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Ramanathan G, Hoover BM, Fleischman AG. Impact of Host, Lifestyle and Environmental Factors in the Pathogenesis of MPN. Cancers (Basel) 2020; 12:E2038. [PMID: 32722135 PMCID: PMC7463688 DOI: 10.3390/cancers12082038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
Philadelphia-negative myeloproliferative neoplasms (MPNs) occur when there is over-production of myeloid cells stemming from hematopoietic stem cells with constitutive activation of JAK/STAT signaling, with JAK2V617F being the most commonly occurring somatic driver mutation. Chronic inflammation is a hallmark feature of MPNs and it is now evident that inflammation is not only a symptom of MPN but can also provoke development and precipitate progression of disease. Herein we have considered major MPN driver mutation independent host, lifestyle, and environmental factors in the pathogenesis of MPN based upon epidemiological and experimental data. In addition to the traditional risk factors such as advanced age, there is evidence to indicate that inflammatory stimuli such as smoking can promote and drive MPN clone emergence and expansion. Diet induced inflammation could also play a role in MPN clonal expansion. Recognition of factors associated with MPN development support lifestyle modifications as an emerging therapeutic tool to restrain inflammation and diminish MPN progression.
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Affiliation(s)
- Gajalakshmi Ramanathan
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92617, USA;
| | - Brianna M Hoover
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA;
| | - Angela G Fleischman
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92617, USA;
- Department of Biological Chemistry, University of California, Irvine, CA 92617, USA;
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2
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Le M, Ghazawi FM, Rahme E, Alakel A, Netchiporouk E, Savin E, Zubarev A, Glassman SJ, Sasseville D, Popradi G, Litvinov IV. Identification of significant geographic clustering of polycythemia vera cases in Montreal, Canada. Cancer 2019; 125:3953-3959. [PMID: 31381139 DOI: 10.1002/cncr.32417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Polycythemia vera (PV) is a chronic myeloproliferative neoplasm associated at times with debilitating symptoms and a significant mortality rate. Understanding the demographics, epidemiology, and geography of this disease may provide further insight into important risk factors associated with its development. The objective of this study was to analyze patient demographics, incidence, and mortality rates, as well as the geographic distribution of PV patients in Canada between 1992 and 2010. METHODS This study was achieved by analyzing the Canadian Cancer Registry, Le Registre Québécois du Cancer, and the Canadian Vital Statistics patient databases. RESULTS A total of 4645 patients were diagnosed with PV between 1992 and 2010. While the annual incidence rate of this cancer fluctuated in Canada, mortality rate analysis indicated a decreasing trend. Geographically, PV incidence rates were notably elevated in the province of Quebec compared with the Canadian average. Further analysis of high-incidence forward sortation areas indicated a striking clustering of cases in the H4W region encompassing the Côte-Saint-Luc borough of Montreal, with an incidence of 102.97 (95% confidence interval, 75.11-137.79) cases per million per year, which is >13 times the national average. CONCLUSION The residential area of Côte-Saint-Luc is an important PV cluster in Canada, with high concentration of retirement homes and geriatric hospices. Also, Jewish residents comprise >60% of the population in this neighborhood. These findings suggest that an older age and, potentially, an inherent genetic predisposition may be implicated in the pathogenesis of this malignancy. This study provides a comprehensive overview of PV burden/geographic distribution of cases in Canada.
