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Madrigal JM, Flory A, Fisher JA, Sharp E, Graubard BI, Ward MH, Jones RR. Sociodemographic inequities in the burden of carcinogenic industrial air emissions in the United States. J Natl Cancer Inst 2024; 116:737-744. [PMID: 38180898 PMCID: PMC11077313 DOI: 10.1093/jnci/djae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Industrial facilities are not located uniformly across communities in the United States, but how the burden of exposure to carcinogenic air emissions may vary across population characteristics is unclear. We evaluated differences in carcinogenic industrial pollution among major sociodemographic groups in the United States and Puerto Rico. METHODS We evaluated cross-sectional associations of population characteristics including race and ethnicity, educational attainment, and poverty at the census tract level with point-source industrial emissions of 21 known human carcinogens using regulatory data from the US Environmental Protection Agency. Odds ratios and 95% confidence intervals comparing the highest emissions (tertile or quintile) to the referent group (zero emissions [ie, nonexposed]) for all sociodemographic characteristics were estimated using multinomial, population density-adjusted logistic regression models. RESULTS In 2018, approximately 7.4 million people lived in census tracts with nearly 12 million pounds of carcinogenic air releases. The odds of tracts having the greatest burden of benzene, 1,3-butadiene, ethylene oxide, formaldehyde, trichloroethylene, and nickel emissions compared with nonexposed were 10%-20% higher for African American populations, whereas White populations were up to 18% less likely to live in tracts with the highest emissions. Among Hispanic and Latino populations, odds were 16%-21% higher for benzene, 1,3-butadiene, and ethylene oxide. Populations experiencing poverty or with less than high school education were associated with up to 51% higher burden, irrespective of race and ethnicity. CONCLUSIONS Carcinogenic industrial emissions disproportionately impact African American and Hispanic and Latino populations and people with limited education or experiencing poverty thus representing a source of pollution that may contribute to observed cancer disparities.
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Affiliation(s)
- Jessica M Madrigal
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | | | - Jared A Fisher
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Elizabeth Sharp
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Barry I Graubard
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, USA
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The Geographic Context of Racial Disparities in Aggressive Endometrial Cancer Subtypes: Integrating Social and Environmental Aspects to Discern Biological Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148613. [PMID: 35886465 PMCID: PMC9320863 DOI: 10.3390/ijerph19148613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/07/2023]
Abstract
The number of Endometrial Carcinoma (EC) diagnoses is projected to increase substantially in coming decades. Although most ECs have a favorable prognosis, the aggressive, non-endometrioid subtypes are disproportionately concentrated in Black women and spread rapidly, making treatment difficult and resulting in poor outcomes. Therefore, this study offers an exploratory spatial epidemiological investigation of EC patients within a U.S.-based health system's institutional cancer registry (n = 1748) to search for and study geographic patterns. Clinical, demographic, and geographic characteristics were compared by histotype using chi-square tests for categorical and t-tests for continuous variables. Multivariable logistic regression evaluated the impact of risks on these histotypes. Cox proportional hazard models measured risks in overall and cancer-specific death. Cluster detection indicated that patients with the EC non-endometrioid histotypes exhibit geographic clustering in their home address, such that congregate buildings can be identified for targeted outreach. Furthermore, living in a high social vulnerability area was independently associated with non-endometrioid histotypes, as continuous and categorical variables. This study provides a methodological framework for early, geographically targeted intervention; social vulnerability associations require further investigation. We have begun to fill the knowledge gap of geography in gynecologic cancers, and geographic clustering of aggressive tumors may enable targeted intervention to improve prognoses.
