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Chang ET, Ye W, Zeng YX, Adami HO. The Evolving Epidemiology of Nasopharyngeal Carcinoma. Cancer Epidemiol Biomarkers Prev 2021; 30:1035-1047. [PMID: 33849968 DOI: 10.1158/1055-9965.epi-20-1702] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The epidemiology of nasopharyngeal carcinoma (NPC) has long been a source of fascination due to the malignancy's striking geographic distribution, the involvement of the oncogenic Epstein-Barr virus (EBV), the unique association with intake of Chinese-style salt-preserved fish, and etiologic heterogeneity by histologic subtype. METHODS This review summarizes the current epidemiologic literature on NPC, highlighting recent results from our population-based case-control study in southern China. RESULTS Findings from our case-control study provide new insight into the epidemiology of NPC, including a diminished role of Chinese-style salt-preserved fish, a profound impact of EBV genetic sequence variation, modest positive associations with passive smoking and household air pollution, and possible effects of oral health and the oral microbiome. Recent findings from other studies include a protective association with infectious mononucleosis, suggesting a causal role of early EBV infection; familial risk conferred by shared genetic variation in the host antibody-mediated immune response to EBV infection; and an unclear association with occupational exposure to formaldehyde. CONCLUSIONS To shed further light on the interplay of environmental, genetic, and viral causes of NPC, large pooled studies must accumulate sufficient cases with detailed exposure data. IMPACT New epidemiologic findings have reshaped the causal model for NPC.
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Affiliation(s)
- Ellen T Chang
- Center for Health Sciences, Exponent, Inc., Menlo Park, California.
- Department of Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, and Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Beijing Hospital, Beijing, P.R. China
| | - Hans-Olov Adami
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Clinical Effectiveness Group, Institute of Health and Society, University of Oslo, Oslo, Norway
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Andersen ME, Gentry PR, Swenberg JA, Mundt KA, White KW, Thompson C, Bus J, Sherman JH, Greim H, Bolt H, Marsh GM, Checkoway H, Coggon D, Clewell HJ. Considerations for refining the risk assessment process for formaldehyde: Results from an interdisciplinary workshop. Regul Toxicol Pharmacol 2019; 106:210-223. [PMID: 31059732 DOI: 10.1016/j.yrtph.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 01/06/2023]
Abstract
Anticipating the need to evaluate and integrate scientific evidence to inform new risk assessments or to update existing risk assessments, the Formaldehyde Panel of the American Chemistry Council (ACC), in collaboration with the University of North Carolina, convened a workshop: "Understanding Potential Human Health Cancer Risk - From Data Integration to Risk Evaluation" in October 2017. Twenty-four (24) invited-experts participated with expertise in epidemiology, toxicology, science integration and risk evaluation. Including members of the organizing committee, there were 29 participants. The meeting included eleven presentations encompassing an introduction and three sessions: (1) "integrating the formaldehyde science on nasal/nasopharyngeal carcinogenicity and potential for causality"; (2) "integrating the formaldehyde science on lymphohematopoietic cancer and potential for causality; and, (3) "formaldehyde research-data suitable for risk assessment". Here we describe key points from the presentations on epidemiology, toxicology and mechanistic studies that should inform decisions about the potential carcinogenicity of formaldehyde in humans and the discussions about approaches for structuring an integrated, comprehensive risk assessment for formaldehyde. We also note challenges expected when attempting to reconcile divergent results observed from research conducted within and across different scientific disciplines - especially toxicology and epidemiology - and in integrating diverse, multi-disciplinary mechanistic evidence.
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Affiliation(s)
- Melvin E Andersen
- ScitoVation LLC, 100 Capitola Drive, Drive 106, Durham, NC, 27713, USA.
