Residential exposure to petrochemicals and the risk of leukemia: using geographic information system tools to estimate individual-level residential exposure

Representativeness of child controls recruited by random digit dialling

Recruiting control subjects who are representative of the population from which the cases are drawn is a challenge in case-control studies. This paper examines the performance of random digit dialling (RDD) in obtaining a control sample, and the sample's representativeness of the population with respect to socio-economic status. The study subjects were recruited from 2003 to 2006 for a national, population-based case-control study investigating causes of acute lymphoblastic leukaemia (ALL) in children <15 years of age in Australia. Control families' addresses were linked to Australian Bureau of Statistics Census 2006 Collection Districts and thus to Socio-Economic Indexes for Area scores, which are area-based measures of socio-economic status. These scores were compared with those of all collection districts where families lived. We estimate that 55% of eligible families in the RDD sample agreed to participate in the study. Participation was directly related to socio-economic status with those of highest economic status most likely to participate. Completeness of participation in the components of data collection was similarly related to socio-economic status. This evidence of selection according to socio-economic status indicates that there may also be selection with respect to other factors potentially important in the aetiology of ALL.

Use of land surface remotely sensed satellite and airborne data for environmental exposure assessment in cancer research

In recent years, geographic information systems (GIS) have increasingly been used for reconstructing individual-level exposures to environmental contaminants in epidemiological research. Remotely sensed data can be useful in creating space-time models of environmental measures. The primary advantage of using remotely sensed data is that it allows for study at the local scale (e.g., residential level) without requiring expensive, time-consuming monitoring campaigns. The purpose of our study was to identify how land surface remotely sensed data are currently being used to study the relationship between cancer and environmental contaminants, focusing primarily on agricultural chemical exposure assessment applications. We present the results of a comprehensive literature review of epidemiological research where remotely sensed imagery or land cover maps derived from remotely sensed imagery were applied. We also discuss the strengths and limitations of the most commonly used imagery data (aerial photographs and Landsat satellite imagery) and land cover maps.

Can living in the surroundings of a petrochemical complex be a risk factor for autoimmune thyroid disease?

BACKGROUND

Based on a suspicion raised by a health professional and due to a subsequent legal request, a cross-sectional study was made with a comparison group to investigate a possible excess of Hashimoto's thyroiditis-HT and antibodies-ATA in the surroundings of a Petrochemical Complex.

METHODS

People of both sexes aged over 20 years were investigated in a random sample of residents in the area surrounding the Petrochemical Complex. Controls were investigated in an area with steel industries. In the areas searched, participants were chosen randomly and stratified a priori by sex and age group. As a result, 90.5% of the expected sample was obtained, totaling 1533 individuals. HT and ATA prevalences were compared by the chi-square test. Logistic regression was used to control the possible confounding factors for HT and ATA.

RESULTS

Both TH (9.3%) and ATA (17.6%) prevalences were higher in the Petrochemical Complex area than in the control area (3.9% and 10.3%, respectively). After controlling the possible confounding factors, the POR for living in the surroundings of the Complex and presenting HT was 2.39 (CI95%: 1.42-4.03). According to the ATA criterion, the POR for living in the surroundings of the Complex was 1.78 (CI95%: 1.23-2.60).

CONCLUSIONS

The authors have found higher prevalence and risk of developing thyroiditis and anti-thyroid antibodies among residents of areas surrounding the Petrochemical Complex and think these findings need to be further studied in similar areas.

Association between Helicobacter pylori seropositivity and digestive tract cancers

AIM: To explore the role of Helicobacter pylori (H pylori) infection on the risk of digestive tract cancers.

METHODS: In total, 199 oral squamous-cell carcinoma (SCC), 317 esophageal SCC, 196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of H pylori infection. Two hospital- and one community-based control groups were used for the comparisons. H pylori seropositivity was determined by an enzyme linked immunosorbent assay method against H pylori IgG.

RESULTS: Presence of H pylori infection was significantly inversely associated with esophageal SCC [adjusted odds ratio (AOR): 0.315-0.472, all P-value < 0.05] but positively associated with gastric adenocarcinoma (both cardia and non-cardia) (AOR: 1.636-3.060, all P-value < 0.05) in comparison to the three control groups. Similar results were not found in cancers of the oral cavity and colon.

CONCLUSION: Our findings support the finding that H pylori seropositivity is inversely associated with esophageal SCC risk, but increases the risk of gastric cardia adenocarcinoma.

Leukaemia incidence in people living close to an oil refinery

OBJECTIVES

To assess the incidence of leukaemia in an area downwind of a large oil refinery emitting carcinogenic volatile organic compounds (VOCs) including benzene.

