Volcanic tuffs in the Cappadocian region of Turkey have weathered into a dramatic landscape. The soft rock of which they are composed is easily quarried and excavated and has long provided both caves and building material for homes. Studying the complex geology of Cappadocia has shown the presence of zeolitic rocks in some areas which contain respirable fibres of the zeolite group mineral erionite. In 1975, a high incidence of malignant pleural mesothelioma (MPM) was observed in several villages of this region. MPM is a quickly progressing lethal disease with very poor prognosis. Clinical and experimental studies suggested that the disease was linked to the erionite mineral. Extensive studies have since confirmed that it is the erionite, rather than any of the asbestos types known to cause MPM, that is the major cause of this epidemic in the study area. In addition to the three erionite villages of Cappadocia (Tuzköy, Karain and Sar| h| d| r), the list has now been extended to include the villages of Karacaoren, Boyali, Cokek and Yesiloz. The high potential of erionite to induce MPM has now received further confirmation from both epidemiological and other recent experimental work.
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References
1.
1 Mumpton FA: Occurrence and utilization of natural zeolites; a review. International Clay Conference 1975;215–218.
2.
2 Mumpton FA: Discovery and commercial interest in zeolite deposits examined during Zeo-trip ’83; an excursion to selected zeolite deposits in eastern Oregon, southwestern Idaho, and northwestern Nevada, and to the Tahoe-Truckee water reclamation plant, Truckee, California . 1983;66–72.
3.
3 McDonald JC, McDonald AD: Epidemiology of mesothelioma from estimated incidence . Prev Med1977;6: 426–446 .
5 Kohyama N: Biological effects of mineral fibres from occupational exposure to nonoccupational exposure . Journal of the Mineralogical Society of Japan1987;18(3): 191–209 .
6.
6 Leigh J, Davidson P, Hendrie L, Berry D: Malignant mesothelioma in Australia, 1945– 2000 , American Journal of Industrial Medicine2002;41: 188–201 .
7.
7 De Klerk NH, Musk AW, Eccles JL, Hobbs MST: Malignant mesothelioma and exposure to crocidolite at Wittenoom. International Congress on Applied Mineralogy, 1993;25–27.
9 Dogan M, Emri S: Environmental health problems related to mineral dusts in Ankara and Eskisehir, Turkey . Yerbilimleri2000;22: 149–161 .
10.
10 Gibbons W: Amphibole asbestos in Africa and Australia: Geology, health hazard and mining legacy . Journal of the Geological Society of London2000;157(4): 851–858 .
11.
11 Baris YI: Pleural mesotheliomas and asbestos pleurisies due to environmental asbestos exposure in Turkey: An analysis of 120 cases . Hacettepe Bull. Medicine/Surgery1975;8: 167–185 .
12.
12 Baris YI, Sahin AA, Ozesmi M, Kerse I, Ozen E, Kolacan B, Altinors M, Goktepeli A: An outbreak of pleural mesothelioma and chronic fibrosing pleurisy in the village of Karain/Urgup in Anatolia . Thorax1978;33: 181–192 .
13.
13 Ataman G: Les tufs zeolitises de Cappadoce et leur liaison probable avec certain types de cancer du poumon et de Mesothelioma pleural (The zeolitic tuffs of Cappadocia and their probable association with certain types of lung cancer and pleural mesothelioma) . Comp Rendu Acad Sci Ser D1978;287: 207–210 .
14.
14 Artvinli M, Baris YI: Malignant mesotheliomas in a small village in the Anatolian region of Turkey: An epidemiologic study . JNCI1979;63(1): 17–22 .
15.
15 Ataman G: Mise en evidence du role de l’erionite (zeolite) dans le Mesothelioma pulmonaire (Role of erionite (zeolite) in pulmonary Mesothelioma). Comptes Rendus Hebdomadaries des Seances de l’Academie des Sciences, Serie D: Sciences, Serie D : Sciences Naturelles1980;291: 167–169 .
16.
16 Lilis R: Fibrous zeolites and endemic mesothelioma in Cappadocia, Turkey . Journal of Occupational Medicine1981; 23(8): 548–550 .
17.
17 Ozesmi M, Karlsson-Parra A, Hillerdal G, Forsum U: Phenotypic characterisation of peripheral blood lymphoid cells in people exposed to fibrous zeolite . British Journal of Industrial Medicine1986;43: 830–833 .
18.
18 Ozesmi M, Hillerdal G, Krause F: Zur Kenntnis kanzerogener und immunologischer Befunde durch den Faserzeolith Erionit . Pneumologie1990;44: 335–336 .
19.
19 Mumpton FA: Report of reconnaissance study of the association of zeolites with mesothelioma cancer occurrences in central Turkey. Department of Earth Sciences, State University Collage, Brockport, New York , 1979, pp 54-54.
