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Adeleye AJ, Zablotska L, Rinaudo P, Huang D, Lustig RH, Cedars MI. Study protocol for a Developmental Epidemiological Study of Children born through Reproductive Technologies (DESCRT). Hum Reprod Open 2023; 2023:hoad013. [PMID: 37265937 PMCID: PMC10229433 DOI: 10.1093/hropen/hoad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/23/2023] [Indexed: 06/03/2023] Open
Abstract
STUDY QUESTIONS The primary objective of this study is to determine what parental factors or specific ART may influence the risk for adverse cardiometabolic outcomes among children so conceived and their parents. The secondary objective of this study is to prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes. WHAT IS KNOWN ALREADY Pregnancies conceived with ART are at an increased risk of being affected by adverse obstetric and neonatal outcomes when compared to spontaneously conceived (SC) pregnancies among fertile women. Small cohort studies have suggested ART-conceived children may have a higher risk of long-term cardiometabolic disturbances as well. Currently, few studies have compared long-term cardiometabolic outcomes among ART-conceived children and non-IVF treated (NIFT) children, to children conceived spontaneously to parents with infertility (subfertile parents). STUDY DESIGN SIZE DURATION The Developmental Epidemiological Study of Children born through Reproductive Technologies (DESCRT) is a prospective cohort study that aims to: establish a biobank and epidemiological cohort of children born to subfertile or infertile parents who either conceived spontaneously (without assistance) or used reproductive technologies to conceive (all offspring were from couples assessed and/or treated in the same institute); prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes; and determine what parental factors or ART may influence the cardiometabolic risk of children so conceived. Pregnancies and resultant children will be compared by mode of conception, namely offspring that were conceived without medical assistance or SC or following NIFT, IVF with fresh embryo transfer or frozen embryo transfer (FET), and by fertilization method (conventional versus ICSI). DESCRT has a Child group evaluating long-term outcomes of children as well as a Pregnancy group that will compare obstetric and neonatal outcomes of children conceived since the commencement of the study. Recruitment started in May of 2017 and is ongoing. When the study began, we estimated that ∼4000 children would be eligible for enrollment. PARTICIPANTS/MATERIALS SETTING METHODS Eligible participants are first-trimester pregnancies (Pregnancy group) or children (Child group) born to parents who were evaluated at an infertility center in the University of California, San Francisco, CA, USA who were SC or conceived after reproductive treatments (NIFT, IVF ± ICSI, FET). Children in the Child group were conceived at UCSF and born from 2001 onwards. In the Pregnancy group, enrollment began in November of 2017.The primary outcome is the cardiometabolic health of offspring in the Child group, as measured by blood pressure and laboratory data (homeostatic model assessment for insulin resistance (HOMA-IR), oral glucose disposition). There are several secondary outcome measures, including: outcomes from parental survey response (assessing parent/child medical history since delivery-incidence of cardiometabolic adverse events), anthropomorphic measurements (BMI, waist circumference, skinfold thickness), and laboratory data (liver enzymes, lipid panel, metabolomic profiles). In the Pregnancy group, outcomes include laboratory assessments (bhCG, maternal serum analytes, soluble fms-like tyrosine kinase-1 (sFLT-1), and placental growth factor (PlGF)) and placental assessments (placental volume in the second and third trimester and placental weight at delivery). Importantly, aliquots of blood and urine are stored from parents and offspring as part of a biobank. The DESCRT cohort is unique in two ways. First, there is an extensive amount of clinical and laboratory treatment data: parental medical history and physical examination at the time of treatment, along with ovarian reserve and infertility diagnosis; and treatment specifics: for example, fertilization method, culture O2 status, embryo quality linked to each participant. These reproductive data will aid in identifying explanatory variables that may influence the primary cardiometabolic outcomes of the offspring-and their parents. Second, the DESCRT control group includes pregnancies and children SC from parents with subfertility, which may help to assess when infertility, as opposed to reproductive treatments, may be affecting offspring cardiometabolic health. STUDY FUNDING/COMPETING INTERESTS This study is funded by the National Institutes of Health NICHD (1R01HD084380-01A1). A.J.A. is a shareholder in Carrot and consultant for Flo Health. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER NCT03799107. TRIAL REGISTRATION DATE 10 January 2019. DATE OF FIRST PATIENT’S ENROLLMENT 10 May 2017.
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Affiliation(s)
- A J Adeleye
- Correspondence address. Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The University of Chicago, 5841 South Maryland Avenue, MC 2050, Chicago, IL 60637, USA. E-mail:
| | - L Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - P Rinaudo
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - D Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - R H Lustig
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - M I Cedars
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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Huang D, Qin J, Adeleye A, Rinaudo P, Zablotska L, Cedars MI. EFFECTS OF ASSISTED REPRODUCTIVE TECHNOLOGY (ART) ON MATERNAL SERUM ANALYTES IN AN INFERTILE PATIENT POPULATION. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Avelino-silva V, Zablotska L, Martin J. 591The “Big 6”: A purpose-based framework for motivating and teaching epidemiologic methods. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Focus of Presentation
Many beginning students in health-related fields do not understand the types of questions that epidemiology can address. This results in underappreciation of the relevance of epidemiology. Even students dedicated to learning epidemiology and/or medicine have difficulty identifying the common features of disparate research questions and hence are limited in their ability to critique research. The reasons for these limitations are multifold, but we believe that traditional approaches of teaching epidemiology □ by study design □ is a substantial contributor. To better promote and deepen understanding of epidemiology, we have developed a purpose-based teaching approach called the “Big 6”.
Findings
In courses aimed towards graduate students in epidemiology and medical students, we now introduce what epidemiologic research can do and how to perform it according to the general purpose/goal/objective of research. We focus on six of the most common purposes/goals/objectives - the “Big 6”.
Conclusions
Introducing epidemiology according to general purposes of research (the “Big 6”) gives students a framework to understand the relevance of epidemiology and rapidly critique the validity of epidemiologic research.
Key messages
A purpose-based approach to teaching epidemiology may be more engaging and promote better understanding and application of epidemiologic methods.
