Metsovo Lung: History of Population Environmental Exposure to Asbestos
Keywords:
Metsovo lung, mesothelioma, asbestos, tremolite
Abstract
Objectives: Our aim is to review all the literature concerning Metsovo Lung as an emblematic story that demonstrates the strong relationship between non-occupational but environmental and ecological exposure to asbestos and lung diseases. Materials and Methods: We searched data from the 1970s when extensive pleural calcifications causing malignant mesothelioma appeared at a high incidence beyond expectation. The most reliable studies were selected for our research from 2017-2023. Results: There wasn’t occupational exposure in Epirus. This finding reasonably raised the question of whether it was indeed tuberculous pleurisy or something else. The biopsies carried out confirmed that these were tremolite asbestos fibers. These fibers were derived from ‘luto’, a water-shielding material containing asbestos. The entire population of Metsovo was exposed to asbestos, without knowing it. This is a global phenomenon, according to which, it is made from a traditional shielding material. The abandonment of ‘luto’ and its non-use brought about a gradual reduction of the phenomenon, which also marks the reduction of mesothelioma. Conclusion: Lessons learned from the history of Metsovo lung showed the importance of the combination of theory and practice in the context of nonoccupational exposure to asbestos. From a public health point of view, it's crucial to know whether exposure to low levels of asbestos is able to induce pleural mesothelioma.
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References
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2. Baris YI, Bilir N, Artvinli M, Sahin AA, Kalyoncu F, Sebastien P An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos. .Br J Ind Med. 1988 Dec;45(12):838-40. doi: 10.1136/oem.45.12.838.PMID: 2851315
3. Baris YI, Simonato M, Artvinli M, et al. Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four year study in the Cappadocian region of Turkey Int J Cancer 1987; 39: 10–17.
4. Bazas T, Bazas B, Kitas D, Gilson JC, McDonald JC Pleural calcification in northwest Greece. Lancet. 1981; 1: 254
5. Bouros D Metsovo Lung. Case closed Pneumon 2014;27(suppl 1):26.
6. Burilkov T, Machailova L. Asbestos content of the soil and endemic pleural asbestosis. Environm Res. 1970; 3: 443-449
7. Constantopoulos SH, Dalavanga YA, Sakellariou K, Goudevenos J, Kotoulas OB.Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? Am Rev Respir Dis. 1992 Dec;146(6):1565-70. doi: 10.1164/ajrccm/146.6.1565.PMID: 1456576
8. Constantopoulos SH, Goudevenos JA, Saratzis N, Langer AM, Selikoff IJ, Moutsopoulos HM. Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology. Environ Res. 1985 Dec;38(2):319-31. doi: 10.1016/0013-9351(85)90096-9.PMID: 4065080
9. Constantopoulos SH, Langer AM, Saratzis N, et al Regional findings in Metsovo Lung. Lancet 1987;2:452-453.
10. Constantopoulos SH, Malamou-Mitsi V, Goudevenos J, Papathanasiou MP, Pavlidis NA, Papadimitriou CS High incidence of malignant pleural mesothelioma in neighlxmring villages of Northwest Greece. Respiration. 1987; 51: 266-271
11. Constantopoulos SH, Saratzis NA, Goudevenos JA, Kontogiannis D, Karantanas A, Katsiotis P. Tremolite whitewashing and pleural calcifications. Chest. 1987; 92: 709-712
12. Constantopoulos SH, Theodoracopoulos P, Dascalopoulos G, Saratzis N, Sideris K. Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece. Chest. 1991 May;99(5):1158-61. doi: 10.1378/chest.99.5.1158.PMID: 2019171
13. Constantopoulos SH. Environmental mesothelioma associated with tremolite asbestos: lessons from the experiences of Turkey, Greece, Corsica, New Caledonia and Cyprus. Regul Toxicol Pharmacol 2008; 52: 110–115
14. Constantopoulos SH: Metsovo Lung. A medical detective story with a happy ending. Pneumon 2014;27(suppl 1):31-41.
15. Darcey DJ, Alleman T Occupational and environmental exposure to asbestos. In: Roggli VL, Oury TD, Sporn ThA, eds. Pathology of Asbestos-Associated Diseases2nd Edn. Springer, New York, 2004; pp. 17–33.
