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DeBono NL, Daniels RD, Beane Freeman LE, Graber JM, Hansen J, Teras LR, Driscoll T, Kjaerheim K, Demers PA, Glass DC, Kriebel D, Kirkham TL, Wedekind R, Filho AM, Stayner L, Schubauer-Berigan MK. Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification. Saf Health Work 2023; 14:141-152. [PMID: 37389311 PMCID: PMC10300491 DOI: 10.1016/j.shaw.2023.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Objective We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program. Methods A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses. Results Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses. Conclusions There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.
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Affiliation(s)
- Nathan L. DeBono
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Judith M. Graber
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, USA
| | - Johnni Hansen
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul A. Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Deborah C. Glass
- School of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - David Kriebel
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, USA
| | - Tracy L. Kirkham
- Occupational Cancer Research Centre, Ontario Health, Toronto, Canada
| | - Roland Wedekind
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Adalberto M. Filho
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
| | - Leslie Stayner
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics
| | - Mary K. Schubauer-Berigan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, Lyon, France
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Yazici S, Del Biondo D, Napodano G, Grillo M, Calace FP, Prezioso D, Crocetto F, Barone B. Risk Factors for Testicular Cancer: Environment, Genes and Infections-Is It All? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040724. [PMID: 37109682 PMCID: PMC10145700 DOI: 10.3390/medicina59040724] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors.
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Affiliation(s)
- Sertac Yazici
- Department of Urology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Dario Del Biondo
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
| | - Giorgio Napodano
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
| | - Marco Grillo
- Department of Urology, ASL NA1 Centro Ospedale del Mare, 80147 Naples, Italy
- University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesco Paolo Calace
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Domenico Prezioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80131 Naples, Italy
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Marjerrison N, Jakobsen J, Demers PA, Grimsrud TK, Hansen J, Martinsen JI, Nordby KC, Veierød MB, Kjærheim K. Comparison of cancer incidence and mortality in the Norwegian Fire Departments Cohort, 1960-2018. Occup Environ Med 2022; 79:oemed-2022-108331. [PMID: 35589382 PMCID: PMC9606497 DOI: 10.1136/oemed-2022-108331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Elevated risk of cancer at several sites has been reported among firefighters, although with mixed findings. The purpose of this study was to calculate standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) for cancer and compare them to assess whether use of the different measures could be a source of inconsistencies in findings. METHODS The Norwegian Fire Departments Cohort, comprising 4295 male employees who worked at 15 fire departments across Norway, was linked to health outcome registries for the period 1960-2018. SIRs and SMRs were derived using national reference rates. RESULTS Overall, we observed elevated incidence of colon cancer (SIR, 95% CI 1.27, 1.01 to 1.58), mesothelioma (2.59, 1.12 to 5.11), prostate cancer (1.18, 1.03 to 1.34) and all sites combined (1.15, 1.08 to 1.23). Smaller, non-significant elevations were found for mortality of colon cancer (SMR, 95% CI 1.20, 0.84 to 1.67) and mesothelioma (1.66, 0.34 to 4.86), while SMR for prostate cancer was at unity. Potential errors were observed in some of the mortality data, notably for mesothelioma cases. Among those who died of cancer, 3.7% (n=14) did not have a prior diagnosis of malignancy at the same site group. CONCLUSIONS Assessment of incidence or mortality did not greatly influence the interpretation of results. The most prominent differences in SIR and SMR appeared to be due to inconsistencies between sites of cancer diagnosis and cause of death. The difference in SIR and SMR for prostate cancer suggested a detection bias from differential screening practices.
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Affiliation(s)
- Niki Marjerrison
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Jarle Jakobsen
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Paul A Demers
- Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
| | - Tom K Grimsrud
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Johnni Hansen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Karl-Christian Nordby
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
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Laroche E, L’Espérance S. Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2519. [PMID: 33802629 PMCID: PMC7967542 DOI: 10.3390/ijerph18052519] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
Firefighters are exposed to carcinogens that may increase their risk of developing many types of occupational cancer. Many systematic reviews (SRs) have been produced with sometimes conflicting conclusions. In this overview of reviews, we aim to assess the conclusion consistency across the available systematic reviews on the cancer risk in firefighters. Literature searches were conducted in several indexed databases and grey literature to retrieve systematic reviews aiming to evaluate cancer incidence or cancer mortality in firefighters. Results from included SRs were analyzed according to the tumour site. Out of 1054 records identified by the search in the databases, a total of 11 SRs were ultimately included. The original studies (n = 104) analyzed in the SRs were published between 1959 and 2018. The results consistently reported a significant increase in the incidence of rectal, prostate, bladder and testicular cancers as well as mesothelioma and malignant melanoma in firefighters compared to the general population. The SRs also indicate that death rates from rectal cancer and non-Hodgkin's lymphoma are higher among firefighters. Consistent SR results suggest that several types of cancer may be more frequent in firefighters than in the general population.
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Affiliation(s)
- Elena Laroche
- School of Administration Sciences, Université TELUQ, Quebec, QC G1K 9H6, Canada;
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Casjens S, Brüning T, Taeger D. Cancer risks of firefighters: a systematic review and meta-analysis of secular trends and region-specific differences. Int Arch Occup Environ Health 2020; 93:839-852. [PMID: 32306177 PMCID: PMC7452930 DOI: 10.1007/s00420-020-01539-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 04/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to conduct a systematic review and meta-analysis to evaluate the cancer risks among firefighters in the time course and from different geographical areas. METHOD A PubMed search was performed to identify cohort studies about cancer risk and firefighting presented with standardized incidence ratios (SIRs) or standardized mortality ratios (SMRs). Using random-effect models, meta-relative risk estimates (mSIRs, mSMRs) and 95% confidence intervals (CI) were assessed. Cohort studies with employment starting before 1950 were classified as "old", studies starting between 1950 and 1970 as "medium", and later studies as "new". RESULTS The general cancer risk of firefighters was similar to the general population, but mSMR decreased over time (new studies: mSMR = 0.81, 95% CI 0.70-0.92). We observed an increase of mSIR for melanoma of the skin and prostate cancer as well as a decrease of mSIR for stomach cancer with later employment onset. For those cancer sites, we did not observe a secular trend of mSMRs. Regional differences between relative cancer risks were particularly observed for bladder cancer. CONCLUSIONS Among other things, innovative firefighting techniques and better personal protective equipment have provided a safer and healthier working environment for firefighters over time leading to a reduction of overall cancer incidence and mortality ratios. Increased general preventive medical checkups and possible additional screenings for firefighters might have led to more findings of malignant melanoma of the skin and prostate cancer in the recent past.