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Affiliation(s)
- Vivian Avelino-silva
- University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
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Besson C, Moore A, Wu W, Vajdic CM, de Sanjose S, Camp NJ, Smedby KE, Shanafelt TD, Morton LM, Brewer JD, Zablotska L, Engels EA, Cerhan JR, Slager SL, Han J, Berndt SI. Common genetic polymorphisms contribute to the association between chronic lymphocytic leukaemia and non-melanoma skin cancer. Int J Epidemiol 2021; 50:1325-1334. [PMID: 33748835 DOI: 10.1093/ije/dyab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated a positive association between chronic lymphocytic leukaemia (CLL) and non-melanoma skin cancer (NMSC). We hypothesized that shared genetic risk factors between CLL and NMSC could contribute to the association observed between these diseases. METHODS We examined the association between (i) established NMSC susceptibility loci and CLL risk in a meta-analysis including 3100 CLL cases and 7667 controls and (ii) established CLL loci and NMSC risk in a study of 4242 basal cell carcinoma (BCC) cases, 825 squamous cell carcinoma (SCC) cases and 12802 controls. Polygenic risk scores (PRS) for CLL, BCC and SCC were constructed using established loci. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Higher CLL-PRS was associated with increased BCC risk (OR4th-quartile-vs-1st-quartile = 1.13, 95% CI: 1.02-1.24, Ptrend = 0.009), even after removing the shared 6p25.3 locus. No association was observed with BCC-PRS and CLL risk (Ptrend = 0.68). These findings support a contributory role for CLL in BCC risk, but not for BCC in CLL risk. Increased CLL risk was observed with higher SCC-PRS (OR4th-quartile-vs-1st-quartile = 1.22, 95% CI: 1.08-1.38, Ptrend = 1.36 × 10-5), which was driven by shared genetic susceptibility at the 6p25.3 locus. CONCLUSION These findings highlight the role of pleiotropy regarding the pathogenesis of CLL and NMSC and shows that a single pleiotropic locus, 6p25.3, drives the observed association between genetic susceptibility to SCC and increased CLL risk. The study also provides evidence that genetic susceptibility for CLL increases BCC risk.
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Affiliation(s)
- Caroline Besson
- Service d'hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, 94805, Villejuif, France
| | - Amy Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Wenting Wu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, USA
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Nicola J Camp
- Department of Internal Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Karin E Smedby
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tait D Shanafelt
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - James R Cerhan
- Service d'hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay; Université Paris-Saclay, UVSQ, Inserm, Équipe "Exposome et Hérédité", CESP, 94805, Villejuif, France
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Rodriguez-Almaraz JE, Chang S, Clarke J, Oberheim-Bush NA, Taylor J, Buerki R, Berger M, Zablotska L, Lobach I, Butowski N. A systematic review and meta-analysis examining the effects of cannabis and its derivatives in adults with malignant CNS tumors. Neurooncol Pract 2020; 7:376-383. [PMID: 32765889 DOI: 10.1093/nop/npaa013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Primary CNS tumors constitute a heterogeneous group of neoplasms that share a considerable morbidity and mortality rate. To help control tumor growth and clinical outcomes (overall survival, progression-free survival, quality of life) symptoms, patients often resort to alternative therapies, including the use of cannabis. Despite rapidly growing popularity, cannabis and its impact on patients with primary malignant CNS tumors is understudied. Methods To shed light on the lack of scientific evidence in this field, in November 2018 we conducted a search and examination of cannabis in neuro-oncology in major journal databases and bibliographies of selected articles, and through abstracts of annual meetings using prespecified criteria in line with the Cochrane Collaboration guidelines. Results We identified 45 publications, of which 9 were selected. Five studies were included. Publication dates ranged from 2004 to 2018 and included varying histologies of primary brain tumors. The average survival at 1 year was 56.09% (95% CI: 48.28-63.9). There was no difference in risk ratio (RR) for death at 1 year between groups (RR: 1.069 [95% CI: 0.139-8.25]). We found strong evidence of heterogeneity (Q = 74.0%; P = .021). We found no statistical evidence of publication bias (P = .117; SD = 1.91). Conclusions There was limited moderate-quality evidence that supports the use of cannabinoids as adjuvant to the standard of care in the treatment of brain and CNS tumors. There was very low-quality evidence suggesting that cannabinoids were associated with adult-onset gliomas. Further prospective clinical trials are necessary to adequately evaluate the impact of cannabinoids on CNS tumors, specifically on survival and quality of life.
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Affiliation(s)
| | - Susan Chang
- University of California, San Francisco, Neuro-Oncology Division
| | - Jennifer Clarke
- University of California, San Francisco, Neuro-Oncology Division
| | | | - Jennie Taylor
- University of California, San Francisco, Neuro-Oncology Division
| | - Robin Buerki
- University of California, San Francisco, Neuro-Oncology Division
| | - Mitchel Berger
- University of California, San Francisco, Neuro-Oncology Division
| | - Lydia Zablotska
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Iryna Lobach
- University of California, San Francisco, Department of Epidemiology and Biostatistics
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Sheng Y, Huang C, Lobach S, Zablotska L, Lobach I. Genetic effect estimates in case‐control studies when a continuous variable is omitted from the model. Genet Epidemiol 2020. [DOI: 10.1002/gepi.22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ying Sheng
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco California
| | - Chiung‐Yu Huang
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco California
| | - Siarhei Lobach
- Applied Mathematics and Computer Science DepartmentBelarusian State UniversityMinsk Belarus
| | - Lydia Zablotska
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco California
| | - Iryna Lobach
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan Francisco California
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Lobach I, Sheng Y, Lobach S, Zablotska L, Huang CY. Case-control versus case-only estimates of gene-environment interactions with common and misclassified clinical diagnosis. Genet Epidemiol 2019; 44:4-15. [PMID: 31667895 DOI: 10.1002/gepi.22266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 11/07/2022]
Abstract
Genetic studies provide valuable information to assess if the effect of genetic variants varies by the nongenetic "environmental" variables, what is traditionally defined to be gene-environment interaction (GxE). A common complication is that multiple disease states present with the same set of symptoms, and hence share the clinical diagnosis. Because (a) disease states might have distinct genetic bases; and (b) frequencies of the disease states within the clinical diagnosis vary by the environmental variables, analyses of association with the clinical diagnosis as an outcome variable might result in false positive or false negative findings. We develop estimates for this setting to be able to assess GxE in a case-only study and we compare the case-control and case-only estimates. We report extensive simulation studies that evaluate empirical properties of the estimates and show the application to a study of Alzheimer's disease.
