Document zo8Evjg5xby2yKO19mpaaaqa6

ap* Familial Mesothelioma After Intense the Asbestos Exposure at Hometery. nally illat- i obcclu- !jn of FMreedseroickthP.eLli.ioMmD;aJaciosb Lporkimicha, rMilDy; Jaannet Lfaapmeyil,yMwDe;re examined after the diagnosis en- >01 FofcllfcourdpaBt.ioNneapltunde,isMeaDs; eEarleofW. aWsiblkeinssto, sJr, MoDf mesothelioma in their sister. Patient 4, until workers, but the neoplasm, may also a 30-year-old housewife, showed slightly id in left of develop after intense exposure to tabestos outside the workplace.*1 *This report of pleural mesotheliomas in the wife and a daughter of an asbestos handler suggests that gross prominent lung markings in the chest roentgenogram, but pleural or pulmonary disease could not be diagnosed. Patient 5 (aged 23 years) had normal clinical and roentgenographic findings. The father had installed asbestos asbestos contamination of the home insulation on ships, and his exposure to can be a serious health hazard. dusts was reported to be particularly Report of Cases intense during World War II and several years thereafter. Family members stated Patient 1 (Figure), the father, worked as that when he returned home, his work pipe insulator at a shipyard for approxi clothes were often covered with a whitish, mately 25 years (1940 to 1965). Pulmonary powdery layer of dust. The mother shook rsbestosis was diagnosed at age 60 years the soiled clothes on the porch, laundered in 1966. He also smoked one to two packs them in the kitchen, and dried them on a of cigarettes daily for several decades. In line: her children played nearby. Family^ 1977, metastatic adenocarcinoma in the members denied other sources of intense left upper lobe of the lung developed and exposure to asbestos. There was no history the patient died. Findings from an autopsy of consanguinity or cancer among other demonstrated severe pulmonary asbes- close relatives. The family lived for many tnsis and lung cancer. years in a clean, residential, middle-class Patient 2, the mother, was in good neighborhood located approximately 6 km health until a right pleural effusion deveP from the shipyard. oped in 1967 at age 50 years. A righe Review of the histopathologic character thoracotomy and a pteural biopsy spec istics confirms the diagnosis of mesothe imen showed a mesothelioma. She was not lioma in the mother and daughter. The l cigarette smoker and had not experi daughter's tumor had a biphasic or mixed enced occupational exposures to asbestos. pattern of epithelial-type cells with papil She failed to respond to radiotherapy to lary formations, gland-like spaces, and the right thorax and died in August 1968. spindle cell metaplasia. Mitoses were An autopsy was not performed. numerous; mucicarmine stains were nega Patient 3, a daughter, was born in 1943. J tive. The mother's tumor had a similar A right pleural effusion developed at 34 ** appearance, though fibrosis was more pears of age in 1977. Thoracentesis and a extensive. pleural biopsy specimen revealed a meso thelioma. The patient had lived through- Comment . tot childhood in her parents' home, and liter worked in clerical and secretarial jobs without exposure to asbestos or chem ical agents. She had been in good health ttcept for a suspected pulmonary embo lism in 1974, which was attributed to oral contraceptive ingestion. She had intermit tently smoked several cigarettes a day for Mesotheliomas usually develop in older men with a history of occupa tional exposure to asbestos several decades before diagnosis.1 However, Anderson et al! recently reported mesotheliomas in four persons who resided with asbestos workers, and spproximately 15 years. The two younger daughters in the -h \w2 rtcry -BZ4, in at the PopSure From the Clinical Studies Section, Clinical | Epidemiology Branch, National Cancer Institute : Bt LI); the Department of Medicine, Sidney [ Fuller Cancer Institute (Dr Lokich); the Depart- m! ol Pathology, New England Deaconess j ttnpllal (Or Lapey); the Department of Surgery, i INuachusetts General Hospital. Harvard Medical : tchool (Dr Wilkins); and the Overholt Thoracic CMc (Dr Neptune). Boston. Reprint requests to Clinical Studies Section, ; Chiral Epidemiology . Branch, National Cancer : MItule, 35 Binney St. Boston, MA 02115 (Or 10. A, cX 05 [] Man with asbestosis and lung cancer 3 Woman with mes Bthelioma Pedigree of family. summarized 33 published cases of mesothelioma after domestic expo sure to asbestos; none of the 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 in 11 (50%) of 22 before 50 years of age. The preponderance of women and young patients can be explained by asbestos exposure during laundering of dusty work clothes in ten 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 the other hand, the dosage of asbestos to induce mesothelioma in susceptible persons may be low and hardly noticed. Several studies1 have impli cated pollution from asbestos mines and factories in the development of mesothelioma among residents in the neighborhood. In the present family, three cancers can be attributed to asbestos from the shipyard. The fa ther had lung cancer, which develops with particularly high frequency among asbestos workers who are also cigarette smokers.3 In addition, he had carried asbestos on his work clothes into his home. Mesotheliomas subsequently developed in both his wife, who laundered the clothing, and his daughter who was exposed during childhood. No 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 in 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.1 Thus, long term surveillance for cancer in these patients is needed.. References 1. Greenberg M, Davies TAL: Mesothelioma register 1967-G8. Br J Ind Med 31:91-104,1974. 2. Anderson HA, Lilis R, Daum SM, et al: Household-contact asbestos neoplastic risk. Ann NY Acad Sci 271:311-323,1976. 3. Hammond E, SelikofF IJ: Relation of ciga rette smoking to risk of death of asbestosassociated disease among insulation workers in the United States, in Bogovski P, Gilson JC, Timbrel! V, et al (eds): Biological Effects of Asbestos. Lyons, France, International Agency for Research on Cancer, 1973, pp 312-317. Bt al JAMA, Aug 4, 1978^-Vol 240, No. 5 Familial Mesothelioma--Li et al 467