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Affiliation(s)
- Swaantje Casjens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dirk Taeger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Ghazarian AA, McGlynn KA. Increasing Incidence of Testicular Germ Cell Tumors among Racial/Ethnic Minorities in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:1237-1245. [PMID: 32385118 DOI: 10.1158/1055-9965.epi-20-0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/22/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The incidence of testicular germ cell tumors (TGCT) has been rising in the United States and is notably higher among white men. Previously, our group reported that rates were rising among Hispanic men in certain areas. This study sought to determine whether the patterns noted in our prior publication remained evident in more recent years and to determine whether any new patterns have emerged. METHODS Data from 51 U.S. cancer registries were examined. Racial/ethnic-specific incidence rates per 100,000 man-years were calculated overall and by census region. Annual percent changes (APC) were estimated, and joinpoint models were fit. Differences in regional incidence were examined using the Wald test. RESULTS During the time period 2001 to 2016, 126,575 TGCTs were recorded. TGCT incidence was highest among non-Hispanic whites (NHW; 6.63/100,000), followed by Hispanics (4.20), American Indian/Alaska Natives (AI/AN; 3.27), Asian/Pacific Islanders (A/PI; 1.72), and non-Hispanic blacks (NHB; 1.27). TGCT incidence increased significantly among all men; the greatest increase was experienced by A/PIs (APC: 2.47), followed in order by Hispanics (2.10), AI/ANs (1.71), NHBs (1.28), and NHWs (0.41). Significant differences in rates by region were seen for all men except NHBs, with the highest rates among Hispanics (5.38/100,000), AI/ANs (4.47), and A/PIs (2.37) found in the West, and among NHWs (7.60) and NHBs (1.51) found in the Northeast. CONCLUSIONS Although TGCT incidence remained highest among NHWs between 2001 and 2016, the greatest increase was experienced by A/PI men. IMPACT Rising rates of TGCTs among men of all racial/ethnic backgrounds in the United States suggest that future attention is warranted.
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Affiliation(s)
- Armen A Ghazarian
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Katherine A McGlynn
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
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Jalilian H, Ziaei M, Weiderpass E, Rueegg CS, Khosravi Y, Kjaerheim K. Cancer incidence and mortality among firefighters. Int J Cancer 2019; 145:2639-2646. [PMID: 30737784 DOI: 10.1002/ijc.32199] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 11/07/2022]
Abstract
Firefighters are exposed to both known and suspected carcinogens. This study aims to systematically review the literature on the association of firefighting occupation and cancer incidence and mortality, overall and for specific cancer sites. A systematic review using PubMed, Embase, and Web of Science was performed up to January 1, 2018. We extracted risk estimates of cancers and calculated summary incidence risk estimates (SIRE), summary mortality risk estimates (SMRE), and their 95% confidence intervals (CI). Publication bias and risk of bias in individual studies were assessed using Begg's and Egger's tests and the Newcastle-Ottawa scale (NOS), respectively. We included 50 papers in the review and 48 in the meta-analysis. We found significantly elevated SIREs for cancer of the colon (1.14; CI 1.06 to 1.21), rectum (1.09; CI 1.00 to 1.20), prostate (1.15; CI 1.05 to 1.27), testis (1.34; CI 1.08 to 1.68), bladder (1.12; CI 1.04 to 1.21), thyroid (1.22; CI 1.01 to 1.48), pleura (1.60; CI 1.09 to 2.34), and for malignant melanoma (1.21; CI 1.02 to 1.45). We found significant SMREs of 1.36 (1.18 to 1.57) and 1.42 (1.05 to 1.90) for rectal cancer and Non-Hodgkin's lymphoma, respectively. Considering the significantly elevated risk of some cancers in this occupational group, we suggest improving preventive measures and securing adequate and relevant medical attention for this group. Further studies with more accurate and in-depth exposure assessments are indicated.
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Affiliation(s)
- Hamed Jalilian
- Department of Occupational Health and Safety, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mansour Ziaei
- School of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Corina Silvia Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital and Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Yahya Khosravi
- Department of Occupational Health and Safety, Research Center for Health, Safety and Environment, Alborz University of Medical Sciences, Karaj, Iran
| | - Kristina Kjaerheim
- Department of Research, Cancer Registry of Norway - Institute of Population-Based Cancer Research, Oslo, Norway
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Glass DC, Del Monaco A, Pircher S, Vander Hoorn S, Sim MR. Mortality and cancer incidence among female Australian firefighters. Occup Environ Med 2019; 76:215-221. [PMID: 30674605 DOI: 10.1136/oemed-2018-105336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the mortality and cancer incidence of female firefighters, a group where there are limited published findings. METHODS Participating fire agencies supplied records of individual firefighters including the number and type of incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. Standardised mortality ratios and standardised cancer incidence ratios were calculated separately for paid and volunteer firefighters. Volunteer firefighters were grouped into tertiles by the duration of service and by a number of incidents attended and relative mortality ratios and relative incidence ratios calculated. RESULTS For volunteer firefighters (n=37 962), the overall risk of mortality and risk from all major causes of death were reduced when compared with the general population whether or not they had ever attended incidents. Volunteer firefighters had a similar cancer incidence when compared with the general population for most major cancer categories. Female volunteer firefighters have usually attended few fires. Of those who had turned out to incidents, only one-third had attended more than 12 fires about half the number for male volunteers. Mortality and cancer incidence for paid female firefighters (n=1682) were similar to the general population but the numbers were small and so power was limited. CONCLUSIONS Female volunteer firefighters have a cancer incidence similar to the general population but a reduced risk of mortality which is likely to be a result of a 'healthy volunteer' effect.Most of the paid female firefighters were relatively recent recruits and it will be important to monitor the health of this group as more women are recruited to front-line firefighting roles.
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Affiliation(s)
- Deborah Catherine Glass
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Del Monaco
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sabine Pircher
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen Vander Hoorn
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Ross Sim
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Gurney JK. The puzzling incidence of testicular cancer in New Zealand: what can we learn? Andrology 2019; 7:394-401. [PMID: 30663250 DOI: 10.1111/andr.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Testicular germ cell tumour is the most common cancer to be diagnosed among young men. In New Zealand, we have observed some puzzling trends in the epidemiology of this disease. METHODS We have conducted a narrative review of available evidence regarding the puzzling epidemiology of testicular germ cell tumour in New Zealand and discussed the possible drivers of these trends. RESULTS AND DISCUSSION Whereas testicular cancer is most commonly a disease of White men, in New Zealand it is the indigenous Māori population that suffer by far the greatest rate of disease (age-adjusted relative risk: 1.80, 95% CI 1.58-2.05). Even more curiously, the rate of testicular germ cell tumour among Māori men aged 15-44 (28/100,000) is substantially greater than for Pacific Island men (9/100,000), a rare example of divergence between these two populations in terms of the incidence of any disease (cancer or otherwise). Our observations beg the following questions: first, why are rates of testicular germ cell tumour so much higher among Māori New Zealanders compared to the already high rates observed among European/Other New Zealanders? Second, why are rates of testicular germ cell tumour so completely divergent between Māori and Pacific New Zealanders, when these two groups typically move in parallel with respect to the incidence of given diseases? Finally, what might we learn about the factors that cause testicular germ cell tumour in general by answering these questions? CONCLUSION This review examines the possible drivers of our observed disparity, discusses their feasibility, and highlights new work that is underway to further understand these drivers.