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Affiliation(s)
- Iryna Lobach
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Ying Sheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Siarhei Lobach
- Applied Mathematics and Computer Science Department, Belarusian State University, Minsk, Belarus
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Venado A, McCulloch C, Greenland JR, Katz P, Soong A, Shrestha P, Hays S, Golden J, Shah R, Leard LE, Kleinhenz ME, Kukreja J, Zablotska L, Allen IE, Covinsky K, Blanc P, Singer JP. Frailty trajectories in adult lung transplantation: A cohort study. J Heart Lung Transplant 2019; 38:699-707. [PMID: 31005571 DOI: 10.1016/j.healun.2019.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/31/2019] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Frailty is common in adults with advanced lung disease and is associated with death before and after lung transplantation. We aimed to determine whether frailty changes from before to after the lung transplant. METHODS In a single-center, prospective cohort study among adults undergoing lung transplantation from 2010 to 2017, we assessed frailty by the Short Physical Performance Battery (SPPB; higher scores reflect less frailty) and Fried Frailty Phenotype (FFP; higher scores reflect greater frailty) before and repeatedly up to 36 months after transplant. We tested for changes in frailty scores over time using segmented mixed effects models, adjusting for age, sex, and diagnosis. We quantified the proportion of subjects transitioning between frailty states (frail vs not frail) from before to after the transplant. RESULTS In 246 subjects, changes in frailty occurred within the first 6 post-operative months and remained stable thereafter. The overall change in frailty was attributable to improvements among those subjects who were frail before transplant. They experienced a 5.1-point improvement in SPPB (95% confidence interval [CI] 4.6-5.7) and a 1.8-point improvement in FFP (95% CI -2.1 to -1.6) during the early period. Frailty by SPPB and FFP did not change in those who were not frail before transplant. Approximately 84% of survivors who were frail before transplant became not frail after transplant. CONCLUSIONS Pre-operative frailty resolves in many patients after lung transplantation. Because a large proportion of frailty may be attributable to advanced lung disease, frailty alone should not be an absolute contraindication to transplantation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jasleen Kukreja
- Departments of Surgery, University of California, San Francisco, San Francisco, California, USA
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Rage E, Do M, Demers PA, Fenske N, Kreuzer M, Laurier D, Samet J, Schubauer-Berigan M, Sobotzki C, Tomasek L, Zablotska L, Richardson D. Pooled Uranium Miners Analysis (PUMA): The Setting Up of an International Occupational Cohort. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191404003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lane R, Tomášek L, Zablotska L, Rage E, Momoli F, Little J. Low radon exposures & lung cancer risk: joint analysis of Czech, French & Beaverlodge uranium miners. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191404015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Karpov A, Takhauov R, Zerenkov A, Dolgopolov Y, Izmestev K, Blinov A, Zablotska L. Descriptive characteristics of the cohort of workers from the Siberian Group of Chemical Enterprises (SGCE). BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191404012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ostroumova E, Hatch M, Brenner A, Nadyrov E, Veyalkin I, Polyanskaya O, Yauseyenka V, Polyakov S, Levin L, Zablotska L, Rozhko A, Mabuchi K. Non-thyroid cancer incidence in Belarusian residents exposed to Chernobyl fallout in childhood and adolescence: Standardized Incidence Ratio analysis, 1997-2011. Environ Res 2016; 147:44-49. [PMID: 26851723 PMCID: PMC4821667 DOI: 10.1016/j.envres.2016.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/22/2015] [Accepted: 01/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND While an increased risk of thyroid cancer from post-Chernobyl exposure to Iodine-131 (I-131) in children and adolescents has been well-documented, risks of other cancers or leukemia as a result of residence in radioactively contaminated areas remain uncertain. METHODS We studied non-thyroid cancer incidence in a cohort of about 12,000 individuals from Belarus exposed under age of 18 years to Chernobyl fallout (median age at the time of Chernobyl accident of 7.9 years). During 15 years of follow-up from1997 through 2011, 54 incident cancers excluding thyroid were identified in the study cohort with 142,968 person-years at risk. We performed Standardized Incidence Ratio (SIR) analysis of all solid cancers excluding thyroid (n=42), of leukemia (n=6) and of lymphoma (n=6). RESULTS We found no significant increase in the incidence of non-thyroid solid cancer (SIR=0.83, 95% Confidence Interval [CI]: 0.61; 1.11), lymphoma (SIR=0.66, 95% CI: 0.26; 1.33) or leukemia (SIR=1.78, 95% CI: 0.71; 3.61) in the study cohort as compared with the sex-, age- and calendar-time-specific national rates. These findings may in part reflect the relatively young age of study subjects (median attained age of 33.4 years), and long latency for some radiation-related solid cancers. CONCLUSIONS We found no evidence of statistically significant increases in solid cancer, lymphoma and leukemia incidence 25 years after childhood exposure in the study cohort; however, it is important to continue follow-up non-thyroid cancers in individuals exposed to low-level radiation at radiosensitive ages.
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Affiliation(s)
- Evgenia Ostroumova
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Drive, MSC 9776, Bethesda, 20892 MD, USA.
| | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Drive, MSC 9776, Bethesda, 20892 MD, USA.
| | - Alina Brenner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Drive, MSC 9776, Bethesda, 20892 MD, USA.
| | - Eldar Nadyrov
- The Republican Research Center for Radiation Medicine and Human Ecology, 290 Ilyicha Street, Gomel 246040, Belarus.
| | - Ilya Veyalkin
- The Republican Research Center for Radiation Medicine and Human Ecology, 290 Ilyicha Street, Gomel 246040, Belarus.
| | - Olga Polyanskaya
- The Republican Research Center for Radiation Medicine and Human Ecology, 290 Ilyicha Street, Gomel 246040, Belarus.
| | - Vasilina Yauseyenka
- The Republican Research Center for Radiation Medicine and Human Ecology, 290 Ilyicha Street, Gomel 246040, Belarus.
| | - Semion Polyakov
- State Institution "Republican Scientific and Practical Center for Medical Technologies, Informatization, Administration and Management of Health", 7-a Petrus Brovka Street, Minsk 220600, Belarus.
| | - Leonid Levin
- Cancer Registry, State Establishment "N.N.Alexandrov National Cancer Center of Belarus for Oncology and Medical Radiology", P.O., Lesnoy 223040, Belarus.
| | - Lydia Zablotska
- University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, 94118 CA, USA.
| | - Alexander Rozhko
- The Republican Research Center for Radiation Medicine and Human Ecology, 290 Ilyicha Street, Gomel 246040, Belarus.
| | - Kiyohiko Mabuchi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Drive, MSC 9776, Bethesda, 20892 MD, USA.
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Chumak V, Drozdovitch V, Kryuchkov V, Bakhanova E, Babkina N, Bazyka D, Gudzenko N, Hatch M, Trotsuk N, Zablotska L, Golovanov I, Luckyanov N, Voillequé P, Bouville A. Dosimetry Support of the Ukrainian-American Case-control Study of Leukemia and Related Disorders Among Chornobyl Cleanup Workers. Health Phys 2015; 109:296-301. [PMID: 26313587 PMCID: PMC4557628 DOI: 10.1097/hp.0000000000000341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper describes dose reconstruction for a joint Ukrainian-American case-control study of leukemia that was conducted in a cohort of 110,645 male Ukrainian cleanup workers of the Chornobyl (Chernobyl) accident who were exposed to various radiation doses over the 1986-1990 time period. Individual bone-marrow doses due to external irradiation along with respective uncertainty distributions were calculated for 1,000 study subjects using the RADRUE method, which employed personal cleanup history data collected in the course of an interview with the subject himself if he was alive or with two proxies if he was deceased. The central estimates of the bone-marrow dose distributions range from 3.7 × 10(-5) to 3,260 mGy, with an arithmetic mean of 92 mGy. The uncertainties in the individual stochastic dose estimates can be approximated by lognormal distributions; the average geometric standard deviation is 2.0.
