Unusual Asbestos Exposures
We know that for all practical purposes, the only known cause of mesothelioma is exposure to asbestos. Yet, in many cases, lawyers for asbestos defendants and their insurance companies argue that there is no evidence that workers in a particular occupation, trade, or area had enough asbestos exposure to be a cause. Often the occupational setting is clear – insulators, pipefitters, drywall mechanics, etc. have well-documented exposures. But sometimes it takes a lot of digging to find the connection. A recent paper by C. Mensi and others titled “The Upholsterer and the Asbestos” provides a wonderful illustration and a helpful reminder that sometimes one has to dig a little deeper to find the connection, but it’s an effort worth undertaking.
In the Lombardy region of Northern Italy, all cases of mesothelioma must by law be reported to the Lombardy Mesothelioma Registry which then undertakes a further inquiry to ascertain the relevant facts. This case involved a 63 year old man with confirmed mesothelioma, but no source of asbestos exposure was easily found. It turned out that he had spent much of his adult life working as an independent upholsterer, manufacturing covers, stuffing, and padding for mattresses, sofas, and armchairs. To make the upholstery stuffing, he collected about 450 pounds (200 kilograms) of cotton waste material each year, which came to him in the form of bales of recycled cotton, wool rags, and cloth.
Fortunately, the Registry knew of literature in Tuscany that established a relationship between asbestos exposure and the handling of secondhand clothing by workers directly involved in that industry; the asbestos seemed to come from the recycling of jute sacks that had originally been used to ship asbestos fiber to local industrial concerns. These bags were also shredded and used for mattress padding. This led to a suspicion that the upholsterer might have had indirect asbestos exposure from handling bales of waste materials. Fortunately, tissue specimens were available at the hospital, and these were subjected to scanning electron microscope analysis which revealed markedly elevated levels of mostly chrysotile asbestos in the lung tissue, which confirmed an intensive occupational asbestos exposure that would otherwise have escaped notice. Congratulations to the authors and the Lombardy Mesothelioma Registry for a fine piece of detective work.