Newsgroup: it.scienza.medicina
Titolo: mieloma e amianto

Sono interessato a sapere se esiste una correlazione positiva tra
esposizione all'amianto e lo sviluppo di una neoplasia quale il mieloma
multiplo. La mia abitazione è infatti dotata di un serbatoio per l'acqua
potabile in eternit, e un mio familiare è affetto da questa malattia.
Ringrazio anticipatamente coloro che avranno la cortesia di rispondermi.
Alessandro

Non sono un medico, e cio che dico e' frutto solo di un po' di esperienza
come studente di ingegneria che ha avuto a che fare (studio) con l'amianto e
quindi con i suoi effetti cancerogeni.
Che ne sappia io, l'amianto puo' essere la causa di tumori all'apparato
respiratorio.
E' inizialmente una questione "meccanica" l'amianto "sono" dei microscopici
cristalli di forma allungata che rimangono in sospensione nell'aria con
molta facilita'.
Questi aghi se respirati si conficcano nei tessuti polmonari e ...
in certi casi, in certe quantita' in certe situazioni ... fanno insorgere
tumori.
Credo che il tipo di tumore sia quasi esclusivamente il mesotelioma (ma qui
e' bene che intervenga un medico).
Comunque un metodo per bonificare una zona con amianto e' proprio l'uso di
acqua per fare precipitare la "polvere di amianto" e/o per fissarla a
qualche altro elemento.
Il consiglio che viene dato ha chi possiede canne fumaria, tubi, cisterne,
tettoie in amianto e' sostanzialmente questo:
1 se puoi Bonicare con una ditta SERIA!!!
2 se non puoi NON TOCCARE, NON BUCARE, NON ROMPERE, NON SFREGARE. LASCIARE
STARE E GIRARE ALLA LARGA.
Nel tuo caso specifico io credo che a tuo vantaggio venga il fatto che
l'acqua contiene molti sali che creano incrostazioni di Calcare e altro,
ecco queste incrostazioni fanno da fissativo ulteriore allo strato interno
del serbatoio.
Un saluto e auguri per il tuo familiare.

 multiplo.
Ci sono alcuni studi sull'argomento; tieni presente, però, che
per alcuni si questi studi si tratta di ricerche relative
all'esposizione professionale a determinati agenti e che non è
possibile estrapolare da dati relativi ad una esposizione
professionale delle informazioni relative alla popolazione
generale: la popolazione in età lavorativa è diversa dalla
popolazione generale (l'età è differente, c'è una prevalenza
differente dei due sessi in diverse professioni, eccetera), e
soprattutto può essere molto diversa dalla popolazione generale
se si considerano alcune particolari attività lavorative,
l'esposizione è differente (in termini di quantità e durata), e
inoltre in ambiente di lavoro sono in atto dei sistemi di
controllo (monitoraggio ambientale e biologico, sorveglianza
sanitaria) che sono assenti nella popolazione generale (o almeno
questi sistemi di controllo dovrebbero esserci e a volte non ci
sono, ma questo è un altro discorso); oltre tutto una determinata
categoria professionale può venire a contatto con agenti
differenti e spesso è difficile studiare uno solo di questi
agenti (se ad esempio uno osserva un'aumentata incidenza della
neoplasia X in una popolazione professionale esposta agli agenti
A, B e C è difficile dire quale di questi agenti sia implicato;
inoltre spesso nelle produzioni industriali si formano dei
prodotti intermedi che non vengono studiati nel monitoraggio
ambientale); infine ci sono anche delle interazioni fra
un'esposizione professionale ed una esposizione non professionale
(ad esempio un lavoratore esposto all'amianto e basta è diverso
da uno esposto all'amianto che però fuma anche): quindi si tratta
di dati da interpretare con particolare attenzione: comunque di
seguito ci sono alcuni abstract sull'argomento:
[1] Int Arch Occup Environ Health 2001 Sep;74(7):459-69
Asbestos exposure and malignant lymphomas--a review of the
epidemiological literature.
Becker N, Berger J, Bolm-Audorff U.
Deutsches Krebsforschungszentrum, Division of Clinical
Epidemiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
There has been a significant number of case reports on the
occurrence of lymphomas in people previously exposed to asbestos.