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Odutola MK, Benke G, Fritschi L, Giles GG, van Leeuwen MT, Vajdic CM. A systematic review and meta-analysis of occupational exposures and risk of follicular lymphoma. ENVIRONMENTAL RESEARCH 2021; 197:110887. [PMID: 33607095 DOI: 10.1016/j.envres.2021.110887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The etiology of follicular lymphoma (FL), a common non-Hodgkin lymphoma subtype, is largely unknown. OBJECTIVE We performed a systematic review and meta-analysis of observational studies examining the relationship between occupational exposures and FL risk. METHODS We searched Ovid MEDLINE, Ovid EMBASE, and Web of Science for eligible observational studies examining job titles or occupational exposures prior to January 1, 2020. We performed a narrative synthesis and used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95%CI) for exposures reported by three or more studies. RESULTS Fifty-eight studies were eligible. Ten cohort and 37 case-control studies quantified FL risk in relation to any exposure to one or more occupational groups or agents. Eight cohort and 19 case-control studies examined dose-response relationships. We found evidence of a positive association with increasing plasma concentration of dichlorodiphenyldichloroethylene (DDE; meta-RR = 1.51, 95%CI = 0.99, 2.31; I2 = 0.0%) and polychlorinated biphenyls (PCBs; meta-RR = 1.47, 95%CI = 0.97, 2.24; I2 = 8.6%). We observed a positive association with exposure to any solvent (meta-RR = 1.16, 95%CI = 1.00, 1.34; I2 = 0.0%) and chlorinated solvents (meta-RR = 1.35, 95%CI = 1.09, 1.68; I2 = 0.0%). Single studies reported a significant positive dose-response association for exposure to any pesticide, hexachlorobenzene, any organophosphate, diazinon, metolachlor, carbaryl, lindane, trichloroethylene, oils/greases, and extremely low-frequency magnetic fields. Job title-only analyses suggested increased risk for medical doctors and spray painters, and decreased risk for bakers and teachers. Overall, studies demonstrated low risk of bias, but most studies examined small numbers of exposed cases. CONCLUSIONS Current evidence indicates a positive association between FL and occupational exposure to DDE, PCBs, any solvent and chlorinated solvents. Our findings may help guide policies and practices on the safe use of solvents and inform models of lymphomagenesis. Future studies with larger sample sizes and comprehensive quantitative exposure measures may elucidate other avoidable carcinogenic exposures.
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Affiliation(s)
- Michael K Odutola
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia; Precision Medicine, School of Clinical Sciences at Monash Health Monash University, Melbourne, Australia
| | - Marina T van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
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Taj T, Poulsen AH, Ketzel M, Geels C, Brandt J, Christensen JH, Puett R, Hvidtfeldt UA, Sørensen M, Raaschou-Nielsen O. Long-term exposure to PM 2.5 and its constituents and risk of Non-Hodgkin lymphoma in Denmark: A population-based case-control study. ENVIRONMENTAL RESEARCH 2020; 188:109762. [PMID: 32535359 DOI: 10.1016/j.envres.2020.109762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Particulate matter (PM) air pollution is a complex mixture and the various PM constituents likely affect health differently. The literature on the relationships among specific PM constituents and the risk of cancer is sparse. In this study, we aimed to evaluate the association of PM2.5 and its constituents with the incidence of non-Hodgkin lymphoma (NHL) and the two main NHL subtypes. METHODS We undertook a nationwide register-based case-control study including 20,847 cases registered in the Danish Cancer Registry with NHL between 1989 and 2014. Among the entire Danish population, we selected 41,749 age and sex-matched controls randomly from the Civil Registration System. We assessed modelled outdoor PM concentrations at addresses of cases and controls with a state-of-the-art multi scale air pollution modelling system and used conditional logistic regression to estimate odds ratios (ORs) adjusted for individual and neighborhood level socio-demographic variables. RESULTS The 10-year time-weighted average concentrations of PM2.5, primary carbonaceous particles (BC/OC), secondary inorganic aerosols (SIA), secondary organic aerosols (SOA) and sea salt were 17.4, 2.3, 7.8, 0.3, and 4.1 μg/m3, respectively among controls. The results showed higher risk for NHL in association with exposure to BC/OC (OR = 1.03; 95% CI: 1.00, 1.07, per interquartile range (IQR)) and SOA (OR = 1.54; 95% CI: 1.13, 2.09, per IQR). The results indicated a higher risk for follicular lymphoma in association with several PM components. Including PM2.5 (OR = 1.16; 95% CI: 0.98-1.38), BC/OC (OR = 1.05; 95% CI: 0.97-1.14), SIA (OR = 1.44; 95% CI: 0.80-1.08), SOA (OR = 4.52; 95% CI: 0.86-23.83) per IQR. CONCLUSION This is the first study on PM constituents and the risk of NHL. The results indicated an association with primary carbonaceous and secondary organic PM. The results need replication in other settings before any firm conclusion can be reached.
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Affiliation(s)
- Tahir Taj
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, Denmark.
| | - Aslak Harbo Poulsen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE) Department of Civil and Environmental Engineering University of Surrey, United Kingdom
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Robin Puett
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, Denmark; Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen Ø, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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A clandestine culprit with critical consequences: Benzene and acute myeloid leukemia. Blood Rev 2020; 47:100736. [PMID: 32771228 DOI: 10.1016/j.blre.2020.100736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
While most clinicians recognize adult therapy-related leukemias following cytotoxic chemotherapy and radiation, environmental regulatory agencies evaluate exposure to "safe levels" of leukemogenic compounds. Benzene represents the most notorious leukemogenic chemical. Used in the production of ubiquitous items such as plastics, lubricants, rubbers, dyes, and pesticides, benzene may be responsible for the higher risk of acute myeloid leukemia (AML) among automobile, janitorial, construction, and agricultural workers. It is possible that ambient benzene may contribute to many cases of "de novo" AML not arising out of germline predispositions. In this appraisal of the available literature, we evaluate and discuss the association between chronic, low-dose and ambient exposure to environmental benzene and the development of adult AML.