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Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | - Akram Alakel
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | | | - Evgeny Savin
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Andrei Zubarev
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Steven J Glassman
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Gizelle Popradi
- Division of Hematology, McGill University, Montreal, Quebec, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, Québec, Canada.,Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
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Irvin-Barnwell EA, Benson KM, Lu M, Ragin A, Wheeler J, Hoffman R. Environmental Toxins Found Historically in the Polycythemia Vera Cluster Area and their Potential for Inducing DNA Damage. ACTA ACUST UNITED AC 2018; 8. [PMID: 34094707 PMCID: PMC8176869 DOI: 10.4172/2161-0525.1000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2006, the Agency for Toxic Substances and Disease Registry received a request to determine whether a cluster of polycythemia vera patients existed in a northeast Pennsylvania community. A significant cluster of PV cases was identified at the nexus of three counties near several hazardous waste sites. The current study evaluated the potential for a select number of environmental contaminants previously detected in the cluster area to induce DNA damage using in vitro assays with hematopoietic stem-cell derived progenitor cells. CD34+ cells were isolated from normal cord blood samples and were cultured for 48–72 hours to generate erythroid progenitor cells. Eighteen compounds were chosen for the assay; arsenic trioxide, benzo(a)pyrene, benzene, methylene chloride, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), trichloroethylene, potassium chloride, ethylbenzene, benzo[k]fluoranthene, styrene, cadmium chloride, hydroquinone, 1,1,1-trichloroethane, sodium cyanide, manganese chloride, chromium oxide, lead oxide, and sodium arsenite. Genotoxicity of the compounds was determined using the comet assay, and toxicity determined via the cell viability assay. Using the comet assay, 16 compounds at 10 nM concentration, induced a significant amount of DNA damage compared to the control. When evaluating whether a dose-dependent relationship was present, seventeen of the eighteen compounds led to greater DNA damage with increasing exposure concentrations. 2,3,7,8-TCDD was particularly potent, inducing DNA damage in virtually all cells at 1 μM. In conclusion, most of the toxins evaluated using the comet assay showed potential to induce DNA damage in hematopoietic cells, and the genotoxic effects were dose-dependent.
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Affiliation(s)
| | - K M Benson
- Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - M Lu
- Icahn School of Medicine, Mt. Sinai, New York, NY, USA
| | - A Ragin
- Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - J Wheeler
- Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - R Hoffman
- Icahn School of Medicine, Mt. Sinai, New York, NY, USA
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Migliaccio AR. A vicious interplay between genetic and environmental insults in the etiology of blood cancers. Exp Hematol 2017; 59:9-13. [PMID: 29248611 DOI: 10.1016/j.exphem.2017.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
Over the years, the etiology of cancer has been attributed alternatively to genetic and environmental insults. According to the genetic hypothesis, cancer cells arise from the acquisition of mutations that dysregulate the intrinsic mechanisms controlling normal cell growth and survival. In contrast, the environmental hypothesis holds that cancer can be caused by multiple extrinsic challenges that alter normal tissue homeostasis, but may not necessarily involve mutations. It is, however, quite possible that these two mechanisms are not mutually exclusive. According to this third hypothesis, environmental challenges, by mechanisms still poorly understood, may act by imposing a selection pressure that confers a proliferative advantage on cells carrying specific driver mutations, leading to disease initiation. The authors of a brief report published in this journal (Exp Hematol. 2017;56:1-6) tested this third hypothesis experimentally and provide new evidence that chronic inflammation, by increasing tumor necrosis factor (TNF)-α, may positively select malignant hematopoietic stem cells (HSCs) carrying loss-of-function TET2 mutations that switch the TNF-α signaling responses to activate proliferation rather than inducing quiescence. Furthermore, these mutations skew hematopoietic differentiation toward the myelomonocytic lineage and the output of macrophages producing TNF-α constitutively, promoting further environment-independent expansion of the malignant HSCs. These findings support a model in which the formation of a malignant population is triggered by a vicious interplay between genetic (TET2 mutations) and environmental (inflammation) insults, suggesting the need for strategies that target both the malignant cells and their environment.
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Affiliation(s)
- Anna Rita Migliaccio
- Department of Biomedical and Neuromotorial Sciences, Alma Mater University, Bologna, Italy; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York.
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Heavner K, Gross-Davis CA, Frank AL, Newschaffer C, Klotz J, Burstyn I. Working environment and myeloproliferative neoplasm: A population-based case-control study following a cluster investigation. Am J Ind Med 2015; 58:595-604. [PMID: 25880722 DOI: 10.1002/ajim.22451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Occupational exposures, including those to polycyclic aromatic hydrocarbons (PAH), are suspected risk factors for myeloproliferative neoplasms (MPN). METHODS We investigated occupational exposures and MPN risk (54 cases and 472 controls) in a population-based case-control study in three rural Pennsylvania counties. Occupational histories, coded to SIC/SOC 1980, were linked to a previously created PAH job-exposure matrix. Odds ratios for industry (17 categories), occupation (26 categories), and PAH exposure were adjusted using logistic regression. RESULTS No industries or occupations were strongly or consistently associated with increased MPN risk. Analysis of employment duration found that being employed for 5 or more years in transportation, communications, and other public utilities was associated with MPN risk. There was no indication of an association with cumulative PAH exposure. CONCLUSIONS These few associations did not appear to have a common exposure. This exploratory study does not support the hypothesis that occupational exposure, including PAH, are strong risk factors for MPNs.
