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Lipworth L, Tarone RE, McLaughlin JK. Renal cell cancer among African Americans: an epidemiologic review. BMC Cancer 2011; 11:133. [PMID: 21486465 PMCID: PMC3087713 DOI: 10.1186/1471-2407-11-133] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 04/12/2011] [Indexed: 02/08/2023] Open
Abstract
Incidence rates for renal cell cancer, which accounts for 85% of kidney cancers, have been rising more rapidly among blacks than whites, almost entirely accounted for by an excess of localized disease. This excess dates back to the 1970s, despite less access among blacks to imaging procedures in the past. In contrast, mortality rates for this cancer have been virtually identical among blacks and whites since the early 1990s, despite the fact that nephrectomy rates, regardless of stage, are lower among blacks than among whites. These observations suggest that renal cell cancer may be a less aggressive tumor in blacks. We have reviewed the epidemiology of renal cell cancer, with emphasis on factors which may potentially play a role in the observed differences in incidence and mortality patterns of renal cell cancer among blacks and whites. To date, the factors most consistently, albeit modestly, associated with increased renal cell cancer risk in epidemiologic studies among whites--obesity, hypertension, cigarette smoking--likely account for less than half of these cancers, and there is virtually no epidemiologic evidence in the literature pertaining to their association with renal cell cancer among blacks. There is a long overdue need for detailed etiologic cohort and case-control studies of renal cell cancer among blacks, as they now represent the population at highest risk in the United States. In particular, investigation of the influence on renal cell cancer development of hypertension and chronic kidney disease, both of which occur substantially more frequently among blacks, is warranted, as well as investigations into the biology and natural history of this cancer among blacks.
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Affiliation(s)
- Loren Lipworth
- International Epidemiology Institute, 1455 Research Boulevard, Suite 550, Rockville, MD 20850, USA.
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Lipworth L, Tarone RE, Lund L, McLaughlin JK. Epidemiologic characteristics and risk factors for renal cell cancer. Clin Epidemiol 2009; 1:33-43. [PMID: 20865085 PMCID: PMC2943168 DOI: 10.2147/clep.s4759] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Incidence rates of renal cell cancer, which accounts for 85% of kidney cancers, have been rising in the United States and in most European countries for several decades. Family history is associated with a two- to four-fold increase in risk, but the major forms of inherited predisposition together account for less than 4% of renal cell cancers. Cigarette smoking, obesity, and hypertension are the most consistently established risk factors. Analgesics have not been convincingly linked with renal cell cancer risk. A reduced risk of renal cell cancer among statin users has been hypothesized but has not been adequately studied. A possible protective effect of fruit and vegetable consumption is the only moderately consistently reported dietary finding, and, with the exception of a positive association with parity, evidence for a role of hormonal or reproductive factors in the etiology of renal cell cancer in humans is limited. A recent hypothesis that moderate levels of alcohol consumption may be protective for renal cell cancer is not strongly supported by epidemiologic results, which are inconsistent with respect to the categories of alcohol consumption and the amount of alcohol intake reportedly associated with decreased risk. For occupational factors, the weight of the evidence does not provide consistent support for the hypotheses that renal cell cancer may be caused by asbestos, gasoline, or trichloroethylene exposure. The established determinants of renal cell cancer, cigarette smoking, obesity, and hypertension, account for less than half of these cancers. Novel epidemiologic approaches, including evaluation of gene–environment interactions and epigenetic mechanisms of inherited and acquired increased risk, are needed to explain the increasing incidence of renal cell cancer.
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Affiliation(s)
- Loren Lipworth
- International Epidemiology Institute, Rockville, MD, USA
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Charbotel B, Fevotte J, Martin JL, Bergeret A. [Renal cell carcinoma and exposure to trichloroethylene: are the French limits of occupational exposure relevant?]. Rev Epidemiol Sante Publique 2009; 57:41-7. [PMID: 19155150 DOI: 10.1016/j.respe.2008.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 09/08/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Several studies have investigated the association between trichloroethylene (TCE) exposure and renal cell cancer (RCC) but findings were inconsistent. The analysis of a case control study has shown an increased risk of RCC among subjects exposed to high cumulative exposure. The aim of this complementary analysis is to assess the relevance of current exposure limits regarding a potential carcinogenic effect of TCE on kidney. METHODS Eighty-six cases and 316 controls matched for age and gender were included in the study. Successive jobs and working circumstances were described using a detailed occupational questionnaire. An average level of exposure to TCE was attributed to each job-period in turn. The main occupational exposures described in the literature as increasing the risk of RCC were assessed as well as non-occupational factors. A conditional logistic regression was performed to test the association between TCE and RCC risk. Three exposure levels were studied (average exposure during the eight-hour shift): 35ppm, 50ppm and 75ppm. Potential confounding factors identified were taken into account at the threshold limit of 10% (p=0.10) (body mass index [BMI], tobacco smoking, occupational exposures to cutting fluids and to other oils). RESULTS Adjusted for tobacco smoking and BMI, the odd-ratios associated with exposure to TCE were respectively 1.62 [0.77-3.42], 2.80 [1.12-7.03] and 2.92 [0.85-10.09] at the thresholds of 35ppm, 50ppm and 75ppm. Among subjects exposed to cutting fluids and TCE over 50ppm, the OR adjusted for BMI, tobacco smoking and exposure to other oils was 2.70 [1.02-7.17]. CONCLUSION Results from the present study as well as those provided in the international literature suggest that current French occupational exposure limits for TCE are too high regarding a possible risk of RCC.