METHODS

Using a dispersion model and the prevailing wind direction, two parishes with about 5000 inhabitants were a priori considered to be exposed to VOCs from the refinery. Numbers of observed and expected leukaemia cases in 1975-2004 were calculated using regional sex- and age-specific incidence rates. In addition, five nearby parishes (12000 inhabitants), considered unaffected by the emissions, served as a local reference area. Based on emission data, dispersion modelling and VOC measurements, the refinery's contribution to the population's exposure to carcinogenic VOCs was estimated. Published "unit risks" for carcinogenic VOCs were used to estimate the expected excess leukaemia risk.

RESULTS

The incidence of leukaemia in the "exposed parishes" was significantly increased in 1975-2004 (33 cases v. 22 expected cases), owing to an increase in the last 10-year period, from 1995 to 2004 (19 cases v. 8.5 expected cases). The leukaemia incidence in the local control area was normal (50 cases v. 56 expected cases). The estimated contribution from the refinery to VOC concentrations was, however, only about 2 microg/m(3) (yearly average) for benzene, 2 microg/m(3) for ethylene, 0.5 microg/m(3) for 1,3-butadiene and 5 microg/m(3) for propene. Calculations of expected excess risk using published risk estimates would indicate a much lower excess risk in the exposed parishes.

CONCLUSIONS

Using risk estimates extrapolated from high-level exposure, we would not expect an increase of leukaemia at low exposure to VOC emissions. Nevertheless, the clear elevation of leukaemia in the priori selected, exposed parishes was remarkable. Our finding may reflect a causal association due to emissions, but it could also be due to unknown confounding, or chance.

Multi-compartmental environmental surveillance of a petrochemical area: levels of micropollutants

Since 2002, the chemical/petrochemical industrial zone of Tarragona County (Catalonia, Spain) is being annually monitored. As part of the environmental surveillance program, in this study the levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs), polychlorinated naphthalenes (PCNs), polycyclic aromatic hydrocarbons (PAHs), and metals (As, Cd, Cr, Hg, Mn, Pb and V) were determined in soil and vegetation samples collected in 4 areas of Tarragona County (chemical, petrochemical, urban/residential, and unpolluted). Moreover, the airborne concentrations of the same micropollutants were determined in each area. In soil samples, significant higher levels of PCNs and higher concentrations of PCDD/Fs and PAHs were found in the urban zone. PCDD/F levels in vegetation samples significantly decreased from 2002. The concentrations of Cr in soil samples, as well as V levels in vegetation samples collected in the vicinity of an oil refinery were significantly higher than those found in the unpolluted zones. A significant and progressive increase in V concentrations was also noted. The current results clearly indicate that the petrochemical industry is still being an important focus of inorganic pollution for the surrounding environment. In air, the higher amount of the 7 carcinogenic PAHs suggests a relatively greater impact on the petrochemical and urban areas. The temporal trend of the global pollution was also studied an Integral Risk Index was applied.

Cured meat, vegetables, and bean-curd foods in relation to childhood acute leukemia risk: a population based case-control study

Background

Consumption of cured/smoked meat and fish leads to the formation of carcinogenic N-nitroso compounds in the acidic stomach. This study investigated whether consumed cured/smoked meat and fish, the major dietary resource for exposure to nitrites and nitrosamines, is associated with childhood acute leukemia.

Methods

A population-based case-control study of Han Chinese between 2 and 20 years old was conducted in southern Taiwan. 145 acute leukemia cases and 370 age- and sex-matched controls were recruited between 1997 and 2005. Dietary data were obtained from a questionnaire. Multiple logistic regression models were used in data analyses.

Results

Consumption of cured/smoked meat and fish more than once a week was associated with an increased risk of acute leukemia (OR = 1.74; 95% CI: 1.15–2.64). Conversely, higher intake of vegetables (OR = 0.55; 95% CI: 0.37–0.83) and bean-curd (OR = 0.55; 95% CI: 0.34–0.89) was associated with a reduced risk. No statistically significant association was observed between leukemia risk and the consumption of pickled vegetables, fruits, and tea.

Conclusion

Dietary exposure to cured/smoked meat and fish may be associated with leukemia risk through their contents of nitrites and nitrosamines among children and adolescents, and intake of vegetables and soy-bean curd may be protective.