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Affiliation(s)
- J K Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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De Toni L, Šabovic I, Cosci I, Ghezzi M, Foresta C, Garolla A. Testicular Cancer: Genes, Environment, Hormones. Front Endocrinol (Lausanne) 2019; 10:408. [PMID: 31338064 PMCID: PMC6626920 DOI: 10.3389/fendo.2019.00408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022] Open
Abstract
Testicular cancer (TC) represents one of the most peculiar clinical challenges at present. In fact, currently treatments are so effective ensuring a 5 years disease-free survival rate in nearly 95% of patients. On the other hand however, TC represents the most frequent newly diagnosed form of cancer in men between the ages of 14 and 44 years, with an incidence ranging from <1 to 9.9 affected individuals per 100,000 males across countries, while the overall incidence is also increasing worldwide. Furthermore, cancer survivors show a 2% risk of developing cancer in the contralateral testis within 15 years of initial diagnosis. This complex and multifaceted scenario requires a great deal of effort to understand the clinical base of available evidence. It is now clear that genetic, environmental and hormonal risk factors concur and mutually influence both the development of the disease and its prognosis, in terms of response to treatment and the risk of recurrence. In this paper, the most recent issues describing the relative contribution of the aforementioned risk factors in TC development are discussed. In addition, particular attention is paid to the exposure to environmental chemical substances and thermal stress, whose role in cancer development and progression has recently been investigated at the molecular level.
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Affiliation(s)
- Luca De Toni
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Iva Šabovic
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Ilaria Cosci
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
- Department of Clinical and Experimental Oncology, IOV-IRCCS, Padova, Italy
| | - Marco Ghezzi
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
- *Correspondence: Carlo Foresta
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
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Harris MA, Kirkham TL, MacLeod JS, Tjepkema M, Peters PA, Demers PA. Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort. Am J Ind Med 2018; 61:815-823. [PMID: 30073696 DOI: 10.1002/ajim.22891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Firefighters, police, and armed services may be exposed to hazards such as combustion by-products and shift work. METHODS The CanCHEC cohort linked 1991 census data to the Canadian cancer registry for follow up. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate risks for firefighter, police, or armed forces compared to workers in other occupations. RESULTS The cohort of 1 108 410 men included 4535 firefighters, 10 055 police, and 9165 armed forces. For firefighters, elevated risks were noted for Hodgkin's lymphoma (HR: 2.89, 95%CI: 1.29-6.46), melanoma (HR: 1.67, 95%CI: 1.17-2.37), and prostate cancer (HR: 1.18, 95%CI: 1.01-1.37). Police had elevated risks for melanoma (HR:1.69, 95%CI: 1.32-2.16) and prostate cancer (HR:1.28, 95%CI: 1.14-1.42). No significant associations were found for armed forces workers. CONCLUSIONS Canadian firefighters, police, and armed services, may be at an increased risk of developing certain cancers. Results suggested that a healthy worker effect may influence risk estimates.
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Affiliation(s)
- M. Anne Harris
- School of Occupational and Public Health; Ryerson University; Toronto Ontario Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
| | - Tracy L. Kirkham
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
| | - Jill S. MacLeod
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
| | - Michael Tjepkema
- Statistics Canada; Health Analysis Division; Toronto Ontario Canada
| | - Paul A. Peters
- Department of Health Sciences; Carleton University; Toronto Ontario Canada
| | - Paul A. Demers
- Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
- Occupational Cancer Research Centre; Cancer Care Ontario; Toronto Ontario Canada
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Shen B, Whitehead TP, Gill R, Dhaliwal J, Brown FR, Petreas M, Patton S, Hammond SK. Organophosphate flame retardants in dust collected from United States fire stations. ENVIRONMENT INTERNATIONAL 2018; 112:41-48. [PMID: 29247842 DOI: 10.1016/j.envint.2017.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 05/12/2023]
Abstract
Firefighters are exposed to chemicals during fire events and we previously demonstrated that fire station dust has high levels of polybrominated diphenyl ethers (PBDEs). In conducting the Fire Station Dust Study, we sought to further characterize the chemicals to which firefighters could be exposed - measuring the emerging class of phosphorous-containing flame retardants (PFRs) in fire stations, for the first time, as well as PBDEs. Dust samples from 26 fire stations in five states were collected from vacuum-cleaner bags and analyzed for PFRs and PBDEs. PFR concentrations were found to be on the same order of magnitude as PBDE concentrations (maximum PFR: 218,000ng/g; maximum PBDE: 351,000ng/g). Median concentrations of tri-n-butyl phosphate (TNBP), tris (2-chloroisopropyl) phosphate (TCIPP), and tris(1,3-dichloroisopropyl)phosphate (TDCIPP) in dust from fire stations were higher than those previously reported in homes and other occupational settings around the world. Total PFR levels did not vary significantly among states. Levels of TDCIPP were higher in stations where vacuum cleaners were used to clean surfaces other than the floor. PBDE levels were comparable to those found in our previous study of 20 California fire stations and much higher than levels in California residences. PFR and PBDE levels in fire station dust are higher than in other occupational and residential settings, underscoring the need to identify and control sources of this contamination.
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Affiliation(s)
- Beverly Shen
- School of Public Health, University of California, 50 University Hall, Berkeley, CA, USA.