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Affiliation(s)
- B Charbotel
- Unité mixte de recherche épidémiologique et de surveillance transport travail environnement, Umrestte, unité mixte Inrets/UCBL/InVS-Umrestte, UMR T n(o) 9405, domaine Rockefeller, université Lyon-1, Lyon, France.
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Abstract
PURPOSE We identified and examined risk factors for renal cell cancer, some of which may explain in part the trends of steadily increasing incidence rates, particularly in black Americans. MATERIALS AND METHODS Epidemiological studies were identified through a MEDLINE(R) search of the literature through February 2006. A qualitative summary of the results of individual studies is presented. RESULTS Cigarette smoking and obesity are the most consistently established causal risk factors, accounting for about 20% and 30% of renal cell cancers, respectively. Hypertension appears to independently influence renal cell cancer risk. Neither acetaminophen nor other analgesics have been convincingly linked with renal cell cancer. With respect to diet a general protective effect of fruit and vegetable consumption is the only consistently reported finding. For occupational factors the weight of the evidence provides no consistent support for the hypotheses that renal cell cancer may be caused by asbestos, gasoline or trichloroethylene exposure. Self-reported family history is associated with 2 to 3-fold increases in risk and the major inherited forms of renal cell cancer together account for about 2% of this malignancy. CONCLUSIONS A further reduction in cigarette smoking, and a decrease in the rates of obesity and hypertension would likely moderate the increasing incidence of renal cell cancer. Epidemiological studies, including evaluation of gene-environment interactions, are needed to specifically identify reasons for the increasing incidence, particularly for assessing the roles of obesity and hypertension. Special attention should be focused on black Americans since their incidence rate recently increased to significantly surpass that in white Americans.
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Affiliation(s)
- Loren Lipworth
- International Epidemiology Institute, 1455 Research Boulevard, Rockville, MD 20850, USA
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Lock EA, Reed CJ. Trichloroethylene: mechanisms of renal toxicity and renal cancer and relevance to risk assessment. Toxicol Sci 2006; 91:313-31. [PMID: 16421178 DOI: 10.1093/toxsci/kfj107] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
1,1,2-Trichloroethylene (TCE) is an important solvent that is widespread in the environment. We have reviewed carcinogenicity data from seven bioassays with regard to renal injury and renal tumors. We report a consistent but low incidence of renal tubule carcinoma in male rats. Epidemiology studies on workers exposed to TCE (and other chlorinated solvents) indicate a weak association between high-level exposure and renal cancer. There appears to be a threshold below which no renal injury or carcinogenicity is expected to arise. TCE is not acutely nephrotoxic to rats or mice, but subchronic exposure to rats produces a small increase in urinary markers of renal injury. Following chronic exposure, pathological changes (toxic nephrosis and a high incidence of cytomegaly and karyomegaly) were observed. The basis for the chronic renal injury probably involves bioactivation of TCE. Based on the classification by E. A. Lock and G. C. Hard (2004, Crit. Rev. Toxicol. 34, 211-299) of chemicals that induce renal tubule tumors, we found no clear evidence to place TCE in category 1 or 2 (chemicals that directly or indirectly interact with renal DNA), category 4 (direct cytotoxicity and sustained tubule cell regeneration), category 5 (indirect cytotoxicity and sustained tubule cell regeneration associated with alpha2u-globulin accumulation), or category 6 (exacerbation of spontaneous chronic progressive nephropathy). TCE is best placed in category 3, chemicals that undergo conjugation with GSH and subsequent enzymatic activation to a reactive species. The implication for human risk assessment is that TCE should not automatically be judged by linear default methods; benchmark methodology could be used.
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Affiliation(s)
- Edward A Lock
- School of Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF United Kingdom.