Association of bladder cancer with residential exposure to petrochemical air pollutant emissions in Taiwan

To investigate the relationship between petrochemical air pollution and risk of death due to bladder cancer, studies were conducted using a matched cancer case-control model based upon deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible bladder cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of individuals who died from causes other than neoplasms or diseases associated with genitourinary problems. The controls were pair matched to the cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. The proportion of a municipality's total population employed in the petrochemical industry in a municipality was used as an indicator of a resident's exposure to air emissions from the petrochemical industry. The subjects were divided into three levels (< or =25th percentile; 25th-50th percentile; >50th percentile). Subjects who lived in the group of municipalities characterized by the high levels of petrochemical air pollution had a significantly higher risk of death attributed to bladder cancer than subjects in the group that lived in municipalities with the lowest petrochemical air pollution levels, after controlling for possible confounders. The findings of this study warrant further investigation of the role of petrochemical air pollution in the etiology of bladder cancer.

Childhood leukemia and traffic air pollution in Taiwan: petrol station density as an indicator

To investigate the relationship between traffic air pollution exposure and development of childhood leukemia (14 yr of age or younger), a matched case-control study was conducted using childhood deaths that occurred in Taiwan from 1996 through 2006. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or diseases that were not associated with respiratory complications. The controls were pair matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Data on the number of petrol stations in study municipalities were collected from the two major petroleum supply companies, Chinese Petroleum Corporation (CPC) and Formosa Petrochemical Corporation (FPCC). The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in evaporative losses of petrol or to air emissions from motor vehicles. The subjects were divided into tertiles according to PSD in their residential municipality. The results showed that there was a significant exposure-response relationship between PSD and the risk of leukemia development in young children after controlling for possible confounders. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of childhood leukemia.

Chemical risk factors and childhood leukaemia: a review of recent studies

The search for chemical risks factors as determinants of childhood leukaemia has been ongoing for over two decades. Results of epidemiological studies, published from 1998 to the present, evaluating parental smoking, outdoor sources of pollution, indoor contaminants and chemicals from drinking water are reported. Overall, results were mostly negative. This may be due to the relatively small study sizes to detect environmental effects, usually measured imprecisely. Another reason may be that such effects, which may be revealed among the genetically susceptible, have rarely accounted for genetic susceptibility. The few studies that have are also reported here. Suggestions are made for work in the immediate future, which include pooling of data and of analyses, as well as carrying out in-depth reviews of studies with the goal of understanding the reasons for discrepant results.

A population-based, case-control study of green tea consumption and leukemia risk in southwestern Taiwan

OBJECTIVE

This study investigated the association between green tea consumption and leukemia.

METHODS

A total of 252 cases (90.3% response) and 637 controls (53.4% response) were enrolled. Controls were matched for cases on age and gender. Information was collected on participants' living habits, including tea consumption. Green tea was used as a standard to estimate the total amount of individual catechin consumption. We stratified individual consumption of catechins into four levels. Conditional logistic regression models were fit to subjects aged 0-15 and 16-29 years to evaluate separate associations between leukemia and catechin consumption.

RESULTS

A significant inverse association between green tea consumption and leukemia risk was found in individuals aged 16-29 years, whereas no significant association was found in the younger age groups. For the older group with higher amounts of tea consumption (>550 units of catechins), the adjusted odds ratio (OR) compared with the group without tea consumption was 0.47 [95% confidence interval (CI) = 0.23-0.97]. After we adjusted for smoking status and medical irradiation exposure, the overall OR for all participants was 0.49 (95% CI = 0.27-0.91), indicating an inverse relation between large amounts of catechins and leukemia.

CONCLUSION

Drinking sufficient amounts of tea, especially green tea, which contains more catechins than oolong tea and black tea, may reduce the risk of leukemia.

Using satellite derived land cover information for a multi-temporal study of self-reported recall of proximity to farmland