This raises the question of whether corresponding results are
available from analytical epidemiological studies. In the present
review of the epidemiological literature, we describe the results
of the six cohort and 16 case-control studies that - according to
our research - were published up to 1999 and, directly or
indirectly. shed light on the above question. In summarizing the
results of these studies, we have distinguished between
non-Hodgkin lymphoma (NHL), chronic lymphatic leukemia (CLL) and
plasmocytoma/ multiple myeloma (MM). A causal relationship
between asbestos exposure and the subsequent development of
lymphomas cannot be derived from the available results. However,
since quite a number of studies and the combined analysis
indicate a (weakly) increased risk, this question should be
considered directly in future epidemiological studies. Such
studies should address separately the various sub-entities,
employing the latest internationally agreed classification, and
should also use the latest methods of quantifying exposure.
PMID: 11697448 [PubMed - in process]
[2] Occup Environ Med 2000 Sep;57(9):595-604
Updated mortality among diverse operating segments of a petroleum
company.
Lewis RJ, Schnatter AR, Katz AM, Thompson FS, Murray N, Jorgensen
G, Theriault G.
ExxonMobil Biomedical Sciences, 1545 Route 22, Room LF 264, PO
Box 971, Annandale, NJ 08801-0971, USA.
OBJECTIVES: To update mortality for 34 560 employees from diverse
operating segments of a Canadian petroleum company; and to
investigate potential relations with occupational factors.
METHODS: Employees from 1964-83 were linked to the Canadian
mortality data base to provide 11 years additional follow up.
There were 6760 deaths and 750 683 person-years of follow up
compared with 3909 and 428 190, respectively, in the earlier
study. Analyses used standardised mortality ratios (SMRs) to
compare worker cause specific mortality with the Canadian general
population. Duration of employment and latency analyses were
performed for causes previously found to be increased in this and
other petroleum cohorts, as well as any findings of interest.
RESULTS: For the period 1964-94, employees experienced
significantly low overall mortality (SMR=0.86 men, SMR=0.80
women). Kidney cancer, which has been increased in some studies
of petroleum workers, was not increased. Acute non-lymphocytic
leukaemia in exposed operating segments was consistent with the
expected or only slightly, non-significantly increased. The most
notable finding was increased deaths from mesothelioma among
refinery and petrochemical workers (SMR 8.68; 95% confidence
interval (95% CI) 5.51 to 13.03), most of whom were long term
employees in jobs with presumed exposure to asbestos (mechanical
and pipefitters). Deaths from multiple myeloma among marketing
and distribution workers, which were previously increased,
remained increased (SMR 2.08; 95% CI 0.95 to 3.95) in the update
period 1984-94; however, there was no clear pattern by duration
of employment or latency. Aortic aneurysms, which also were
previously significantly increased among marketing and
distribution workers approached the expected in the update period
(SMR 1.18; 95% CI 0. 65-1.98). Analyses by duration of employment
showed suggestive trends for aortic aneurysms, but earlier
studies of this cohort have not found a relation between aortic
aneurysms and exposure to hydrocarbons. CONCLUSION: The
additional 2851 deaths and 322 493 person-years of follow up
strengthened the assessment of mortality patterns relative to
occupational factors. With the exception of mesothelioma, no
clear work related increases in disease were identified.
PMID: 10935940 [PubMed - indexed for MEDLINE]
[3] Occup Med (Lond) 1999 Nov;49(8):536-9
Mortality due to asbestos-related causes among railway carriage
construction and repair workers.
Battista G, Belli S, Comba P, Fiumalbi C, Grignoli M, Loi F, Orsi
D, Paredes I.
Unit of Workers Preventive Medicine, University of Siena, Italy.
The objective of this study was to further clarify the cancer
risk associated with asbestos exposure in railway carriage
construction and repair. The cohort included 734 subjects
employed between 1 January 1945 and 31 December 1969. Vital
status was ascertained at 31 December 1997. Mortality was
investigated in the time span 1970-97. Forty-two subjects (6%)
were lost to follow-up and eight causes of death (4%) could not
be ascertained. The overall mortality was not above the expected
value. Among neoplastic diseases, excesses were observed for lung
standardized mortality ratio (SMR) = 124; 90% confidence interval
(CI) = 87-172; 26 obs), pleura (SMR = 1,327; CI = 523-2,790; 5
obs), larynx (SMR = 240; CI = 95-505; 5 obs), liver (SMR = 241;
CI = 126-420; 9 obs), pancreas (SMR = 224; CI = 98-443; 6 obs)
and multiple myeloma (SMR = 429; CI = 117-1,109; 3 obs). The
observed excess of lung and pleural neoplasms can be causally
related to asbestos exposure in the manufacture of railway
carriages. A causal role of asbestos exposure in the raised SMRs
from laryngeal and pancreatic neoplasms and multiple myeloma
cannot be conclusively proven.