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Affiliation(s)
- Vadim Chumak
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Elena Bakhanova
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Natalya Babkina
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Dimitry Bazyka
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | | | - Maureen Hatch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Natalya Trotsuk
- National Research Centre for Radiation Medicine, Kyiv, Ukraine
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Ivan Golovanov
- Burnasyan Federal Medical Biophysical Centre, Moscow, Russia
| | - Nickolas Luckyanov
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - André Bouville
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Pletcher MJ, Pignone M, Earnshaw S, McDade C, Phillips KA, Auer R, Zablotska L, Greenland P. Using the coronary artery calcium score to guide statin therapy: a cost-effectiveness analysis. Circ Cardiovasc Qual Outcomes 2014; 7:276-84. [PMID: 24619318 PMCID: PMC4156513 DOI: 10.1161/circoutcomes.113.000799] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The coronary artery calcium (CAC) score predicts future coronary heart disease (CHD) events and could be used to guide primary prevention interventions, but CAC measurement has costs and exposes patients to low-dose radiation. METHODS AND RESULTS We estimated the cost-effectiveness of measuring CAC and prescribing statin therapy based on the resulting score under a range of assumptions using an established model enhanced with CAC distribution and risk estimates from the Multi-Ethnic Study of Atherosclerosis. Ten years of statin treatment for 10,000 55-year-old women with high cholesterol (10-year CHD risk, 7.5%) was projected to prevent 32 myocardial infarctions, cause 70 cases of statin-induced myopathy, and add 1108 years to total life expectancy. Measuring CAC and targeting statin treatment to the 2500 women with CAC>0 would provide 45% of the benefit (+501 life-years), but CAC measurement would cost $2.25 million and cause 9 radiation-induced cancers. Treat all was preferable to CAC screening in this scenario and across a broad range of other scenarios (CHD risk, 2.5%-15%) when statin assumptions were favorable ($0.13 per pill and no quality of life penalty). When statin assumptions were less favorable ($1.00 per pill and disutility=0.00384), CAC screening with statin treatment for persons with CAC>0 was cost-effective (<$50 000 per quality-adjusted life-year) in this scenario, in 55-year-old men with CHD risk 7.5%, and in other intermediate risk scenarios (CHD risk, 5%-10%). Our results were critically sensitive to statin cost and disutility and relatively robust to other assumptions. Alternate CAC treatment thresholds (>100 or >300) were generally not cost-effective. CONCLUSIONS CAC testing in intermediate risk patients can be cost-effective but only if statins are costly or significantly affect quality of life.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco 185 Berry Street, Suite 5700 San Francisco, CA 94107 Office: (415) 514-8008, Fax: (415) 514-8150,
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | | | | | - Cheryl McDade
- RTI Health Solutions, RTI International, Research Triangle Park, NC
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy, UCSF Institute for Health Policy Studies, UCSF Comprehensive Cancer Center, and UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California, San Francisco, CA
| | - Reto Auer
- Department of Epidemiology and Biostatistics, University of California, San Francisco 185 Berry Street, Suite 5700 San Francisco, CA 94107 Office: (415) 514-8008, Fax: (415) 514-8150,
| | - Lydia Zablotska
- Department of Epidemiology and Biostatistics, University of California, San Francisco 185 Berry Street, Suite 5700 San Francisco, CA 94107 Office: (415) 514-8008, Fax: (415) 514-8150,
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Little MP, Azizova TV, Bazyka D, Bouffler SD, Cardis E, Chekin S, Chumak VV, Cucinotta FA, de Vathaire F, Hall P, Harrison JD, Hildebrandt G, Ivanov V, Kashcheev VV, Klymenko SV, Laurent O, Ozasa K, Tapio S, Taylor AM, Tzoulaki I, Vandoolaeghe WL, Wakeford R, Zablotska L, Zhang W, Lipshultz SE. Comment on "dose-responses from multi-model inference for the non-cancer disease mortality of atomic bomb survivors" (Radiat. Environ. Biophys (2012) 51:165-178) by Schöllnberger et al. Radiat Environ Biophys 2013; 52:157-9. [PMID: 23296519 DOI: 10.1007/s00411-012-0453-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 12/20/2012] [Indexed: 05/05/2023]
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Tronko M, Mabuchi K, Bogdanova T, Hatch M, Likhtarev I, Bouville A, Oliynik V, McConnell R, Shpak V, Zablotska L, Tereshchenko V, Brenner A, Zamotayeva G. Thyroid cancer in Ukraine after the Chernobyl accident (in the framework of the Ukraine-US Thyroid Project). J Radiol Prot 2012; 32:N65-N69. [PMID: 22394669 PMCID: PMC3902783 DOI: 10.1088/0952-4746/32/1/n65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As a result of the accident at the Chernobyl Nuclear Power Plant, millions of residents of Belarus, Russia, and Ukraine were exposed to large doses of radioactive iodine isotopes, mainly I-131. The purpose of the Ukraine-American (UkrAm) and Belarus-American (BelAm) projects are to quantify the risks of thyroid cancer in the framework of a classical cohort study, comprising subjects who were aged under 18 years at the time of the accident, had direct measurements of thyroid I-131 radioactivity taken within two months after the accident, and were residents of three heavily contaminated northern regions of Ukraine (Zhitomir, Kiev, and Chernigov regions). Four two-year screening examination cycles were implemented from 1998 until 2007 to study the risks associated with thyroid cancer due to the iodine exposure caused during the Chernobyl accident. A standardised procedure of clinical examinations included: thyroid palpation, ultrasound examination, blood collection followed by a determination of thyroid hormone levels, urinary iodine content test, and fine-needle aspiration if required. Among the 110 cases of thyroid cancer diagnosed in UkrAm as the result of four screening examinations, 104 cases (94.5%) of papillary carcinomas, five cases (4.6%) of follicular carcinomas, and one case (0.9%) of medullary carcinoma were diagnosed.
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Affiliation(s)
- Mykola Tronko
- State Institution 'V P Komisarenko Institute of Endocrinology and Metabolism', National Academy Medical Sciences Ukraine, Vyshgorodska 69, Kiev 04114, Ukraine.