16. Davis YI, Saracci R, Simonato L, Skidmode JW Malignant mesothelioma and radiologic chest abnormalities in two villages of central Turkey. Lancet. 1981; 1: 984-987
17. Filetti V, Lombardo C, Loreto C, Dounias G, Bracci M … Small RNA-Seq Transcriptome Profiling of Mesothelial and Mesothelioma Cell Lines Revealed microRNA Dysregulation after Exposure to Asbestos-like … - Biomedicines, 2023 - mdpi.com
18. Galani V, Constantopoulos S, Manda-Stachouli C, Frangou-Lazaridis M, Mavridis A, Vassiliou M, Dalavanga Y. Additional proteins in BAL fluid of Metsovites environmentally exposed to asbestos: more evidence of "protection" against neoplasia? Chest. 2002 Jan;121(1):273-8. doi:10.1378/chest.121.1.273. PMID: 11796462
19. Gibbs AR, Role of asbestos and other fibres in the development of diffuse malignant mesothelioma. Thorax. 1990; 45: 649-654
20. Gogali A, Manda-Stachouli C, Ntzani EE, et al: Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later. Eur Res J 2012;39:1
21. Gogali A, Ntzani EE, Manda-Stachouli C, Peristeri S, Tzarouchi L, Laiou E, Konstantinidis A, Constantopoulos SH, Dalavanga Y Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece..Respiration. 2017;94(6):510-517. doi: 10.1159/000480151. Epub 2017 Oct 12. PMID: 29020669 Free article.
22. Gogou E, Hatzoglou C, Siachpazidou D … Asbestos Ban Policies and Mesothelioma Mortality in Greece - 2023 - researchsquare.com
23. Gogou E, C Hatzoglou, SG Zarogiannis, F Malli… Mesothelioma mortality rates in Greece for the period 2005–2015 is increased compared to previous decades - Medicina, 2019 - mdpi.com …
24. Goldberg M, Luce D.The health impact of nonoccupational exposure to asbestos: what do we know? Eur J Cancer Prev. 2009 Nov;18(6):489-503. doi: 10.1097/CEJ.0b013e32832f9bee.PMID: 19617842 .
25. Gourgoulianis KI - Lessons from the investigation of" Metsovo Lung [Πνεύμων Μετσόβου], 2014 - Citeseer …
26. Grant DC Seltzer SE, Antman KH, Finberg HJ, Koster K. Computed tomography of malignant pleural mesothelioma. J Comput Assist Tomog. 1983; 7: 626-632
27. Hillerdal G. Mesothelioma: cases associated with non-occupational and low dose exposures.. Occup Environ Med 1999; 56: 505–513
28. Langer AM, Nolan RP, Constantopoulos SH, Moutsopoulos HM. Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash. Lancet. 1987 Apr 25;1(8539):965-7. doi: 10.1016/s0140-6736(87)90305-9.PMID: 2882352
29. Manda-Stachouli C, Dalavanga Y, Daskalopoulos G, Leontaridi C, Vassiliou M, Constantopoulos SH. Decreasing prevalence of pleural calcifications among Metsovites with nonoccupational asbestos exposure.Chest. 2004 Aug;126(2):617-21. doi: 10.1378/chest.126.2.617.PMID: 15302752
30. Manos E, N Palatianos, P Panagou " Metsovo Lung" with benign pleural calcifications: A CXR image with complimentary information from Ultrasound Elastography. - Pneumon, 2019 - search.ebscohost.com
31. Navratil M, Trippe F. Prevalence of pleural calcifications in persons exposed to asbestos dust, and in the general population in the same district. Environm Res. 1972; 5: 210-216
32. Papiris SA, Maniati MA, Sakellariou K, Gosios C, Kontogiannis D, Constantopoulos SH. Round atelectasis and Metsovo lung. Chest. 1993 Jun;103(6):1759-62. doi: 10.1378/chest.103.6.1759.PMID: 8404097
33. Rabinowitz JG, Efremidis SG, Cohen B, Dan S Efremidis A, Chahinian AP et al. A comparative study of mesothelioma and asbestosis using computed tomography and conventional chest radiography. Diagn Radiol. 1982; 144: 453-460
34. Raptis L, Efpraxia M, Akritidis N. Primary malignant peritoneal mesothelioma associated with Metsovo lung. JBR-BTR. 2007 May-Jun;90(3):204-5.PMID: 17696098
35. Rey DR Asbestosis no ocupacional: un riesgo potencial a tener en consideración - Revista americana de medicina respiratoria, 2022 - SciELO Argentina
36. Ricchiuti C, A Bloise, R Punturo Occurrence of asbestos in soils: state of the art - Episodes Journal of International …, 2020 - episodes.org
37. Sakellariou K, Malamou-Mitsi V, Haritou A, Koumpaniou C, Stachouli C, Dimoliatis ID, Constantopoulos SH. Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? Eur Respir J. 1996 Jun;9(6):1206-10. doi: 10.1183/09031936.96.09061206.PMID: 8804939
38. Senyig˘it A, Babayig˘it C, Go¨kirmak M, et al Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey Respiration 2000; 67: 610–614.
