Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later

Abstract

To the Editors: Malignant mesothelioma (MM) is a devastating disease, almost exclusively due to inhalation of asbestos fibres, and with higher risk for amphiboles [1]. Mediterranean regions, such as Turkey, Cyprus and Corsica, and others, such as New Caledonia [2], have experienced epidemics of MM as a result of nonoccupational, “domestic” exposure to tremolite asbestos and fibrous erionite [3]. In 1987, we reported on the very high incidence, 300 times higher than expected, of MM in the area of Metsovo, a complex of small villages in the prefecture of Ioannina in north-west Greece [4]. This, in conjunction with the previously noted very frequent pleural calcifications among Metsovites [5], led to the discovery of the culprit, a tremolite asbestos-containing whitewash (“luto” in the local dialect) [6]. The material was used by practically all households until 1940–1950. After that, it was gradually substituted by modern materials that did not contain asbestos. In 1980, luto was used by only 18% of builders and by 1990 it had been abandoned altogether (fig. 1) [7]. In 1996, we reported that the incidence of MM in the period 1985–1994 declined to one-third compared with the period 1980–1984, and we attributed the reduction to the abandonment of the use of luto. As a result, we concluded that the “Metsovo mesothelioma epidemic” would decline by 2020–2030 [8]. Figure 1– Percentage of Metsovo (Greece) households using luto from 1940–1990 (•) and the decline in Metsovo malignant mesothelioma (MM) cases between 1980 and 2009 in 5-yr (white bars) and 10-yr intervals (grey bars). In the …