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Ayuso-Álvarez A, García-Pérez J, Triviño-Juárez JM, Larrinaga-Torrontegui U, González-Sánchez M, Ramis R, Boldo E, López-Abente G, Galán I, Fernández-Navarro P. Association between proximity to industrial chemical installations and cancer mortality in Spain. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 260:113869. [PMID: 31991345 DOI: 10.1016/j.envpol.2019.113869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
It is likely that pollution from chemical facilities will affect the health of any exposed population; however, the majority of scientific evidence available has focused on occupational exposure rather than environmental. Consequently, this study assessed whether there could have been an excess of cancer-related mortality associated with environmental exposure to pollution from chemical installations - for populations residing in municipalities in the vicinity of chemical industries. To this end, we designed an ecological study which assessed municipal mortality due to 32 types of cancer in the period from 1999 to 2008. The exposure to pollution was estimated using distance from the facilities to the centroid of the municipality as a proxy for exposure. In order to assess any increased cancer mortality risk in municipalities potentially exposed to chemical facilities pollution (situated at a distance of ≤5 km from a chemical installation), we employed Bayesian Hierarchical Poisson Regression Models. This included two Bayesian inference methods: Integrated Nested Laplace Approximations (INLA) and Markov Chain Monte Carlo (MCMC, for validation). The reference category consisted of municipalities beyond the 5 km limit. We found higher mortality risk (relative risk, RR; estimated by INLA, 95% credible interval, 95%CrI) for both sexes for colorectal (RR, 1.09; 95%CrI, 1.05-1.15), gallbladder (1.14; 1.03-1.27), and ovarian cancers (1.10; 1.02-1.20) associated with organic chemical installations. Notably, pleural cancer (2.27; 1.49-3.41) in both sexes was related to fertilizer facilities. Associations were found for women, specifically for ovarian (1.11; 1.01-1.22) and breast cancers (1.06; 1.00-1.13) in the proximity of explosives/pyrotechnics installations; increased breast cancer mortality risk (1.10; 1.03-1.18) was associated with proximity to inorganic chemical installations. The results suggest that environmental exposure to pollutants from some types of chemical facilities may be associated with increased mortality from several different types of cancer.
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Affiliation(s)
- Ana Ayuso-Álvarez
- National Center of Tropical Medicine, Network Collaborative Research in Tropical Diseases (RICET), Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, PC, 28029, Madrid, Spain
| | - Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | | | - Unai Larrinaga-Torrontegui
- Medicina Preventiva OSI Debabarrena, Hospital de Mendaro, Calle Mendarozabal Kalea, s/n, 20850 Mendaro Gipuzkoa, Spain
| | - Mario González-Sánchez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Elena Boldo
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Gonzalo López-Abente
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Iñaki Galán
- Department of Chronic Diseases. Nacional Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; School of Medicine, Autonomous University of Madrid/IdiPAZ (Instituto de Investigación del Hospital Universitario La Paz/La Paz University Teaching Hospital Research Institute), Calle del Arzobispo Morcillo 4, PC 28029, Madrid, Spain
| | - Pablo Fernández-Navarro
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
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Detourmignies L, Leroyer A, Ligier K, Plouvier S, Genin M. Population-based incidence of lymphomas in the French Nord-Pas-de-Calais region between 2001 and 2005: Annual estimations and spatial analysis. Rev Epidemiol Sante Publique 2019; 67:319-327. [PMID: 31327522 DOI: 10.1016/j.respe.2019.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-Hodgkin's lymphomas (NHL) are the seventh most commonly diagnosed cancer in France. Nord-Pas-de-Calais is ranked as the region with the highest incidence of cancers and deaths by cancer in France. With its rich industrial past and its contrasted population densities between urban and rural territories, Nord-Pas-de-Calais represents a geographic area of interest to study the overall incidence of NHL and examine spatial variation of NHL incidence between the 170 cantons of the region. METHODS LYMPHONOR was a population-based multicentre retrospective study of patients residing in the Nord-Pas-de-Calais region and diagnosed with NHL between January 2001 and December 2005. Spatial distribution of NHL incidence in Nord-Pas-de-Calais was explored using two complementary approaches: adjusted smoothed standardised incidence ratio (SIR) and spatial scan statistics (detection of atypical clusters). RESULTS Between 2001 and 2005, 2132 new cases of NHL were diagnosed in the Nord-Pas-de-Calais region. In 2005, age-standardised NHL incidence rates were 10.2 and 7.0 cases per 100,000 person-years in male and female residents, respectively. No significant spatial disparities in NHL incidence were found within the Nord-Pas-de-Calais region. The age-adjusted smoothed SIR varied from 0.82 to 1.25 between cantons. Consistently, spatial scan statistics did not detect any significant atypical cluster of high NHL incidence. CONCLUSION Comparison with national data collected during the same period does not show an overincidence of NHL in the Nord-Pas-de-Calais region. In addition, no evidence for spatial heterogeneity and clustering of NHL incidence was found within this region. Future epidemiological research using large-scale registries is needed to better appraise spatial variation of NHL incidence in France and to investigate possible reasons for significant clusters.