| | - Todd P Whitehead
- School of Public Health, University of California, 50 University Hall, Berkeley, CA, USA
| | - Ranjit Gill
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, 700 Heinz Avenue, Berkeley, CA, USA
| | - Joginder Dhaliwal
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, 700 Heinz Avenue, Berkeley, CA, USA
| | - F Reber Brown
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, 700 Heinz Avenue, Berkeley, CA, USA
| | - Myrto Petreas
- Environmental Chemistry Laboratory, California Department of Toxic Substances Control, 700 Heinz Avenue, Berkeley, CA, USA
| | - Sharyle Patton
- Biomonitoring Resource Center, Commonweal, 451 Mesa Road, Bolinas, CA, USA
| | - S Katharine Hammond
- School of Public Health, University of California, 50 University Hall, Berkeley, CA, USA
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Sritharan J, Pahwa M, Demers PA, Harris SA, Cole DC, Parent ME. Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies. Environ Health 2017; 16:124. [PMID: 29149887 PMCID: PMC5693511 DOI: 10.1186/s12940-017-0336-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/27/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to evaluate potential associations between firefighting and police occupations, and prostate cancer incidence and mortality. METHODS Original epidemiological studies published from 1980 to 2017 were identified through PubMed and Web of Science. Studies were included if they contained specific job titles for ever/never firefighting and police work and associated prostate cancer risk estimates with 95% confidence intervals (CI). Study quality was assessed using a 20-point checklist. Prostate cancer meta-risk estimates (mRE) and corresponding 95% CIs were calculated for firefighting and police work separately and by various study characteristics using random effects models. Between-study heterogeneity was evaluated using the I2 score. Publication bias was assessed using Begg's and Egger's tests. RESULTS A total of 26 firefighter and 12 police studies were included in the meta-analysis, with quality assessment scores ranging from 7 to 19 points. For firefighter studies, the prostate cancer incidence mRE was 1.17 (95% CI = 1.08-1.28, I2 = 72%) and the mortality mRE was 1.12 (95% CI = 0.92-1.36, I2 = 50%). The mRE for police incidence studies was 1.14 (95% CI = 1.02-1.28; I2 = 33%); for mortality studies, the mRE was 1.08 (95% CI = 0.80-1.45; I2 = 0%). By study design, mREs for both firefighter and police studies were similar to estimates of incidence and mortality. CONCLUSION Small excess risks of prostate cancer were observed from firefighter studies with moderate to substantial heterogeneity and a relatively small number of police studies, respectively. There is a need for further studies to examine police occupations and to assess unique and shared exposures in firefighting and police work.
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Affiliation(s)
- Jeavana Sritharan
- Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON M5G 2L3 Canada
- Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON M5G 2L3 Canada
| | - Manisha Pahwa
- Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON M5G 2L3 Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON M5G 2L3 Canada
- Institute of Medical Science, University of Toronto, 525 University Avenue, Toronto, ON M5G 2L3 Canada
- CAREX Canada, Simon Fraser University, Burnaby, Canada
- Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON M5G 2L3 Canada
| | - Shelley A. Harris
- Occupational Cancer Research Centre, Cancer Care Ontario, 525 University Avenue, Toronto, ON M5G 2L3 Canada
- Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON M5G 2L3 Canada
- Population Health and Prevention, Cancer Care Ontario, 525 University Avenue, Toronto, ON M5G 2L3 Canada
| | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, 525 University Avenue, Toronto, ON M5G 2L3 Canada
| | - Marie-Elise Parent
- INRS-Institut Armand-Frappier, University of Quebec, 531 Boulevard des Prairies, Laval, Quebec, H7V 1B7 Canada
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Glass DC, Del Monaco A, Pircher S, Vander Hoorn S, Sim MR. Mortality and cancer incidence among male volunteer Australian firefighters. Occup Environ Med 2017; 74:628-638. [DOI: 10.1136/oemed-2016-104088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/19/2017] [Accepted: 01/30/2017] [Indexed: 11/04/2022]
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Glass DC, Pircher S, Del Monaco A, Hoorn SV, Sim MR. Mortality and cancer incidence in a cohort of male paid Australian firefighters. Occup Environ Med 2016; 73:761-771. [DOI: 10.1136/oemed-2015-103467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 07/01/2016] [Indexed: 12/27/2022]
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Elzinga-Tinke JE, Dohle GR, Looijenga LH. Etiology and early pathogenesis of malignant testicular germ cell tumors: towards possibilities for preinvasive diagnosis. Asian J Androl 2016; 17:381-93. [PMID: 25791729 PMCID: PMC4430936 DOI: 10.4103/1008-682x.148079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malignant testicular germ cell tumors (TGCT) are the most frequent cancers in Caucasian males (20-40 years) with an 70% increasing incidence the last 20 years, probably due to combined action of (epi)genetic and (micro)environmental factors. It is expected that TGCT have carcinoma in situ(CIS) as their common precursor, originating from an embryonic germ cell blocked in its maturation process. The overall cure rate of TGCT is more than 90%, however, men surviving TGCT can present long-term side effects of systemic cancer treatment. In contrast, men diagnosed and treated for CIS only continue to live without these long-term side effects. Therefore, early detection of CIS has great health benefits, which will require an informative screening method. This review described the etiology and early pathogenesis of TGCT, as well as the possibilities of early detection and future potential of screening men at risk for TGCT. For screening, a well-defined risk profile based on both genetic and environmental risk factors is needed. Since 2009, several genome wide association studies (GWAS) have been published, reporting on single-nucleotide polymorphisms (SNPs) with significant associations in or near the genes KITLG, SPRY4, BAK1, DMRT1, TERT, ATF7IP, HPGDS, MAD1L1, RFWD3, TEX14, and PPM1E, likely to be related to TGCT development. Prenatal, perinatal, and postnatal environmental factors also influence the onset of CIS. A noninvasive early detection method for CIS would be highly beneficial in a clinical setting, for which specific miRNA detection in semen seems to be very promising. Further research is needed to develop a well-defined TGCT risk profile, based on gene-environment interactions, combined with noninvasive detection method for CIS.
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Affiliation(s)
| | | | - Leendert Hj Looijenga
- Department of Pathology, Laboratory of Experimental Patho-Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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Daniels RD, Bertke S, Dahm MM, Yiin JH, Kubale TL, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of U.S. firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med 2015; 72:699-706. [PMID: 25673342 DOI: 10.1136/oemed-2014-102671] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine exposure-response relationships between surrogates of firefighting exposure and select outcomes among previously studied US career firefighters. METHODS Eight cancer and four non-cancer outcomes were examined using conditional logistic regression. Incidence density sampling was used to match each case to 200 controls on attained age. Days accrued in firefighting assignments (exposed-days), run totals (fire-runs) and run times (fire-hours) were used as exposure surrogates. HRs comparing 75th and 25th centiles of lagged cumulative exposures were calculated using loglinear, linear, log-quadratic, power and restricted cubic spline general relative risk models. Piecewise constant models were used to examine risk differences by time since exposure, age at exposure and calendar period. RESULTS Among 19,309 male firefighters eligible for the study, there were 1333 cancer deaths and 2609 cancer incidence cases. Significant positive associations between fire-hours and lung cancer mortality and incidence were evident. A similar relation between leukaemia mortality and fire-runs was also found. The lung cancer associations were nearly linear in cumulative exposure, while the association with leukaemia mortality was attenuated at higher exposure levels and greater for recent exposures. Significant negative associations were evident for the exposure surrogates and colorectal and prostate cancers, suggesting a healthy worker survivor effect possibly enhanced by medical screening. CONCLUSIONS Lung cancer and leukaemia mortality risks were modestly increasing with firefighter exposures. These findings add to evidence of a causal association between firefighting and cancer. Nevertheless, small effects merit cautious interpretation. We plan to continue to follow the occurrence of disease and injury in this cohort.
