thought objectives: This study examines the incidence of malignant pleural mesothelioma (MPM) in a rural population of Turkey with environmental in all senses to asbestos-contaminated soil mixtures (white soil).

Design: A field-based epidemiologic study

Setting and subjects: A cohort of villagers (the "Eskisehir" cohort) from 11 villages around Eskisehir in central Anatolia, who had been environmentally expos to asbestos appropriate to the use of white soil.

Measurements: The mineral contented and asbestos contamination of the white soil used in these villages was determined, as well as airborne fiber concentrations. Cohort members' details of age, sex ambient exposing data, duration of residence in the villages, and hospital records, including pathologic diagnosis, were recorded.

Results: The Eskisehir cohort consisted of 1886 villagers. During the observation time, 377 deaths occurr and 24 MPM cases were diagnosed. Average annual mesothelioma incidence rates were 1148/100000 for men and 1598/100000 for women

Conclusions: These data indicate that the risk of mesothelioma is 883 times greater in men and 799 times greater in women respectively, in comparison to world background incidence rates.

first note of the scale words: asbestos; environmental exposure; epidemiology; mesothelioma; pleural cancer

Abbreviations: AMIR = annual mesothelioma incidence rate; f/mL = fibers for milliliter; MPM = malignant pleural mesothelioma; mSIR = mesothelioma standardized incidence ratio

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Malignant pleural mesothelioma (MPM) is a common cause of death in any parts of rural Anatolia in Turkey In previous studies, it has been well demonstrated that environmental prospect to asbestos through the use of asbestos-contaminated soil mixtures causes a high risk of MPM in these rural regions. (1-3) These soil mixtures containing asbestos are commonly construct surrounding these rural areas and are known in Anatolia as aktoprak (white soil) or corak. The villagers in these mainly agricultural regions use this soil as a whitewash or plaster material (white stucco) for walls, as insulation and water proofing, for floors and covers for baby powder, and also in earthen ware (1,4-6)

Our clinic is a department of the Medical Faculty of Osmangazi University in Eskisehir, Turkey The Eskisehir district is located in central Anatolia. The total population is 641057 with 163621 living within 403 villages. There is no occupational asbestos outlook in these areas; however, many patients with MPM or other asbestos-related chest diseases, are admitted to our clinic each year from rural regions where the use of white soil has been widespread and continues to a less extent today. In our 1999 studious mood (3) it was determined that > 10000 villagers remain expos to asbestos-contaminated white soil.

Although the main dependence of cause and effect of environmental asbestos exposure is an increased risk of malignant mesothelioma, we do not in addition know the actual mesothelioma rates from this token of environmental exposure. Therefore, our aim in the not away study was to determine the mesothelioma rate in a cohort of villagers with the environmental asbestos outlook described. This exposure is also usual in some other rural parts of the world. (7-10)

MATERIALS AND METHODS

Eskisehir Cohort

The Eshisehir cohort was formed as follows: of the 403 villages of Eskisehir, we were able to acquire data, via a questionnaire, from 196 villages. We learned that white soil had been used in 140 villages and was still being used in 126 villages. We randomly chose 67 villages from these 126 villages. We were receiving patients from a certain quantity of of these villages already, and we assembleed white soil samples from them. We institute tremolite or other types of asbestos fiber contamination in a total of 41 villages. A total of 10120 clan are still living in these villages and are still being expos to asbestos. (3) at random sampling, we identified 11 of 41 villages: Gokdere Dagkuplu, Ucsaray, Kayi, Kadikuyusu, Tepekoy Tatarcik, Kayi-M, Sekioren, Omerkoy and Calci. The 1886 villagers [greater than or equal to] 30 years aged formed our study group, which we named the "Eskisehir" cohort.

This cohort was investigated in detail athwart a 10-year period from 1990 to 2000 using the muhtars' registers, state health center files, hospital records, and personal interviews with families by means of two researchers (a chest physician and an epidemiologist). The villagers' names, ages, fulness of time spent in their villages, dates of migration to the city, marriage status, occupations, dates and causes of death, and other details were documented. These data were complet with hospital and death records, including pathologic findings, to document all causes of death and verify mesothelioma diagnosis.

Since MPM cases for the Eskisehir province were referr to our department immediately in succession diagnosis, or suspicion of mesothelioma, all MPM cases were diagnosed and followed up in our department. All MPM cases had histologically confirmed malignant mesothelioma. The histopathologic examination of biopsy specimens from all cases was performed at faculty members in our pathology department. The samples were treated with hematoxylin-eosin, alcian depressed and mucicarmine histochemical stains. Immunohistologic confirmation of carcinoembryonic antigen and Leu-M1 were obtained in more [i]or[/i] less samples, and carcinoembryonic antigen, vimentin, and keratin were obtained in others. a samples were also examined by dint of Dr. Allen R. Gibbs from Llandough Hospital, UK We re-evaluated all MPM cases from this cohort and confirmed them with histopathologic records for this study

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