Document em0by1rV5ovy3jwZdw5yxMZGy

n / ;< n n n j s [familial Mesothelioma After Intense (Asbestos Exposure at Home : F It. MO. JacoB Lekiett. MO: Janat Looey. MO: ***0*0 8. Nopiuno. MO. Carta W. WUkaia, Jr. MO If eS* r*. - iT> .:1a: raa- * if -'jic It!* rir- .i:al is at of -t*rr l he ..Jal .st bt iiteal -ased. patch and is .ronic the graft. j: b* - orv r.:. Ia i: -arcs is * poctta spot* MESOTHELIOMA is primarily an jcupational disease of asbestos xarkers. but the neoplasm may also ; jvelop after intense exposure to . jibeftos outside the workplace. This fport of pleural mesotheliomas in ist wife and a daughter of an uocstos handler suggests that gross iibestos contamination of the home . he a serious health hazard. I Report of Caaos * Patient 11 Figure i. the father, worked as . pipe insulator at a shipyard for approxi* rauly MS years (1940 to 196S>. Pulmonary uhsstosis was diagnosed at age 60 years : 1966. He aiao smoked one to two packs | icigarettes daily for several decades. In | 377. metastatic adenocarcinoma in the 1 A upper lobe of the lung developed end as patient died. Findings from an autopsy monitrated sever* pulmonary ssbosana snd lung cancer. Patient 2. the mother, was in good ssahh until a right pleural effusion dorolpM in 1967 at ago 50 years. A right aoncoumy and a pleural biopsy specass snowed a mesothelioma. She was not * cigarette smoker and- hnd not exporimead occupational exposures to asbestos, me failed to respond to radiotherapy to at right thorax and died ia August 1968. Is autopsy was not performed. Patient 3. a daughter, was born ia 1941 1 right pleural effusion devoiopod at 34 *nn of age in 1977. Thoracentesis and a Mtrai biopsy specimen revealed a meanasliama The patient had lived throughsu childhood ia her parents' home, and Jar worked in clerical and secretarial ms without exposure to asbestos or ehema! sgenta. She hnd been in good health ueept for t suspected pulmonary embo rn in 1974. which was attributed to oral -ntraceptivo ingestion. She had intermit; 'estly smoked several cigarettes a day for Uproximaiely 13 years. The two younger daughters la the . artafT ilia al me CSmcal Siu4iee Section. Ousel HeMii|>y( Brancn. National Cancer Inctawrc S' 10. me Oeoanmem at Me*cme. SiOney **ew Cancer metmne (Or Lenient me Oeoart* er esinelegs. New Cnyiene Oseconese ^*1 (Or Laeey): me Oeoanmem el Siwoery. ^mscriusens General Hosons'. Hsrvsro Mcoical j**w (Or OMams): sn* me Overnes Thoracic ** (0* Neotune). Sesian. .***>; reoueete le O--cel Slue Section, ^ai (smenuereoy Srench. National Cancer >m. 14 temey Si. Seelon. ms 02 its (Or family wore examined after the diagnoois of mtoothtlioma ia thoir sister. Pttient 4, n 30-year-old housewife, showed slightly prominent lung markings is the chest roentgenogram, but pleural or pulmonary disease could not bo diagnosed. Patient 5 (aged 23 yearn had normal clinical and roontgtnographic findings. The father had installed asbootoo insulation on ships, and his exposure to dusts was ruportod to be particularly intons* during World War II and sovtral years thereafter. Family members stated that when he returned home, his work clothes were often covered with n whitish, powdery layer of dust. The mother shook the soiled clothes on tho porch, laundered them in the kitchen, and dried them on line; her children played nearby. Family members denied other sources of intense exposure to asbestos. There was no history of consanguinity or cancer among other dose relatives. The family lived for many years in n dean, residential middle-daas neighborhood located approximately 6 km from th* shipyard. Review of the histopathologic character istics confirms tho diagnosis of mesothe lioma ia the mother and daughter. The daughter's tumor had a biphasic or mixed pattern of epithelial-typo colls with papil lary formations, gland-likt spaces, aad spindl* call metaplasia. Mitoses w*r* numerous: muecarmino stains were nega tive. The mother's tumor had a similar appearance, though fibrosis was men txtensivs. Common! Mesotheliomas usually dovolop in older man with a history of occupa tional exposure to asbestos several decades before diagnosis' However, Anderson ct al: recently reported mesotheliomas in four persons who resided with asbestos workers, and --t ^2 A c\ 0. Man with aaboatoaia and lung cancor 3 Woman wltn mownntiioma summarized 33 published cases of mesothelioma after domestic expo sure to asbestos; none of tho persons had contact with the fiber at work. The data on these 37 patients were fragmentary and showed that 27 (82%) of 33 were women and that mesothelioma was diagnosed ia 11 (50%) of 22 before 50 years of age. The preponderance of womon and young patients can be explained by asbestos exposure during laundering of dusty work clothes in tea patients, and during childhood in 11. It is possible that asbestos did not cause the mesotheliomas in patients 2 and 3. since exposure to the agent cannot be identified in the histories of all mesothelioma patients. On tho other hand, the dosage of asbestos to induct mesothelioma in susceptible persons may bo low and hardly noticed. Several studies' have impli cated pollution from asbestos mines and factories in the development of mesothelioma among residents in tho neighborhood. In the present family, three cancers can be attributed to asbestos from tho shipyard. The fa ther had lung cancer, which develops with particularly high frequency among asbestos workers who are also cigarette smokers.1 In addition, ho had carried asbestos on his work clothes into his home. Mesotheliomas subsequently developed in both his wifo, who laundered the clothing, and his daughter who was exposed during childhood. Ho other source of intense asbestos exposure was identified. Contributing factors may include ge netic susceptibility to cancer among family members and exposure at an early age in patient 3. The younger daughters ia the family had shorter and perhaps less-intense exposure to asbestos. They are presently free of cancer, but the latent period of asbes tos-associated mesothelioma is often more than three decades.' Thus, long term surveillance for cancer in these patients is needed. Referones* I. Greenberg M, Damn TAL Meaetbeliema refiner 1167-0. BrJIad Mad 21:91-10*.1974. 1 Andaman HA. Lilia 8. Dana SM. at at Houaabold-coatact aabaataa aaapiaatie rialt Aaa HYAt^Sei nun-m in 8 Hammond E. Salikaff U: lUiauaa af d*ratta mokinc to riak af doth af aabaaina aaaociatad disaaa* amanf insulation worker* ia tha United State*. in Bosevaki P, Gilaao JC. Timbrtil V, at al (adat Bioicgtcal Efftra tf 4<6uroa Lroaa. Franca. International *pwr far Rataartk oa Cancar. 1173. pp *12-117. j *t a' Au 4. 1978--Vol 240. No. S Familial Moeotftoiioma--Li al al 487 0^737 DOW