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17
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Hatch M, Polyanskaya O, McConnell R, Gong Z, Drozdovitch V, Rozhko A, Prokopovich A, Petrenko S, Brenner A, Zablotska L. Urinary Iodine and Goiter Prevalence in Belarus: experience of the Belarus-American cohort study of thyroid cancer and other thyroid diseases following the Chornobyl nuclear accident. Thyroid 2011; 21:429-37. [PMID: 21323597 PMCID: PMC3070334 DOI: 10.1089/thy.2010.0143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Because iodine deficiency can influence background rates of thyroid disease or modify radiation dose-response relationships, we compiled descriptive data on iodine status among participants in a Belarusian-American screening study who were exposed in childhood to radioiodine fallout from the Chornobyl nuclear accident. We have used the data from two consecutive screening cycles to examine whether indicators of iodine status changed before and after documented government initiatives to improve iodine intake. METHODS Urinary iodine concentrations in spot samples and prevalence of diffuse goiter by palpation were assessed in 11,676 exposed subjects who were 18 years or younger at the time of the accident on April 26, 1986, and were screened beginning 11 years later in connection with the Belarus-American Thyroid Study. Data for the first ( January 1997-March 2001) and second (April 2001-December 2004) screening cycles, which largely correspond to time periods before and after official iodination efforts in 2000/2001, were compared for the cohort overall as well as by oblast of residence (i.e., state) and type of residency (urban/rural). RESULTS Median urine iodine levels among cohort members increased significantly in the later period (111.5 mg/L) compared to the earlier (65.3 mg/L), with the cycle 2 level in the range defined as adequate iodine intake by the World Health Organization. During the same period, a significant decline in diffuse goiter prevalence was also observed. In both cycles, urinary iodine levels were lower in rural than in urban residents. Urinary iodine levels, but not rates of goiter, varied by oblast of residence. In both periods, adjusted median urine iodine concentrations were similar in Gomel and Minsk oblasts, where *89% of cohort members resided, and were lowest in Mogilev oblast. Yet Mogilev oblast and rural areas showed the most marked increases over time. CONCLUSIONS Trends in urinary iodine concentrations and prevalence of diffuse goiter by palpation suggest that iodination efforts in Belarus were successful, with benefits extending to the most iodine-deficient populations. Iodine status should be considered when evaluating thyroid disease risk in radioiodine-exposed populations since it can change over time and may influence rates of disease and, possibly, dose-response relationships
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Affiliation(s)
- Maureen Hatch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
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Hatch M, Furukawa K, Brenner A, Olinjyk V, Ron E, Zablotska L, Terekhova G, McConnell R, Markov V, Shpak V, Ostroumova E, Bouville A, Tronko M. Prevalence of hyperthyroidism after exposure during childhood or adolescence to radioiodines from the chornobyl nuclear accident: dose-response results from the Ukrainian-American Cohort Study. Radiat Res 2010; 174:763-72. [PMID: 21128800 DOI: 10.1667/rr2003.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Relatively few data are available on the prevalence of hyperthyroidism (TSH concentrations of <0.3 mIU/liter, with normal or elevated concentrations of free T4) in individuals exposed to radioiodines at low levels. The accident at the Chornobyl (Chernobyl) nuclear plant in Ukraine on April 26, 1986 exposed large numbers of residents to radioactive fallout, principally to iodine-131 ((131)I) (mean and median doses = 0.6 Gy and 0.2 Gy). We investigated the relationship between (131)I and prevalent hyperthyroidism among 11,853 individuals exposed as children or adolescents in Ukraine who underwent an in-depth, standardized thyroid gland screening examination 12-14 years later. Radioactivity measurements taken shortly after the accident were available for all subjects and were used to estimate individual thyroid doses. We identified 76 cases of hyperthyroidism (11 overt, 65 subclinical). Using logistic regression, we tested a variety of continuous risk models and conducted categorical analyses for all subjects combined and for females (53 cases, n = 5,767) and males (23 cases, n = 6,086) separately but found no convincing evidence of a dose-response relationship between (131)I and hyperthyroidism. There was some suggestion of elevated risk among females in an analysis based on a dichotomous dose model with a threshold of 0.5 Gy chosen empirically (OR = 1.86, P = 0.06), but the statistical significance level was reduced (P = 0.13) in a formal analysis with an estimated threshold. In summary, after a thorough exploration of the data, we found no statistically significant dose-response relationship between individual (131)I thyroid doses and prevalent hyperthyroidism.
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Affiliation(s)
- M Hatch
- Division of Cancer Epidemiology and Genetics, NCI/NIH/DHHS, Rockville, Maryland 20852, USA.
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O'Kane P, Shelkovoy E, McConnell RJ, Shpak V, Parker L, Brenner A, Zablotska L, Tronko M, Hatch M. Frequency of undetected thyroid nodules in a large I-131-exposed population repeatedly screened by ultrasonography: results from the Ukrainian-American cohort study of thyroid cancer and other thyroid diseases following the Chornobyl accident. Thyroid 2010; 20:959-64. [PMID: 20615138 PMCID: PMC2964362 DOI: 10.1089/thy.2010.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Imperfect detection on screening tests can lead to erroneous conclusions about the natural history of thyroid nodules following radiation exposure. Our objective was to assess in a repeatedly screened I-131-exposed population the frequency with which a thyroid nodule could be retrospectively identified on ultrasonography studies preceding the one on which it was initially detected. METHODS A cohort of over 13,000 young people exposed to fallout from Chornobyl underwent ultrasonography screening at 2-year intervals from 1998 to 2007. The study group consisted of screening examinations on which a thyroid nodule was detected following one or more prior negative examinations. In the study group there were 48 cancers and 92 benign nodules. For each of these 140 index studies a comparison set was created containing all available prior studies plus (to test for bias) negative studies from control subjects. While viewing the index study, three independent reviewers scored the comparison studies for the presence and size of a preexisting nodule. Detection rates were compared for true priors versus controls, for cancer versus benign, and for histologic subtypes of papillary carcinoma. RESULTS A preexisting nodule was identified by at least one reviewer in 24.0% of the true prior versus 8.3% of the controls and by all three reviewers in 11% versus 1% (Fisher's exact test, p < 0.0001). There was no significant difference in detection rates between cancers and benign nodules (22.4% vs. 24.7%, p = 0.411). There was no correlation between time from prior to index study and change in nodule size for either malignant or benign nodules (r = 0.01, NS). There were no differences in detection rates or size among papillary cancer subtypes. Reviewers could not distinguish between true priors and controls. CONCLUSIONS These findings, showing significant rates of undetected benign and malignant nodules and no evidence for rapid growth, suggest that conclusions drawn from screening studies about the frequency of late-developing, rapidly growing thyroid nodules following radiation exposure should be interpreted with caution.
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Affiliation(s)
- Patrick O'Kane
- Radiology Department, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
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20
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Bozhok Y, Greenebaum E, Bogdanova TI, McConnell RJ, Zelinskaya A, Brenner AV, Zurnadzhy LY, Zablotska L, Tronko MD, Hatch M. NA cohort study of thyroid cancer and other thyroid diseases after the Chernobyl accident: cytohistopathologic correlation and accuracy of fine-needle aspiration biopsy in nodules detected during the first screening in Ukraine (1998-2000). Cancer 2009; 117:73-81. [PMID: 19365829 DOI: 10.1002/cncy.20002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Ukrainian American Cohort Study was established to evaluate the risk of thyroid disorders in a group exposed as children and adolescents to 131I by the Chernobyl accident (arithmetic mean thyroid dose, 0.79 grays). Individuals are screened by palpation and ultrasound and are referred to surgery according to fine-needle aspiration biopsy (FNA). However, the accuracy of FNA cytology for detecting histopathologically confirmed malignancy after this level of internal exposure to radioiodines is unknown. METHODS During the first screening cycle (1998-2000), 13,243 individuals were examined, 356 individuals with thyroid nodules were referred for FNA, 288 individuals completed the procedure, 85 individuals were referred to surgery, 82 individuals underwent surgery, and preoperative cytology was available for review in 78 individuals. Cytologic interpretation for the nodule that resulted in surgical referral was correlated with final pathomorphology; discrepancies were reviewed retrospectively; and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNA cytology were calculated. RESULTS All 24 cytologic interpretations that were definite for papillary thyroid cancer (PTC) were confirmed histopathologically (PPV, 100%); and, of 11 cytologic interpretations that were suspicious for PTC, 10 were confirmed (PPV, 90.9%). Ten of 41 FNAs that were interpreted as either definite or suspect for follicular neoplasm were confirmed as malignant (PPV, 24.4%), including 2 follicular thyroid cancers and 8 PTCs (all but 1 of the follicular or mixed subtypes). Depending on whether a cytologic interpretation of follicular neoplasm was considered "positive" or "negative," the sensitivity was 100% and 77.3%, respectively; similarly, the respective specificity was 17.6% and 97.1%, the respective PPV was 61.1% and 97.1%, and the respective NPV was 100% and 76.7%. CONCLUSIONS Among children and adolescents who were exposed to 131I after the Chernobyl accident and were evaluated 12 to 14 years later, thyroid cytology had a sensitivity and a predictive value similar to those reported in unexposed populations.
