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Nilles JD, Lim D, Boyer MP, Wilson BD, Betar RA, Showalter HA, Liu D, Ananieva EA. The occurrence of bone and joint cancers and their association with rural living and radon exposure in Iowa. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2023; 45:925-940. [PMID: 35381949 PMCID: PMC8983034 DOI: 10.1007/s10653-022-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Primary bone and joint cancers are rare and understudied, yet these neoplasms are difficult to treat and impact all age groups. To explore the long-term changes in the occurrence of bone and joint cancers, patients diagnosed with these neoplasms between 1975 and 2016 were identified in the Surveillance Epidemiology and End Results of the National Cancer Institute of the USA. The age-adjusted incidence (AAIR) and mortality (AAMR) rates were calculated for three decades and compared to AAIR and AAMR in years 1975-1984. By using the population-based cancer registries of the USA, Iowa was identified as a state with increased cases of bone and joint malignancies. The bone and joint cancer cases in Iowa were correlated with the percentage of rural population, the average farmland size, or the residential radon levels. Results demonstrated that the mean AAIR of bone and joint cancers for US female and male patients (< 50 years of age) increased from 0.57 (95% C.I. 0.55-0.63) and 0.76 (95% C.I. 0.69-0.82) for years 1975-1984 to 0.71 (95% C.I. 0.66-0.76) and 0.94 (95% C.I. 0.87-1.07) for years 2005-2014, respectively. The increase in bone and joint cancer cases in Iowa positively correlated with the percentage rural population (R = 0.222, P < 0.02), and the average farmland size (R = 0.236, P < 0.02) but not the radon levels (R = - 0.038, P < 0.7). The findings revealed that patients younger than 50 years of age and those who resided in rural areas and engaged in farming were more likely to be diagnosed with primary bone and joint cancers.
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Affiliation(s)
- Jonathan D Nilles
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Dooyoung Lim
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Michael P Boyer
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Brittany D Wilson
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Rebekah A Betar
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Holly A Showalter
- Waukee Aspiring Professional Experience (APEX), 295 SE Ashworth Road, Waukee, IA, 50263, USA
| | - Darren Liu
- Department of Public Health, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA
| | - Elitsa A Ananieva
- Department of Biochemistry and Nutrition, Des Moines University, 3200 Grand Avenue, Des Moines, IA, 50312, USA.
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Palmer JD, Prasad RN, Cioffi G, Kruchtko C, Zaorsky NG, Trifiletti DM, Gondi V, Brown PD, Perlow HK, Mishra MV, Chakravarti A, Barnholtz-Sloan JS, Ostrom QT. Exposure to radon and heavy particulate pollution and incidence of brain tumors. Neuro Oncol 2023; 25:407-417. [PMID: 35762336 PMCID: PMC9925706 DOI: 10.1093/neuonc/noac163] [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: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Global incidence for brain tumors varies substantially without explanation. Studies correlating radon exposure and incidence are inconclusive. Particulate pollution has been linked to increased tumor incidence. Particulates may disrupt the blood-brain barrier allowing intracranial exposure to oncogenic radon. We investigated the relationship between exposure to residential radon, particulate pollution, and brain tumor incidence in the United States (US). METHODS County-level median radon testing results and annual air quality index values were obtained and divided into tertiles. Counties without both values were excluded. Four groups of counties were generated: high particulate/high radon (high/high), high/low, low/high, and low/low. Using incidence data from the Central Brain Tumor Registry of the US (provided by CDC's National Program of Cancer Registries and NCI's SEER), annual age-adjusted incidence rates (AAAIRs) by group were generated by behavior. Incidence rate ratios were calculated to examine for significant differences (α = .05). Poisson regression accounting for possible confounders was conducted. RESULTS Counties with available data included 83% of the US population. High/high exposure was significantly associated with increased AAAIR of all non-malignant tumors (up to 26% higher, including most meningiomas) even after accounting for potential confounders. An increased AAAIR was noted for all malignant tumors (up to 10% higher), including glioblastoma, but was negated after accounting for demographic/socioeconomic differences. CONCLUSIONS We present the first report suggesting increased non-malignant brain tumor incidence in regions with high particulate and radon exposure. These findings provide insight into unexplained variation in tumor incidence. Future studies are needed to validate these findings in other populations.