PMID: 10658307 [PubMed - indexed for MEDLINE]
[4] Am J Hematol 1996 Jul;52(3):217-20
Risk of monoclonal gammopathy of undetermined significance: a
case-referent study.
Pasqualetti P, Collacciani A, Casale R.
Department of Internal Medicine and Public Health, School of
Medicine and Surgery, University of L'Aquila, Italy.
A retrospective study was conducted in 285 cases of monoclonal
gammopathy of undetermined significance (MGUS) and in 570 sex-
and age-matched hospital controls in order to investigate the
possible association between socioeconomic status, residence,
alcohol and tobacco habits, occupation, occupational exposure to
toxic substances, chronic antigenic stimulation, and risk of
MGUS. Significant associations with the risk of MGUS were found
for farmers (P < 0.005) and for workers in industry (P < 0.025).
Occupational exposure to asbestos, fertilizers, mineral oils and
petroleum, paints and related products, pesticides, and radiation
was significantly (P < 0.05) associated with an increase in risk
of MGUS. Chronic immune-stimulating conditions, when considered
as a group, presented a significant (P < 0.025) association with
the risk of MGUS, but no specific disease has been found to be
significantly associated. These data are in agreement with the
previous reports on multiple myeloma, suggesting that these
factors may play an important role in the development of
monoclonal gammopathies. However, these findings need to be
confirmed in prospective larger population-based studies.
PMID: 8756092 [PubMed - indexed for MEDLINE]
* attenzione che la MGUS ed il mieloma multiplo sono due cose
differenti
[5] Occup Med 1995 Oct-Dec;10(4):803-20
The risk of cancer in firefighters.
Golden AL, Markowitz SB, Landrigan PJ.
Division of Environmental and Occupational Medicine, Department
of Community Medicine, Mount Sinai School of Medicine, New York,
USA.
A substantial body of literature now exists on the carcinogenic
hazards of firefighting. The authors discuss in detail the data
on the carcinogens benzene, asbestos, PAHS, formaldehyde, and
diesel exhaust, and they go on to examine the prevalent cancers
in firefighters, including leukemia, non-Hodgkin's lymphoma,
multiple myeloma, and cancer of the brain and bladder.
Publication Types:
Review
Review, Tutorial
PMID: 8903750 [PubMed - indexed for MEDLINE]
[6] Br J Ind Med 1992 Feb;49(2):95-103
Comment in: Br J Ind Med. 1992 Nov;49(11):815-6
Occupational and other environmental factors and multiple
myeloma: a population based case-control study.
Eriksson M, Karlsson M.
Department of Oncology, University Hospital, Umea, Sweden.
Epidemiological studies on the aetiology of multiple myeloma are
reviewed as a background to this population based case-control
study performed in an area with a high incidence of multiple
myeloma. The purpose was to identify and evaluate several
suspected environmental factors in relation to this disease. A
total of 275 confirmed cases diagnosed in four counties in
northern Sweden during four years were compared with the same
number of control subjects drawn from population registries. The
controls were matched for age, sex, county, and vital status.
Occupations and work associated exposures to chemicals and other
potential carcinogens were assessed by an extensive questionnaire
that also included questions on smoking habits, residential
building materials, vicinity to electrical power lines, and
leisure time contact with animals, electrical equipment, and
chemicals. Information obtained from the questionnaires was
completed by telephone interviews when necessary. Univariate
analysis and multivariate logistic regression were performed. The
study confirmed an association found earlier between farming and
multiple myeloma. Some domestic animals (cattle, horses, and
goats) and two types of pesticides (phenoxyacetic acids and DDT)
were indicated as risk factors within farming. Exposure to
electromagnetic fields, asbestos, and organic solvents were
negatively associated with myeloma in this study.