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Affiliation(s)
- Robert D Daniels
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Stephen Bertke
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Matthew M Dahm
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - James H Yiin
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Travis L Kubale
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Thomas R Hales
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Dalsu Baris
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, Maryland, USA
| | - Shelia H Zahm
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Gaithersburg, Maryland, USA
| | - James J Beaumont
- UC Davis Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Kathleen M Waters
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Lynne E Pinkerton
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Yousif L, Hammer GP, Emrich K, Blettner M, Zeeb H. Occupational risk factors for testicular cancer: a registry-based case-control study in Rhineland Palatinate-Germany. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2013; 11:Doc16. [PMID: 24265602 PMCID: PMC3836396 DOI: 10.3205/000184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 10/03/2013] [Indexed: 01/20/2023]
Abstract
Objectives: Testicular cancer affects mainly men below the age of 50. An association with occupation and social status has been suggested but risk factors are not well understood. A registry-based case-control study focusing on occupation was performed in Germany. Methods: All 348 testicular cancer cases with available gainful occupational information registered between 2000 and 2005; as well as 564 suitable controls (from a pool of other cancers) were drawn from the Cancer Registry of Rhineland-Palatinate. Unconditional logistic regression was used to compute odds ratios (OR) and associated 95% confidence intervals (CI). Results: Slightly elevated OR were observed for technicians and related professionals (OR 1.62, 95% CI 1.00–2.63) and for clerical support workers (OR 1.71, 95% CI 1.14–2.56). This increase was highest in the age group 20–50 for technicians (OR 2.02, 95% CI 1.23–3.33) and clerks (OR 2.00, 95% CI 1.30–3.09), respectively. An association with testicular cancer was observed for no other occupation. Conclusion: An increased risk of testicular cancer was observed for technicians and related professionals and clerical support workers. This could be related to socioeconomic status or sedentary life style, two factors that were identified in previous studies. While the feasibility of a purely registry-based study was shown, missing occupational data and the choice of cancer controls represent challenges to the validity of this approach.
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Affiliation(s)
- Lamyaa Yousif
- Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz, Germany
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Béranger R, Le Cornet C, Schüz J, Fervers B. Occupational and environmental exposures associated with testicular germ cell tumours: systematic review of prenatal and life-long exposures. PLoS One 2013; 8:e77130. [PMID: 24155923 PMCID: PMC3796551 DOI: 10.1371/journal.pone.0077130] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/06/2013] [Indexed: 01/11/2023] Open
Abstract
Background Testicular germ cell tumours (TGCT) are the most common cancers in men aged between 15 and 44 years and the incidence has increased steeply over the past 30 years. The rapid increase in the incidence, the spatial variation and the evolution of incidence in migrants suggest that environmental risk factors play a role in TGCT aetiology. The purpose of our review is to summarise the current state of knowledge on occupational and environmental factors thought to be associated with TGCT. Methods A systematic literature search of PubMed. All selected articles were quality appraised by two independent researchers using the ‘Newcastle-Ottawa Quality Assessment Scale’. Results After exclusion of duplicate reports, 72 relevant articles were selected; 65 assessed exposure in adulthood, 7 assessed parental exposures and 2 assessed both. Associations with occupation was reported for agricultural workers, construction workers, firemen, policemen, military personnel, as well as workers in paper, plastic or metal industries. Electromagnetic fields, PCBs and pesticides were also suggested. However, results were inconsistent and studies showing positive associations tended to had lower quality ranking using the assessment scale (p=0.02). Discussion Current evidence does not allow concluding on existence of any clear association between TGCT and adulthood occupational or environmental exposure. The limitations of the studies may partly explain the inconsistencies observed. The lack of association with adulthood exposure is in line with current hypotheses supporting the prenatal origin of TGCT. Future research should focus on prenatal or early life exposure, as well as combined effect of prenatal and later life exposure. National and international collaborative studies should allow for more adequately powered epidemiological studies. More sophisticated methods for assessing exposure as well as evaluating gene–environment interactions will be necessary to establish clear conclusion.
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Affiliation(s)
- Rémi Béranger
- Unité Cancer et Environnement, Centre Léon Bérard, Lyon, France
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
- Université Claude, Bernard, Lyon, France
- * E-mail :
| | - Charlotte Le Cornet
- Unité Cancer et Environnement, Centre Léon Bérard, Lyon, France
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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Davis SR, Tao X, Bernacki EJ, Alfriend AS, Delowery ME. Evaluation of a bladder cancer cluster in a population of criminal investigators with the Bureau of Alcohol, Tobacco, Firearms and Explosives--part 2: the association of cancer risk and fire scene investigation. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:986023. [PMID: 23690807 PMCID: PMC3649665 DOI: 10.1155/2013/986023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/06/2013] [Accepted: 01/21/2013] [Indexed: 11/17/2022]
Abstract
This study evaluated the association of bladder cancer risk and fire scene investigation within a cohort of white male criminal investigators with the United States Bureau of Alcohol, Tobacco, Firearms and Explosives that was found to be at increased risk for bladder cancer. Medical surveillance data were used in a nested case-control study to determine odds ratios (ORs) estimating the relative risk of the cancer associated with post-fire investigation. The study comprised seven bladder cancer cases and 1525 controls. Six of the cases reported holding assignments associated with post-fire investigation. The OR for bladder cancer was 19.01 (95% confidence interval = 1.94-186.39) for those holding any one or more of these assignments for one to four years versus zero years and 12.56 (1.14-138.58) for those holding any one or more of these assignments for five or more years versus zero years. The risk for bladder cancer is significantly elevated for those holding post-fire investigation assignments compared to those not holding these assignments.
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Affiliation(s)
- Susan R Davis
- Federal Occupational Health, United States Department of Health and Human Services, 4550 Montgomery Avenue, Bethesda, MD 20814, USA.
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Abstract
The incidence of testicular cancer has been increasing over the past several decades in many developed countries. The reasons for the increases are unknown because the risk factors for the disease are poorly understood. Some research suggests that in utero exposures, or those in early childhood, are likely to be important in determining an individual's level of risk. However, other research suggests that exposure to various factors in adolescence and adulthood is also linked to the development of testicular cancer. Of these, two adult occupational exposures-fire fighting and aircraft maintenance--and one environmental exposure (to organochlorine pesticides) are likely to be associated with increased risk of developing testicular cancer. By contrast, seven of the identified factors--diet, types of physical activity, military service, police work as well as exposure to ionizing radiation, electricity and acrylamide--are unlikely to increase the risk of developing testicular cancer. Finally, seven further exposures--to heat, polyvinyl chloride, nonionizing radiation, heavy metals, agricultural work, pesticides and polychlorinated biphenyls as well as marijuana use--require further study to determine their association with testicular cancer.
