RESUMEN
Previous studies conducted in the municipality of Sibaté (Colombia) have revealed alarming findings regarding asbestos exposure in the region, as it is the site of the country's first mesothelioma cluster. Non-occupational asbestos exposure events were identified in this population, and the young age of the mesothelioma cases at the time of diagnosis suggests that asbestos exposure occurred during their childhood. The creation of landfilled zones in the 1980s and 1990s, utilizing friable asbestos among other disposed materials, may have been a significant asbestos exposure event contributing to the elevated number of mesothelioma cases. The objective of this study was to model various historical exposure scenarios related to the creation and interaction of the population with asbestos-contaminated landfilled zones, in light of the absence of asbestos monitoring in the region. The models utilized a multi-agent simulation process, focusing on a 10-year period (1986-1995). Various relevant variables were incorporated into the modeling process, including, for example, the number of children playing in the landfilled zones and the percentage of children carrying asbestos fibers on their clothes to their homes. A range of values for input data for the models were utilized, spanning from very conservative numbers to exposure-promoting values. The average number of exposed individuals estimated over 750 simulation runs, considering all scenarios, was 571, with a range between 31 and 3800 exposed individuals. The use of multi-agent simulation models can assist the understanding of past asbestos exposure events, especially when there is a lack of environmental surveillance data.
Asunto(s)
Amianto , Exposición a Riesgos Ambientales , Amianto/análisis , Humanos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Monitoreo del Ambiente/métodos , Mesotelioma/epidemiología , Mesotelioma/inducido químicamenteRESUMEN
OBJECTIVE: To review the pathological diagnosis of possible cases and/or hidden cases of malignant mesothelioma (MM) between 2000 and 2012 using the Hospital-Based Cancer Registry database in the state of São Paulo, Brazil. METHODS: Possible cases were retrieved by assessing the database. Inclusion criteria were being older than 30 years of age and having ICD-O-3 topography and morphology codes related to MM. A board of expert pathologists reviewed the pathology reports and requested paraffin blocks in cases that demanded revision. After staining with calretinin, D2-40, WT-1 (as positive MM markers) and Ber-EP4 and MOC31 (as negative MM markers), cases were divided and studied independently by a pair of pathologists to confirm or discard the diagnosis of MM. RESULTS: Our sample comprised 482 cases from 25 hospitals, and 130 needed further histological revision. We received 73 paraffin blocks with adequate material. After board analysis, there were 9 cases with a definitive diagnosis of MM, improving the diagnostic rate in 12%. Two cases of previously diagnosed MM were discarded by review. CONCLUSIONS: Our results confirm that part of MM underdiagnosis and underreporting in Brazil is due to incomplete or mistaken pathological diagnosis.
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Neoplasias Pulmonares , Mesotelioma Maligno , Mesotelioma , Sistema de Registros , Humanos , Brasil/epidemiología , Mesotelioma/patología , Mesotelioma/epidemiología , Mesotelioma/diagnóstico , Mesotelioma Maligno/patología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/epidemiología , Adulto , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Neoplasias Pleurales/patología , Neoplasias Pleurales/epidemiología , Neoplasias Pleurales/diagnósticoRESUMEN
Introduction: The asbestos industry began its operations in Colombia in 1942 with the establishment of an asbestos-cement facility in Sibaté, located in the Department of Cundinamarca. Despite extensive asbestos use and production in Colombia, the country lacks a reliable epidemiological surveillance system to monitor the health effects of asbestos exposure. The Colombian health information system, known as SISPRO, did not report mesothelioma cases diagnosed in the municipality, posing a significant challenge in understanding the health impacts of asbestos exposure on the population of Sibaté. Methods: To address this issue, an active surveillance strategy was implemented in Sibaté. This strategy involved conducting door-to-door health and socioeconomic structured interviews to identify Asbestos-Related Diseases (ARDs). Validation strategies included a thorough review of medical records by a panel of physicians, and the findings were communicated to local, regional, and national authorities, as well as the general population. Results: The active surveillance strategy successfully identified a mesothelioma cluster in Sibaté, revealing the inadequacy of the existing health information system in monitoring asbestos-related diseases. The discovery of this cluster underscores the critical importance of implementing active surveillance strategies in Colombia, where governmental institutions and resources are often limited. Conclusion: The findings of this study emphasize the urgent need for Colombia to establish a reliable epidemiological surveillance system for asbestos-related diseases (ARDs). Active surveillance strategies can play a crucial role in identifying mesothelioma clusters and enhancing our understanding of the health effects of asbestos exposure in low- and middle-income countries.
Asunto(s)
Amianto , Mesotelioma Maligno , Mesotelioma , Exposición Profesional , Síndrome de Dificultad Respiratoria , Humanos , Colombia/epidemiología , Países en Desarrollo , Exposición Profesional/efectos adversos , Mesotelioma/epidemiologíaRESUMEN
The lack of safe levels of asbestos exposure and the long latency of asbestos-related disease (ARD) makes workers' health surveillance challenging, especially in lower-income countries. This paper aims to present the recently developed Brazilian system for monitoring workers and general population exposed to asbestos (Datamianto), and to discuss the main challenges and opportunities for workers' health surveillance. METHODS: a descriptive study of the Datamianto development process, examining all the stages of system planning, development, improvement, validation, availability, and training of health services for its use, in addition to presenting the main challenges and opportunities for its implementation. RESULTS: The system was developed by a group of software developers, workers' health specialists, and practitioners, and it was recently incorporated by the Ministry of Health to be used for workers' health surveillance. It can facilitate the monitoring of exposed individuals, epidemiological data analysis, promote cooperation between health services, and ensure periodical medical screening guaranteed to workers by labor legislation. Moreover, the system has a Business Intelligence (BI) platform to analyze epidemiologic data and produce near real-time reports. CONCLUSIONS: Datamianto can support and qualify the healthcare and surveillance of asbestos-exposed workers and ARD, promoting a better quality of life for workers and improving companies' compliance with legislation. Even so, the system's significance, applicability, and longevity will depend on the efforts aimed at its implementation and improvement.