| | | | - James A Swenberg
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth A Mundt
- Ramboll US Corporation, Amherst, MA (currently with Cardno Chemrisk, Boston, MA, USA
| | | | | | - James Bus
- Center for Toxicology and Mechanistic Biology, Exponent, Alexandria, VA, USA
| | | | | | - Hermann Bolt
- Leibniz Institute for Working Environment and Human Factors (IfADo), Dortmund, Germany
| | - Gary M Marsh
- Department of Biostatistics, Center for Occupational Biostatistics and Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Harvey Checkoway
- University of California, San Diego, Department of Family Medicine and Public Health, USA
| | - David Coggon
- MRC Lifecourse Epidemiology Unit, University of Southampton, United Kingdom
| | - Harvey J Clewell
- Ramboll US Corporation, 6 Davis Drive, Suite 13, Research Triangle Park, NC, 27709, USA
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Mundt KA, Gentry PR, Dell LD, Rodricks JV, Boffetta P. Six years after the NRC review of EPA's Draft IRIS Toxicological Review of Formaldehyde: Regulatory implications of new science in evaluating formaldehyde leukemogenicity. Regul Toxicol Pharmacol 2017; 92:472-490. [PMID: 29158043 DOI: 10.1016/j.yrtph.2017.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/27/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Abstract
Shortly after the International Agency for Research on Cancer (IARC) determined that formaldehyde causes leukemia, the United States Environmental Protection Agency (EPA) released its Draft IRIS Toxicological Review of Formaldehyde ("Draft IRIS Assessment"), also concluding that formaldehyde causes leukemia. Peer review of the Draft IRIS Assessment by a National Academy of Science committee noted that "causal determinations are not supported by the narrative provided in the draft" (NRC 2011). They offered recommendations for improving the Draft IRIS assessment and identified several important research gaps. Over the six years since the NRC peer review, significant new science has been published. We identify and summarize key recommendations made by NRC and map them to this new science, including extended analysis of epidemiological studies, updates of earlier occupational cohort studies, toxicological experiments using a sensitive mouse strain, mechanistic studies examining the role of exogenous versus endogenous formaldehyde in bone marrow, and several critical reviews. With few exceptions, new findings are consistently negative, and integration of all available evidence challenges the earlier conclusions that formaldehyde causes leukemia. Given formaldehyde's commercial importance, environmental ubiquity and endogenous production, accurate hazard classification and risk evaluation of whether exposure to formaldehyde from occupational, residential and consumer products causes leukemia are critical.
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Affiliation(s)
- Kenneth A Mundt
- Environment and Health, Ramboll Environ, Amherst MA, United States.
| | - P Robinan Gentry
- Environment and Health, Ramboll Environ, Amherst MA, United States
| | - Linda D Dell
- Environment and Health, Ramboll Environ, Amherst MA, United States
| | | | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nielsen GD, Larsen ST, Wolkoff P. Re-evaluation of the WHO (2010) formaldehyde indoor air quality guideline for cancer risk assessment. Arch Toxicol 2017; 91:35-61. [PMID: 27209488 PMCID: PMC5225186 DOI: 10.1007/s00204-016-1733-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/27/2016] [Indexed: 11/11/2022]
Abstract
In 2010, the World Health Organization (WHO) established an indoor air quality guideline for short- and long-term exposures to formaldehyde (FA) of 0.1 mg/m3 (0.08 ppm) for all 30-min periods at lifelong exposure. This guideline was supported by studies from 2010 to 2013. Since 2013, new key studies have been published and key cancer cohorts have been updated, which we have evaluated and compared with the WHO guideline. FA is genotoxic, causing DNA adduct formation, and has a clastogenic effect; exposure-response relationships were nonlinear. Relevant genetic polymorphisms were not identified. Normal indoor air FA concentrations do not pass beyond the respiratory epithelium, and therefore FA's direct effects are limited to portal-of-entry effects. However, systemic effects have been observed in rats and mice, which may be due to secondary effects as airway inflammation and (sensory) irritation of eyes and the upper airways, which inter alia decreases respiratory ventilation. Both secondary effects are prevented at the guideline level. Nasopharyngeal cancer and leukaemia were observed inconsistently among studies; new updates of the US National Cancer Institute (NCI) cohort confirmed that the relative risk was not increased with mean FA exposures below 1 ppm and peak exposures below 4 ppm. Hodgkin's lymphoma, not observed in the other studies reviewed and not considered FA dependent, was increased in the NCI cohort at a mean concentration ≥0.6 mg/m3 and at peak exposures ≥2.5 mg/m3; both levels are above the WHO guideline. Overall, the credibility of the WHO guideline has not been challenged by new studies.
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Affiliation(s)
- Gunnar Damgård Nielsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark.
