A nested case-control study of non-Hodgkin lymphoma and serum organochlorine residues

Risk factors for non-Hodgkin's lymphoma according to family history of haematolymphoproliferative malignancies

BACKGROUND

Aetiological profiles of non-Hodgkin's lymphoma (NHL) may differ depending upon whether the disease is inheritance-related or sporadic. Because familial risk (a probable surrogate of inheritance-relatedness) of NHL is influenced by haematolymphoproliferative malignancies (HLPM), we evaluated whether non-familial risk factors differ between NHL with and without a family history of HLPM, using the Selected Cancers Study data.

METHODS

Cases were 1511 men aged 31-59 and diagnosed with NHL during 1984-1988. Controls were men without NHL, frequency-matched to cases by age range and cancer registry (n = 1910). These groups were compared: cases with a family history of HLPM and without, and controls without such a family history.

RESULTS

Polytomous logistic regression analyses showed that the odds ratio (OR) estimates of homosexual behaviour were 18.2 (95% confidence interval (CI) : 4.8-69.4) and 5.6 (95% CI : 3.3-9.5) for NHL with and without a family history of HLPM, respectively. The corresponding estimates were 3.9 (95% CI : 1.7-8.9) and 2.2 (95% CI : 1.5-3.1) for history of enlarged lymph nodes. Variables only related to NHL with a family history were use of heroin (OR = 15.6, 95% CI : 3.4-70.4), exposure to a chlorinated hydrocarbon pesticide (OR = 2.3, 95% CI : 1.0-5.0), occupational exposure to plywood, fibreboard or particleboard (OR = 2.0, 95% CI : 1.2-3.4) and history of liver diseases (other than hepatitis or cirrhosis) (OR = 6.5, 95% CI : 1.2-36.2). The association between homosexual behaviour and NHL among men with a family history was stronger for those aged 31-44, especially for B-cell type of the disease.

CONCLUSIONS

This study suggests differences in the risk factor profiles between NHL with and without a family history of HLPM. The higher risks of NHL for homosexual behaviour and heroin use, surrogates of HIV infection, in men with a family history of HLPM imply that genetic susceptibility may be influential on the occurrence of HIV-related NHL.

Carcinogenic effects of polychlorinated biphenyls

As part of its mandate, the Agency for Toxic Substances and Disease Registry (ATSDR) prepares toxicological profiles on hazardous chemicals found at Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) sites that have the greatest public health impact. These profiles comprehensively summarize toxicological and environmental information. This article constitutes the release of an important section of the Toxicological profile for polychlorinated biphenyls [ATSDR. 2000: Toxicological profile for polychlorinated biphenyls. Atlanta, GA: US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry.] into the scientific literature. This article focuses on the carcinogenic effects of this group of synthetic organic chemicals (polychlorinated biphenyls) in humans and animals. Information on other health effects, toxicokinetics, mechanisms of toxicity, biomarkers, interactions, chemical and physical properties, potential for human exposure, and regulations and advisories is detailed in the profile.

Serum concentrations of organochlorines in men: a search for markers of exposure

Analysis of single marker substances in serum could provide cost-effective assessment of human exposure to complex mixtures of organochlorines. We studied the serum concentrations of 10 polychlorinated biphenyl (PCB) congeners and 11 chlorinated pesticides and some of their metabolites in samples collected from 120 Swedish men (mean age 63 years, range 40-74 years) from the general Swedish population. The median concentrations of individual PCB congeners increased in the order PCB 52 < PCB 101 < or = PCB28 < PCB 105 < PCB 167 < PCB 156 < PCB 118 < PCB 138 < PCB 180 < PCB 153. The concentrations of o,p'-DDT, o,p'-DDE, p,p'-DDD, alpha-HCH and gamma-HCH were in most cases below the quantification limit (2-4 ng/g lipid). Among the other chlorinated pesticides the median concentration increased in the order oxychlordane (12 ng/g lipid) < p,p'-DDT < trans-nonachlor < beta-HCH < HCB < p,p'-DDE (586 ng/g lipid). The observed concentrations of PCB and chlorinated pesticides were in the same range as those found in similar groups of men from Sweden and Norway, but lower than those found in male populations with recent occupational exposure or high environmental exposure. Strong relationships were found between the concentrations of single mono- and di-ortho PCB congeners and groups of PCB congeners in serum. In our group of men PCB 153 was a good marker substance for the concentration of sigma PCB and sigma di-ortho PCB concentrations in serum. Moreover, among the mono-ortho PCB congeners analyzed, PCB 156 could be used as a marker for the sigma mono-ortho PCB TEQ concentrations in serum in the studied group. No useful marker substances were found among DDT compounds and other chlorinated pesticides and metabolites, except for trans-nonachlor which predicted the concentration of the metabolite oxychlordane fairly well.

Pesticide exposures in children with non-Hodgkin lymphoma

BACKGROUND

The association between pesticide exposure and non-Hodgkin lymphoma (NHL) in adults has been the subject of numerous case-control and cohort studies. However, to the authors' knowledge, data regarding pesticide exposures in children diagnosed with NHL have been lacking.