Asunto(s)
Amianto , Asbestosis , Neoplasias Pulmonares , Mesotelioma , Exposición Profesional , Humanos , Asbestosis/epidemiología , Brasil , Calidad de Vida , Vigilancia de la Población , Mesotelioma/epidemiología , Neoplasias Pulmonares/epidemiologíaRESUMEN
Asbestos has been used by automobile, construction, manufacturing, power, and chemical industries for many years due to its particular properties, i.e. high tensile strength, non-flammable, thermal and electrical resistance and stability, and chemical resistance. However, such a mineral causes harmful effects to human health, including different types of cancer (e.g., mesothelioma). As a result, the use of asbestos has been banned since the 1980s in many countries. Nonetheless, asbestos is still part of the daily life of the population as asbestos-containing materials (ACMs) are still present in many buildings constructed and renovated before the 1990s. This work aims to present a current literature review about asbestos. The literature review was composed mainly of research articles published in international journals from the medical and engineering disciplines to provide an overview of asbestos use effects reported in interdisciplinary areas. The literature review comprised asbestos characteristics and its relationship to the risks of human exposure, countries where asbestos use is permitted or banned, reducing asbestos in the built environment, and environmental impact due to use and disposal of asbestos. The main findings were that ACMs are still responsible for severe human diseases, particularly in areas where there is a lack of coordinated asbestos management plans, reduced awareness about asbestos health risks, or even a delay in the implementation of asbestos-ban. Such issues may be more prevailing in developing countries. The current research in many countries contemplates several methodologies and techniques to process ACMs into inert and recyclable materials. The identification and coordinated management of ACM hazardous waste is a significant challenge to be faced by countries, and its inadequate disposal causes severe risk of exposure to asbestos fibres. Based on this work, it was concluded that banning asbestos is indicated in all countries in the world.
Asunto(s)
Amianto , Mesotelioma , Exposición Profesional , Comercio , Humanos , Cooperación Internacional , Mesotelioma/epidemiología , Mesotelioma/etiologíaRESUMEN
El mesotelioma es considerado en el mundo industrializado a consecuencia de la exposición ocupacional a fibras de asbesto. A nivel país se considera una enfermedad profesional. El objetivo del presente trabajo fue conocer y describir casos de mesotelioma notificados en Uruguay entre los años 2002 y 2014, con énfasis en los aspectos de la exposición ocupacional. El presente trabajo corresponde a un estudio descriptivo retrospectivo, a partir de los casos notificados se recrearon historias médicas enlazando con datos de servicios asistenciales. Se identificaron fuentes de exposición al asbesto en diferentes ocupaciones e industrias en el país. Resultados: fueron notificados 122 casos. Se accedió a la historia clínica en un tercio (47/122). El dato ocupación estaba consignado solo en 27/47, en 3/47 se explicitaba la exposición al asbesto/amianto. Los sectores productivos identificados mayoritariamente correspondieron a transporte, metalúrgico, construcción y limpieza. Se evidenció un registro insuficiente del dato ocupación y de los antecedentes laborales. Ésta información laboral es fundamental para establecer el nexo causal de la exposición en estudio y la condición de enfermedad profesional. La gravedad de la enfermedad y el conocimiento del riesgo derivado de la exposición, laboral, justifica el desarrollo de políticas en salud ocupacional. Es necesario fortalecer la formación de los profesionales de la salud sobre la importancia del trabajo como determinante del proceso salud - enfermedad.
Mesothelioma is considered in the industrialized world as a consequence of occupational exposure to asbestos fibers - asbestos. At the country level it is considered an occupational disease. The objective was to know and describe cases of mesothelioma notified in Uruguay between the years 2002 and 2014, with emphasis on aspects of occupational exposure. The present work corresponds to a retrospective descriptive study, from the reported cases medical records were recreated linking with data from healthcare services. Sources of asbestos exposure were identified in different occupations and industries in the country. Results: 122 cases were notified. The medical history was accessed in one third (47/122). The occupation data was only in 27/47, in 3/47 the exposure to asbestos / asbestos was specified. The productive sectors identified mainly corresponded to transportation, metallurgy, construction and cleaning. Insufficient registration of occupation and employment history was evidenced. This work information is essential to establish the causal link between the exposure under study and the occupational disease condition. The severity of the disease and knowledge of the risk derived from exposure occupational, justify the development of occupation health policies. It is necessary to strengthen the training of health professionals on the importance of work as a determinant of the health - disease process.
O mesotelioma é considerado no mundo industrializado como consequência da exposição ocupacional às fibras de amianto - o asbesto. Em nível nacional, é considerada uma doença ocupacional. O objetivo foi conhecer e descrever os casos de mesotelioma notificados no Uruguai entre os anos de 2002 a 2014, com ênfase nos aspectos de exposição ocupacional. O presente trabalho corresponde a um estudo descritivo retrospectivo, a partir dos casos relatados, prontuários médicos foram recriados vinculando-os a dados de serviços de saúde. Fontes de exposição ao amianto foram identificadas em diferentes ocupações e indústrias no país. Resultados: foram notificados 122 casos. O histórico médico foi acessado em um terço (47/122). Os dados de ocupação foram apenas em 27/47, em 3/47 foi especificada a exposição ao amianto / amianto. Os setores produtivos identificados corresponderam principalmente a transportes, metalurgia, construção e limpeza. Foi evidenciado registro insuficiente de ocupação e histórico de empregos. Essas informações de trabalho são essenciais para estabelecer o nexo causal entre a exposição em estudo e a condição de doença ocupacional. A gravidade da doença e o conhecimento do risco decorrente da exposição ocupacional, justificam o desenvolvimento de políticas de saúde ocupacional. É preciso fortalecer a formação dos profissionais de saúde sobre a importância do trabalho como determinante do processo saúde - doença.