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Affiliation(s)
- Katherine A McGlynn
- Division of Hormonal and Reproductive Epidemiology, National Cancer Institute, Suite 550 6120 Executive Boulevard, Rockville, MD 20852, USA.
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Peters JA, Kenen R, Hoskins LM, Glenn GM, Kratz C, Greene MH. Close ties: an exploratory Colored Eco-Genetic Relationship Map (CEGRM) study of social connections of men in Familial Testicular Cancer (FTC) families. Hered Cancer Clin Pract 2012; 10:2. [PMID: 22381132 PMCID: PMC3323467 DOI: 10.1186/1897-4287-10-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 03/01/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Testicular cancer, while rare compared with other adult solid tumors, is the most common cancer in young men in northern Europe and North America. Risk factors include white race, positive family history, contralateral testicular cancer, cryptorchidism, infertility and testicular microlithiasis. As the genetic causes of familial clusters (Familial Testicular Cancer or FTC) are being sought, it is also important to understand the psycho-social experiences of members of FTC families. METHODS This is a cross-sectional examination via the Colored Eco-Genetic Relationship Map (CEGRM) of social connections reported by 49 men in FTC families participating in NCI research study 02-C-178. RESULTS The CEGRM was acceptable and feasible for use with men in FTC families, and valuable in understanding their social connections. These men have largely adjusted to the TC history in themselves and/or their relatives. They have considerable social and emotional support from family and friends, although there is wide variability in sources and types. CONCLUSIONS The CEGRM focuses on men's social connections and close emotional bonds in FTC families. This action-oriented process of placing colored symbols on significant relationships uncovered previously under-appreciated emotions accompanying men's social exchanges. Most men in FTC families succeed in re-establishing a sense of normalcy in their lives and social connections, in the aftermath of a testicular cancer diagnosis.
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Affiliation(s)
- June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, 6120 Executive Blvd, Rockville, MD, 20852 USA.
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Kang D, Davis LK, Hunt P, Kriebel D. Cancer incidence among male Massachusetts firefighters, 1987-2003. Am J Ind Med 2008; 51:329-35. [PMID: 18306327 DOI: 10.1002/ajim.20549] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Firefighters are known to be exposed to recognized or probable carcinogens. Previous studies have found elevated risks of several types of cancers in firefighters. METHODS Standardized morbidity odds ratio (SMORs) were used to evaluate the cancer risk in white, male firefighters compared to police and all other occupations in the Massachusetts Cancer Registry from 1986 to 2003. Firefighters and police were identified by text search of the usual occupation field. All other occupations included cases with identifiable usual occupations not police or firefighter. Control cancers were those not associated with firefighters in previous studies. RESULTS Risks were moderately elevated among firefighters for colon cancer (SMOR = 1.36, 95% CI: 1.04-1.79), and brain cancer (SMOR = 1.90, 95% CI: 1.10-3.26). Weaker evidence of increased risk was observed for bladder cancer (SMOR = 1.22, 95% CI: 0.89-1.69), kidney cancer (SMOR = 1.34, 95% CI: 0.90-2.01), and Hodgkin's lymphoma (SMOR = 1.81, 95% CI: 0.72-4.53). CONCLUSIONS These findings are compatible with previous reports, adding to the evidence that firefighters are at increased risk of a number of types of cancer.
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Affiliation(s)
- Dongmug Kang
- Department of Preventive and Occupational Medicine, Pusan National University School of Medicine, Busan, Korea
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Thonneau P, Walschaerts M, Muller A. Facteurs de risques environnementaux et/ou professionnels du cancer du testicule. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf03040363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sluiter JK, Frings-Dresen MHW. What do we know about ageing at work? Evidence-based fitness for duty and health in fire fighters. ERGONOMICS 2007; 50:1897-1913. [PMID: 17972208 DOI: 10.1080/00140130701676005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study sought to collect evidence on age and workability in fire fighters, using systematic international literature searches, interviews, and secondary analyses from Dutch fire fighter studies. Recent decades have witnessed growing demands on fire fighters, who face peak task demands during duty. Older Dutch fire fighters experience greater emotional and mental demands than their younger colleagues. Huge inter-individual variation emerged in task performance with over six-fold differences in time-on-tasks and the percentage heart rate reserve between and within age groups. However, no age-effect was observed in lifting capacity during simulations. Compared to their youngest colleagues, older Dutch fire fighters face a six-fold increase in the risk of health complaints. The international literature lacks psychological age effects studies. Semi-functional tests, (e.g. exercise stress testing or push-ups) do not predict workability. Regular screening of fire fighters, using multi-modal functional tests that closely simulate real job activities, is recommended.
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Affiliation(s)
- J K Sluiter
- Academic Medical Center, Department: Coronel Institute of Occupational Health, University of Amsterdam, Amsterdam, DE, The Netherlands.
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Abstract
BACKGROUND There is no consensus whether firefighters are at increased cancer risk for particular cancers. Previous studies have been small, mostly investigated cancer mortality, and suggested increased risks for brain, bladder, testicular, prostate, thyroid and colo-rectal cancers, leukemia, and melanoma. METHODS Records of all male cancers registered in California during 1988-2003 were obtained. Firefighters were identified from occupation and industry text fields. Logistic regression analysis used other cancers as controls. RESULTS Of the 804,000 eligible records, 3,659 had firefighting as their occupation. Firefighting was associated with testicular cancer (odds ratio = 1.54, 95% confidence interval: 1.18-2.02), melanoma (1.50, 1.33-1.70), brain cancer (1.35, 1.06-1.72), esophageal cancer (1.48, 1.14-1.91), and prostate cancer (1.22, 1.12-1.33). CONCLUSIONS Use of other-cancer controls and lack of an occupational history may have biased relative risks towards the null. However, this study, which contained more firefighter cancers than any previous epidemiologic study, produced evidence supporting some prior hypotheses.
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Affiliation(s)
- Michael N Bates
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California 94720-7360, USA.
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LeMasters GK, Genaidy AM, Succop P, Deddens J, Sobeih T, Barriera-Viruet H, Dunning K, Lockey J. Cancer risk among firefighters: a review and meta-analysis of 32 studies. J Occup Environ Med 2007; 48:1189-202. [PMID: 17099456 DOI: 10.1097/01.jom.0000246229.68697.90] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to review 32 studies on firefighters and to quantitatively and qualitatively determine the cancer risk using a meta-analysis. METHODS A comprehensive search of computerized databases and bibliographies from identified articles was performed. Three criteria used to assess the probable, possible, or unlikely risk for 21 cancers included pattern of meta-relative risks, study type, and heterogeneity testing. RESULTS The findings indicated that firefighters had a probable cancer risk for multiple myeloma with a summary risk estimate (SRE) of 1.53 and 95% confidence interval (CI) of 1.21-1.94, non-Hodgkin lymphoma (SRE = 1.51, 95% CI = 1.31-1.73), and prostate (SRE = 1.28; 95% CI = 1.15-1.43). Testicular cancer was upgraded to probable because it had the highest summary risk estimate (SRE = 2.02; 95% CI = 1.30-3.13). Eight additional cancers were listed as having a "possible" association with firefighting. CONCLUSIONS Our results confirm previous findings of an elevated metarelative risk for multiple myeloma among firefighters. In addition, a probable association with non-Hodgkin lymphoma, prostate, and testicular cancer was demonstrated.