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Affiliation(s)
- L Detourmignies
- Service d'hématologie clinique, Hôpital de Roubaix, 11-17, boulevard Lacordaire, 59056 Roubaix, France.
| | - A Leroyer
- Université de Lille, CHU de Lille, Institut Pasteur de Lille, EA 4483, IMPECS, IMPact of Environmental Chemicals on human health, 59000 Lille, France; CHU de Lille, Pôle de Santé Publique, 59000 Lille, France; Institut Pasteur de Lille, 59000 Lille, France
| | - K Ligier
- Registre général des cancers de Lille et de sa région, C2RC, 59037 Lille, France; Conseil Départemental du Pas-de-Calais, 62018 Arras, France
| | - S Plouvier
- Registre général des cancers de Lille et de sa région, C2RC, 59037 Lille, France
| | - M Genin
- Université de Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, 59000 Lille, France
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Characterizing Lymphoma Incidence and Disparities for a Cancer Center Catchment Region. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:699-708.e5. [PMID: 31494062 DOI: 10.1016/j.clml.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Racial disparities in non-Hodgkin lymphoma (NHL) are not well-elucidated for specific catchment areas, which can influence outcomes. Leveraging regional data from a population-based cancer registry may provide unique opportunities to quantify NHL disparities. MATERIALS AND METHODS Using Surveillance, Epidemiology, and End Results (SEER) data for NHL cases diagnosed in Georgia from 2001 to 2015, we examined NHL incidence rates by lymphoma subtype and racial differences in baseline characteristics and outcomes for diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). Cox regression models identified predictors of overall survival (OS). RESULTS SEER documented 38,504 NHL cases in Georgia from 2001 to 2015. The age-adjusted incidence rate for NHL in Georgia increased 1.03% per year, and the annual percentage change was 1.72 in blacks compared with 0.84 in whites. Compared with whites, blacks with DLBCL and FL were more likely to be diagnosed at a younger age (DLBCL, 54.1 vs. 65.5 years; P < .0001; FL, 58.4 vs. 64.0 years; P < .0001) and with B symptoms (DLBCL, 44.4% vs. 33.4%; P < .0001; FL, 28.5% vs. 21.4%; P = .004). Across racial categories, age at diagnosis > 60 years, advanced stage, and B symptoms predicted worse OS in DLBCL and FL. Blacks with DLBCL more commonly were diagnosed with stage III/IV disease (55.5% vs. 48.1%; P < .0001) and had worse 5-year relative survival (58.8% vs. 62.3%; P = .01). CONCLUSIONS Regional cancer registry data can be used to define incidence patterns and disparities in outcomes across NHL subtypes to help define key targets for interventions in a catchment area.
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Tomei F, Rosati MV, Lorusso G, Ricci L, Damato FM, Caciari T, Giubilati R, Casale T, Pimpinella B, Marchione S, Nardone N, di Luca NM, Massoni F, Anzelmo V, Massimi R, Tomei G, Ricci P, Sacco C, Ricci S. No Correlation between Blood Benzene Levels and Luteinizing Hormone Plasma Values in Outdoor Workers. Endocr Metab Immune Disord Drug Targets 2019; 19:1165-1171. [PMID: 31038083 DOI: 10.2174/1871530319666190417112818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of the study is to evaluate whether low-dose exposure to benzene, an environmental pollutant to which male and female traffic policemen are daily exposed to could cause alterations in plasma luteinizing hormone (LH) levels. METHODS From an initial sample of 1594 workers, we only selected 95 workers of whom study we knew the values of late-shift benzene and LH hormone. All subjects underwent biological monitoring (final blood benzene evaluation) and luteinizing hormone dosing. Excluding subjects with the main confounding factors, the final sample included 76 workers. The normal distribution of the variables was evaluated using the Kolmogorov - Smirnov test, followed by the logarithmic transformation of the LH and benzene values. The comparison among means was performed by using the t-test for the independent samples. The ANOVA test was performed for variables with more than 2 modes (ages and seniority) and Pearson correlation index between variables in the total sample and after subdivision as to sex, job, sports activity and smoking. The results were considered significant when p values were less than 0.05. RESULTS/CONCLUSION The study did not show a correlation between benzene levels and LH plasma levels in outdoor workers.