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Affiliation(s)
- Karyn Heavner
- Department of Environmental and Occupational Health; Drexel University; Philadelphia Pennsylvania
| | - Carol Ann Gross-Davis
- Department of Environmental and Occupational Health; Drexel University; Philadelphia Pennsylvania
- Environmental Protection Agency; Region 3; Philadelphia Pennsylvania
| | - Arthur L. Frank
- Department of Environmental and Occupational Health; Drexel University; Philadelphia Pennsylvania
| | - Craig Newschaffer
- Drexel University; A.J. Drexel Autism Institute; Philadelphia Pennsylvania
- Drexel University; Department of Epidemiology and Biostatistics; Philadelphia Pennsylvania
| | - Judith Klotz
- Department of Environmental and Occupational Health; Drexel University; Philadelphia Pennsylvania
| | - Igor Burstyn
- Department of Environmental and Occupational Health; Drexel University; Philadelphia Pennsylvania
- Drexel University; A.J. Drexel Autism Institute; Philadelphia Pennsylvania
- Drexel University; Department of Epidemiology and Biostatistics; Philadelphia Pennsylvania
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6
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Gross-Davis CA, Heavner K, Frank AL, Newschaffer C, Klotz J, Santella RM, Burstyn I. The role of genotypes that modify the toxicity of chemical mutagens in the risk for myeloproliferative neoplasms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2465-85. [PMID: 25719551 PMCID: PMC4377912 DOI: 10.3390/ijerph120302465] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/12/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The etiology of myeloproliferative neoplasms (MPN) (polycythemia vera; essential thrombocythemia; primary myelofibrosis) is unknown, however they are associated with a somatic mutation--JAK2 V617F--suggesting a potential role for environmental mutagens. METHODS We conducted a population-based case-control study in three rural Pennsylvania counties of persons born 1921-1968 and residing in the area between 2000-2008. Twenty seven MPN cases and 292 controls were recruited through random digit dialing. Subjects were genotyped and odds ratios estimated for a select set of polymorphisms in environmentally sensitive genes that might implicate specific environmental mutagens if found to be associated with a disease. RESULTS The presence of NAT2 slow acetylator genotype, and CYP1A2, GSTA1, and GSTM3 variants were associated with an average 3-5 fold increased risk. CONCLUSIONS Exposures, such as to aromatic compounds, whose toxicity is modified by genotypes associated with outcome in our analysis may play a role in the environmental etiology of MPNs.
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Affiliation(s)
- Carol Ann Gross-Davis
- Environmental Protection Agency, Region 3, 1650 Arch Street, Philadelphia, PA 19103, USA.
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Karyn Heavner
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Arthur L Frank
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Craig Newschaffer
- Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA.
| | - Judith Klotz
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Regina M Santella
- Department of Environmental Health Services, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA 19104, USA.
- Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA.
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7
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Roda P, Ferrari A, Tang X, Erlich P, Eisenhower C, Patel MD, Irvin-Barnwell EA. Determination of accuracy of polycythemia vera diagnoses and use of the JAK2V617F test in the diagnostic scheme. Ann Hematol 2014; 93:1467-72. [PMID: 24687383 DOI: 10.1007/s00277-014-2068-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/18/2014] [Indexed: 01/11/2023]
Abstract
In 2005, three independent research groups described the presence of a specific mutation in the JAK2 gene, JAK2V617F, in patients with a Philadelphia chromosome-negative myeloproliferative neoplasm (MPN). The percentage of patients with the mutation varied according to specific disease with >98 % of polycythemia vera (PV) patients having the mutation. In 2008, the World Health Organization issued new diagnostic criteria for PV including use of the JAK2V617F test as a major diagnostic criterion. The goal of the present study is to determine the accuracy of diagnosing PV in a community practice and reporting of PV to cancer registries, as well as assessing the integration of molecular testing into diagnostic paradigms. Using Geisinger Medical Center's electronic medical records (EMR), patients with a PV diagnosis being seen by a hematologist/oncologist during 2004-2009 were identified. Records were reviewed by a single hematologist/oncologist to determine accuracy of the treating physician's diagnosis and use of the molecular test for the JAK2V617F mutation. There was a diagnosis of PV from the treating physicians in 121 of the 204 evaluable patients (59 %) and another MPN in 21 (10 %). However, we confirmed a PV diagnosis in only 90 patients (44 %). Of the 90 confirmed PV patients, 64 were JAK2V617F-mutation positive while 24 were not tested. While JAK2V617F testing has made a major impact in facilitating the successful delineation of the type of polycythemia (PV versus secondary polycythemia) in patients evaluated in a large, community-based Hematology/Oncology practice, physician usage of other critical tests is inconsistent leading to errors in diagnosis. JAK2V617F mutation testing in combination with other diagnostic criteria may help reduce diagnostic errors.