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Brauch H, Weirich G, Klein B, Rabstein S, Bolt HM, Brüning T. VHL mutations in renal cell cancer: does occupational exposure to trichloroethylene make a difference? Toxicol Lett 2004; 151:301-10. [PMID: 15177666 DOI: 10.1016/j.toxlet.2003.12.074] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 12/03/2003] [Accepted: 12/03/2003] [Indexed: 10/26/2022]
Abstract
Occupational exposures have long been suspected to play a role in the incidence of renal cell carcinoma (RCC). Especially, the carcinogenicity of the industrial solvent trichloroethylene (TCE) has been controversially debated, both with respect to the epidemiological and the molecular studies. In order to further elucidate this issue, it appeared important to compare suitable RCC patient groups, i.e., TCE-exposed versus non-TCE-exposed patients. We evaluated RCC from a previous German study that had described differences in RCC risks between TCE-exposed (n=17) and non-exposed patients (n=21). We compared age at diagnosis and histopathologic parameters of tumors as well as somatic mutation characteristics in the kidney cancer causing VHL tumor suppressor gene. RCC did not differ with respect to histopathological characteristics in both patient groups. We noticed a younger age at diagnosis in TCE-exposed patients compared to non-exposed patients (P=0.01). Moreover, the non-TCE-exposed patients did not share the somatic VHL mutation characteristics of TCE-exposed patients such as the previously identified hot spot mutation 454 C > T P81S or multiple mutations. These data support the notion of a putative genotoxic effect of TCE leading to VHL gene damage and subsequent occurrence of RCC in highly exposed subjects.
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Affiliation(s)
- Hiltrud Brauch
- Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Auerbachstr. 112, D-70396 Stuttgart, Germany. hiltrud.brauch@ikp=stuttgart.de
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Brüning T, Pesch B, Wiesenhütter B, Rabstein S, Lammert M, Baumüller A, Bolt HM. Renal cell cancer risk and occupational exposure to trichloroethylene: results of a consecutive case-control study in Arnsberg, Germany. Am J Ind Med 2003; 43:274-85. [PMID: 12594774 DOI: 10.1002/ajim.10185] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND German studies of high exposure prevalence have been debated on the renal carcinogenicity of trichloroethylene (TRI). METHODS A consecutive hospital-based case-control study with 134 renal cell cancer (RCC) cases and 401 controls was conducted to reevaluate the risk of TRI in this region which were estimated in a previous study. Exposure was self-assessed to compare these studies. Additionally, the job history was analyzed, using expert-based exposure information. RESULTS The logistic regression results, adjusted for age, gender, and smoking, confirmed a TRI-related RCC risk in this region. Using the database CAREX for a comparison of industries with and without TRI exposure, a significant excess risk was estimated for the longest held job in TRI-exposing industries (odds ratio (OR) 1.80, 95% confidence interval (CI) 1.01-3.20). Any exposure in "metal degreasing" was a RCC risk factor (OR 5.57, 95% CI 2.33-13.32). Self-reported narcotic symptoms, indicative of peak exposures, were associated with an excess risk (OR 3.71, 95% CI 1.80-7.54). CONCLUSIONS The study supports the human nephrocarcinogenicity of trichloroethylene.
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Affiliation(s)
- Thomas Brüning
- Institut für Arbeitsphysiologie an der Universität Dortmund (IfADo), Dortmund, Germany
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Rudén C. Scrutinizing three trichloroethylene carcinogenicity classifications in the European Union--implications for the risk assessment process. Int J Toxicol 2002; 21:441-50. [PMID: 12537640 DOI: 10.1080/10915810290169864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this paper, carcinogenicity classifications of the chlorinated solvent trichloroethylene (TCE) made by the European Union Commission Expert Groups in 1976, 1988, and 2001 are scrutinized and alternative classifications are proposed. It is argued that the TCE database at these three points in time could have been interpreted to fulfill the criteria for stricter classifications than those actually made. Implications of this for the classification process are discussed.
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Affiliation(s)
- Christina Rudén
- Philosophy Unit, Royal Institute of Technology, Stockholm, Sweden.
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Dow JL, Green T. Trichloroethylene induced vitamin B(12) and folate deficiency leads to increased formic acid excretion in the rat. Toxicology 2000; 146:123-36. [PMID: 10814845 DOI: 10.1016/s0300-483x(00)00156-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exposure of rats to trichloroethylene induces a sustained excretion of large amounts of formic acid in urine. Both of the major metabolites, trichloroethanol and trichloroacetic acid, were found to induce this response, but not the minor metabolite S-(1, 2-dichlorovinyl) cysteine. Other polychlorinated solvents, including carbon tetrachloride and chloroform, also increased urinary formate excretion. Addition of folic acid either to diet or drinking water modulated the response indicating that these rats were folate deficient. Two markers of vitamin B(12) deficiency, methylmalonic acid and 5-methyltetrahydrofolate, were also markedly increased in urine and plasma respectively. The increase in 5-methyltetrahydrofolate is consistent with a folate deficiency caused by an inhibition of the vitamin B(12) dependent methionine salvage pathway. Since both vitamin B(12) and chemicals containing polychlorinated carbon atoms readily form free radicals, it is suggested that trichloroacetic acid and trichloroethanol interact with vitamin B(12) through a free radical mechanism inducing a B(12) deficiency and, as a consequence, a folate deficiency. As a result of the folate deficiency, excess formic acid, which is normally utilised through this pathway, is excreted in urine.
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Affiliation(s)
- J L Dow
- Zeneca, Central Toxicology Laboratory, Alderley Park, Macclesfield, Cheshire, UK
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