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Affiliation(s)
- Joshua D Palmer
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rahul N Prasad
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA.,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchtko
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Vinai Gondi
- Brain and Spine Tumor Center, Northwestern Medicine Cancer Center and Proton Center, Warrensville, Illinois, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Haley K Perlow
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Arnab Chakravarti
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA.,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.,Center for Biomedical Informatics and Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA.,Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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Criterion Validity of Radon Test Values Reported by a Commercial Laboratory versus the Environmental Protection Agency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063615. [PMID: 35329302 PMCID: PMC8949003 DOI: 10.3390/ijerph19063615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
Objective: Radon exposure is a proven cause of lung cancer and is a possible cause of other diseases. Recently, several ecologic studies explored the correlation of county-wide incidence rates for non-lung cancers with residential radon levels, using radon data reported by a commercial laboratory. However, the validity of the commercial radon data, i.e., whether they are an accurate representation of the radon levels in the counties from which they were drawn, is unknown. Methods: We compared county-wide radon data from the commercial laboratory with corresponding measurements from the same counties reported previously by the Environmental Protection Agency (EPA). Matching data were available for four states, Iowa, North Dakota, Texas, and Wisconsin, and were compared by paired t-tests. Criterion validity of the commercial tests, i.e., how well the commercial data predicted the EPA data, was tested using non-parametric methods, Kendall’s tau, Lin’s concordance, and Passing−Bablok regression. Results: The commercial and EPA data pairs from the four states were significantly positively correlated, although the size of the correlations was modest (tau = 0.490, Lin = 0.600). Passing−Bablok regression indicated that the commercial radon values were significantly higher than their EPA pairs and significantly overestimated radon at low levels (<4 pCi/L, p < 0.001). Conclusions: The commercial laboratory data were moderately predictive of EPA radon levels at the county level but were significantly biased upwards at low levels. The disagreement likely has several causes, including selection bias from homes that were tested voluntarily. Ecologic studies that employ radon data obtained from commercial laboratories should be interpreted with caution.
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Mozzoni P, Pinelli S, Corradi M, Ranzieri S, Cavallo D, Poli D. Environmental/Occupational Exposure to Radon and Non-Pulmonary Neoplasm Risk: A Review of Epidemiologic Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10466. [PMID: 34639764 PMCID: PMC8508162 DOI: 10.3390/ijerph181910466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Abstract
Although Radon (Rn) is a known agent for lung cancer, the link between Rn exposure and other non-pulmonary neoplasms remains unclear. The aim of this review is to investigate the role of Rn in the development of tumors other than lung cancer in both occupational and environmental exposure. Particularly, our attention has been focused on leukemia and tumors related to brain and central nervous system (CNS), skin, stomach, kidney, and breast. The epidemiologic literature has been systematically reviewed focusing on workers, general population, and pediatric population. A weak increase in leukemia risk due to Rn exposure was found, but bias and confounding factors cannot be ruled out. The results of studies conducted on stomach cancer are mixed, although with some prevalence for a positive association with Rn exposure. In the case of brain and CNS cancer and skin cancer, results are inconclusive, while no association was found for breast and kidney cancers. Overall, the available evidence does not support a conclusion that a causal association has been established between Rn exposure and the risk of other non-pulmonary neoplasms mainly due to the limited number and heterogeneity of existing studies. To confirm this result, a statistical analysis should be necessary, even if it is now not applicable for the few studies available.
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Affiliation(s)
- Paola Mozzoni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (P.M.); (S.P.); (M.C.); (S.R.)
- Centre for Research in Toxicology (CERT), University of Parma, Via A. Gramsci 14, 43126 Parma, Italy
| | - Silvana Pinelli
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (P.M.); (S.P.); (M.C.); (S.R.)
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (P.M.); (S.P.); (M.C.); (S.R.)
- Centre for Research in Toxicology (CERT), University of Parma, Via A. Gramsci 14, 43126 Parma, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (P.M.); (S.P.); (M.C.); (S.R.)
| | - Delia Cavallo
- INAIL Research, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy;
| | - Diana Poli
- INAIL Research, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00078 Monte Porzio Catone, Italy;
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Williamson MR, Klug MG, Schwartz GG. Brain cancer incidence rates and the presence of nuclear reactors in US states: a hypothesis-generating study. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:3967-3975. [PMID: 33768349 PMCID: PMC8463636 DOI: 10.1007/s10653-021-00896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The etiology of brain cancer is poorly understood. The only confirmed environmental risk factor is exposure to ionizing radiation. Because nuclear reactors emit ionizing radiation, we examined brain cancer incidence rates in the USA in relation to the presence of nuclear reactors per state. METHODS Data on brain cancer incidence rates per state for Whites by sex for three age groups (all ages, 50 and older, and under 50) were obtained from cancer registries. The location, number, and type of nuclear reactor, i.e., power or research reactor, was obtained from public sources. We examined the association between these variables using multivariate linear regression and ANOVA. RESULTS Brain cancer incidence rates were not associated with the number of nuclear power reactors. Conversely, incidence rates per state increased with the number of nuclear research reactors. This was significant for both sexes combined and for males in the 'all ages' category (β = 0.08, p = 0.0319 and β = 0.12, p = 0.0277, respectively), and for both sexes combined in the'50 and older' category (β = 0.18, p = 0.0163). Brain cancer incidence rates for counties with research reactors were significantly higher than the corresponding rates for their states overall (p = 0.0140). These findings were not explicable by known confounders. CONCLUSIONS Brain cancer incidence rates are positively associated with the number of nuclear research reactors per state. These findings merit further exploration and suggest new opportunities for research in brain cancer epidemiology.
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Affiliation(s)
- Mark R Williamson
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Marilyn G Klug
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Gary G Schwartz
- Department of Population Health, School of Medicine & Health Sciences, University of North Dakota, 1301 N Columbia Rd Stop 9037, Grand Forks, ND, 58202-9037, USA.
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