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Affiliation(s)
- Paul Roda
- Geisinger Health System, 100 N. Academy Ave., Danville, PA, 17822, USA
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8
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Abstract
Major advances in myeloproliferative neoplasms in the last decade have cast light on their complexity. The identification of JAK2 (V617F) briefly promised a unifying mechanism of pathogenesis with a single pathway that could be efficiently targeted. Instead, there have been major advances in understanding acquired and background genetic and epigenetic contributors to this group of disorders, with refined risk prediction models and experimental therapeutics that have provided a more nuanced model of disease. In aggregate these observations likely explain the heterogeneity of these disorders and their generally unpredictable response to therapy. Molecular studies, beginning with the identification of JAK2 (V617F), have led to a concept of MPN subtypes existing on a continuum, and additional discoveries such as TET2 and EZH2 mutations have provided the molecular underpinnings to begin to explain overlapping phenotypes in myeloid malignancies more generally. In many ways the pace of molecular discovery is outstripping our ability to integrate these observations into clinical care, both in terms of molecular diagnostics and medical decision making. This review will attempt to summarize, within a clinical context, our evolving understanding of myeloproliferative neoplasms. It focuses on biology, histopathology, prognostic scoring systems, stem cell transplantation as well as selected clinical/preclinical therapeutic observations.
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Affiliation(s)
- Harper G Hubbeling
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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9
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Kremyanskaya M, Mascarenhas J, Hoffman R. Why Does My Patient Have Erythrocytosis? Hematol Oncol Clin North Am 2012; 26:267-83, vii-viii. [DOI: 10.1016/j.hoc.2012.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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Seaman V, Dearwent SM, Gable D, Lewis B, Metcalf S, Orloff K, Tierney B, Zhu J, Logue J, Marchetto D, Ostroff S, Hoffman R, Xu M, Carey D, Erlich P, Gerhard G, Roda P, Iannuzzo J, Lewis R, Mellow J, Mulvihill L, Myles Z, Wu M, Frank A, Gross-Davis CA, Klotz J, Lynch A, Weissfeld J, Weinberg R, Cole H. A multidisciplinary investigation of a polycythemia vera cancer cluster of unknown origin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1139-52. [PMID: 20617023 PMCID: PMC2872321 DOI: 10.3390/ijerph7031139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 03/13/2010] [Accepted: 03/16/2010] [Indexed: 11/16/2022]
Abstract
Cancer cluster investigations rarely receive significant public health resource allocations due to numerous inherent challenges and the limited success of past efforts. In 2008, a cluster of polycythemia vera, a rare blood cancer with unknown etiology, was identified in northeast Pennsylvania. A multidisciplinary group of federal and state agencies, academic institutions, and local healthcare providers subsequently developed a multifaceted research portfolio designed to better understand the cause of the cluster. This research agenda represents a unique and important opportunity to demonstrate that cancer cluster investigations can produce desirable public health and scientific outcomes when necessary resources are available.
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Affiliation(s)
- Vincent Seaman
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-770-488-3682; Fax: +1-770-488-1537
| | - Steve M Dearwent
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Debra Gable
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Brian Lewis
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Susan Metcalf
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Ken Orloff
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Bruce Tierney
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - Jane Zhu
- Agency for Toxic Substances and Disease Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA; E-Mails:
(S.D.);
(D.G.);
(B.L.);
(S.M.);
(K.O.);
(B.T.);
(J.Z.)
| | - James Logue
- Pennsylvania Department of Health, 7 & Forster Streets, Harrisburg, PA 17120, USA; E-Mails:
(J.L.);
(D.M.);
(S.O.)
