4 (16 por ciento). Radioterapia se administró a 11 pacientes y quimioterapia a 7. El tiempo libre de enfermedad promedio fue 37,9 meses (rango 1-137), el cual se disminuye a 14,1 meses si excluimos al paciente que duró 137 meses. este tiempo fue influido si la cirugía fue o no...