| | - Søren Thor Larsen
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Peder Wolkoff
- National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
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Respiratory Symptoms due to Occupational Exposure to Formaldehyde and MDF Dust in a MDF Furniture Factory in Eastern Thailand. Adv Prev Med 2016; 2016:3705824. [PMID: 28119784 PMCID: PMC5227115 DOI: 10.1155/2016/3705824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/09/2016] [Accepted: 11/24/2016] [Indexed: 11/17/2022] Open
Abstract
The study aimed to investigate factors associated with respiratory symptoms in workers in a medium-density fiberboard (MDF) furniture factory in Eastern Thailand. Data were collected from 439 employees exposed to formaldehyde and MDF dust using questionnaire and personal sampler (Institute of Occupational Medicine; IOM). The average concentration of formaldehyde from MDF dust was 2.62 ppm (SD 367), whereas the average concentration of MDF dust itself was 7.67 mg/m3 (SD 3.63). Atopic allergic history was a factor associated with respiratory irritation symptoms and allergic symptoms among the workers exposed to formaldehyde and were associated with respiratory irritation symptoms and allergic symptoms among those exposed to MDF dust. Exposure to MDF dust at high level (>5 mg/m3) was associated with respiratory irritation symptoms and allergic symptoms. Excluding allergic workers from the study population produced the same kind of results in the analysis as in all workers. The symptoms were associated with the high concentrations of formaldehyde and MDF dust in this factory. If the concentration of MDF dust was >5 mg/m3, the risk of irritation and allergic symptoms in the respiratory system increased. The respiratory health of the employees with atopic allergic history exposed to formaldehyde and MDF dust should be monitored closely.
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Marsh GM, Morfeld P, Zimmerman SD, Liu Y, Balmert LC. An updated re-analysis of the mortality risk from nasopharyngeal cancer in the National Cancer Institute formaldehyde worker cohort study. J Occup Med Toxicol 2016; 11:8. [PMID: 26937249 PMCID: PMC4774098 DOI: 10.1186/s12995-016-0097-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether the National Cancer Institute's (NCI) suggestion of a persistent increased mortality risk for nasopharyngeal cancer (NPC) in relation to formaldehyde (FA) exposure is robust with respect to alternative methods of data analysis. METHODS NCI provided the cohort data updated through 2004. We computed U.S. and local county rate-based standardized mortality ratios (SMRs) and internal cohort rate-based relative risks (RR) in relation to four formaldehyde exposure metrics (highest peak, average intensity, cumulative, and duration of exposure), using both NCI categories and alternative categorizations. We modeled the plant group-related interaction structure using continuous and categorical forms of each FA exposure metric and evaluated the impact of NCI's decision to exclude non-exposed workers from the baseline category. RESULTS Overall, our results corroborate the findings of our earlier reanalyses of data from the 1994 NCI cohort update. Six of 11 NPC deaths observed in the NCI study occurred in Plant 1, two (including the only additional NPC death) occurred in Plant 3 among workers in the lowest exposure category of highest peak, average intensity and cumulative FA exposure and in the second exposure category of duration of exposure, and the remaining cases occurred individually in three of eight remaining plants. A large, statistically significant, local rate-based NPC SMR of 7.34 (95 % CI = 2.69-15.97) among FA-exposed workers in Plant 1 contrasted with an 18 % deficit in NPC deaths (SMR = 0.82, 95 % CI = .17-2.41) among exposed workers in Plants 2-10. Overall, the new NCI findings led to: (1) reduced SMRs and RRs in the remaining nine study plants in unaffected exposure categories, (2) attenuated exposure-response relations for FA and NPC for all the FA metrics considered and (3) strengthened and expanded evidence that the earlier NCI internal analyses were non-robust and mis-specified as they did not account for a statistically significant interaction structure between plant group (Plant 1 vs. Plants 2-10) and FA exposure. CONCLUSIONS Our updated reanalysis provided little or no evidence to support NCI's suggestion of a persistent association between FA exposure and mortality from NPC. NCI's suggestion continues to be driven heavily by anomalous findings in one study plant (Plant 1).
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Affiliation(s)
- Gary M. Marsh
- />Center for Occupational Biostatistics and Epidemiology and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 USA
| | - Peter Morfeld
- />Institute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive Research, University of Cologne, Cologne, Germany
- />Institute for Occupational Epidemiology and Risk Assessment of Evonik Industries, Essen, Germany
| | - Sarah D. Zimmerman
- />Center for Occupational Biostatistics and Epidemiology and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 USA
| | - Yimeng Liu
- />Center for Occupational Biostatistics and Epidemiology and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 USA
| | - Lauren C. Balmert
- />Center for Occupational Biostatistics and Epidemiology and Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261 USA
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Abstract
Hair cosmetics are an important tool that helps to increase patient's adhesion to alopecia and scalp treatments. This article reviews the formulations and the mode of action of hair cosmetics: Shampoos, conditioners, hair straightening products, hair dyes and henna; regarding their prescription and safetiness. The dermatologist's knowledge of hair care products, their use, and their possible side effects can extend to an understanding of cosmetic resources and help dermatologists to better treat hair and scalp conditions according to the diversity of hair types and ethnicity.
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Affiliation(s)
- Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Fluminense Federal University, Niterói, Brazil
- Department of Dermatology, Azulay Dermatology Institute, Rio de Janeiro, Brazil
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