20.
20 Baris YI, Simonato L, Artvinli M, Pooley F, Saracci R, Skidmoore J, Wagner C: Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: A four-year study in the Cappadocian region of Turkey . International Journal of Cancer1987;39: 10–17 .
21.
21 Simonato L, Baris YI, Saracci R, Skidmore J, Winkelmann R: Relation of environmental exposure to erionite fibres to risk of respiratory cancer, in Bignon J, Peto J, Saracci R, (eds): Non-Occupational Exposure to Mineral Fibres. World Health Organization International Agency for Research on Cancer (IARC) Scientific Publications No. 90, 1989;398–405.
22.
22 Rohl AN, Langer AM, Moncure G, Selikoff IJ, Fischbein A: Endemic pleural disease associated with exposure to mixed fibrous dust in Turkey . Science1982;216(4545): 518–520 .
23.
23 Sebastien P, Bignon J, Baris YI, Awad L, Petit G: Ferruginous bodies in sputum as an indication of exposure to airborne mineral fibres in the mesothelioma villages of Cappadocia . Arch. Environ. Health1984;39(1): 18–23 .
24.
24 Wagner JC, Skidmore JW, Hill RJ, Griffiths DM: Erionite exposure and mesotheliomas in rats . British Journal of Cancer1985;51: 727–730 .
25.
25 Baris YI, Saracci R, Simonato L, Skidmore JW, Artvinli M: Malignant mesothelioma and radiological chest abnormalities in two villages in central Turkey–An epidemiological and environmental investigation. The Lancet 1981;984–987.
26.
26 Casey KR, Moatamed F, Shigeoka J, Rom WN: Demonstration of fibrous zeolite in pulmonary tissue . Am Rev Respir Dis1981;123: 98-98 .
27.
27 Sebastien P, Gaudichet A, Bignon J, Baris YI: Zeolite bodies in human lungs from Turkey . Laboratory Investigation1981;44(5): 420–425 .
28.
28 Sebastien P, Gaudichet A, Bignon J, Baris YI: Ferruginous bodies in sputum as an indication of exposure to airborne mineral fibres in the mesothelioma villages of Cappadocia . Arch Environ Health1981;39: 18–23 .
29.
29 Artvinli M, Baris YI: Environmental fibreinduced pleura-pulmonary diseases in an Anatolian village: An epidemiological study . Arch. Environ. Health1982;37(3): 177–181 .
30.
30 Maltoni C, Minardi F, Morisi L: Pleural mesotheliomas in Sprague-Dawley rats by erionite: First experimental evidence . Environ. Res.1982;29: 238–244 .
31.
31 Suzuki Y: Carcinogenic and fibrogenic effects of zeolites: Preliminary observations . Environ Res1982;27: 433–445 .
32.
32 Hillerdal G, Baris YI: Radiological study of pleural changes in relation to mesothelioma in Turkey . Thorax1983;38(6): 443–448 .
33.
33 Casey KR, Shigeoka JW, Rom WN, Moatamed F: Zeolite exposure and associated pneumoconiosis . Chest1985;87: 837–840 .
35 Tatrai E, Wojnarovits I, Ungary G: Nonfibrous zeolite induced experimental pneumoconiosis in rats . Exp Pathol1991:43: 41–46 .
36.
36 Tatrai E, Bacsy E, Karpati J, Ungary G: On the examination of the pulmonary toxicity of mordenite in rats . Polish J Occup Med Environ Health1992;5: 237–243 .
37.
37 McDonald AD, McDonald JC: Malignant mesothelioma in North America . Cancer1980;46: 1650–1656 .
38.
38 Boman G, Schubert V, Svane B, Westerholm P, Bolinder E, Rohl AN, Fischbein A: Malignant mesothelioma in Turkish immigrants residing in Sweden . Scan J Work Environ Health1982;8: 108–112 .
39.
39 Artvinli M, Baris YI: Erionite-related diseases in Turkey. in Beck EG, J Bignon J (eds): Vitro Effects of Mineral Dusts, NATO ASI Series-G3 1985;515–519.
40.
40 Ozesmi M, Hillerdal G, Svane B, Widstrom O: Prospective clinical and radiologic study of zeolite-exposed Turkish immigrants in Sweden . Respiration1990;57(5): 325–328 .
41.
41 MetintasM, Hillerdal G, Metintas S: Malignant mesothelioma due to environmental exposure to erionite: follow-up of a Turkish emigrant cohort . European Respiratory Journal1999;13(3): 523–526 .
42.
42 Suzuki Y, Kohyama N: Malignant mesothelioma induced by asbestos and zeolite in the mouse peritoneal cavity . Environ. Res.1984;35: 277–292 .
