Clapper, Patti, Schweizer and Mason

The results of a recent study published in the British Journal of Urology International (BJUI) reaffirm the link between asbestos and a rare form of mesothelioma which develops in the testes.  Mesothelioma of the tunica vaginalis testis is a very rare form of asbestos cancer that attacks the membrane covering the testicles in men who have had prior asbestos exposure.  In the Lombardy region of Italy, in which the study was conducted, the disease strikes fewer than 0.2 cases per million people per year.  In fact, in the decade between 2000 and 2010 only 13 cases were reported in Lombardy – one of the most densely populated portions of the country. 

The cancer is so rare than many were questioning if that specific form of mesothelioma was indeed caused by asbestos.  The Italian study used extremely detailed data and analysis to put those doubts to rest and confirms that asbestos is the cause of mesothelioma in the testicles.

How Does Mesothelioma Form in Testicles?

While most people associate mesothelioma with the pleural membranes within the body, such as malignant pleural mesothelioma that starts in the lining around the lungs, it can also affect the peritoneal membranes as well (those lining the interior of the abdomen and encasing the digestive tract.  The most common form of peritoneal mesothelioma occurs around the intestines and stomach.  However, the testacies have a peritoneal sac that surrounds them as well.  This is a leftover piece of tissue from prenatal days when the testicles had yet to descend into the scrotum.  As they descend, the peritoneum follows the sex organs down to their new home.  As the testicles develop, this portion of the peritoneum is cut off and forms a closed sac around the testicles. 

This portion of the peritoneum is just as susceptible to asbestos diseases including mesothelioma as the other portions of the tissue but exposure instances are more limited.  However, the hard-hitting conclusion of the Italian study is that asbestos if invariably the cause of testicular mesothelioma.

Details of the Italian Study

A joint team of researchers was compiled from the Department of Preventive Medicine at the Fondazione IRCCS Ca' Granda – Ospedale Maggiore Policlinico (the Hospital and Polyclinic of Milan,) the Inhaled Dust Biological Effects Centre, and the Department of Occupational Health, Università degli Studi di Milano.  The group examined cases of mesothelioma of the tunica vaginalis testis reported between 2000 to 2010 from the Lombardy region of Italy.

They chose the Lombardy region for a number of reasons.  Not only is it one of the most densely populated portions of the country, it’s also highly industrialized – therefore asbestos exposure rates are high.  In fact, mesothelioma hits the Lombardy region so hard that a special database called the Lombardy Mesothelioma Registry was created to keep track of them all. 

Researchers sorted through the details of the 13 testicular mesothelioma cases reported between 2000 and 2012, including exacting details about the patient’s life-history, normally missing from such medical data, available in the Lombardy registry. 

They discovered that asbestos exposure had been confirmed in 67% of the testicular mesothelioma cases, and suspected in several others.  This, they claimed, confirmed the causal role of asbestos in this rare form of mesothelioma. 

Lessons Learned from Mesothelioma Research

In addition to reaffirming the link between a certain type of mesothelioma and asbestos, researchers discovered that the methodology used by the Lombardy Mesothelioma Registry was extremely helpful.  By reporting not only medical data but information pertaining to the patient’s personal life and work history, the Lombardy Mesothelioma Registry had become an invaluable tool for understanding the disease, predicting mesothelioma occurrences, and potentially opening up new venues for prevention and treatment. 

In fact, the researchers also recommended in their conclusions that all mesothelioma databases should include such detailed occupational histories of patients in order to facilitate communal research.  They suggest that all medical databases employ specifically trained interviewers to get the most important biographic information from mesothelioma patients.  The report stated that the level of detail included in the Lombardy Mesothelioma Registry was essential for drawing their conclusions and without it their research would not only have been more difficult but the conclusions would have been faulty as well.

Unfortunately, most medical databases don’t include such information.  In fact, many reports and journal papers fail to include all of the discoveries made during experiments, as one recent study by another group of Italian mesothelioma researchers.