39. Shevas AT, Kastanioudakis IG, Constantopoulos SH, Assimakopoulos DA. Acquired nasopharyngeal obstruction and "Metsovo lung". Rhinology. 1995 Dec;33(4):240-3.PMID: 8919220
40. Sichletides L Dascalopoulou E Chloros D Vlachogiannis M Chatzidimitriou N Michailides K Kontos D. Pleural asbestosis in rural population of the area of Pella, Presented at the Fourth Medical Conference of Northern Greece 1989, Thessaloniki, May, Abstract 106 (Greek)
41. Theodorakopoulos P, Constantopoulos SH. Endemic pleural calcifications in Greece. Seventh Congress of European Society of Pulmonology. Budapest, September, 1988. European Respiratory Journal, Abstract Book, p. 292S
42. Tzilas V, Tzouvelekis A, Bouros D. Metsovo Lung: A Story of Episteme, Techne, and Phronesis. Respiration. 2017;94(6):491-492. doi: 10.1159/000481291. Epub 2017 Oct 13.PMID: 29024926
43. Velasco-Garcia MI, MJ Cruz, C Diego, MA Montero…First identification of pulmonary asbestos fibres in a Spanish population - Lung, 2017 – Springer
44. Zerva LV, Constantopoulos SH, Moutsopoulos HM. Humoral immunity alterations after environmental asbestos exposure. Respiration. 1989;55(4):237-41. doi: 10.1159/000195740. PMID: 2595107
2. Baris YI, Bilir N, Artvinli M, Sahin AA, Kalyoncu F, Sebastien P An epidemiological study in an Anatolian village environmentally exposed to tremolite asbestos. .Br J Ind Med. 1988 Dec;45(12):838-40. doi: 10.1136/oem.45.12.838.PMID: 2851315
3. Baris YI, Simonato M, Artvinli M, et al. Epidemiological and environmental evidence of the health effects of exposure to erionite fibres: a four year study in the Cappadocian region of Turkey Int J Cancer 1987; 39: 10–17.
4. Bazas T, Bazas B, Kitas D, Gilson JC, McDonald JC Pleural calcification in northwest Greece. Lancet. 1981; 1: 254
5. Bouros D Metsovo Lung. Case closed Pneumon 2014;27(suppl 1):26.
6. Burilkov T, Machailova L. Asbestos content of the soil and endemic pleural asbestosis. Environm Res. 1970; 3: 443-449
7. Constantopoulos SH, Dalavanga YA, Sakellariou K, Goudevenos J, Kotoulas OB.Lymphocytic alveolitis and pleural calcifications in nonoccupational asbestos exposure. Protection against neoplasia? Am Rev Respir Dis. 1992 Dec;146(6):1565-70. doi: 10.1164/ajrccm/146.6.1565.PMID: 1456576
8. Constantopoulos SH, Goudevenos JA, Saratzis N, Langer AM, Selikoff IJ, Moutsopoulos HM. Metsovo lung: pleural calcification and restrictive lung function in northwestern Greece. Environmental exposure to mineral fiber as etiology. Environ Res. 1985 Dec;38(2):319-31. doi: 10.1016/0013-9351(85)90096-9.PMID: 4065080