METHODS

The Children's Cancer Group conducted a study comparing 268 children who developed NHL or leukemia with bulk disease with a group of matched, randomly selected regional population controls. The telephone interviews of both the case and control mothers included selected questions regarding occupational and home exposures to pesticides around the time of the index pregnancy and exposure of the child.

RESULTS

A significant association was found between risk of NHL and increased frequency of reported pesticide use in the home (odds ratio [OR] = 7.3 for use most days; trend P = 0.05), professional exterminations within the home (OR = 3.0; P = 0.002), and postnatal exposure (OR = 2.4; P = 0.001). Elevated risks were found for T-cell and B-cell lymphomas; for lymphoblastic, large cell, and Burkitt morphologies; and in both young (age < 6 years) and older children. There was an increased risk of NHL with occupational exposure to pesticides (OR = 1.7) that was not significant overall, but that was significant for Burkitt lymphoma (OR = 9.6; P < 0.05).

CONCLUSIONS

The results of the current study provide further evidence linking pesticide exposure to the risk of NHL, but the authors were unable to implicate any specific agent.

Testicular cancer and occupational exposures with a focus on xenoestrogens in polyvinyl chloride plastics

In a case-control study of 148 cases of testicular cancer and 314 healthy controls information was collected on lifetime working histories and specific exposures. The main finding was a six-fold increase in the risk for seminoma, one type of testicular cancer, among plastic workers exposed to polyvinyl chloride (PVC). No overrisks were observed for other plastics than PVC. There may be an aetiological link to xenoestrogens, i.e. chemicals in the environment with oestrogenic properties. Phthalates are used in PVC as plasticizer and have oestrogenic properties that could promote the growth of endocrine sensitive tumour cells. However, this "endocrine disruptors" hypothesis must be further evaluated in experimental models with regard to the causative mechanisms of the oestrogenic tumour promotion.

Benzene and non-Hodgkin's lymphoma

Incidence rates for non-Hodgkin's lymphoma (NHL) have been rising throughout the world for several decades, and no convincing explanation exists for the majority of this increase. The commonest subtypes of NHL have no well-defined aetiological factors but lymphoma development has been linked with exposure to a variety of chemicals, including nitrates, pesticides, herbicides, and solvents. Benzene, a solvent and important constituent of petrochemical products, is a potent lymphomagen in experimental animals and high-dose exposure in humans is associated with both acute myeloid leukaemia and NHL. Much current interest centres on the possibility that environmental benzene exposure in the general public may underlie a proportion of the increase in NHL. Seventy per cent of benzene exposure in the environment is derived from vehicle exhaust emissions, whose increase has closely paralleled the rise in frequency of the disease. Mathematical modelling has been used to calculate an acceptable concentration of benzene in air based on risk estimates derived from industrial exposure, but the recommended target concentration in the U.K. of 1 ppb is regularly exceeded in urban locations. Detailed investigation of the health effects of low-level benzene exposure awaits an accurate assay for quantifying long-term human exposure. The (32)P post-labelling technique for the detection of toxin-specific DNA adducts is extremely sensitive and has been applied in the biomonitoring of exposure to a number of carcinogens, but benzene-DNA adducts have to date proved elusive of detection.

Unexplained increases in cancer incidence in the United States from 1975 to 1994: possible sentinel health indicators?

To search for unexplained patterns in cancer incidence, we analyzed data from 1975 to 1994 that represent approximately 10% of the population of the United States. Our analysis focused on long-term time trends in incidence and on deviations from those trends attributable to birth cohorts or to calendar periods. On average, cancer incidence rose 0.8% annually in white women and 1.8% in white men. After removing several cancers related to smoking and increased screening, average annual increases fell to 0.1% in white women but persisted at 1.7% in white men. In particular, yearly increases in non-Hodgkin's lymphoma averaged 2.4% in white women and 4.7% in white men. Among men, incidence changes attributable to cohorts grew progressively larger from one cohort to the next. Cancer incidence patterns among black men and women were similar to those among whites despite smaller population sizes. Unexplained patterns of cancer incidence may signal changes in underlying risk factors and highlight the continuing need for research on cancer etiology and prevention.

Level, sources and toxicity of polychlorinated biphenyls in the Italian diet

We used the duplicate portion method to measure the daily dietary intake of total and congener-specific polychlorinated biphenyls (PCB) and to assess their potential toxicity in a group of 20 subjects consuming a typical Italian diet. The mean +/- SD intake of total PCB, measured by GC-MS, was 3.72 +/- 1.51 micrograms/person/day, comparable to values reported in similar studies world-wide, with individual intakes varying within one order of magnitude, from 0.97 to 10.59 micrograms/person/day. The di-ortho congeners 153, 18 and 138 were the PCB found in the highest concentrations (respectively 13.8%, 11.4% and 10.9% of the total) while the non-ortho coplanar congeners (77, 126 and 169) amounted to 0.5% of the total. The corresponding levels of toxicity (TCDD-like TEQ values ascribable to PCB) ranged from 4.6 up to 119 pg/person/day of TCDD-equivalents in 18 subjects, i.e. presumed no-risk levels, but with peaks of 2109 and 4553 pg/person/day in two subjects with significant intakes of the congener 126. Principal components analysis and redundancy analysis showed dairy products, meat and fish were the principal sources of PCB, and vegetables those with the highest toxicity index in the Italian diet.

