{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:41:59Z","timestamp":1787794919015,"version":"build-2784847793"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,10,25]],"date-time":"2017-10-25T00:00:00Z","timestamp":1508889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Turkish Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP). The aim of this study was to analyze the results of the TUNMES-EAECP. Patients diagnosed with MM (code C45.0\u2013C45.9) between 2008 and 2012 were identified. The \u201cfrom case to the field\u201d method was used to determine the villages with current or previous asbestos exposure. Special public health teams took soil samples from these villages, which were then examined using an X-ray diffractometer. Direct Standardized Average Annual Mesothelioma Incidence Rate (AMIR) and relative risk (RR) of MM were calculated. Finally, a projection on the incidence of MM between 2013 and 2033 was made. The number of confirmed MM cases was 5617 with a male to female ratio of 1.36. Mean age was 61.7 \u00b1 13.4 (20\u201396) years. The median survival was eight (95% CI 7.6\u20138.4) months. Asbestos exposure continues in 379 villages, with 158,068 people still living in high risk areas. The standardized AMIR was 2.33\/100,000 per year. The risk of MM was higher in males, in both sexes over the age of 40, in asbestos-containing provinces, and in those where the TUNMES was organized. Among the population with continuing asbestos exposure in rural areas, the number of MM cases between 2013 and 2033 was estimated as 2511. As such, the incidence of MM in Turkey is as high as in industrialized countries. Asbestos exposure in rural areas continues to be a serious problem in Turkey, which obviates the necessity for effective preventive measures.<\/jats:p>","DOI":"10.3390\/ijerph14111293","type":"journal-article","created":{"date-parts":[[2017,10,25]],"date-time":"2017-10-25T11:13:27Z","timestamp":1508930007000},"page":"1293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program"],"prefix":"10.3390","volume":"14","author":[{"given":"Selma","family":"Metinta\u015f","sequence":"first","affiliation":[{"name":"Medical Faculty Department of Public Health, Eskisehir Osmangazi University, Eskisehir 26040, Turkey"},{"name":"Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir 26040, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan Fevzi","family":"Bat\u0131rel","sequence":"additional","affiliation":[{"name":"Medical Faculty Department of Chest Surgery, Marmara University, \u0130stanbul 34722, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Bayram","sequence":"additional","affiliation":[{"name":"Medical Faculty Department of Chest Diseases, Ko\u00e7 University, \u0130stanbul 34450, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dclk\u00fc","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Medical Faculty Department of Chest Diseases, Health Science University, Ankara 06430, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Karada\u011f","sequence":"additional","affiliation":[{"name":"Medical Faculty Department of Chest Diseases, Uluda\u011f University, Bursa 16059, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnt\u00fcl\u00fc","family":"Ak","sequence":"additional","affiliation":[{"name":"Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir 26040, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzaffer","family":"Metinta\u015f","sequence":"additional","affiliation":[{"name":"Lung and Pleural Cancers Research and Clinical Center, Eskisehir Osmangazi University, Eskisehir 26040, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,10,25]]},"reference":[{"key":"ref_1","unstructured":"Harber, P., and Gee, J.B.L. (2015). Clinicians\u2019 approach to mesothelioma. Malignant Mesothelioma, Springer."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/CPM.0b013e318235181f","article-title":"Asbestos-Related Lung Disease: An Update","volume":"18","author":"Schuhmann","year":"2011","journal-title":"Clin. Pulm. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1378\/chest.122.6.2224","article-title":"Malignant mesothelioma due to environmental exposure to asbestos","volume":"122","author":"Metintas","year":"2002","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1378\/chest.102.3.790","article-title":"Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases","volume":"102","author":"Emri","year":"1992","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1183\/09031936.99.13352399","article-title":"Malignant mesothelioma due to environmental exposure to erionite: Follow-up of a Turkish emigrant cohort","volume":"13","author":"Hillerdal","year":"1999","journal-title":"Eur. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"214","DOI":"10.15585\/mmwr.mm6608a3","article-title":"Malignant mesothelioma mortality\u2014United States, 1999\u20132015","volume":"66","author":"Mazurek","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/jcp.22724","article-title":"Malignant mesothelioma: Facts, myths and hypotheses","volume":"227","author":"Carbone","year":"2012","journal-title":"J. Cell Physiol."},{"key":"ref_8","first-page":"S1","article-title":"Turkey asbestos control strategic plan final report","volume":"16","author":"Metintas","year":"2015","journal-title":"Turkish Thorac. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1159\/000056289","article-title":"Incidence of malignant pleural mesothelioma due to environmental asbestos exposure in the southeast of Turkey","volume":"67","author":"Topcu","year":"2000","journal-title":"Respiration"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1093\/jnci\/djj106","article-title":"Prospective study of mesothelioma mortality in Turkish villages with exposure to fibrous zeolite","volume":"15","author":"Baris","year":"2006","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1080\/19338240903390305","article-title":"Endemic malignant mesothelioma: Exposure to erionite is more important than genetic factors","volume":"65","author":"Metintas","year":"2010","journal-title":"Arch. Environ. Occup. Health"},{"key":"ref_12","unstructured":"Institute for Health Metrics and Evaluation (2015). The Global Burden of Disease: Generating Evidence, Guiding Policy, Institute for Health Metrics and Evaluation."},{"key":"ref_13","unstructured":"Ahmad, O.B., Boschi-Pinto, C., Lopez, A.D., Murray, J.L.C., Lozano, R., and Inoue, M. (2017, January 20). GPE Age Standardization of Rates: A New Who Standard, Available online: https:\/\/seer.cancer.gov\/stdpopulations\/world.who.html."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Corfiati, M., Scarselli, A., Binazzi, A., Di Marzio, D., Verardo, M., Mirabelli, D., Gennaro, V., Mensi, C., Schallemberg, G., and Merler, E. (2015). Epidemiological patterns of asbestos exposure and spatial clusters of incident cases of malignant mesothelioma from the Italian national registry. BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1301-2"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1378\/chest.11-2727","article-title":"High risk of malignant mesothelioma and pleural plaque in subjects born close to ophiolites","volume":"143","author":"Bayram","year":"2013","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1440-1843.2007.01187.x","article-title":"Epidemiology of pleural mesothelioma in a population with non-occupational asbestos exposure","volume":"13","author":"Metintas","year":"2008","journal-title":"Respirology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1111\/j.1440-1843.2009.01493.x","article-title":"Observations environmental asbestos exposure in a high-risk area","volume":"14","author":"Bircan","year":"2009","journal-title":"Respirology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0954-6111(99)90318-9","article-title":"Environmental asbestos exposure and malignant pleural mesothelioma","volume":"93","author":"Hillerdal","year":"1999","journal-title":"Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/10937404.2016.1195322","article-title":"Environmental risk of mesothelioma in the United States: An emerging concern-epidemiological issues","volume":"19","author":"Baumann","year":"2016","journal-title":"J. Toxicol. Environ. Health B"},{"key":"ref_20","first-page":"718","article-title":"Latent period for malignant mesothelioma of occupational origin","volume":"34","author":"Lanphear","year":"1992","journal-title":"J. Occup. Med."},{"key":"ref_21","first-page":"393","article-title":"Malignant mesothelioma mortality\u2014United States, 1999\u20132005","volume":"58","author":"Bang","year":"2009","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1183\/09031936.05.00136404","article-title":"Non-malignant pleural lesions due to environmental exposure to asbestos","volume":"26","author":"Metintas","year":"2005","journal-title":"Eur. Respir. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1136\/oem.56.8.505","article-title":"Mesothelioma: Cases associated with non-occupational and low dose exposures","volume":"56","author":"Hillerdal","year":"1999","journal-title":"Occup. Environ. Med."},{"key":"ref_24","first-page":"1","article-title":"T\u00fcrkiye\u2019de Asbest ve Erionite ile \u0130lgili Hastal\u0131klar","volume":"8","author":"Akay","year":"2007","journal-title":"Toraks. Dergisi."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/j.1440-1843.2005.00714.x","article-title":"Advances in the diagnosis, evaluation and management of malignant pleural mesothelioma","volume":"10","author":"Sterman","year":"2005","journal-title":"Respirology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.jtcvs.2015.09.121","article-title":"Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy","volume":"151","author":"Batirel","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1097\/JTO.0b013e3181ba2033","article-title":"Prognostic factors according to the treatment schedule in malignant pleural mesothelioma","volume":"4","author":"Ak","year":"2009","journal-title":"J. Thorac. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1179\/oeh.2004.10.1.22","article-title":"Global use of asbestos and the incidence of mesothelioma","volume":"10","author":"Tossavainen","year":"2004","journal-title":"Int. J. Occup. Environ. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1038\/sj.bjc.6602307","article-title":"The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050","volume":"92","author":"Hodgson","year":"2005","journal-title":"Br. J. Cancer"},{"key":"ref_30","unstructured":"Health and Safety Executive (2011). Mesothelioma Mortality in Great Britain. The Revised Risk and Two-Stage Clonal Expansion Models."},{"key":"ref_31","unstructured":"Australian Mesothelioma Registry (2016, October 20). 1st Annual Report Mesothelioma in Australia 2011, Safe Work Australia. Available online: http:\/\/www.mesothelioma-australia.com."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Marsili, D., Terracini, B., Santana, V.S., Ramos-Bonilla, J.P., Pasetto, R., Mazzeo, A., Loomis, D., Comba, P., and Algranti, E. (2016). Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13050494"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:48:23Z","timestamp":1760208503000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,25]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11]]}},"alternative-id":["ijerph14111293"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14111293","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,25]]}}}