Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust

Around the town of Cermik in south-east Turkey there are many deposits of asbestiform minerals, some of which are used to make whitewash or stucco. A sample of 7000 of the population revealed 461 (6.5%) with pleural thickening and calcification, of whom 103 (1.47% of the total) had evidence of interstitial pulmonary fibrosis. Forty-one patients with respiratory cancer were admitted to the Diyarbakir Chest Hospital from around Cermik and from a comparable area of equal population (but without asbestos deposits) in 1977-8. Of these 23 were mesotheliomas, 22 coming from around Cermik. In addition, 11 of the 18 primary bronchial cancers came from around Cermik. A similar excess of mesothelioma and bronchial cancer had been admitted from the Cermik area in previous years. The whitewash or stucco material has been shown to contain fibrous tremolite and non-fibrous antigorite/lizardite, chlorite, and talc. A lung biopsy of a patient from Cermik contained large numbers of tremolite fibres, both free and forming asbestos bodies. There were only occasional chrysotile fibres.