Occupational chlorophenol exposure and non-Hodgkin's lymphoma

Occupational exposure to chlorophenols is suspected to increase non-Hodgkin's lymphoma (NHL) risk. This association was examined using data on 995 NHL cases and 1783 controls from the Selected Cancers Study, a population-based case-control study of men aged 32 to 60 years from eight population-based cancer registries conducted from 1984 to 1988. Potential chlorophenol exposure was characterized by an industrial hygienist using intensity estimates and confidence ratings, based upon review of verbatim job histories. Cases with substantial chlorophenol exposure had a significantly greater number of years of chlorophenol exposure (median years: cases, 4.0; controls, 2.0; P = 0.046); however, in conditional logistic regression models, the odds ratio for more than 8 years of substantial exposure was 1.51 (95% CI, 0.88 to 2.59). Overall, the findings do not provide strong support for an association with NHL risk. Chlorophenol exposure in this study is not based upon measured values and, therefore, may fail to characterize actual chlorophenol exposures accurately. Because of the large presence of machinists in the potentially chlorophenol-exposed group, these results may be underestimated by exposure misclassification if these subjects were not exposed to chlorophenolic biocides. However, these results are consistent with other findings, which suggest that chlorophenol exposure is not likely to be a strong risk factor for NHL.

A case-control study of non-Hodgkin lymphoma and exposure to pesticides

BACKGROUND

The incidence of non-Hodgkin lymphoma (NHL) has increased in most Western countries during the last few decades. Immunodefective conditions are established risk factors. In 1981, the authors reported an increased risk for NHL following exposure to certain pesticides. The current study was designed to further elucidate the importance of phenoxyacetic acids and other pesticides in the etiology of NHL.

METHODS

A population-based case-control study in northern and middle Sweden encompassing 442 cases and twice as many controls was performed. Exposure data were ascertained by comprehensive questionnaires, and the questionnaires were supplemented by telephone interviews. In total, 404 cases and 741 controls answered the questionnaire. Univariate and multivariate analyses were performed with the SAS statistical data program.

RESULTS

Increased risk for NHL was found for subjects exposed to herbicides (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.5) and fungicides (OR, 3.7; 95% CI, 1.1-13.0). Among herbicides, the phenoxyacetic acids dominated (OR, 1.5; 95% CI, 0.9-2.4); and, when subclassified, one of these, 4-chloro-2-methyl phenoxyacetic acid (MCPA), turned out to be significantly associated with NHL (OR, 2.7; 95% CI, 1.0-6.9). For several categories of herbicides, it was noted that only exposure during the most recent decades before diagnosis of NHL was associated with an increased risk of NHL. Exposure to impregnating agents and insecticides was, at most, only weakly related to NHL.

CONCLUSIONS

Exposure to herbicides in total, including phenoxyacetic acids, during the decades before NHL diagnosis resulted in increased risk for NHL. Thus, the risk following exposure was related to the latency period. Fungicides also increased the risk for NHL when combined, but this group consisted of several different agents, and few subjects were exposed to each type of fungicide.

Agricultural use of DDT and risk of non-Hodgkin's lymphoma: pooled analysis of three case-control studies in the United States

OBJECTIVES

The objective of this pooled analysis was to examine whether exposure to DDT was associated with the risk of non-Hodgkin's lymphoma among male farmers.

METHODS

Data from three case-control studies from four midwestern states in the United States (Nebraska, Iowa, Minnesota, Kansas) were pooled to carry out analyses of 993 cases and 2918 controls. Information on use of agricultural pesticides and other risk factors was based on interviews. Non-farmers (people who had never lived or worked on a farm) were used as a reference category.

RESULTS

There were 161 cases and 340 controls who reported use of DDT on animals or crops, or on both, yielding an odds ratio (OR) of 1.2 (95% confidence intervals (95% CI) 1.0 to 1.6). Farmers who had used DDT for > or = 15 years had an OR of 1.5 (95% CI 1.0 to 2.3). Adjustment for respondent status and use of other pesticides resulted in slightly reduced ORs. Analyses by the number of days of use a year was limited to the Nebraska data. The most notable increase was found among farmers who used DDT for > or = 5 days a year (OR 2.6, 95% CI 1.1 to 5.9); however, additional adjustment for use of organophosphates, phenoxyacetic acids, and the individual pesticides lindane, malathion, and atrazine reduced the ORs to 1.0, 0.9, 1.1, 1.6, and 1.9 respectively.

CONCLUSIONS

No strong consistent evidence was found for an association between exposure to DDT and risk of non-Hodgkin's lymphoma. It seems that the excess risk initially found may be explained by use of other pesticides.