Pleural mesothelioma in a brake mechanic.

A high risk for the development of diffuse pleural mesothelioma is known to exist in various occupational settings associated with the use of asbestos.' Although a serious hazard has been recognised among asbestos miners, millers, and shipyard workers, recent evidence suggests that a high risk of mesothelioma may exist among occupational groups previously thought to be at low risk for developing this neoplasm.23 Over the past 40 years, occasional reports of asbestosis among "brake liners" and "brake lining weavers" have been reported.45 Lung cancer and mesothelioma among these workers initially seemed to be limited to those working in friction product manufacture, although more recent data indicate that a significant risk of mesothelioma may exist among workers engaged in installing and repairing friction materials.6 We review a case of pleural mesothelioma in a car brake mechanic whose only known exposure to asbestos (chrysotile) was from clutch and brake repair work over 11 years. Since asbestos related mesothe-lioma in brake mechanics has received little attention and since the carcinogenic potential of chrysotile asbestos in man is currently controversial, a short report on this topic appears justified. Case report A 47 year old, lifetime non-smoking man was admitted to another hospital in November 1983 with a one week history of right pleuritic chest pain, shortness of breath, and dyspnoea on exertion. He had lost 10 lbs (4 5 kg) in the three months before admission. Previous medical history was negative except for exposure to "carborator cleaner" in 1973 which required admission to hospital. He also had a history of recurrent pleural effusion since 1978. (A thorough check up for a right pleural effusion in 1978 was negative for malignancy and of uncertain aetiology). Chest x ray examination at the time of admission Accepted 18 January 1988 69 showed a large opaque density at the right lung base with erosion along the inferior margin of the 8th and 9th right posterior ribs. A CT scan showed total encasement of the right hemithorax with a nodular pleural mass that extended into the chest wall with rib destruction in the posterior base of the hemithorax. Massive mediastinal nodal involvement was also noted. Excisional biopsy at this time showed malignant mesothelioma of the epithelial subtype. The left lung field and pleura were free of disease. Chemotherapy consisting of cis-platinum, adriamycin, and cyclophosphamide (Cytoxan) was started in November 1983. Although six monthly cycles of chemotherapy were initially planned, …