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Affiliation(s)
- Grace K LeMasters
- Epidemiology and Biostatistics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
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Ma F, Fleming LE, Lee DJ, Trapido E, Gerace TA. Cancer incidence in Florida professional firefighters, 1981 to 1999. J Occup Environ Med 2006; 48:883-8. [PMID: 16966954 DOI: 10.1097/01.jom.0000235862.12518.04] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine the cancer risk associated with firefighting. METHODS Standardized incidence ratio analysis (SIR) was used to determine the relative cancer risk for firefighters as compared with the Florida general population. RESULTS Among 34,796 male (413,022 person-years) and 2,017 female (18,843 person-years) firefighters, 970 male and 52 female cases of cancer were identified. Male firefighters had significantly increased incidence rates of bladder (SIR = 1.29; 95% confidence interval = 1.01-1.62), testicular (1.60; 1.20-2.09), and thyroid cancers (1.77; 1.08-2.73). Female firefighters had significantly increased incidence rates of overall cancer (1.63; 1.22-2.14), cervical (5.24; 2.93-8.65), and thyroid cancer (3.97; 1.45-8.65) and Hodgkin disease (6.25; 1.26-18.26). CONCLUSIONS Firefighting may be associated with an increased risk of selected site-specific cancers in males and females, including an overall increased cancer risk in female firefighters.
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Affiliation(s)
- Fangchao Ma
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA.
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Guo J, Pukkala E, Kyyrönen P, Lindbohm ML, Heikkilä P, Kauppinen T. Testicular cancer, occupation and exposure to chemical agents among Finnish men in 1971-1995. Cancer Causes Control 2005; 16:97-103. [PMID: 15868451 DOI: 10.1007/s10552-004-2236-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2004] [Accepted: 08/18/2004] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To find associations between testicular cancer, occupation and chemical exposure. METHODS A cohort of all economically active Finnish men born between 1906 and 1945 was followed-up for 19.7 million person-years during 1971-1995. Incident cases of testicular cancer (n=387) were identified in a record linkage with the Finnish Cancer Registry. The Census occupations in 1970 were converted to chemical exposures with a job-exposure matrix (FINJEM). Cumulative exposure (CE) was calculated as the product of prevalence, level, and duration of the exposure. Standardised incidence ratio (SIR) was calculated for each of the 393 occupations, and for CE categories of the 43 chemical agents, using average male population as reference. Relative risks (RR) comparing various CE-categories with unexposed ones were defined for selected agents by Poisson regression analysis. RESULTS Elevated SIRs were observed among railway traffic supervisors (5.8, 95% CI 1.6-14.7), programmers (4.3, 1.4-9.9), university teachers (4.1, 1.3-9.5) and electrical engineers (3.9, 1.1-10.1). A significant exposure-response trend (mainly contributed by seminoma) was observed for pesticides, textile dust, aliphatic and alicyclic hydrocarbons, and some other organic solvents. CONCLUSIONS Risk of testicular cancer increased only in four occupations. Pesticides, textile dust, and some organic solvents may be related to an excess risk of seminoma.
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Affiliation(s)
- Johannes Guo
- Finnish Institute of Occupational Health, Topeliuksenk, Helsinki, Finland.
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Stang A, Ahrens W, Baumgardt-Elms C, Bromen K, Stegmaier C, Jöckel KH. Carpenters, cabinetmakers, and risk of testicular germ cell cancer. J Occup Environ Med 2005; 47:299-305. [PMID: 15761327 DOI: 10.1097/01.jom.0000155716.63919.0a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A recent cohort study showed an increased risk of testicular cancer among members of the United Brotherhood of Carpenters and Joiners of America. We explored our data of a German population-based case-control study on the etiology of testicular cancer with regard to this association. METHODS The case-control study included 269 testicular cancer cases and 797 controls. We applied conditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). RESULTS People who worked as cabinetmakers or carpenters had an OR of 0.84 (95% CI = 0.45-1.56). Risks were increased among cabinetmakers who worked at least 15 years ago (OR = 5.81, 95% CI = 1.20-28.09). Ever being employed as a carpenter was associated with a reduced OR of 0.59 (95% CI = 0.24-1.46). CONCLUSIONS Cabinetmakers may be at an increased risk of testicular cancer.
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Affiliation(s)
- Andreas Stang
- Institute of Medical Epidemiology, Biometry and Informatics, University Hospital of Halle, Magdeburgerstrasse 27, 06097 Halle, Germany.
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Stotts RC. Cancers of the prostate, penis, and testicles: epidemiology, prevention, and treatment. Nurs Clin North Am 2004; 39:327-40. [PMID: 15159183 DOI: 10.1016/j.cnur.2004.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cancer is a disease that most people fear. Nurses are required to provide information on how to avoid cancer, and, once the diagnosis is made, how to cope with it. Prevention and early detection of the cancers described in this article are in the very early stages of knowledge development, but general health promotion guidance can be offered on how to avoid most cancers (ie, no tobacco use, a high-fiber and low fat diet, exercise, and maintaining a normal weight). Nurses also can advise patients to be screened for colorectal cancer at the appropriate ages and time intervals and to be aware as new developments occur in the scientific base for screenings in the areas of prostate, penile, and testicular cancer. Finally, coping with these forms of cancer often requires the patient to make major lifestyle and psychological changes, especially if surgery in the genital area occurs. Decreased libido, incontinence, and impotence are major complications that can occur with these illnesses. The male cancers described vary tremendously in their prevalence, incidence, mortality, treatment, and survival rates. Within this group, there are remarkably positive outcomes and outcomes much in need of improvement. Penile and testicular cancers are the bright spots in this picture; both are uncommon, and both are eminently treatable. Prostate cancer, on the other hand, is quite common, difficult to screen, difficult to treat without major sexual problems, and yet receives relatively little funding from the NIH. Although as many men die from prostate cancer as women die from breast cancer, NIH funds breast cancer research at much higher levels than prostate cancer. According to the latest data available at the NIH Web site, during the 1990s, the amount of NIH funding varied from four times more for breast cancer (1993) to 2.9 times more in 1999. For fiscal year 2002, NIH is providing $522 million in funding for breast cancer and $278 million for prostate cancer. Private foundation funds for prostate cancer are much smaller than those available for breast cancer. Both types of cancer are extremely important to address, and both should receive adequate research attention. Nurses can advocate for more funding for prostate cancer, from basic science approaches to behavioral science strategies.
