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Asbestos exposure and mesothelioma
Published in Dorsett D. Smith, The Health Effects of Asbestos, 2015
Patients with advanced disease who are not surgical candidates can be treated with a talc pleurodesis. A British group undertook an open-label, parallel-group, randomized controlled trial with any subtype of confirmed or suspected mesothelioma with pleural effusion recruited from 12 hospitals in the United Kingdon. Eligible patients were randomly assigned (1:1) to either video-assisted thoracoscopic partial pleurectomy (VAT-PP) or talc pleurodesis. Overall survival at 1 year was 52% (95% CI: 41–62) in the VAT-PP group and 57% (95% CI: 46–66) in the talc pleurodesis group. The authors concluded that VAT-PP is not recommended for improving overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. (Rintoul RC, Ritchie AJ, Edwards JG et al. Efficacy and cost of videoassisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): An open-label, randomised, controlled trial. Lancet 2014;384:1118–27.)
Pleural disease induced by drugs
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Chemotherapy-induced pneumothorax from metastatic malignancy may be bilateral and occur simultaneously. Chemical pleurodesis through a chest tube should be considered in all patients with chemotherapy-induced secondary spontaneous pneumothorax, as the risk of recurrence with or without further chemotherapy appears to be considerable.
A critical review of talc and ovarian cancer
Published in Journal of Toxicology and Environmental Health, Part B, 2020
Julie E. Goodman, Laura E. Kerper, Robyn L. Prueitt, Charlotte M. Marsh
There is no evidence of talc carcinogenicity in any other tissues, including non-reproductive tissues. If talc were carcinogenic to the ovaries via an inflammatory mechanism, it would be reasonable to expect that it might also exhibit carcinogenicity by the same mechanism in other tissues. There is no evidence, however, of respiratory cancers in humans from occupational or consumer inhalation exposure to asbestos-free talc in settings where the talc dose to lungs is likely far greater than any amount of talc that might reach the human reproductive tract after perineal application (Wehner 2002). The Occupational Safety and Health Administration’s permissible exposure limit for cosmetic talc in air is 20 million particles per cubic foot (Centers for Disease Control and Prevention (CDC), 2016), the recommended exposure limit set by the National Institute for Occupational Safety and Health is 2 mg/m3 (CDC 2016), and the American Conference of Governmental Industrial Hygienists threshold limit value is also 2 mg/m3 (ACGIH, 2010). These values all represent the upper limit of continuous exposure deemed safe by these agencies for workers who are exposed for a 40-hour work week and would result in much higher exposures than perineal talc use. Further, talc has been utilized for decades in a medical procedure, pleurodesis, whereby it is surgically deposited between the parietal and the visceral pleura of the chest to produce an adhesion between them, in order to treat recurrent pneumothorax and other conditions. No increased incidence of lung cancer or mesothelioma has occurred in pleurodesis patients (Baiu, Yevudza, and Shrager 2019; Wehner 2002).