PMID: 1536825 [PubMed - indexed for MEDLINE]
[7] Int J Cancer 1989 Apr 15;43(4):554-9
A case-control study of multiple myeloma nested in the American
Cancer Society prospective study.
Boffetta P, Stellman SD, Garfinkel L.
Department of Epidemiology and Statistics, American Cancer
Society, New York, NY 10036.
Among the subjects enrolled in the American Cancer Society Cancer
Prevention Study II, a large nation-wide prospective study, 282
died from multiple myeloma (MM) during the first 4 years of
follow-up. These were divided into incident cases who were
initially free from disease and prevalent cases who reported MM
or related symptoms at the time of enrollment. For each case, 4
controls matched for age, sex, ethnic group and residence were
randomly selected. Previous history of diabetes [odds ratio (OR)
= 2.0] and employment as farmer (OR = 2.7) were the risk factors
consistently suggested by the results of the analysis. The risk
associated with farming showed a linear trend with duration of
exposure. Pesticide or herbicide exposure was not a risk factor
per se but, when combined with farming, it increased the OR to
4.3. Low education, occupational exposure to dyes, and employment
in a bank, on the railroad or as a maid were also suggested risk
factors, but either they were not statistically significant or
they were based on small numbers of exposed subjects. No
association between MM and asbestos exposure was observed.
PMID: 2703267 [PubMed - indexed for MEDLINE]
[8] Am J Ind Med 1988;14(6):661-71
B cell neoplasms and occupational asbestos exposure.
Schwartz DA, Vaughan TL, Heyer NJ, Koepsell TD, Lyon JL, Swanson
GM, Weiss NS.
Robert Wood Johnson Clinical Scholars Program, University of
Washington, Seattle.
To evaluate the etiologic role of asbestos exposure in B cell
neoplasms, we compared the estimated level of occupational
exposure to asbestos of cases with chronic lymphocytic leukemia
(CLL; N = 429) and multiple myeloma (MM; N = 698) with that of
controls (N = 1,683). Cases were identified through four
population-based cancer registries in the U.S. and controls were
randomly selected from the same geographic areas. Exposure to
asbestos was assessed by classifying each job held by a subject
into one of four categories, based on the estimated intensity of
exposure to asbestos. Evidence was found for a modest increasing
risk of CLL with increasing asbestos exposure. Relative to
persons with no known occupational exposure to asbestos, the risk
for CLL was 1.1 (95% confidence interval (CI) = 0.8-1.6) for low,
1.2 (CI = 0.8-1.8) for medium, and 1.4 (CI = 0.8-2.3) for high
peak asbestos exposure (p value for trend = 0.13). The
association was strongest in white study subjects and in those
individuals exposed 10 to 19 years prior to the interview. No
association was observed between MM and occupational exposure to
asbestos in the entire study population or within specific
subgroups. Given the pattern of immunologic abnormalities that
occur with increased frequency in asbestos-exposed persons, our
observation of an association between occupational asbestos
exposure and CLL deserves attention in subsequent studies.
PMID: 3232686 [PubMed - indexed for MEDLINE]
[9] Cancer Res 1987 Jun 1;47(11):2978-81
A case-control study of multiple myeloma in whites: chronic
antigenic stimulation, occupation, and drug use.
Linet MS, Harlow SD, McLaughlin JK.
A hospital-based case-control study of multiple myeloma in whites
(100 cases and 100 controls from seven Baltimore hospitals) was
conducted to examine a number of postulated risk factors. Cases
and controls were matched on age, sex, hospital, and year of
diagnosis. Distributions by marital status and religious
affiliation were found to be similar. Educational levels of cases
were similar to controls except for postcollege schooling, where
there was a slight excess of cases (6%) compared to controls
(3%). No statistically significant associations were found
between multiple myeloma and prior history of medical conditions
believed to cause prolonged stimulation of the immune system
including chronic bacterial infections [odds ratio (OR) = 0.8],
autoimmune disorders (OR = 1.0), allergy-related disorders (OR =
1.0), or lymphoid tissue surgery (OR = 1.2). Statistically
significant positive associations were found for occupational
exposure to petroleum products (OR = 3.7; 1.3-10.3) and asbestos
(OR = 3.5; 1.0-12.0). No increased risk was found for cigarette
smoking or alcohol consumption or for employment in a variety of
industries and occupations implicated in earlier studies. A
significantly elevated risk was found for prior use of laxatives
(OR = 3.5; 1.1-11.1), and elevated (OR greater than or equal to
1.8) but nonsignificant risks were found for use of other
medications including diphenylhydantoin, phenobarbital, diazepam,
propranolol, ibuprofen, and diet drugs and stimulants. These
findings require clarification in larger, population-based
studies.