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Affiliation(s)
- Yuriy Bozhok
- Institute of Endocrinology and Metabolism, Kiev, Ukraine
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21
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Ostroumova E, Brenner A, Oliynyk V, McConnell R, Robbins J, Terekhova G, Zablotska L, Likhtarev I, Bouville A, Shpak V, Markov V, Masnyk I, Ron E, Tronko M, Hatch M. Subclinical hypothyroidism after radioiodine exposure: Ukrainian-American cohort study of thyroid cancer and other thyroid diseases after the Chornobyl accident (1998-2000). Environ Health Perspect 2009; 117:745-50. [PMID: 19479016 PMCID: PMC2685836 DOI: 10.1289/ehp.0800184] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 12/15/2008] [Indexed: 05/19/2023]
Abstract
BACKGROUND Hypothyroidism is the most common thyroid abnormality in patients treated with high doses of iodine-131 (131I). Data on risk of hypothyroidism from low to moderate 131I thyroid doses are limited and inconsistent. OBJECTIVE This study was conducted to quantify the risk of hypothyroidism prevalence in relation to 131I doses received because of the Chornobyl accident. METHODS This is a cross-sectional (1998-2000) screening study of thyroid diseases in a cohort of 11,853 individuals < 18 years of age at the time of the accident, with individual thyroid radioactivity measurements taken within 2 months of the accident. We measured thyroid-stimulating hormone (TSH), free thyroxine, and antibodies to thyroid peroxidase (ATPO) in serum. RESULTS Mean age at examination of the analysis cohort was 21.6 years (range, 12.2-32.5 years), with 49% females. Mean 131I thyroid dose was 0.79 Gy (range, 0-40.7 Gy). There were 719 cases with hypothyroidism (TSH > 4 mIU/L), including 14 with overt hypothyroidism. We found a significant, small association between (131)I thyroid doses and prevalent hypothyroidism, with the excess odds ratio (EOR) per gray of 0.10 (95% confidence interval, 0.03-0.21). EOR per gray was higher in individuals with ATPO < or = 60 U/mL compared with individuals with ATPO > 60 U/mL (p < 0.001). CONCLUSIONS This is the first study to find a significant relationship between prevalence of hypothyroidism and individual (131)I thyroid doses due to environmental exposure. The radiation increase in hypothyroidism was small (10% per Gy) and limited largely to subclinical hypothyroidism. Prospective data are needed to evaluate the dynamics of radiation-related hypothyroidism and clarify the role of antithyroid antibodies.
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Affiliation(s)
- Evgenia Ostroumova
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Alina Brenner
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
- Address correspondence to A. Brenner, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, MS 7238, 6120 Executive Blvd., Bethesda, MD 20892-7238 USA. Telephone: (301) 402-8680. Fax: (301) 402-0207. E-mail:
| | - Valery Oliynyk
- Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | - Robert McConnell
- Department of Medicine, The Thyroid Clinic, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jacob Robbins
- Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - Lydia Zablotska
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Ilya Likhtarev
- Scientific Center for Radiation Medicine, Academy of Medical Science, Kyiv, Ukraine
| | - Andre Bouville
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Viktor Shpak
- Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | | | - Ihor Masnyk
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Elaine Ron
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Mykola Tronko
- Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | - Maureen Hatch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Hatch M, Brenner A, Bogdanova T, Derevyanko A, Kuptsova N, Likhtarev I, Bouville A, Tereshchenko V, Kovgan L, Shpak V, Ostroumova E, Greenebaum E, Zablotska L, Ron E, Tronko M. A screening study of thyroid cancer and other thyroid diseases among individuals exposed in utero to iodine-131 from Chernobyl fallout. J Clin Endocrinol Metab 2009; 94:899-906. [PMID: 19106267 PMCID: PMC2681280 DOI: 10.1210/jc.2008-2049] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 12/12/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Like stable iodine, radioiodines concentrate in the thyroid gland, increasing thyroid cancer risk in exposed children. Data on exposure to the embryonic/fetal thyroid are rare, raising questions about use of iodine 131 (I-131) in pregnant women. We present here estimated risks of thyroid disease from exposure in utero to I-131 fallout from the Chernobyl nuclear accident. METHODS We conducted a cross-sectional thyroid screening study (palpation, ultrasound, thyroid hormones, and, if indicated, fine needle aspiration) from 2003 to 2006. Participants were 2582 mother-child pairs from Ukraine in which the mother had been pregnant at the time of the accident on April 26, 1986, or 2 months after the time during which I-131 fallout was still present (1494 from contaminated areas, 1088 in the comparison group). Individual cumulative in utero thyroid dose estimates were derived from estimated I-131 activity in the mother's thyroid (mean 72 mGy; range 0-3230 mGy). RESULTS There were seven cases of thyroid carcinoma and one case of Hurthle cell neoplasm identified as a result of the screening. Whereas the estimated excess odds ratio per gray for thyroid carcinoma was elevated (excess odds ratio per gray 11.66), it was not statistically significant (P = 0.12). No radiation risks were identified for other thyroid diseases. CONCLUSION Our results suggest that in utero exposure to radioiodines may have increased the risk of thyroid carcinoma approximately 20 yr after the Chernobyl accident, supporting a conservative approach to medical uses of I-131 during pregnancy.
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Affiliation(s)
- M Hatch
- Chernobyl Research Unit, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard, EPS 7098, Rockville, Maryland 20852, USA.