Exposure misclassification is a major concern in epidemiologic studies. The potential for misclassification becomes even more problematic when participants are asked to recall historical information. Yet, historical information is important in cancer studies, where latency is long and causative exposures may have occurred years or even decades prior to diagnosis. Even though self-reported proximity to farmland is a commonly used exposure measure, the accuracy of recall is seldom, if ever validated. Geographic Information Systems (GISs) and land cover information derived from satellite imagery can allow researchers to assess the accuracy of this exposure measure, and to quantify the extent and importance of exposure misclassification. As part of a bladder cancer case-control study in Michigan, participants were asked whether they lived on a farm, or within a distance of 1/4, 1/4-1, 1-5, or >5 miles from farmland for each residence over their lifespan. Responses from 531 participants over two time periods--1978 and 2001--were investigated. Self reported proximity to farmland was compared to a "gold standard" derived from Michigan land cover files for the same time periods. Logistic regression and other statistical measures including sensitivity, specificity, and percentage matching were evaluated. In comparing self-reported and land cover-derived proximity to farmland, cases exhibited better agreement than controls in 2001 (adjusted OR=1.74; 95% CI=1.01, 2.99) and worse agreement in 1978, although not significantly (adjusted OR=0.74; 95% CI=0.47, 1.16). When comparing 2001 with 1978, both cases and controls showed better agreement in 2001, but only cases showed a significant difference (adjusted OR=2.36; 95% CI=1.33, 4.18). These differences in agreement may be influenced by differences in educational attainment between cases and controls, although adjustment for education did not diminish the association. Gender, age, number of years at residence, and geocoding accuracy did not influence agreement between the proximity approaches. This study suggests that proximity measures taken from satellite-derived land cover imagery may be useful for assessing proximity to farmland, and it raises some concerns about the use of self-reported proximity to farmland in exposure assessments.

Epidemiologic evidence of relationships between reproductive and child health outcomes and environmental chemical contaminants

This review summarizes the level of epidemiologic evidence for relationships between prenatal and/or early life exposure to environmental chemical contaminants and fetal, child, and adult health. Discussion focuses on fetal loss, intrauterine growth restriction, preterm birth, birth defects, respiratory and other childhood diseases, neuropsychological deficits, premature or delayed sexual maturation, and certain adult cancers linked to fetal or childhood exposures. Environmental exposures considered here include chemical toxicants in air, water, soil/house dust and foods (including human breast milk), and consumer products. Reports reviewed here included original epidemiologic studies (with at least basic descriptions of methods and results), literature reviews, expert group reports, meta-analyses, and pooled analyses. Levels of evidence for causal relationships were categorized as sufficient, limited, or inadequate according to predefined criteria. There was sufficient epidemiological evidence for causal relationships between several adverse pregnancy or child health outcomes and prenatal or childhood exposure to environmental chemical contaminants. These included prenatal high-level methylmercury (CH(3)Hg) exposure (delayed developmental milestones and cognitive, motor, auditory, and visual deficits), high-level prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzofurans (PCDFs), and related toxicants (neonatal tooth abnormalities, cognitive and motor deficits), maternal active smoking (delayed conception, preterm birth, fetal growth deficit [FGD] and sudden infant death syndrome [SIDS]) and prenatal environmental tobacco smoke (ETS) exposure (preterm birth), low-level childhood lead exposure (cognitive deficits and renal tubular damage), high-level childhood CH(3)Hg exposure (visual deficits), high-level childhood exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (chloracne), childhood ETS exposure (SIDS, new-onset asthma, increased asthma severity, lung and middle ear infections, and adult breast and lung cancer), childhood exposure to biomass smoke (lung infections), and childhood exposure to outdoor air pollutants (increased asthma severity). Evidence for some proven relationships came from investigation of relatively small numbers of children with high-dose prenatal or early childhood exposures, e.g., CH(3)Hg poisoning episodes in Japan and Iraq. In contrast, consensus on a causal relationship between incident asthma and ETS exposure came only recently after many studies and prolonged debate. There were many relationships supported by limited epidemiologic evidence, ranging from several studies with fairly consistent findings and evidence of dose-response relationships to those where 20 or more studies provided inconsistent or otherwise less than convincing evidence of an association. The latter included childhood cancer and parental or childhood exposures to pesticides. In most cases, relationships supported by inadequate epidemiologic evidence reflect scarcity of evidence as opposed to strong evidence of no effect. This summary points to three main needs: (1) Where relationships between child health and environmental exposures are supported by sufficient evidence of causal relationships, there is a need for (a) policies and programs to minimize population exposures and (b) population-based biomonitoring to track exposure levels, i.e., through ongoing or periodic surveys with measurements of contaminant levels in blood, urine and other samples. (2) For relationships supported by limited evidence, there is a need for targeted research and policy options ranging from ongoing evaluation of evidence to proactive actions. (3) There is a great need for population-based, multidisciplinary and collaborative research on the many relationships supported by inadequate evidence, as these represent major knowledge gaps. Expert groups faced with evaluating epidemiologic evidence of potential causal relationships repeatedly encounter problems in summarizing the available data. A major driver for undertaking such summaries is the need to compensate for the limited sample sizes of individual epidemiologic studies. Sample size limitations are major obstacles to exploration of prenatal, paternal, and childhood exposures during specific time windows, exposure intensity, exposure-exposure or exposure-gene interactions, and relatively rare health outcomes such as childhood cancer. Such research needs call for investments in research infrastructure, including human resources and methods development (standardized protocols, biomarker research, validated exposure metrics, reference analytic laboratories). These are needed to generate research findings that can be compared and subjected to pooled analyses aimed at knowledge synthesis.