Asunto(s)
Humanos , Masculino , Femenino , Amianto/efectos adversos , Exposición Profesional/efectos adversos , Mesotelioma/mortalidad , Mesotelioma/epidemiología , Uruguay/epidemiología , Epidemiología Descriptiva , Incidencia , Estudios Retrospectivos , Distribución por Sexo , Mesotelioma/inducido químicamenteRESUMEN
BACKGROUND: Peru has a public health problem because of asbestos imports. We analyzed the mortality trends for mesothelioma in Peru and its provinces from 2005 to 2014 and estimated their relationship with the amount of asbestos imported previously. METHODS: We computed age-standardized mortality rates (ASMRs) per 100,000 population (direct method and SEGI world standard population reference), and the standardized mortality ratio (SMR). The relationship between the amount of asbestos imported annually along the period 1965-2010 and the number of mesothelioma deaths per year from 2005 to 2014 was estimated by log-linear Poisson regression models and Pearson correlation calculations. RESULTS: After correcting the number of deaths, Peru registered 428 cases (or 430 when corrected cases are rounded by sex) between 2005 and 2014. The highest ASMRs were in Arequipa and Callao (range: 0.40-0.41/100,000 population), followed by Huancavelica (0.36/100,000 population). This translates into approximately one death per each 68-111 of asbestos tons imported. The latency period for the higher level of positive correlation found was 8 years (râ¯=â¯0.8). Male female sex ratio was lower in provinces such as Junin and Hunacavelica with geological asbestos risk. CONCLUSIONS: Two patterns of mesothelioma risk have been detected, occupational and environmental. During the 2002-2006 years, Peru increased the asbestos use. If crocidolite imports were also increased, this could be behind the 8 years latency period detected. Peru should boost strategies towards the total ban of all forms of asbestos.
Asunto(s)
Amianto/efectos adversos , Carcinógenos/toxicidad , Mesotelioma/mortalidad , Exposición Profesional/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Femenino , Geografía , Humanos , Lactante , Recién Nacido , Masculino , Mesotelioma/epidemiología , Mesotelioma/etiología , Persona de Mediana Edad , Perú/epidemiología , Pronóstico , Tasa de Supervivencia , Adulto JovenRESUMEN
Although asbestos exposure and risks can be prevented, only five countries in Latin America have banned asbestos, including Colombia. Beginning in 2011, a collaboration between the Istituto Superiore di Sanità in Italy and Universidad de los Andes in Colombia was established, bringing together relevant expertise aiming to improve our understanding of the asbestos problem. An important result of this collaboration was a recently published study conducted in Sibaté, Colombia, a municipality where an asbestos-cement facility has operated since 1942. The evidence collected suggests the presence of a mesothelioma cluster in Sibaté. Landfilled zones with an underground layer of friable asbestos were also discovered in the urban area of the municipality. The importance of this type of collaboration can go beyond understanding the impact of asbestos at the local level, which is crucial, and may also contribute in solving unanswered questions of the problem in countries that banned asbestos decades ago.
Asunto(s)
Amianto/toxicidad , Conservación de los Recursos Naturales/legislación & jurisprudencia , Estudios Epidemiológicos , Instalaciones Industriales y de Fabricación , Mesotelioma/prevención & control , Neoplasias Pleurales/prevención & control , Academias e Institutos , Amianto/análisis , Colombia/epidemiología , Materiales de Construcción , Exposición a Riesgos Ambientales , Femenino , Humanos , Colaboración Intersectorial , Masculino , Mesotelioma/epidemiología , Mesotelioma/etiología , Exposición Profesional , Neoplasias Pleurales/epidemiología , Neoplasias Pleurales/etiología , Contaminantes del Suelo/análisis , Universidades , Salud Urbana , Instalaciones de Eliminación de ResiduosRESUMEN
PURPOSE: Malignant pleural mesothelioma (MPM) is a highly lethal cancer caused by exposure to asbestos. Currently, the diagnosis is a challenge, carried out by means of invasive methods of limited sensitivity. This is a case-control study to evaluate the individual and combined performance of minimally invasive biomarkers for the diagnosis of MPM. METHOD: A study of 166 incident cases of MPM and 378 population controls of Mestizo-Mexican ethnicity was conducted. Mesothelin, calretinin, and megakaryocyte potentiating factor (MPF) were quantified in plasma by ELISA. The samples were collected from 2011 to 2016. RESULTS: Based on ROC analysis and a preset specificity of 95%, the combination of the three biomarkers reached an AUC of 0.944 and a sensitivity of 82% in men. In women, an AUC of 0.937 and a sensitivity of 87% were reached. In nonconditional logistic regression models, the adjusted ORs in men were 7.92 (95% CI 3.02-20.78) for mesothelin, 20.44 (95% CI 8.90-46.94) for calretinin, and 4.37 (95% CI 1.60-11.94) for MPF. The ORs for women were 28.89 (95% CI 7.32-113.99), 17.89 (95% CI 3.93-81.49), and 2.77 (95% CI 0.47-16.21), respectively. CONCLUSIONS: To our knowledge, this is the first study evaluating a combination of mesothelin, calretinin, and MPF, and demonstrating a sex effect for calretinin. The biomarker panel showed a good performance in a Mestizo-Mexican population, with high sensitivity and specificity for the diagnosis of MPM.
