Prospective Study of Mesothelioma Mortality in Turkish Villages With Exposure to Fibrous Zeolite

Journal of the National Cancer Institute. Vol. 98, No. 6, 414-417, March 15, 2006. [Link]

Y. Izzettin Baris, Philippe Grandjean

Affiliations of authors: Güven Hospital, Ankara, Turkey (YIB); Institute of Public Health, University of Southern Denmark, Odense, Denmark, and Department of Environmental Health, Harvard School of Public Health, Boston, MA (PG)

Correspondence to: Philippe Grandjean, MD, PhD, Department of Environmental Health, Harvard School of Public Health, Landmark Center E3–110, 401 Park Dr., Boston, MA 02215 (e-mail:


Mesothelioma incidence is high in certain villages on the Anatolian plateau in Turkey, where environmental exposure includes erionite, a form of zeolite fibers, from the local volcanic tuff. Previous studies of this exposure were cross-sectional or with a follow-up period of only a few years. A prospective study of residents of two exposed and one nearby control village was initiated in 1979 and continued through December 31, 2003. A total of 891 men and women, aged 20 years or older, were included, 230 of them residing in the village without known exposure to erionite. Mortality data were obtained from hospital records and death certificates. During the 23-year follow-up, 372 deaths occurred; 119 of these were from mesothelioma, which was the cause of 44.5% of all deaths in the exposed villages. Seventeen patients had peritoneal mesothelioma; the rest had pleural mesothelioma. Only two cases of mesothelioma, one of each type, occurred in the control village—both in women born elsewhere. When standardized to the world population, the pleural mesothelioma incidence was approximately 700 and 200 cases per 100 000 people annually in the two exposed villages and about 10 cases per 100 000 people in the control village. When we used Danish data for comparison, the standardized pleural mesothelioma mortality rate was 485 (95% confidence interval = 395 to 590). Our results emphasize the severity of the mesothelioma endemic in erionite-exposed areas of Turkey and call for intensified prevention of mesothelioma by limiting environmental exposures to these fibers.