Association of childhood leukemia with residential exposure to petrochemical air pollution in taiwan

To investigate the relationship between petrochemical air pollution and childhood leukemia (19 yr of age or younger), the authors conducted a matched case-control study using childhood deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or diseases that were not associated with respiratory problems. The controls were pair matched to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. The proportion of a municipality's total population employed in the petrochemical industry in a municipality was used as an indicator of a resident's exposure to air emissions from the petrochemical industry. The subjects were divided into three levels (< or =25th percentile; 25th-75th percentile; > 75th percentile) according to the levels of the index just described. After controlling for possible confounders, results showed that children who lived in the group of municipalities characterized by the highest levels of petrochemical air pollution had a statistically significant higher risk of developing leukemia than the group that lived in municipalities with the lowest petrochemical air pollution levels. The results of this study shed important light on the relationship between the Taiwan petrochemical industry and human health risks.

Maternal and offspring genetic variants of AKR1C3 and the risk of childhood leukemia

The aldo-keto reductase 1C3 (AKR1C3) gene located on chromosome 10p15-p14, a regulator of myeloid cell proliferation and differentiation, represents an important candidate gene for studying human carcinogenesis. In a prospectively enrolled population-based case-control study of Han Chinese conducted in Kaohsiung in southern Taiwan, a total of 114 leukemia cases and 221 controls <20 years old were recruited between November 1997 and December 2005. The present study set out to evaluate the association between childhood leukemia and both maternal and offspring's genotypes. To do so, we conducted a systematic assessment of common single-nucleotide polymorphisms (SNPs) at the 5' flanking 10 kb to 3' UTR of AKR1C3 gene. Gln5His and three tagSNPs (rs2245191, rs10508293 and rs3209896) and one multimarker (rs2245191, rs10508293 and rs3209896) were selected with average 90% coverage of untagged SNPs by using the HapMap II data set. Odds ratios and 95% confidence intervals were adjusted for age and gender. After correcting for multiple comparisons, we observed that risk of developing childhood leukemia is significantly associated with rs10508293 polymorphism on intron 4 of the AKR1C3 gene in both offspring alone and in the combined maternal and offspring genotypes (nominal P < 0.0001, permutation P < 0.005). The maternal methylenetetrahydrofolate reductase A1298C polymorphism was found to be an effect modifier of the maternal intron 4 polymorphism of the AKR1C3 gene (rs10508293) and the childhood leukemia risk. In conclusion, this study suggests that AKR1C3 polymorphisms may be important predictive markers for childhood leukemia susceptibility.

Childhood leukemia development and correlation with traffic air pollution in Taiwan using nitrogen dioxide as an air pollutant marker

To investigate the relationship between traffic air pollution and development of childhood leukemia (14 yr of age or younger), studies were conducted on a matched cancer case-control cohort using childhood deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or from diseases that were not associated with respiratory complications. The controls were pair matched to the cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Air quality data for recorded concentrations of nitrogen dioxide (NO2) from study municipalities for 1995-2005 were obtained as an indicator of a subject's exposure to air emissions from motor vehicles. The subjects were divided into tertiles according to the levels of NO2 in their residential municipality. The results showed that there was a significant exposure-response relationship between exposure to traffic exhaust pollutants and the risk of leukemia among young children after controlling for possible confounders. The findings of this study warrant further investigation of the role of traffic air pollution in the etiology of childhood leukemia.

Association of brain cancer with residential exposure to petrochemical air pollution in Taiwan

To investigate the relationship between petrochemical air pollution and brain cancer (29 yr of age or younger), the authors conducted a matched case-control study using deaths that occurred in Taiwan from 1995 through 2005. Data on all eligible brain cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of subjects who died from causes other than neoplasms or diseases that were not associated with respiratory problems. The controls were pair matched to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. The proportion of a municipality's total population employed in the petrochemical industry in a municipality was used as an indicator of a resident's exposure to air emissions from the petrochemical industry. The subjects were divided into tertiles according to the levels of the index just described. Subjects who lived in the group of municipalities characterized by the highest levels of petrochemical air pollution had a statistically significant higher risk of developing brain cancer than the group that lived in municipalities with the lowest petrochemical air pollution levels after controlling for possible confounders (OR = 1.65, 95% CI = 1.00-2.73). The findings of this study warrant further investigation of the role of petrochemical air pollution in the etiology of brain cancer.