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23
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Romanenko A, Bebeshko V, Hatch M, Bazyka D, Finch S, Dyagil I, Reiss R, Chumak V, Bouville A, Gudzenko N, Zablotska L, Pilinskaya M, Lyubarets T, Bakhanova E, Babkina N, Trotsiuk N, Ledoschuk B, Belayev Y, Dybsky S, Ron E, Howe G. The Ukrainian-American study of leukemia and related disorders among Chornobyl cleanup workers from Ukraine: I. Study methods. Radiat Res 2008; 170:691-7. [PMID: 19138036 PMCID: PMC2856482 DOI: 10.1667/rr1402.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 06/12/2008] [Indexed: 11/03/2022]
Abstract
There are relatively few data on the risk of leukemia among those exposed to external radiation during cleanup operations after the Chornobyl nuclear accident, and results have not been consistent. To investigate this further, we assembled a cohort of 110,645 male cleanup workers from Ukraine and identified cases of leukemia occurring during the period 1986 to 2000. Detailed interviews were conducted and individual bone marrow doses estimated using a new time-and-motion method known as RADRUE described in companion paper II. For the initial analyses we used a nested case-control approach with a minimum of five controls per case, matched for year of birth, oblast (region) of registration, and residence. All identified cases were reviewed by an international panel of experts; 87 of 111 were confirmed. The dose-response analysis and results are given in companion paper III. As background, we describe herein the design, procedures, outcome of case finding and confirmation, control selection, dose estimation and interviewing of subjects.
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Affiliation(s)
- A. Romanenko
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - V Bebeshko
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - M Hatch
- DHHS/NIH/NCI/Division of Cancer Epidemiology and Genetics Bethesda, MD 20892-7238
| | - D Bazyka
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - S. Finch
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, USA
| | - I Dyagil
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - R. Reiss
- College of Physicians and Surgeons, Columbia University New York, NY
| | - V Chumak
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - A Bouville
- DHHS/NIH/NCI/Division of Cancer Epidemiology and Genetics Bethesda, MD 20892-7238
| | - N Gudzenko
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - L Zablotska
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - M. Pilinskaya
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - T. Lyubarets
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - E. Bakhanova
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - N. Babkina
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - N. Trotsiuk
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - B. Ledoschuk
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - Y. Belayev
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - S.S. Dybsky
- Research Center for Radiation Medicine, AMS Ukraine, 04050 Melinkova 53, Kyiv Ukraine
| | - E. Ron
- DHHS/NIH/NCI/Division of Cancer Epidemiology and Genetics Bethesda, MD 20892-7238
| | - G. Howe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
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Siegel AB, McBride RB, El-Serag HB, Hershman D, Brown RS, Zablotska L, Neugut AI. The risk of hepatocellular carcinoma in patients with previous malignancy. Cancer Invest 2008; 26:511-5. [PMID: 18568774 DOI: 10.1080/07357900701788007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Abby B Siegel
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10033, USA.
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Siegel AB, McBride RB, El-Serag H, Hershman D, Zablotska L, Brown R, Neugut AI. The risk of hepatocellular carcinoma in patients with previous malignancy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17075 Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Its incidence has doubled over the past 20 years in the United States. Determination of the pattern of occurrence of HCC as a second primary malignancy might give clues for new risk factors for HCC, or may reveal common genetic or environmental risks. Methods: We identified patients with a diagnosis of a second primary HCC between 1973 and 2002 using the Surveillance, Epidemiology, and End-Results Program (SEER) a compilation of population-based cancer registries in the United States, to calculate the observed to expected (O/E) frequency of second primary HCC after a different primary cancer. We stratified by ethnicity, latency from the year of diagnosis of primary cancer to HCC diagnosis, and period of diagnosis of primary cancer as early (1973–1987) or late (1987–2002). Results: We reviewed 1,931,911 subjects with cancer, and identified 1,185 second primary HCC cases. Overall, a second primary HCC after any primary cancer was less frequent than expected (O/E=0.82, 95% CI=0.77–0.87). We found positive associations with head and neck cancers (oral cavity/pharynx O/E=2.1, 95% CI=1.7–2.5), Kaposi's sarcoma (O/E=3.3, 95% CI=1.2–7.1) and Hodgkin's disease (O/E=2.3, 95% CI=1.2–4.0). Negative associations were seen for breast cancer (O/E=0.7, 95% CI=0.6–0.8), colorectal cancer (O/E=0.6, 95% CI=0.6–0.8), and prostate cancer (O/E=0.7, 95%CI=0.6–0.8). Overall, lower O/E ratios were seen in whites, while in African Americans and those of other races, the O/E ratios were close to one. Latency times were relatively short for head and neck cancers and Kaposi's sarcoma (most within 12–59 months), and greater than 120 months for most cases of HCC after Hodgkin's disease. All cases of Kaposi's sarcoma were seen in the later time period. Conclusions: These results highlight possible shared risk factors of alcohol ingestion and viral exposures which may predispose to second primary HCC after other primary malignancies. Providers should maintain heightened alertness for second primary HCC in these patients, especially those with head and neck cancers and HIV. No significant financial relationships to disclose.
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Affiliation(s)
- A. B. Siegel
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - R. B. McBride
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - H. El-Serag
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - D. Hershman
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - L. Zablotska
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - R. Brown
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
| | - A. I. Neugut
- Columbia University, New York, NY; Baylor College of Medicine, Houston, TX
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Terry MB, Knight JA, Zablotska L, Wang Q, John EM, Andrulis IL, Senie RT, Daly M, Ozcelik H, Briollais L, Santella RM. Alcohol metabolism, alcohol intake, and breast cancer risk: a sister-set analysis using the Breast Cancer Family Registry. Breast Cancer Res Treat 2007; 106:281-8. [PMID: 17268812 DOI: 10.1007/s10549-007-9498-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 01/01/2007] [Indexed: 10/23/2022]
Abstract
Moderate alcohol intake has been consistently associated with a modest (30-50%) increase in breast cancer risk, but it remains unclear if certain individuals have higher susceptibility to the harmful effects of alcohol intake. Individuals differ in their ability to metabolize alcohol through genetic differences in alcohol dehydrogenase (ADH), the enzyme that catalyzes the oxidation of approximately 80% of ethanol to acetaldehyde, a known carcinogen. Using data from the Breast Cancer Family Registry (n = 811 sister sets), we examined whether sisters with breast cancer differ with respect to alcohol consumption and alcohol metabolism (measured by polymorphisms in ADH1B and ADH1C) compared to their sisters without breast cancer. Neither alcohol drinking nor alcohol metabolizing ADH1B and ADH1C genotypes were associated with breast cancer risk. However, only 19% and 42% of sisters were discordant by ADH1B and ADH1C, respectively, and even fewer were discordant by both genotype and alcohol intake, making it difficult to detect differences if they existed.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 724, New York, NY 10032, USA.