PMID: 3567914 [PubMed - indexed for MEDLINE]
[10] J Natl Cancer Inst 1986 Jun;76(6):987-94
Toxic substance exposure and multiple myeloma: a case-control
study.
Morris PD, Koepsell TD, Daling JR, Taylor JW, Lyon JL, Swanson
GM, Child M, Weiss NS.
By means of a population-based, multicenter case-control
investigation, certain toxic substances were evaluated as risk
factors for multiple myeloma. Interviews were completed on 698
subjects with newly diagnosed multiple myeloma, and 1,683
controls were selected from the same geographic areas as those of
the cases. Respondents were asked if they had ever been "highly"
exposed" to one or more of a list of toxic substances or to other
substances not on the list. With the aid of a toxicologist,
responses were then categorized into 20 exposure groups. Those
who reported past exposure to pesticides had an estimated
relative risk of 2.6 for multiple myeloma [95% confidence
interval (CI) = 1.5-4.6]. Subjects exposed to a variety of
compounds commonly used by painters had an estimated relative
risk of 1.6 (95% CI = 1.1-2.4). An increased risk also was found
for those who were exposed to sources of carbon monoxide
(relative risk = 1.8, 95% CI = 1.0-3.2). Associations of
borderline statistical significance were found for metals and
organically high polymers (plastics and elastomers). No
statistically significant associations were seen for exposure to
fertilizers; dyes and inks; alkalies; acids; other caustic
substances; chemical asphyxiants; aliphatic, chlorinated, or
aromatic hydrocarbons; aldehydes and ketones; ethers; esters;
oils; dusts; or asbestos.
PMID: 3458965 [PubMed - indexed for MEDLINE]
[11] Am J Clin Pathol 1983 Jul;80(1):14-20
Lymphoid and plasma cell malignancies: asbestos-related disorders
of long latency.
Kagan E, Jacobson RJ.
We have identified 13 asbestos workers with lymphoplasmacytic
neoplasms: six with chronic lymphocytic leukemia, four with IgG
myeloma, two with IgA myeloma, and one with histiocytic lymphoma.
The subjects' occupations were varied, but all had experienced
protracted asbestos exposure (ranging from 3-37 years). Tumor
latency periods were similar to other known asbestos-related
malignancies and ranged from 16-41 years. Stigmata of
asbestos-related pulmonary disease were evident in 12 subjects.
Malignant pleural mesotheliomas co-existed with IgG myelomas in
two individuals, an association which seems unlikely to be
fortuitous. It has been speculated previously that asbestos may
be a lymphoid system carcinogen. Our findings strongly support
this view and indicate that patients presenting de novo with
lymphoproliferative neoplasms should be investigated for previous
occupational or environmental exposure to asbestos.
PMID: 6344612 [PubMed - indexed for MEDLINE]
[12] Am J Med 1979 Aug;67(2):325-30
Asbestos-associated neoplasms of B cell lineage.
Kagan E, Jacobson RJ, Yeung KY, Haidak DJ, Nachnani GH.
Three different neoplasms of B cell lineage, chronic lymphocytic
leukemia, immunoglobulin A (IgA) myeloma and immunoglobulin G
(IgG) myeloma were detected in three patients who had heavy
occupational exposure to asbestos dust. Two of the patients had
coexistent pulmonary asbestosis, whereas the third patient had a
pleural mesothelioma subsequent to his initial presentation with
myeloma. Defective cell-mediated immunity and hyperactivity of B
cell function have previously been noted in patients with
asbestosis. We suggest the possibility that these
asbestos-related immunologic derangements may predispose to the
development of immunoproliferative and lymphoproliferative
neoplasms, since such tumors have been observed in a variety of
other settings, characterized by protracted hyperactivity of the
immune system.
PMID: 313709 [PubMed - indexed for MEDLINE]
    KS