44 Maltoni C, Minardi F: First available results of long term carcinogenicity bioassay on detergency zeolites (MS 4A and MS 5A) . Ann NY Acad Sci1988;534: 937–985 .
46 Davis JMG, Jones AD, Miller BG: Experimental studies in rats on the effects of asbestos inhalation coupled with the inhalation of titanium dioxide or quartz . Int J Exp Pathol1991;72: 501–525 .
47.
47 Carthew P, Hill RJ, Edwards RE, Lee PN: Intrapleural administration of fibres induced mesothelioma in rats in the same relative order of hazard as occurs in man after exposure . Human Exp Toxicol1992;11: 530–534 .
48.
48 Davis JMG: The histopathology and ultrastructure of pleural mesotheliomas produced in the rat by injections of crocidolite asbestos . British J Exp Path1979;60: 642–652 .
49.
49 Stanton MF, Layard M, Tegeris A, Miller E, May M, Morgan E, Smith A: Relation of particle dimension to carcinogenicity in amphibole asbestos and other fibrous minerals . Journal of National Cancer Institute1981;67(5): 965–975 .
50.
50 Johnson NF, Edwards RE, Munday DE, Rowe N, Wagner JC: Pluripotential nature of mesotheliomata induced by inhalation of erionite in rats . British J Exp Path1984;65: 377–388 .
51.
51 Palekar LD, Eyre JF, Most BM, Coffin DL: Metaphase and anaphase analysis of V79 cells exposed to erionite, UICC chrysotile and UICC crocidolite . Carcinogenesis1987;8: 553–560 .
52.
52 Coffin DL, Palekar LD, Cook PM, Creason JP: Comparison of mesothelioma induction in rats by asbestos and nonasbestos mineral fibres: Possible correlation with human exposure data. in Biological Interaction of Inhaled Mineral Fibers and Cigarette Smoke, Proceedings of an International Symposium/ Workshop held at the Battelle Seattle Conference Center, April 10–14, 1988, Seattle, Washington, Battelle Press , 1989;347–354.
53.
53 Coffin DL, Peters SE, Palekar LD, Stahel EP: A study of the biological activity of erionite in relation to its chemical and structural characteristics. in Biological Interaction of Inhaled Mineral Fibers and Cigarette Smoke , Proceedings of an International Symposium/ Workshop held at the Battelle Seattle Conference Center, April 10–14, 1988, Seattle, Washington, 1989; 313–324 .
54.
54 Newhouse M, Thomson H: Mesothelioma of pleura and peritoneum following exposure to asbestos in the London area . British Journal of Industrial Medicine1965;22: 261–269 .
55.
55 De Lajarte M, Cornet E, Corroller J: Etude clinique et professionelle de 54 mesotheliomes pleuraux diffus . Rev Franc Mal Resp1976;4(2): 63-63 .
56.
56 Bohlig H, Dabbert AF, Dalquen P, Hain E, Hinz I: Epidemiology of malignant mesothelioma in Hamburg, a preliminary report . Environ Resp1970;3: 365-365 .
57.
57 Wagner JC, Sleggs CA, Marchand P: Diffuse pleural mesothelioma and asbestos exposure in the north western Cape province . British Journal of Industrial Medicine1960;17: 260–271 .
58.
58 Milne JEH: Thirty-two cases of mesothelioma in Victoria, Australia: A retrospective survey related to occupational asbestos exposure . British Journal of Industrial Medicine1976;33: 115–122 .
59.
59 McDonald AD, Magner D, Eyssen G: Primary malignant mesothelial tumors in Canada, 1960–1968, A pathological review by the mesothelioma panel of the Canadian Tumour Reference Centre . Cancer1973;31: 869–876 .
60.
60 Enterline PE: Mortality among asbestos products workers in United States . Ann N Y Acad Sci1965;132: 156-156 .
62 Selikoff IJ: Asbestos disease in the United States . Rev Fr Mal Resp1976;4: 7–24 .
63.
63 Temel A, Gundogdu MN: Zeolite occurrences and the erionite-mesothelioma relationship in Cappadocia, Central Anatolia, Turkey . Mineralum Deposita1996;31: 539–547 .
64.
64 Dogan AU, Dogan M, Baris YI: Environmental Mineralogy and Mesothelioma in Cappadocia Region, Turkey. International Colloquium on the Mediterranean: Culture, Environment and Society, University of Haifa, Israel , May 22–25, 2000, 145–148.
65.
65 Dogan AU: Zeolite Mineralogy and Cappadocian Erionite. Indoor Built and Environment 2003.
66.
66 IARC: Erionite, IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans . In Silica and Some Silicates1997;42: 225–239 .