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27
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Bozhok Y, Greenebaum E, Bogdanova TI, McConnell RJ, Zelinskaya A, Brenner AV, Zurnadzhy LY, Zablotska L, Tronko MD, Hatch M. A cohort study of thyroid cancer and other thyroid diseases after the Chornobyl accident: pathology analysis of thyroid cancer cases in Ukraine detected during the first screening (1998-2000). Cancer 2006; 107:2559-66. [PMID: 17083123 PMCID: PMC2983485 DOI: 10.1002/cncr.22321] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Ukrainian American Cohort Study evaluated the risk of thyroid disorders in a group of individuals who were younger than age 18 years at the time of the Chornobyl (Chernobyl) accident. In this article, the authors describe the pathology of thyroid carcinomas detected in the first screening. METHODS From 1998 to 2000, 13,243 individuals completed the first cycle of screening examinations. Eighty patients underwent surgery between 1998 and 2004. Intraoperative and postoperative pathologic studies were performed at the Institute of Endocrinology and Metabolism, Kyiv. RESULTS Pathologic analysis revealed 45 thyroid carcinomas, including 43 papillary thyroid carcinomas (PTCs) (95.6%) and 2 follicular thyroid carcinomas (FTCs) (4.4%). TNM classification (5th edition) of the PTCs included 8 T1 tumors (18.6%), 16 T2 tumors (37.2%), and 19 T4 tumors (44.2%). Fifteen PTCs (34.9%) were N1a,N1b, and 3 PTCs (7.0%) were M1. Among the PTCs, 8 exhibited the classical papillary histologic pattern (18.6%), 14 exhibited a follicular histologic pattern (32.6%), 5 exhibited a solid histologic pattern (11.6%), and 16 exhibited a mixed histologic pattern (37.2%). Both FTCs had a microfollicular-solid structure. Eleven of 20 cohort members who underwent surgery before the first screening had PTCs. Regional metastases (63.6%) and distant metastases (18.2%) were more common in this group. CONCLUSIONS Multifocal growth, lymphatic and blood vessel invasion, extrathyroid spread, and regional and distant metastases were more frequent in less differentiated PTCs (>30% solid structure). Small carcinomas (</=10 mm) comprised 23.3% of PTCs, and most of those (8 of 10 small carcinomas; 80%) were of the papillary-follicular subtype and therefore were more differentiated. The solid subtype of PTC was associated with shorter latency, especially in individuals who were diagnosed before the first screening. The histology of post-Chornobyl cancers is changing with time.
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Affiliation(s)
- Yuriy Bozhok
- Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | - Ellen Greenebaum
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | | | | | - Lydia Zablotska
- Mailman School of Public Health, Columbia University, New York, NY USA
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Likhtarov I, Kovgan L, Vavilov S, Chepurny M, Ron E, Lubin J, Bouville A, Tronko N, Bogdanova T, Gulak L, Zablotska L, Howe G. Post-Chornobyl Thyroid Cancers in Ukraine. Report 2: Risk Analysis. Radiat Res 2006; 166:375-86. [PMID: 16881739 DOI: 10.1667/rr3593.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
On April 26, 1986, the worst nuclear reactor accident to date occurred at the Chornobyl (Chernobyl) power plant in Ukraine. Millions of people in Ukraine, Belarus and Russia were exposed to radioactive nuclides, especially (131)I. Since then, research has been conducted on various subgroups of the exposed population, and it has been demonstrated that the large increase in thyroid cancer is related to the (131)I exposure. However, because of study limitations, quantified risk estimates are limited, and there remains a need for additional information. We conducted an ecological study to investigate the relationship between (131)I thyroid dose and the diagnosis of thyroid cancer in three highly contaminated oblasts in Northern Ukraine. The study population is comprised of 301,907 persons who were between the ages of 1 and 18 at the time of the Chornobyl accident and were living in 1,293 rural settlements in the three study oblasts. Twenty-four percent of the study population had individual thyroid dose estimates and the other 76% had "individualized" estimates of thyroid dose based on direct thyroid measurements taken from a person of the same age and gender living in the same or nearby settlement. Cases include 232 thyroid cancers diagnosed from January 1990 through December 2001, and all were confirmed histologically. Dose-response analyses took into account differences in the rate of ultrasound examinations conducted in the three study oblasts. The estimated excess relative risk per gray was 8.0 (95% CI = 4.6-15) and the excess absolute risk per 10,000 person-year gray was estimated to be 1.5 (95% CI = 1.2-1.9). In broad terms, these estimates are compatible with results of other studies from the contaminated areas, as well as studies of external radiation exposure.
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Affiliation(s)
- I Likhtarov
- Radiation Protection Institute ATS Ukraine, Scientific Centre for Radiation Medicine AMS of Ukraine, Melnikova 53, 04050 Kyiv, Ukraine
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29
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Ahsan H, Chen Y, Parvez F, Zablotska L, Argos M, Hussain I, Momotaj H, Levy D, Cheng Z, Slavkovich V, van Geen A, Howe GR, Graziano JH. Arsenic exposure from drinking water and risk of premalignant skin lesions in Bangladesh: baseline results from the Health Effects of Arsenic Longitudinal Study. Am J Epidemiol 2006; 163:1138-48. [PMID: 16624965 DOI: 10.1093/aje/kwj154] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Millions of persons around the world are exposed to low doses of arsenic through drinking water. However, estimates of health effects associated with low-dose arsenic exposure have been extrapolated from high-dose studies. In Bangladesh, many persons have been exposed to a wide range of doses of arsenic from drinking water over a significant period of time. The authors evaluated dose-response relations between arsenic exposure from drinking water and premalignant skin lesions by using baseline data on 11,746 participants recruited in 2000-2002 for the Health Effects of Arsenic Longitudinal Study in Araihazar, Bangladesh. Several measures of arsenic exposure were estimated for each participant based on well-water arsenic concentration and usage pattern of the wells and on urinary arsenic concentration. In different regression models, consistent dose-response effects were observed for all arsenic exposure measures. Compared with drinking water containing <8.1 microg/liter of arsenic, drinking water containing 8.1-40.0, 40.1-91.0, 91.1-175.0, and 175.1-864.0 microg/liter of arsenic was associated with adjusted prevalence odds ratios of skin lesions of 1.91 (95% confidence interval (CI): 1.26, 2.89), 3.03 (95% CI: 2.05, 4.50), 3.71 (95% CI: 2.53, 5.44), and 5.39 (95% CI: 3.69, 7.86), respectively. The effect seemed to be influenced by gender, age, and body mass index. These findings provide information that should be considered in future research and policy decisions.
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Affiliation(s)
- Habibul Ahsan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Hatch M, Ron E, Bouville A, Zablotska L, Howe G. The Chernobyl disaster: cancer following the accident at the Chernobyl nuclear power plant. Epidemiol Rev 2005; 27:56-66. [PMID: 15958427 DOI: 10.1093/epirev/mxi012] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- M Hatch
- National Cancer Institute, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Institutes of Health, Department of Health and Human Services, Rockville, MD 20852, USA.
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Lane R, Frost S, Ashmore P, Howe G, Zablotska L, Chambers D, Stager R, McLaughlin J, Smith L. 323: Saskatchewan Uranium Miners’ Cohort (SUMC) Study. 1). Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s81b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Lane
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - S Frost
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - P Ashmore
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - G Howe
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - L Zablotska
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - D Chambers
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - R Stager
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - J McLaughlin
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
| | - L Smith
- The Canadian Nuclear Safety Commission, Ottawa, Ontario, K1P 5S9
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