Asunto(s)
Biomarcadores de Tumor/sangre , Calbindina 2/sangre , Proteínas Ligadas a GPI/sangre , Neoplasias Pulmonares/sangre , Mesotelioma/sangre , Neoplasias Pleurales/sangre , Anciano , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Masculino , Mesotelina , Mesotelioma/diagnóstico , Mesotelioma/epidemiología , Mesotelioma Maligno , México/epidemiología , Persona de Mediana Edad , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/epidemiología , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores SexualesRESUMEN
INTRODUCTION: The asbestos industry began operations in Colombia in 1942, with an asbestos-cement facility located in the municipality of Sibaté. In recent years residents from Sibaté have been complaining about what they consider is an unusually large number of people diagnosed with asbestos-related diseases in the town. A study to analyze the situation of Sibaté started in 2015, to verify if the number of asbestos related diseases being diagnosed were higher than expected, and to identify potential asbestos exposure sources in the town. METHODS: A health and socioeconomic survey was implemented door-to-door to identify potential asbestos-related diseases. Several self-reported mesothelioma cases were identified, and for confirmation purposes, copies of the medical record with the histopathology report were obtained. A panel of six physicians analyzed the medical records. Information of validated cases was used to estimate the male and female age-adjusted incidence rate for Sibaté. Based on reports of the existence of potential asbestos-contaminated landfills, topographic maps, a digital elevation model, and current satellite images were crossed using a geographic information system to identify potential landfilled areas, and soils samples were collected in some of these areas. RESULTS: A total of 355 surveys were completed, and 29 self-reported mesothelioma cases were identified. Twenty-five of these cases have been persons who had lived at some moment of their lives in Sibaté. It was possible to obtain copies of the medical diagnosis for 17 cases. Of these, the panel of physicians classified 15 cases as certain pleural mesothelioma, one as probable, and one as not mesothelioma. Based on this information, the estimated age-adjusted incidence rate of mesothelioma in Sibaté was 3.1â¯×â¯105 persons-year for males and 1.6â¯×â¯105 persons-year for females. These rates are high in comparison to those reported in other cities, regions, and countries of the world. Using geographic information systems, landfilled zones in the urban area of Sibaté were identified, on top of which a school and different sports facilities were built. The analysis of four soil samples collected in landfilled zones, confirmed the existence of an underground layer of friable and non-friable asbestos. CONCLUSION: The collected evidence suggests the presence of a malignant pleural mesothelioma cluster in Sibaté.
Asunto(s)
Amianto , Mesotelioma , Exposición Profesional , Adulto , Amianto/toxicidad , Ciudades , Colombia , Exposición a Riesgos Ambientales , Femenino , Humanos , Incidencia , Masculino , Mesotelioma/epidemiología , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, São Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. METHODS: Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS). RESULTS: XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. CONCLUSION: This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.
Asunto(s)
Asbestos Anfíboles/efectos adversos , Asbestosis/epidemiología , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Exposición Profesional/efectos adversos , Neoplasias Pleurales/epidemiología , Anciano , Asbestos Anfíboles/análisis , Asbestosis/etiología , Brasil/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Monitoreo del Ambiente/métodos , Femenino , Humanos , Incidencia , Neoplasias Pulmonares/inducido químicamente , Neoplasias Pulmonares/epidemiología , Masculino , Concentración Máxima Admisible , Mesotelioma/inducido químicamente , Mesotelioma/epidemiología , Mesotelioma Maligno , Persona de Mediana Edad , Minería , Salud Laboral , Neoplasias Pleurales/inducido químicamente , Neoplasias Pleurales/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Espirometría/métodos , Factores de Tiempo , Capacidad VitalRESUMEN
BACKGROUND: Asbestos consumption in Latin America (LA) amounts to 10% of yearly global production. Little is known about the impact of asbestos exposure in the region. OBJECTIVE: To discuss scientific and socio-economic issues and conflicts of interest and to summarize epidemiological data of asbestos health effects in LA. DISCUSSION: Recent data on chrysotile strengthened the evidence of its carcinogenicity and showed an excessive risk of lung cancer at cumulative exposure levels as low as 1.5 fibre-years/ml. Technology for substitution is available for all asbestos-containing products and ceasing asbestos production and manufacturing will not result in unemployment and loss of income, except for the mining industry. The flawed arguments used by the industry to maintain its market, both to the public and in courtrooms, strongly relies on the lack of local evidence of the ill effects and on the invisibility of asbestos-related diseases in LA, due to the limited number of studies and the exposed workers' difficulty accessing health services. The few epidemiological studies available show clear evidence of clusters of mesothelioma in municipalities with a history of asbestos consumption and a forecasted rise in its incidence in Argentina and Brazil for the next decade. In Brazil, non-governmental organizations of asbestos workers were pivotal to counterbalance misinformation and inequities, ending recently in a Supreme Court decision backing an asbestos ban. In parallel, continuous efforts should be made to stimulate the growth of competent and ethical researchers to convey adequate information to the scientific community and to the general public.
Asunto(s)
Asbestos Serpentinas/economía , Asbestos Serpentinas/toxicidad , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/etiología , Mesotelioma/epidemiología , Exposición Profesional/prevención & control , Carcinogénesis , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Exposición a Riesgos Ambientales/prevención & control , Humanos , América Latina/epidemiología , Minería , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Salud PúblicaRESUMEN
BACKGROUND: Malignant pleural mesothelioma (MPM) is an aggressive tumor, associated with poor prognosis. There is a lack of information about the clinical and pathological features related with survival in the Latin American population. METHODS: The MeSO-CLICaP registry identified 302 patients with advanced MPM diagnosed and treated between January 2008 and March 2016. The Cox model was applied to determine the variables associated with survival. A random forest tree model was built to predict the response to first-line chemotherapy among Latin American patients. RESULTS: The median age was 61.1 years (SD 10.6 years), 191 (63.2%) were men, 65.9% were ever smokers, and 38.7% had previous exposure to asbestos. A total of 237 (78.5%) had epithelioid tumors, and 188 (62.3%) and 114 (37.7%) cases had stage III or IV MPM, respectively. A total of 49 patients (16.2%) underwent pleurectomy, 57 (18.9%) received radiotherapy, and 279 patients received first-line platinum-based chemotherapy. The overall response rate to first-line chemotherapy was 40.4%, progression-free survival to first-line treatment was 5.7 months (95% CI 4.9-6.5), and 63 (20.8%) patients had pemetrexed maintenance. The median overall survival was 16.8 months (95% CI 13.0-20.5), and multivariate analysis found that stage (P = 0.013), and pleurodesis (P = 0.048), were independent prognostic factors for first-line overall survival. The model to predict response to first-line chemotherapy obtained a 0.98 area under the curve, a sensitivity of 93%, and a specificity of 95% for detecting responders and non-responders. CONCLUSION: This study identifies factors associated with clinical benefit from chemotherapy among advanced MPM Latin American patients, emphasizing the impact of histology and the clinical benefit of chemotherapy on outcomes.