| | - David Marchetto
- Pennsylvania Department of Health, 7 & Forster Streets, Harrisburg, PA 17120, USA; E-Mails:
(J.L.);
(D.M.);
(S.O.)
| | - Stephen Ostroff
- Pennsylvania Department of Health, 7 & Forster Streets, Harrisburg, PA 17120, USA; E-Mails:
(J.L.);
(D.M.);
(S.O.)
| | - Ronald Hoffman
- Mt. Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA; E-Mails:
(R.H.);
(M.X.)
| | - Mingjiang Xu
- Mt. Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029-6574, USA; E-Mails:
(R.H.);
(M.X.)
| | - David Carey
- Geisinger Health System/Clinic, 100 N. Academy Ave, Danville, PA 17822, USA; E-Mails:
(D.C.);
(P.E.);
(G.G.);
(P.R.)
| | - Porat Erlich
- Geisinger Health System/Clinic, 100 N. Academy Ave, Danville, PA 17822, USA; E-Mails:
(D.C.);
(P.E.);
(G.G.);
(P.R.)
| | - Glenn Gerhard
- Geisinger Health System/Clinic, 100 N. Academy Ave, Danville, PA 17822, USA; E-Mails:
(D.C.);
(P.E.);
(G.G.);
(P.R.)
| | - Paul Roda
- Geisinger Health System/Clinic, 100 N. Academy Ave, Danville, PA 17822, USA; E-Mails:
(D.C.);
(P.E.);
(G.G.);
(P.R.)
| | - Joseph Iannuzzo
- Pennsylvania Department of Environmental Protection, 2 Public Square, Wilkes-Barre, PA 18711, USA; E-Mails:
(J.I.);
(R.L.);
(J.M.)
| | - Robert Lewis
- Pennsylvania Department of Environmental Protection, 2 Public Square, Wilkes-Barre, PA 18711, USA; E-Mails:
(J.I.);
(R.L.);
(J.M.)
| | - John Mellow
- Pennsylvania Department of Environmental Protection, 2 Public Square, Wilkes-Barre, PA 18711, USA; E-Mails:
(J.I.);
(R.L.);
(J.M.)
| | - Linda Mulvihill
- Centers for Disease Control and Prevention, National Program of Cancer Registries, 1600 Clifton, Rd NE, Atlanta, GA 30333, USA; E-Mails:
(L.M.);
(Z.M.);
(M.W.)
| | - Zachary Myles
- Centers for Disease Control and Prevention, National Program of Cancer Registries, 1600 Clifton, Rd NE, Atlanta, GA 30333, USA; E-Mails:
(L.M.);
(Z.M.);
(M.W.)
| | - Manxia Wu
- Centers for Disease Control and Prevention, National Program of Cancer Registries, 1600 Clifton, Rd NE, Atlanta, GA 30333, USA; E-Mails:
(L.M.);
(Z.M.);
(M.W.)
| | - Arthur Frank
- Drexel University School of Public Health, 1505 Race Street, Bellet Building 13th Floor, Philadelphia, PA, 19102, USA; E-Mails:
(A.F.);
(C.A.G);
(J.K.)
| | - Carol Ann Gross-Davis
- Drexel University School of Public Health, 1505 Race Street, Bellet Building 13th Floor, Philadelphia, PA, 19102, USA; E-Mails:
(A.F.);
(C.A.G);
(J.K.)
| | - Judith Klotz
- Drexel University School of Public Health, 1505 Race Street, Bellet Building 13th Floor, Philadelphia, PA, 19102, USA; E-Mails:
(A.F.);
(C.A.G);
(J.K.)
| | - Adam Lynch
- Drexel University School of Public Health, 1505 Race Street, Bellet Building 13th Floor, Philadelphia, PA, 19102, USA; E-Mails:
(A.F.);
(C.A.G);
(J.K.)
| | - Joel Weissfeld
- UPMC Cancer Pavilion, 3rd Floor, 5150 Centre Avenue, Pittsburgh, PA 15232, USA; E-Mail:
| | - Rona Weinberg
- New York Blood Center, 310 East 67th Street, 2-47B, New York, NY 10065, USA; E-Mail:
| | - Henry Cole
- Henry S. Cole & Associates, 7611 S. Osborne Rd, Ste 201, Upper Marlboro, MD 20772, USA; E-Mail:
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