9. Constantopoulos SH, Langer AM, Saratzis N, et al Regional findings in Metsovo Lung. Lancet 1987;2:452-453.
10. Constantopoulos SH, Malamou-Mitsi V, Goudevenos J, Papathanasiou MP, Pavlidis NA, Papadimitriou CS High incidence of malignant pleural mesothelioma in neighlxmring villages of Northwest Greece. Respiration. 1987; 51: 266-271
11. Constantopoulos SH, Saratzis NA, Goudevenos JA, Kontogiannis D, Karantanas A, Katsiotis P. Tremolite whitewashing and pleural calcifications. Chest. 1987; 92: 709-712
12. Constantopoulos SH, Theodoracopoulos P, Dascalopoulos G, Saratzis N, Sideris K. Metsovo lung outside Metsovo. Endemic pleural calcifications in the ophiolite belts of Greece. Chest. 1991 May;99(5):1158-61. doi: 10.1378/chest.99.5.1158.PMID: 2019171
13. Constantopoulos SH. Environmental mesothelioma associated with tremolite asbestos: lessons from the experiences of Turkey, Greece, Corsica, New Caledonia and Cyprus. Regul Toxicol Pharmacol 2008; 52: 110–115
14. Constantopoulos SH: Metsovo Lung. A medical detective story with a happy ending. Pneumon 2014;27(suppl 1):31-41.
15. Darcey DJ, Alleman T Occupational and environmental exposure to asbestos. In: Roggli VL, Oury TD, Sporn ThA, eds. Pathology of Asbestos-Associated Diseases2nd Edn. Springer, New York, 2004; pp. 17–33.
16. Davis YI, Saracci R, Simonato L, Skidmode JW Malignant mesothelioma and radiologic chest abnormalities in two villages of central Turkey. Lancet. 1981; 1: 984-987
17. Filetti V, Lombardo C, Loreto C, Dounias G, Bracci M … Small RNA-Seq Transcriptome Profiling of Mesothelial and Mesothelioma Cell Lines Revealed microRNA Dysregulation after Exposure to Asbestos-like … - Biomedicines, 2023 - mdpi.com
18. Galani V, Constantopoulos S, Manda-Stachouli C, Frangou-Lazaridis M, Mavridis A, Vassiliou M, Dalavanga Y. Additional proteins in BAL fluid of Metsovites environmentally exposed to asbestos: more evidence of "protection" against neoplasia? Chest. 2002 Jan;121(1):273-8. doi:10.1378/chest.121.1.273. PMID: 11796462
19. Gibbs AR, Role of asbestos and other fibres in the development of diffuse malignant mesothelioma. Thorax. 1990; 45: 649-654
20. Gogali A, Manda-Stachouli C, Ntzani EE, et al: Malignant mesothelioma in Metsovo, Greece, from domestic use of asbestos: 30 years later. Eur Res J 2012;39:1
21. Gogali A, Ntzani EE, Manda-Stachouli C, Peristeri S, Tzarouchi L, Laiou E, Konstantinidis A, Constantopoulos SH, Dalavanga Y Evidence Suggesting the End of Universal Domestic Asbestos Exposure in Metsovo, NW Greece..Respiration. 2017;94(6):510-517. doi: 10.1159/000480151. Epub 2017 Oct 12. PMID: 29020669 Free article.
22. Gogou E, Hatzoglou C, Siachpazidou D … Asbestos Ban Policies and Mesothelioma Mortality in Greece - 2023 - researchsquare.com
23. Gogou E, C Hatzoglou, SG Zarogiannis, F Malli… Mesothelioma mortality rates in Greece for the period 2005–2015 is increased compared to previous decades - Medicina, 2019 - mdpi.com …
24. Goldberg M, Luce D.The health impact of nonoccupational exposure to asbestos: what do we know? Eur J Cancer Prev. 2009 Nov;18(6):489-503. doi: 10.1097/CEJ.0b013e32832f9bee.PMID: 19617842 .