Asunto(s)
Neoplasias Pulmonares/epidemiología , Mesotelioma/epidemiología , Platino (Metal)/uso terapéutico , Neoplasias Pleurales/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Femenino , Humanos , América Latina/epidemiología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Mesotelioma/tratamiento farmacológico , Mesotelioma/patología , Mesotelioma/cirugía , Mesotelioma Maligno , Persona de Mediana Edad , Pemetrexed/uso terapéutico , Neoplasias Pleurales/tratamiento farmacológico , Neoplasias Pleurales/patología , Neoplasias Pleurales/cirugía , Supervivencia sin Progresión , Procedimientos Quirúrgicos Torácicos/métodosRESUMEN
Introdução: O mesotelioma pleural maligno é um câncer raro, agressivo e que apresenta expectativa de aumento na incidência até 2030. As melhores formas de tratar essa neoplasia continuam em debate. Objetivo: Sintetizar as evidências de eficácia e segurança dos esquemas quimioterápicos de primeira linha disponíveis para o tratamento do mesotelioma pleural maligno. Método: Foram utilizadas as bases bibliográficas LILACS, MEDLINE, Scopus, Cochrane Controlled Trials Register e Web of Science. Buscaram-se estudos na literatura cinzenta. Os critérios de elegibilidade incluíram ensaios randomizados de fases II ou III, de pacientes com mesotelioma pleural virgem de tratamento quimioterápico, submetidos a qualquer regime terapêutico, tendo como controle outros esquemas quimioterápicos ou controle ativo de sintomas, e apresentando tempo de sobrevida global, tempo livre de progressão, resposta tumoral e toxicidade como desfechos. Todas as etapas foram realizadas por dois revisores, de forma independente. O protocolo da revisão foi registrado no International Prospective Register of Systematic Reviews (PROSPERO 2014: CRD42014014388). Resultados: Treze estudos envolvendo 14 esquemas terapêuticos foram incluídos. O único esquema quimioterápico que se apresentou superior ao comparado com significância estatística nos três desfechos de eficácia foi cisplatina + pemetrexede. Cisplatina + pemetrexede e cisplatina + gemcitabina apresentaram mais casos de toxicidade graus 3 e 4. Conclusão: Existem boas evidências para recomendar combinações de derivado de platina e antifolato como opção de primeira escolha no tratamento quimioterápico do mesotelioma pleural. Mais estudos clínicos são necessários para embasar decisões de incorporação dos antifolatos no tratamento rotineiro dessa neoplasia no Brasil.
Introduction: Malignant pleural mesothelioma is a rare, aggressive cancer that is expected to increase in incidence by 2030. The best ways to treat this neoplasm are still under discussion. Objective: To synthesize the evidence of efficacy and safety of the different first-line chemotherapy regimens available for the treatment of malignant pleural mesothelioma. Method:The LILACS, MEDLINE, Scopus, Cochrane Controlled Trials Register and Web of Science bibliographic databases were used. Studies were sought in the grey literature. Eligibility criteria included randomized phase II or III trials of chemotherapy-naive patients with pleural mesothelioma who underwent any therapeutic regimen, compared to other chemotherapeutic regimens or active symptom control, and presenting overall survival, progression free survival, tumor response and toxicity as outcomes. All steps were performed independently by two reviewers. The review protocol was recorded in the International Prospective Register of Systematic Reviews (PROSPERO 2014: CRD42014014388). Results: Thirteen studies involving fourteen therapeutic regimens were included. The only chemotherapy regimen that presented superior to the comparator with statistical significance in the three efficacy outcomes was cisplatin + pemetrexed. Cisplatin + pemetrexed and cisplatin + gemcitabine presented more grades 3 and 4 toxicity cases. Conclusion: There is good evidence to recommend combinations of platinum and antifolate derivatives as a first-choice option in the chemotherapeutic treatment of pleural mesothelioma. Further clinical studies are needed to support decisions to incorporate antifolates in the routine treatment of this neoplasm in Brazil.
Introducción: El mesotelioma pleural maligno es un cáncer raro, agresivo y que presenta expectativa de aumento en la incidencia hasta 2030. Objetivo: Sintetizar las evidencias de eficacia y seguridad de los diferentes esquemas quimioterápicos de primera línea disponibles para el tratamiento del mesotelioma pleural maligno. Método: Se utilizaron las bases bibliográficas LILACS, MEDLINE, Scopus, Cochrane Controlled Trials Register y Web of Science. Se buscó estudios en la literatura gris. Los criterios de elegibilidad incluyeron ensayos aleatorizados de fase II o III, de pacientes con mesotelioma pleural vírgenes de tratamiento quimioterápico, sometidos a cualquier régimen terapéutico, teniendo como control otros esquemas quimioterápicos o control activo de síntomas, y presentando tiempo de supervivencia global, tiempo libre de progresión, respuesta tumoral y toxicidad como resultados. Todas las etapas fueron realizadas por dos revisores, de forma independiente. El protocolo de la revisión se registró en el International Prospective Register of Systematic Reviews (PROSPERO 2014: CRD42014014388). Resultados: Se incluyeron trece estudios de catorce esquemas terapéuticos. El único esquema uimioterápico que se presentó superior al comparador con significancia estadística en los tres resultados de eficacia fue cisplatino + pemetrexede. Cisplatino + pemetrexed y cisplatino + gemcitabina presentaron más casos de toxicidad grados 3 y 4. Conclusion: Existen buenas evidencias para recomendar combinaciones de derivado de platino y antifolato como opción de primera elección en el tratamiento quimioterápico del mesotelioma pleural. Más estudios clínicos son necesarios para basar decisiones de incorporación de los antifolatos en el tratamiento rutinario de esa neoplasia en Brasil.