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Affiliation(s)
| | - Maria V Rosati
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty Scool of Occupational Medicine, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Giovanna Lorusso
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty Scool of Occupational Medicine, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Lidia Ricci
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Felice M Damato
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | - Stefania Marchione
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Nadia Nardone
- Spin off Sipro, Via Stimigliano 5, 00199 Rome, Italy
| | - Natale Mario di Luca
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Massoni
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Vincenza Anzelmo
- Institute of Public Health, Unit of Occupational Medicine, University of Rome " Cattolica del Sacro Cuore", Largo Agostino Gemelli, 8, 00168 Roma, Italy
| | | | - Gianfranco Tomei
- Department of Psychiatric and Psychological Science, University of Rome " Sapienza ", Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Pasquale Ricci
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Carmina Sacco
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Serafino Ricci
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty Scool of Occupational Medicine, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy.,Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
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Teras LR, Diver WR, Deubler EL, Krewski D, Flowers CR, Switchenko JM, Gapstur SM. Residential ambient benzene exposure in the United States and subsequent risk of hematologic malignancies. Int J Cancer 2019; 145:2647-2660. [DOI: 10.1002/ijc.32202] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Lauren R. Teras
- Epidemiology Research GroupAmerican Cancer Society Atlanta GA
| | - W. Ryan Diver
- Epidemiology Research GroupAmerican Cancer Society Atlanta GA
| | | | - Daniel Krewski
- McLaughlin Centre for Population Health Risk AssessmentUniversity of Ottawa Ottawa ON Canada
- School of Epidemiology, Public Health and Disease PreventionUniversity of Ottawa Ottawa ON Canada
| | - Christopher R. Flowers
- Department of Hematology and Medical OncologyWinship Cancer Institute, Emory University School of Medicine Atlanta GA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and BioinformaticsRollins School of Public Health, Emory University Atlanta GA
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11
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Fernández-Navarro P, García-Pérez J, Ramis R, Boldo E, López-Abente G. Industrial pollution and cancer in Spain: An important public health issue. ENVIRONMENTAL RESEARCH 2017; 159:555-563. [PMID: 28889025 DOI: 10.1016/j.envres.2017.08.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/18/2017] [Accepted: 08/24/2017] [Indexed: 06/07/2023]
Abstract
Cancer can be caused by exposure to air pollution released by industrial facilities. The European Pollutant Release and Transfer Register (E-PRTR) has made it possible to study exposure to industrial pollution. This study seeks to describe the industrial emissions in the vicinity of Spanish towns and their temporal changes, and review our experience studying industrial pollution and cancer. Data on industrial pollutant sources (2007-2010) were obtained from the E-PRTR registries. Population exposure was estimated by the distance from towns to industrial facilities. We calculated the amount of carcinogens emitted into the air in the proximity (<5km) of towns and show them in municipal maps. We summarized the most relevant results and conclusions reported by ecological E-PRTR-based on studies of cancer mortality and industrial pollution in Spain and the limitations and result interpretations of these types of studies. There are high amounts of carcinogen emissions in the proximity of towns in the southwest, east and north of the country and the total amount of emitted carcinogens is considerable (e.g. 20Mt of arsenic, 63Mt of chromium and 9Mt of cadmium). Although the emissions of some carcinogens in the proximity of certain towns were reduced during the study period, emissions of benzene, dioxins+furans and polychlorinated biphenyls rose. Moreover, the average population of towns lying within a 5km radius from emission sources of carcinogens included in the International Agency for Research on Cancer list of carcinogens was 9 million persons. On the other hand, the results of the reviewed studies suggest that those Spanish regions exposed to the pollution released by certain types of industrial facilities have around 17% cancer excess mortality when compared with those unexposed. Moreover, excess mortality is focused on digestive and respiratory tract cancers, leukemias, prostate, breast and ovarian cancers. Despite their limitations, ecological studies are a useful tool in environmental epidemiology, not only for proposing etiological hypotheses about the risk of living close to industrial pollutant sources, but also for providing data to account for situations of higher mortality in specific areas. Nevertheless, the reduction of emissions should be a goal, with special relevance given to establishing limits for known carcinogens and other toxic substances in the environs of population centers, as well as industry-specific emission limits.