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Affiliation(s)
- R Craig Stotts
- The University of Tennessee Health Science Center, College of Nursing, 877 Madison Avenue, Room 612, Memphis, TN 38163, USA.
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Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol 2004; 22:2-14. [PMID: 15034740 DOI: 10.1007/s00345-004-0398-8] [Citation(s) in RCA: 193] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Accepted: 01/22/2004] [Indexed: 01/22/2023] Open
Abstract
Clinical epidemiology is sometimes called the basic science of clinical medicine. In terms of the pathogenesis of testicular germ cell tumors (GCTs), clinical epidemiology analyzes suspected risk factors. The present review highlights the risk factors established so far and briefly summarizes those factors currently under investigation. In analogy to the methods of evidence based medicine, this review attributes levels of evidence to each of the putative risk factors. Level I represents highest quality of evidence while level V denotes the lowest level. So far, undescended testis (UDT), contralateral testicular GCT and familial testis cancer are established risk factors attaining high levels of evidence (levels I-III a). In a meta-analysis of 21 studies exploring the association of UDT with GCT risk, an over-all relative risk (RR) of 4.8 (95% confidence interval 4.0-5.7) was found. Contralateral testicular GCT involves a roughly 25-fold increased RR of GCT, while familial testis cancer constitutes a RR of 3-10. Infertility, testicular atrophy, and twin-ship represent risk factors with lesser levels of evidence (level III a). There is also some evidence for HIV infection being a predisposing factor for GCT (level IV a). Scrotal trauma is probably not associated with GCT risk. The estrogen excess theory implies high estrogen levels during the first trimester of pregnancy. As a consequence, primordial germ cells lose track of the normal developmental line and transform into premalignant cells that later become testicular intraepithelial neoplasia (TIN), the precursor of full-blown testicular GCT. Surrogate parameters for high gestational estrogen levels are investigated in case control studies. Such factors are maternal age >30 years, first-born, low birth weight, maternal breast cancer, high sex-ratio of siblings. So far, the sum of evidence is promising but still conflicting (especially for level III b). Another novel theory is the childhood nutrition hypothesis. This concept postulates a modulating or "catalyzing" effect by high dietary intake during childhood on the pathogenesis of testicular GCT. A surrogate parameter of early childhood nutrition is adult height. So far, 12 controlled studies have looked to the possible association of attained height and GCT risk of which six demonstrated a significant association. Thus, the sum of evidence corresponds to level III b. This concept is appealing because it would explain several hitherto unexplained epidemiological features of GCT.
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Affiliation(s)
- K-P Dieckmann
- Urologische Abteilung, Albertinen-Krankenhaus, Süntelstrasse 11a, D-22 457 Hamburg, Germany.
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Stang A, Jöckel KH, Baumgardt-Elms C, Ahrens W. Firefighting and risk of testicular cancer: results from a German population-based case-control study. Am J Ind Med 2003; 43:291-4. [PMID: 12594776 DOI: 10.1002/ajim.10178] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is some evidence of an elevated risk for testicular cancer among firefighters. METHODS We performed a population-based case-control study including 269 testicular cancer cases and 797 controls matching on age and region with a special focus on occupational exposures. Job tasks were coded according to the International Standard Classification of Occupations (ISCO 68). We used conditional logistic regression to calculate odds ratios (OR). RESULTS Three controls (0.4%) and four cases (1.5%) ever worked as firefighters. Firefighters showed an increased odds of testicular cancer in the matched evaluation (OR = 4.3, 95% confidence interval (95% CI) 0.7-30.5). The adjustment for a history of cryptorchidism or family history of testicular cancer did not alter our results. CONCLUSION Although the association between firefighting and testicular cancer risk is based on only small numbers of exposed subjects in our study, the finding is consistent with a recent cohort study from New Zealand. Occupational hazards experienced by firefighters may increase the risk of testicular cancer.
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Affiliation(s)
- Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. Essen, Germany.
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Fawcett J, Garrett N, Bates MN. Follow-up methods for retrospective cohort studies in New Zealand. Aust N Z J Public Health 2002; 26:256-61. [PMID: 12141622 DOI: 10.1111/j.1467-842x.2002.tb00683.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To define a general methodology for maximising the success of follow-up processes for retrospective cohort studies in New Zealand, and to illustrate an approach to developing country-specific follow-up methodologies. METHODS We recently conducted a cohort study of mortality and cancer incidence in New Zealand professional fire fighters. A number of methods were used to trace vital status, including matching with records of the New Zealand Health Information Service (NZHIS), pension records of Work and Income New Zealand (WINZ), and electronic electoral rolls. Non-electronic methods included use of paper electoral rolls and the records of the Registrar of Births Deaths and Marriages. RESULTS 95% of the theoretical person-years of follow-up of the cohort were traced using these methods. In terms of numbers of cohort members traced to end of follow-up, the most useful tracing methods were fire fighter employment records, the NZHIS, WINZ, and the electronic electoral rolls. CONCLUSIONS The follow-up process used for the cohort study was highly successful. On the basis of this experience, we propose a generic, but flexible, model for follow-up of retrospective cohort studies in New Zealand. Similar models could be constructed for other countries. IMPLICATIONS Successful follow-up of cohort studies is possible in New Zealand using established methods. This should encourage the use of cohort studies for the investigation of epidemiological issues. Similar models for follow-up processes could be constructed for other countries.
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Affiliation(s)
- Jackie Fawcett
- Institute of Environmental Science and Research Ltd, New Zealand
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Abstract
Testicular cancer remains a major success story in the realm of solid tumors. Although testicular cancer is highly treatable and curable, there are still many young men who succumb to the disease. Over the past year, important data regarding the diagnosis, treatment, and prognosis of testicular cancer have been reported. The significance of genetic and molecular alterations, such as i12p and epidermal growth factor receptor expression, remain at the forefront of research. However surgery and platinum-based chemotherapy are still the main treatment modalities. Attempts to limit chemotherapy and surgery while preserving cure rates are promising. The contribution of long-term platinum retention to the well-documented risk of late toxicity is unknown but provides a specific avenue for research. New tumor markers, such as lactate dehydrogenase isoenzyme-1, may provide a greater risk stratification. Positron emission tomography imaging may reduce the need for surgical resection posttherapy and provide a more comprehensive means of observation.
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Fawcett J, Garrett N, Bates MN. Follow-up methods for retrospective cohort studies in New Zealand. Aust N Z J Public Health 2002. [DOI: 10.1111/j.1467-842x.2002.tb00162.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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