Asunto(s)
Humanos , Neoplasias Pulmonares/prevención & control , Mesotelioma/epidemiología , Medicina Basada en la Evidencia , Quimioterapia , Revisión SistemáticaRESUMEN
The study proposes the creation of a system to monitor cases of malignant mesothelioma in the municipality of Curitiba, Paraná State, Brazil, based on the Italian model. This diagnosis-type action-research project featured exploratory and planning phases conducted from July 2015 to May 2017. The following search tools were used: Hospital-Based Cancer Registries Integrator with specific morphologies for mesothelioma; Hospital-Based Cancer Registry with codes C38.4 and C45 of the International Classification of Diseases, 10th revision, and/or records coded by the ICD-O with topographies C38 and C48; Population-Based Cancer Registry of the Curitiba Municipal Health Department, with the same codes. The study also identified, analyzed, and adapted to the Brazilian reality the model, questionnaires, and registry software for mesothelioma from Lombardy, Italy. Fifteen cases of mesothelioma were recorded in the Hospital-Based Cancer Registries Integrator. Two cases were recorded in the University Hospital-Based Cancer Registry and 16 in the Cancer Hospital. There were 317 cases recorded in the Population-Based Cancer Registry during the same period. Although some information was complete, data were lacking on patients' occupational history, thereby preventing the determination of a causal nexus. Given a predicted increase in cases of mesothelioma in the coming decades and the response to court cases, the implementation of registries has become essential to facilitate knowledge and follow-up on the determination of the causal link and specific sources of asbestos exposure in the country.
Este estudo objetivou propor a criação de um sistema de monitoramento dos casos de mesotelioma maligno no Município de Curitiba, Paraná, Brasil, desenvolvido com base no modelo italiano. Trata-se de uma pesquisa-ação tipo diagnóstica, que utiliza as fases exploratória e de planejamento, desenvolvida no período de julho de 2015 a maio de 2017. Utilizaram-se como ferramentas de busca os seguintes instrumentos: Integrador de Registro Hospitalar de Câncer, com as morfologias específicas para mesotelioma; Registro Hospitalar de Câncer, com os códigos C38.4 e C45, da Classificação Internacional de Doenças, 10ª revisão, e/ou registros codificados pelo CID-O, com as topografias C38 e C48; Registro de Câncer de base populacional da Secretaria Municipal de Saúde de Curitiba, com os mesmos códigos. Também foram conhecidos, analisados e adaptados para a realidade brasileira o modelo, os questionários e o software de registro de mesotelioma da Lombardia, na Itália. Observou-se que, no Integrador de Registro Hospitalar de Câncer, foram registrados 15 casos de mesotelioma. No Registro Hospitalar de Câncer do hospital universitário, foram dois. No hospital oncológico, 16. Os dados do Registro de Câncer de Base Populacional, por sua vez, indicaram 317 registros relativos ao período. Apesar de algumas informações estarem mais completas, existe a falta de dados relacionados à história laboral, impossibilitando estabelecer o nexo causal. Com o aumento do número de casos de mesotelioma previstos para as próximas décadas e o atendimento às demandas legais, a implantação de registros torna-se essencial para auxiliar no conhecimento, no acompanhamento, na determinação de nexo causal e nas fontes de contaminação específicas no país.
El objetivo de este estudio fue proponer la creación de un sistema de monitoreo de casos de mesotelioma maligno en el municipio de Curitiba, Paraná, Brasil, desarrollado en base al modelo italiano. Se trata de una investigación-acción de tipo diagnóstica, que usa fases de carácter exploratorio y de planificación, desarrolladas durante el período de julio de 2015 a mayo de 2017. Se utilizaron como herramientas de búsqueda los siguientes instrumentos: Integrador del Registro Hospitalario de Cáncer con morfologías específicas para mesotelioma; Registro Hospitalario de Cáncer con los códigos C38.4 y C45, procedentes de la Clasificación Internacional de Enfermedades décima revisión, y/o registros codificados por el CID-O con topografías C38 y C48; Registro de Cáncer de base poblacional de la Secretaría Municipal de Salud de Curitiba con los mismos códigos. También se presentaron, analizaron y adaptaron a la realidad brasileña el modelo, los cuestionarios y el software de registro de mesotelioma de Lombardía, en Italia. Se observó que, en el Integrador de Registro Hospitalario de Cáncer, se registraron 15 casos de mesotelioma. En el Registro Hospitalario de Cáncer del hospital universitario, fueron dos. En el hospital oncológico, 16. Los datos del Registro de Cáncer de Base Poblacional, a su vez, indicaron 317 registros relacionados con este período. A pesar de que algunos datos estaban más completos, existe una falta de datos relacionados con la historia laboral, imposibilitando establecer el nexo causal. Con el aumento del número de casos de mesotelioma previstos para las próximas décadas, y la atención a las demandas legales, la implantación de los registros se convierte en esencial para apoyar el conocimiento, el seguimiento, así como la determinación del nexo causal y las fuentes de contaminación específicas en el país.