25. Gourgoulianis KI - Lessons from the investigation of" Metsovo Lung [Πνεύμων Μετσόβου], 2014 - Citeseer …
26. Grant DC Seltzer SE, Antman KH, Finberg HJ, Koster K. Computed tomography of malignant pleural mesothelioma. J Comput Assist Tomog. 1983; 7: 626-632
27. Hillerdal G. Mesothelioma: cases associated with non-occupational and low dose exposures.. Occup Environ Med 1999; 56: 505–513
28. Langer AM, Nolan RP, Constantopoulos SH, Moutsopoulos HM. Association of Metsovo lung and pleural mesothelioma with exposure to tremolite-containing whitewash. Lancet. 1987 Apr 25;1(8539):965-7. doi: 10.1016/s0140-6736(87)90305-9.PMID: 2882352
29. Manda-Stachouli C, Dalavanga Y, Daskalopoulos G, Leontaridi C, Vassiliou M, Constantopoulos SH. Decreasing prevalence of pleural calcifications among Metsovites with nonoccupational asbestos exposure.Chest. 2004 Aug;126(2):617-21. doi: 10.1378/chest.126.2.617.PMID: 15302752
30. Manos E, N Palatianos, P Panagou " Metsovo Lung" with benign pleural calcifications: A CXR image with complimentary information from Ultrasound Elastography. - Pneumon, 2019 - search.ebscohost.com
31. Navratil M, Trippe F. Prevalence of pleural calcifications in persons exposed to asbestos dust, and in the general population in the same district. Environm Res. 1972; 5: 210-216
32. Papiris SA, Maniati MA, Sakellariou K, Gosios C, Kontogiannis D, Constantopoulos SH. Round atelectasis and Metsovo lung. Chest. 1993 Jun;103(6):1759-62. doi: 10.1378/chest.103.6.1759.PMID: 8404097
33. Rabinowitz JG, Efremidis SG, Cohen B, Dan S Efremidis A, Chahinian AP et al. A comparative study of mesothelioma and asbestosis using computed tomography and conventional chest radiography. Diagn Radiol. 1982; 144: 453-460
34. Raptis L, Efpraxia M, Akritidis N. Primary malignant peritoneal mesothelioma associated with Metsovo lung. JBR-BTR. 2007 May-Jun;90(3):204-5.PMID: 17696098
35. Rey DR Asbestosis no ocupacional: un riesgo potencial a tener en consideración - Revista americana de medicina respiratoria, 2022 - SciELO Argentina
36. Ricchiuti C, A Bloise, R Punturo Occurrence of asbestos in soils: state of the art - Episodes Journal of International …, 2020 - episodes.org
37. Sakellariou K, Malamou-Mitsi V, Haritou A, Koumpaniou C, Stachouli C, Dimoliatis ID, Constantopoulos SH. Malignant pleural mesothelioma from nonoccupational asbestos exposure in Metsovo (north-west Greece): slow end of an epidemic? Eur Respir J. 1996 Jun;9(6):1206-10. doi: 10.1183/09031936.96.09061206.PMID: 8804939
38. Senyig˘it A, Babayig˘it C, Go¨kirmak M, et al Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey Respiration 2000; 67: 610–614.
39. Shevas AT, Kastanioudakis IG, Constantopoulos SH, Assimakopoulos DA. Acquired nasopharyngeal obstruction and "Metsovo lung". Rhinology. 1995 Dec;33(4):240-3.PMID: 8919220
40. Sichletides L Dascalopoulou E Chloros D Vlachogiannis M Chatzidimitriou N Michailides K Kontos D. Pleural asbestosis in rural population of the area of Pella, Presented at the Fourth Medical Conference of Northern Greece 1989, Thessaloniki, May, Abstract 106 (Greek)
41. Theodorakopoulos P, Constantopoulos SH. Endemic pleural calcifications in Greece. Seventh Congress of European Society of Pulmonology. Budapest, September, 1988. European Respiratory Journal, Abstract Book, p. 292S
42. Tzilas V, Tzouvelekis A, Bouros D. Metsovo Lung: A Story of Episteme, Techne, and Phronesis. Respiration. 2017;94(6):491-492. doi: 10.1159/000481291. Epub 2017 Oct 13.PMID: 29024926
43. Velasco-Garcia MI, MJ Cruz, C Diego, MA Montero…First identification of pulmonary asbestos fibres in a Spanish population - Lung, 2017 – Springer
44. Zerva LV, Constantopoulos SH, Moutsopoulos HM. Humoral immunity alterations after environmental asbestos exposure. Respiration. 1989;55(4):237-41. doi: 10.1159/000195740. PMID: 2595107
Published
2025-01-15
How to Cite
Sxiza, C., Zagorianakou, N., Vlami, C., Farantos, G., Rapisarda, V., & Dounias, G. (2025). Metsovo Lung: History of Population Environmental Exposure to Asbestos. European Scientific Journal, ESJ, 21(37), 18. https://doi.org/10.19044/esj.2025.v21n37p18
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Copyright (c) 2025 C. Sxiza, N. Zagorianakou, C. Vlami, G. Farantos, V. Rapisarda, G. Dounias
This work is licensed under a Creative Commons Attribution 4.0 International License.