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Affiliation(s)
- Pablo Fernández-Navarro
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain.
| | - Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Rebeca Ramis
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Elena Boldo
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
| | - Gonzalo López-Abente
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos, 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Spain
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12
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Ortega-García JA, López-Hernández FA, Cárceles-Álvarez A, Fuster-Soler JL, Sotomayor DI, Ramis R. Childhood cancer in small geographical areas and proximity to air-polluting industries. ENVIRONMENTAL RESEARCH 2017; 156:63-73. [PMID: 28319819 PMCID: PMC5685507 DOI: 10.1016/j.envres.2017.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/02/2017] [Accepted: 03/06/2017] [Indexed: 05/13/2023]
Abstract
AIM Pediatric cancer has been associated with exposure to certain environmental carcinogens. The purpose of this work is to analyse the relationship between environmental pollution and pediatric cancer risk. METHOD We analysed all incidences of pediatric cancer (<15) diagnosed in a Spanish region during the period 1998-2015. The place of residence of each patient and the exact geographical coordinates of main industrial facilities was codified in order to analyse the spatial distribution of cases of cancer in relation to industrial areas. Focal tests and focused Scan methodology were used for the identification of high-incidence-rate spatial clusters around the main industrial pollution foci. RESULTS The crude rate for the period was 148.0 cases per 1,000,0000 children. The incidence of pediatric cancer increased significantly along the period of study. With respect to spatial distribution, results showed significant high incidence around some industrial pollution foci group and the Scan methodology identify spatial clustering. We observe a global major incidence of non Hodgkin lymphomas (NHL) considering all foci, and high incidence of Sympathetic Nervous System Tumour (SNST) around Energy and Electric and organic and inorganic chemical industries foci group. In the analysis foci to foci, the focused Scan test identifies several significant spatial clusters. Particularly, three significant clusters were identified: the first of SNST was around energy-generating chemical industries (2 cases versus the expected 0.26), another of NHL was around residue-valorisation plants (5 cases versus the expected 0.91) and finally one cluster of Hodgkin lymphoma around building materials (3 cases versus the expected 2.2) CONCLUSION: Results suggest a possible association between proximity to certain industries and pediatric cancer risk. More evidences are necessary before establishing the relationship between industrial pollution and pediatric cancer incidence.
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Affiliation(s)
- Juan A Ortega-García
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain.
| | | | - Alberto Cárceles-Álvarez
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - José L Fuster-Soler
- Oncology & Hematology Section, Pediatrics Department, Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Diana I Sotomayor
- Pediatric Environmental Health Speciality Unit, Department of Paediatrics, Laboratory of Environmental and Human Health (A5), Institute of Biomedical Research, IMIB-Arrixaca, Clinical University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain
| | - Rebeca Ramis
- Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology, Instituto de Salud Carlos III - ISCIII, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
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13
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Bulka C, Nastoupil LJ, Koff JL, Bernal-Mizrachi L, Ward KC, Williams JN, Bayakly AR, Switchenko JM, Waller LA, Flowers CR. Relations Between Residential Proximity to EPA-Designated Toxic Release Sites and Diffuse Large B-Cell Lymphoma Incidence. South Med J 2017; 109:606-614. [PMID: 27706495 DOI: 10.14423/smj.0000000000000545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Examining the spatial patterns of diffuse large B-cell lymphoma (DLBCL) incidence and residential proximity to toxic release locations may provide insight regarding environmental and sociodemographic risk factors. METHODS We linked and geocoded cancer incidence data for the period 1999-2008 from the Georgia Comprehensive Cancer Registry with population data from the US Census and the Environmental Protection Agency's Toxics Release Inventory. We conducted cluster analyses and constructed Poisson regression models to assess DLBCL incidence as a function of mean distance to the toxic release sites. RESULTS In total, 3851 incident DLBCL cases occurred among adults residing in Georgia between 1999 and 2008. Significant focal clustering was observed around 57% of ethylene oxide sites, 5% of benzene sites, 9% of tetrachloroethylene sites, 7% of styrene sites, 10% of formaldehyde sites, 5% of trichloroethylene sites, and 10% of all release sites. Mean distance to sites was significantly associated with DLBCL risk for all chemicals. CONCLUSIONS Proximity to Toxics Release Inventory sites can be linked to increased DLBCL risk as assessed through focal clustering and Poisson regression, and confirmatory studies using geospatial mapping can aid in further specifying risk factors for DLBCL.