Asunto(s)
Amianto/toxicidad , Carcinógenos/toxicidad , Notificación de Enfermedades/métodos , Exposición a Riesgos Ambientales/efectos adversos , Registros de Hospitales , Neoplasias Pulmonares/epidemiología , Mesotelioma/epidemiología , Brasil/epidemiología , Humanos , Neoplasias Pulmonares/etiología , Mesotelioma/etiología , Mesotelioma MalignoRESUMEN
Este estudo objetivou propor a criação de um sistema de monitoramento dos casos de mesotelioma maligno no Município de Curitiba, Paraná, Brasil, desenvolvido com base no modelo italiano. Trata-se de uma pesquisa-ação tipo diagnóstica, que utiliza as fases exploratória e de planejamento, desenvolvida no período de julho de 2015 a maio de 2017. Utilizaram-se como ferramentas de busca os seguintes instrumentos: Integrador de Registro Hospitalar de Câncer, com as morfologias específicas para mesotelioma; Registro Hospitalar de Câncer, com os códigos C38.4 e C45, da Classificação Internacional de Doenças, 10ª revisão, e/ou registros codificados pelo CID-O, com as topografias C38 e C48; Registro de Câncer de base populacional da Secretaria Municipal de Saúde de Curitiba, com os mesmos códigos. Também foram conhecidos, analisados e adaptados para a realidade brasileira o modelo, os questionários e o software de registro de mesotelioma da Lombardia, na Itália. Observou-se que, no Integrador de Registro Hospitalar de Câncer, foram registrados 15 casos de mesotelioma. No Registro Hospitalar de Câncer do hospital universitário, foram dois. No hospital oncológico, 16. Os dados do Registro de Câncer de Base Populacional, por sua vez, indicaram 317 registros relativos ao período. Apesar de algumas informações estarem mais completas, existe a falta de dados relacionados à história laboral, impossibilitando estabelecer o nexo causal. Com o aumento do número de casos de mesotelioma previstos para as próximas décadas e o atendimento às demandas legais, a implantação de registros torna-se essencial para auxiliar no conhecimento, no acompanhamento, na determinação de nexo causal e nas fontes de contaminação específicas no país.
The study proposes the creation of a system to monitor cases of malignant mesothelioma in the municipality of Curitiba, Paraná State, Brazil, based on the Italian model. This diagnosis-type action-research project featured exploratory and planning phases conducted from July 2015 to May 2017. The following search tools were used: Hospital-Based Cancer Registries Integrator with specific morphologies for mesothelioma; Hospital-Based Cancer Registry with codes C38.4 and C45 of the International Classification of Diseases, 10th revision, and/or records coded by the ICD-O with topographies C38 and C48; Population-Based Cancer Registry of the Curitiba Municipal Health Department, with the same codes. The study also identified, analyzed, and adapted to the Brazilian reality the model, questionnaires, and registry software for mesothelioma from Lombardy, Italy. Fifteen cases of mesothelioma were recorded in the Hospital-Based Cancer Registries Integrator. Two cases were recorded in the University Hospital-Based Cancer Registry and 16 in the Cancer Hospital. There were 317 cases recorded in the Population-Based Cancer Registry during the same period. Although some information was complete, data were lacking on patients' occupational history, thereby preventing the determination of a causal nexus. Given a predicted increase in cases of mesothelioma in the coming decades and the response to court cases, the implementation of registries has become essential to facilitate knowledge and follow-up on the determination of the causal link and specific sources of asbestos exposure in the country.
El objetivo de este estudio fue proponer la creación de un sistema de monitoreo de casos de mesotelioma maligno en el municipio de Curitiba, Paraná, Brasil, desarrollado en base al modelo italiano. Se trata de una investigación-acción de tipo diagnóstica, que usa fases de carácter exploratorio y de planificación, desarrolladas durante el período de julio de 2015 a mayo de 2017. Se utilizaron como herramientas de búsqueda los siguientes instrumentos: Integrador del Registro Hospitalario de Cáncer con morfologías específicas para mesotelioma; Registro Hospitalario de Cáncer con los códigos C38.4 y C45, procedentes de la Clasificación Internacional de Enfermedades décima revisión, y/o registros codificados por el CID-O con topografías C38 y C48; Registro de Cáncer de base poblacional de la Secretaría Municipal de Salud de Curitiba con los mismos códigos. También se presentaron, analizaron y adaptaron a la realidad brasileña el modelo, los cuestionarios y el software de registro de mesotelioma de Lombardía, en Italia. Se observó que, en el Integrador de Registro Hospitalario de Cáncer, se registraron 15 casos de mesotelioma. En el Registro Hospitalario de Cáncer del hospital universitario, fueron dos. En el hospital oncológico, 16. Los datos del Registro de Cáncer de Base Poblacional, a su vez, indicaron 317 registros relacionados con este período. A pesar de que algunos datos estaban más completos, existe una falta de datos relacionados con la historia laboral, imposibilitando establecer el nexo causal. Con el aumento del número de casos de mesotelioma previstos para las próximas décadas, y la atención a las demandas legales, la implantación de los registros se convierte en esencial para apoyar el conocimiento, el seguimiento, así como la determinación del nexo causal y las fuentes de contaminación específicas en el país.
Asunto(s)
Humanos , Amianto/toxicidad , Carcinógenos/toxicidad , Registros de Hospitales , Notificación de Enfermedades/métodos , Exposición a Riesgos Ambientales/efectos adversos , Neoplasias Pulmonares/epidemiología , Mesotelioma/epidemiología , Brasil/epidemiología , Neoplasias Pulmonares/etiología , Mesotelioma/etiologíaRESUMEN
El mesotelioma es un tumor poco frecuente, sobretodo en localización peritoneal. Originado en las células mesoteliales de superficies serosas. Su etiología es desconocida, aunque en muchos casos se relaciona con exposición a asbestos. Su frecuencia va en aumento en los últimos años, tiene mayor incidencia en varones de edad media. Se presentó un paciente de 73 años diabético e hipertenso que llevaba 21 días con sensación de llenura, aumento de volumen del abdomen, decaimiento marcado, pérdida del apetito. En este período presentó una pérdida de peso corporal de 10 kilos. Por todo lo anterior se decidió su ingreso para estudio y tratamiento (AU).
The mesothelioma is a little frequent tumor, especially in peritoneal location, originated in the mesothelial cells of serous surfaces. Its etiology is unknown, although in many cases it is related with exposition to asbestos. Its frequency increases in the last years, showing higher incidence in medium-age male people. The case of a diabetic, hypertensive patient aged 73 years was presented. He was already 21 days feeling bloating, having increase of the abdominal volume, remarked weakness, appetite loss. In this period he had a body weight loss of 10 kg. For that all, his admission was decided for study and treatment (AU).
