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Malignant Mesothelioma and Its Nonasbestos Causes.

To the Editor.--Attanoos and colleagues (1) reviewed the literature concerning nonasbestos causes for malignant mesothelioma. They concluded that most mesotheliomas not clearly attributable to asbestos exposure are spontaneous. Their review did not consider a common occult form of asbestos exposure arising from the use of talcum powders. In 1976, Rohl et al (2) analyzed consumer talcums and reported that 10 of the 20 products (50%) analyzed contained tremolite and anthophyllite. Blount (3) reported asbestiform tremolite contamination of the ore used in a popular baby powder. Gordon et al (4) found asbesti form tremolite and anthophyllite in a popular body powder, and Anderson et al (5) found anthophyllite fibers in the same brand.

Statista (6) (Hamburg, Germany), a market research company, reported that some 100 million Americans used body and baby powders in the years 2011 to 2017. It is possible to draw inferences about the prevalence of exposures to talcum powders in subjects with mesothelioma by querying the database of lung asbestos fiber-burden measurements compiled by Victor Roggli, MD (Duke University Medical Center, Durham, North Carolina).

Fiber-burden measurements were made on 566 subjects (female, n = 75; 13%) with pleural mesothelioma. Talc fibers were detected in 332 of 491 (68%) of the men and 62 of 75 (83%) of the women. The detection of tremolite was significantly associated with the presence of talc (P < .001) as was the detection of anthophyllite (P = .002). The presence of talc and associated amphiboles was more common in women than it was in men (odds ratio, 3.24; 95% CI, 1.65-6.35). This would be expected if women were more likely to be users of baby and body powders than men were.

Lung burdens of talc and its amphibole contaminants are markers of exposure to talc-containing dusts. In addition to talc exposures from talcum powders, there has been occupational and hobby exposure to industrial talc in the United States, but the number of persons with exposures to industrial talc is small compared with the 100 million users of baby and body powders.

I conclude that:

1. The use of body and baby powders is common in the United States. Consumer surveys found that about one-third of the population used those powders between 2011 and 2017;

2. Measurements of retail talc products have found amphibole asbestos contamination of those products;

3. A large series of measurements of asbestos fiber burdens in patients with pleural mesothelioma has found the presence of talc to be common, exceeding 65% among both men and women;

4. Women were more than twice as likely as men were to have talc in their tissues, compatible with the hypothesis that women were more likely to be users of baby and body powders. Without accounting for amphibole asbestos exposures arising from the use of baby and body powders, it is not possible to conclude, as Attanoos and colleagues have done, that "In North America few mesotheliomas in women at any site are attributable to asbestos exposure." (1(p753))

It is my opinion that, without accounting for those occult asbestos exposures, it is inappropriate to conclude that "most mesotheliomas not clearly attributable to asbestos exposure are spontaneous (idiopathic)." (1(p753))

Murray M. Finkelstein, PhD, MD

University of Toronto, Family and Community Medicine, Toronto, Ontario, Canada

(1.) Attanoos RL, Churg A, Galateau-Salle F, Gibbs AR, Roggli VL. Malignant mesothelioma and its non-asbestos causes. Arch Pathol Lab Med. 2018; 142(6):753-760. doi: 10.5858/arpa. 2017-0365-RA.

(2.) Rohl AN, Langer AM, Selikoff IJ, et al. Consumer talcums and powders: mineral and chemical characterization. J Toxicol Environ Health. 1976;2(2):255-284.

(3.) Blount AM. Amphibole content of cosmetic and pharmaceutical talcs. Environ Health Perspect. 1991;94:225-230.

(4.) Gordon RE, Fitzgerald S, Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women [published correction appears in Int J Occup Environ Health. 2015; 21(4):347-348]. Int J Occup Environ Health. 2014; 20(4):318-232.

(5.) Anderson EL, Sheehan PJ, Kalmes RM, Griffin JR. Assessment of health risk from historical use of cosmetic talcum powder. Risk Anal. 2017;37(5): 918-929.

(6.) Statista. U.S. population: most used brands of body and baby powder from 2011 to 2017. https:// Accessed July 16, 2018

Accepted for publication July 16, 2018.

The author has served as a consultant toplaintiff's lawyers in asbestos and talc litigation.

doi: 10.5858/arpa.2018-0145-LE
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Title Annotation:Letters to the Editor
Author:Finkelstein, Murray M.
Publication:Archives of Pathology & Laboratory Medicine
Article Type:Letter to the editor
Date:Jun 1, 2019
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