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Affiliation(s)
- Catherine Bulka
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Loretta J Nastoupil
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Jean L Koff
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Leon Bernal-Mizrachi
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Kevin C Ward
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Jessica N Williams
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - A Rana Bayakly
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Jeffrey M Switchenko
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Lance A Waller
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
| | - Christopher R Flowers
- From the Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, the University of Texas MD Anderson Cancer Center, Houston, the Departments of Hematology and Oncology and Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, and the Departments of Epidemiology and Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, and the Georgia Department of Public Health, Atlanta
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14
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Casale T, Sacco C, Ricci S, Loreti B, Pacchiarotti A, Cupelli V, Arcangeli G, Mucci N, Antuono V, De Marco F, Tomei G, Tomei F, Rosati MV. Workers exposed to low levels of benzene present in urban air: Assessment of peripheral blood count variations. CHEMOSPHERE 2016; 152:392-398. [PMID: 27011318 DOI: 10.1016/j.chemosphere.2016.01.096] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/04/2015] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Few studies in the literature have examined the effects of benzene on blood cells. AIM The aim of this study was to evaluate the possible correlation between the blood benzene levels and the blood cell counts. MATERIALS AND METHODS From a population of 2658 workers, we studied a group of 215 subjects. Each worker underwent blood sampling for the assessment of the blood benzene levels and the blood cell counts. The Mann-Whitney U test for two-mode variables and the Kruskal-Wallis test for more-than-two-mode variables were performed on all subjects. We estimated the Pearson correlation index between the variables in the total sample and the subgroups divided according to sex, the smoking habit, and job. After the main confounding factors were evaluated, multiple linear regression was performed on both the total sample and the subgroups. RESULTS A significant inverse correlation was found among the blood benzene levels and the white blood cells, lymphocytes, and neutrophils in traffic policemen, motorcyclists, and other outdoor workers. We did not find any significant correlation with any other parameters of blood cell count. DISCUSSION AND CONCLUSIONS Our results, which must be considered preliminary, indicate that increased blood benzene levels in outdoor workers lead to decreased counts of white blood cells, neutrophils, and lymphocytes, because of possible immune effects. These are worth investigating in the future by specific immune tests.
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Affiliation(s)
- Teodorico Casale
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Carmina Sacco
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Serafino Ricci
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Beatrice Loreti
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Alessandro Pacchiarotti
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Vincenzo Cupelli
- Chair of Occupational Medicine, Health Services Research Unit, Department of Clinical and Experimental Medicine, University of Florence. 1/23 Largo Piero Palagi, Florence, Italy
| | - Giulio Arcangeli
- Chair of Occupational Medicine, Health Services Research Unit, Department of Clinical and Experimental Medicine, University of Florence. 1/23 Largo Piero Palagi, Florence, Italy
| | - Nicola Mucci
- Chair of Occupational Medicine, Health Services Research Unit, Department of Clinical and Experimental Medicine, University of Florence. 1/23 Largo Piero Palagi, Florence, Italy; Institute of Occupational Medicine, Catholic University of Sacred Heart, 1 Largo Francesco Vito, 00168 Rome, Italy
| | - Vittorio Antuono
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Federica De Marco
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
| | - Gianfranco Tomei
- Department of Psychiatric and Psychological Science, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
| | - Francesco Tomei
- Spin off of University of Rome " Sapienza " "Sipro", Viale Regina Elena 336, 00161 Rome, Italy
| | - Maria Valeria Rosati
- University of Rome "La Sapienza", Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, Viale Regina Elena 336, 00161 Rome, Italy
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15
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Switchenko JM, Bulka C, Ward K, Koff JL, Bayakly AR, Ryan PB, Waller LA, Flowers CR. Resolving uncertainty in the spatial relationships between passive benzene exposure and risk of non-Hodgkin lymphoma. Cancer Epidemiol 2016; 41:139-51. [PMID: 26949112 PMCID: PMC4946246 DOI: 10.1016/j.canep.2016.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 11/17/2022]
Abstract
Background Benzene is a known occupational carcinogen associated with increased risk of hematologic cancers, but the relationships between quantity of passive benzene exposure through residential proximity to toxic release sites, duration of exposure, lag time from exposure to cancer development, and lymphoma risk remain unclear. Methods We collected release data through the Environmental Protection Agency’s Toxics Release Inventory (TRI) from 1989 to 2003, which included location of benzene release sites, years when release occurred, and amount of release. We also collected data on incident cases of non-Hodgkin lymphoma (NHL) from the Georgia Comprehensive Cancer Registry (GCCR) for the years 1999–2008. We constructed distance-decay surrogate exposure metrics and Poisson and negative binomial regression models of NHL incidence to quantify associations between passive exposure to benzene and NHL risk and examined the impact of amount, duration of exposure, and lag time on cancer development. Akaike’s information criteria (AIC) were used to determine the scaling factors for benzene dispersion and exposure periods that best predicted NHL risk. Results Using a range of scaling factors and exposure periods, we found that increased levels of passive benzene exposure were associated with higher risk of NHL. The best fitting model, with a scaling factor of 4 kilometers (km) and exposure period of 1989–1993, showed that higher exposure levels were associated with increased NHL risk (Level 4 (1.1–160 kilograms (kg)) vs. Level 1: risk ratio 1.56 [1.44–1.68], Level 5 (>160 kg) vs. Level 1: 1.60 [1.48–1.74]). Conclusions Higher levels of passive benzene exposure are associated with increased NHL risk across various lag periods. Additional epidemiological studies are needed to refine these models and better quantify the expected total passive benzene exposure in areas surrounding release sites.