Asunto(s)
Humanos , Masculino , Peritoneo/patología , Mesotelioma/complicaciones , Mesotelioma/mortalidad , Mesotelioma/patología , Mesotelioma/terapia , Mesotelioma/epidemiología , Neoplasias/complicaciones , Neoplasias/mortalidad , Neoplasias/epidemiología , Informes de Casos , Quimioterapia/métodos , Quimioterapia/mortalidad , Lesión Pulmonar/complicaciones , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/epidemiologíaRESUMEN
El mesotelioma es un tumor poco frecuente, sobretodo en localización peritoneal. Originado en las células mesoteliales de superficies serosas. Su etiología es desconocida, aunque en muchos casos se relaciona con exposición a asbestos. Su frecuencia va en aumento en los últimos años, tiene mayor incidencia en varones de edad media. Se presentó un paciente de 73 años diabético e hipertenso que llevaba 21 días con sensación de llenura, aumento de volumen del abdomen, decaimiento marcado, pérdida del apetito. En este período presentó una pérdida de peso corporal de 10 kilos. Por todo lo anterior se decidió su ingreso para estudio y tratamiento (AU).
The mesothelioma is a little frequent tumor, especially in peritoneal location, originated in the mesothelial cells of serous surfaces. Its etiology is unknown, although in many cases it is related with exposition to asbestos. Its frequency increases in the last years, showing higher incidence in medium-age male people. The case of a diabetic, hypertensive patient aged 73 years was presented. He was already 21 days feeling bloating, having increase of the abdominal volume, remarked weakness, appetite loss. In this period he had a body weight loss of 10 kg. For that all, his admission was decided for study and treatment (AU).
Asunto(s)
Humanos , Masculino , Peritoneo/patología , Mesotelioma/complicaciones , Mesotelioma/mortalidad , Mesotelioma/patología , Mesotelioma/terapia , Mesotelioma/epidemiología , Neoplasias/complicaciones , Neoplasias/mortalidad , Neoplasias/epidemiología , Informes de Casos , Quimioterapia/métodos , Quimioterapia/mortalidad , Lesión Pulmonar/complicaciones , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/epidemiologíaRESUMEN
Malignant pleural mesothelioma is an occupational tumor caused by asbestos exposure. In Mexico, as asbestos usage is not prohibited, an increase in the number of cases is expected. Asbestos exposure is ubiquitous due to the great amount of products in which it is present. Its carcinogenicity is caused as the inhaled asbestos fibers cannot be eliminated by macrophages and, thus, they travel to the pleura through lymphatic pathways, producing a persistent inflammatory response. Diagnosis approach includes occupational history, along with clinical signs and symptoms, and paraclinical studies, such as pleural fluid cytology, chest x-rays, computed tomography, magnetic resonance imaging, and biopsy with immunohistochemistry. The main differential diagnosis is lung adenocarcinoma. Regarding the treatment of this tumor, it mainly comprises palliative care, even though chemotherapy, radiotherapy, and, in selected cases, surgical treatments have been used. There is an urgent need for general physicians and specialists to identify asbestos exposure, in order to make a timely diagnosis. Research is necessary to develop screening and prompt diagnostic tools, along with an epidemiological surveillance program for the workers and the general population exposed to asbestos.
El mesotelioma maligno pleural es un tumor ocupacional ocasionado por la exposición a cualquier tipo de fibra de asbesto. Y dado que en México el uso del asbesto no está prohibido, se espera que la incidencia de este tumor siga aumentando. La exposición al asbesto es ubicua, debido a la gran diversidad de productos en los que se encuentra. Su carcinogenicidad está dada porque las fibras de asbesto inhaladas no pueden ser eliminadas por los macrófagos y viajan hacia la pleura por vía linfática, donde producen una reacción inflamatoria persistente. Para su diagnóstico se precisa de una historia clínica laboral, además de que hay que orientarse con base en el cuadro clínico y los estudios paraclínicos, como la citología de líquido pleural, radiografía de tórax, tomografía axial computarizada, resonancia magnética y biopsia con inmunohistoquímica. El principal diagnóstico diferencial es el adenocarcinoma de pulmón. El tratamiento es principalmente paliativo, aunque se ha utilizado quimioterapia, radioterapia y, en seleccionados casos, cirugía. Para lograr un diagnóstico oportuno y certero es de vital importancia identificar las exposiciones al asbesto. Por otra parte, es necesaria la investigación para desarrollar pruebas de diagnóstico temprano y tamizaje, además de un programa de vigilancia epidemiológica para los trabajadores y la población general expuesta al asbesto.
Asunto(s)
Mesotelioma , Enfermedades Profesionales , Neoplasias Pleurales , Terapia Combinada , Humanos , Mesotelioma/diagnóstico , Mesotelioma/epidemiología , Mesotelioma/fisiopatología , Mesotelioma/terapia , México/epidemiología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/fisiopatología , Enfermedades Profesionales/terapia , Cuidados Paliativos , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/epidemiología , Neoplasias Pleurales/fisiopatología , Neoplasias Pleurales/terapiaRESUMEN
To justify the continuous use of two million tons of asbestos every year, it has been argued that a safe/controlled use can be achieved. The aim of this review was to identify recent scientific studies that present empirical evidence of: 1) health consequences resulting from past asbestos exposures and 2) current asbestos exposures resulting from asbestos use. Articles with evidence that could support or reject the safe/controlled use argument were also identified. A total of 155 articles were included in the review, and 87 % showed adverse asbestos health consequences or high asbestos exposures. Regarding the safe/controlled use, 44 articles were identified, and 82 % had evidence suggesting that the safe/controlled use is not being achieved. A large percentage of articles with evidence that support the safe/controlled use argument have a conflict of interest declared. Most of the evidence was developed in high-income countries and in countries that have already banned asbestos.