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Affiliation(s)
- Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Catherine Bulka
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Georgia Center for Cancer Statistics, Atlanta, GA, USA
| | - Jean L Koff
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - P Barry Ryan
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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16
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Koff JL, Chihara D, Phan A, Nastoupil LJ, Williams JN, Flowers CR. To Each Its Own: Linking the Biology and Epidemiology of NHL Subtypes. Curr Hematol Malig Rep 2015; 10:244-55. [PMID: 26104907 PMCID: PMC5738916 DOI: 10.1007/s11899-015-0267-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-Hodgkin lymphoma (NHL) constitutes a diverse group of more than 40 subtypes, each characterized by distinct biologic and clinical features. Until recently, pinpointing genetic and epidemiologic risk factors for individual subtypes has been limited by the relative rarity of each. However, several large pooled case-control studies have provided sufficient statistical power for detecting etiologic differences and commonalities between subtypes and thus yield new insight into their unique epidemiologic backgrounds. Here, we review the subtype-specific medical, lifestyle, and biologic components identified in these studies, which suggest that a complex interplay between host genetics, autoimmune disorders, modifiable risk factors, and occupation contributes to lymphomagenesis.
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Affiliation(s)
- Jean L Koff
- Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Rd NE, Building B, Suite 4302, Atlanta, GA, USA,
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17
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Staton AD, Koff JL, Chen Q, Ayer T, Flowers CR. Next-generation prognostic assessment for diffuse large B-cell lymphoma. Future Oncol 2015; 11:2443-57. [PMID: 26289217 DOI: 10.2217/fon.15.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Current standard of care therapy for diffuse large B-cell lymphoma (DLBCL) cures a majority of patients with additional benefit in salvage therapy and autologous stem cell transplant for patients who relapse. The next generation of prognostic models for DLBCL aims to more accurately stratify patients for novel therapies and risk-adapted treatment strategies. This review discusses the significance of host genetic and tumor genomic alterations seen in DLBCL, clinical and epidemiologic factors, and how each can be integrated into risk stratification algorithms. In the future, treatment prediction and prognostic model development and subsequent validation will require data from a large number of DLBCL patients to establish sufficient statistical power to correctly predict outcome. Novel modeling approaches can augment these efforts.
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Affiliation(s)
- Ashley D Staton
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
| | - Jean L Koff
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
| | - Qiushi Chen
- H Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30318, USA
| | - Turgay Ayer
- H Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30318, USA
| | - Christopher R Flowers
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
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18
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Siangphoe U, Wheeler DC. Evaluation of the performance of smoothing functions in generalized additive models for spatial variation in disease. Cancer Inform 2015; 14:107-16. [PMID: 25983545 PMCID: PMC4415687 DOI: 10.4137/cin.s17300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/28/2022] Open
Abstract
Generalized additive models (GAMs) with bivariate smoothing functions have been applied to estimate spatial variation in risk for many types of cancers. Only a handful of studies have evaluated the performance of smoothing functions applied in GAMs with regard to different geographical areas of elevated risk and different risk levels. This study evaluates the ability of different smoothing functions to detect overall spatial variation of risk and elevated risk in diverse geographical areas at various risk levels using a simulation study. We created five scenarios with different true risk area shapes (circle, triangle, linear) in a square study region. We applied four different smoothing functions in the GAMs, including two types of thin plate regression splines (TPRS) and two versions of locally weighted scatterplot smoothing (loess). We tested the null hypothesis of constant risk and detected areas of elevated risk using analysis of deviance with permutation methods and assessed the performance of the smoothing methods based on the spatial detection rate, sensitivity, accuracy, precision, power, and false-positive rate. The results showed that all methods had a higher sensitivity and a consistently moderate-to-high accuracy rate when the true disease risk was higher. The models generally performed better in detecting elevated risk areas than detecting overall spatial variation. One of the loess methods had the highest precision in detecting overall spatial variation across scenarios and outperformed the other methods in detecting a linear elevated risk area. The TPRS methods outperformed loess in detecting elevated risk in two circular areas.
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Affiliation(s)
- Umaporn Siangphoe
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
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