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Pordanjani SR, Kavousi A, Mirbagheri B, Shahsavani A, Etemad K. Spatial analysis and geoclimatic factors associated with the incidence of acute lymphoblastic leukemia in Iran during 2006-2014: An environmental epidemiological study. ENVIRONMENTAL RESEARCH 2021; 202:111662. [PMID: 34273372 DOI: 10.1016/j.envres.2021.111662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The present study aims to determine the cumulative incidence rate of acute lymphoblastic leukemia (ALL), the degree of spatial autocorrelation and clustering of ALL, the hotspot and coldspots of ALL and geoclimatic conditions affecting the incidence of ALL in Iran and to draw a comparison between global and local regression models. MATERIALS AND METHODS In this ecological study, an exploratory-etiologic multiple-group method has been adopted to investigate all children under 15 years of age with ALL in Iran during 2006-2014. Data analysis was performed using Mann Whitney U, Pearson correlation coefficients (PCCs), Global Moran's I, Optimized hotspot analysis (OHSA), Global Poisson regression (GPR), Geographically Weighted Poisson Regression (GWPR) at a significant level of α = 0.05. RESULTS The cumulative incidence rate of ALL was estimated at 21,315 per 100,000 Iranian children under 15 years of age. The value of Global Moran's I index was estimated 0.338 and significant (<0.001 P-value). Coldspots were observed in north and northwest of Iran and hotspots were identified in south, southwest and mid-east of Iran. In the present study, Max Temperature of Warmest Month (MTWM) and Direct Normal Irradiation (DNI) were risk factors and Precipitation of the Coldest Quarter (PCQ) and Altitude (AL) were protective factors in the incidence of ALL, even though the non-stationarity of local coefficients and local t-values was clear. GWPR, by capturing and applying spatial heterogeneity and spatial autocorrelation, had a greater performance and goodness of fit than GPR. DISCUSSION ALL has created spatial clusters in Iran. The incidence of ALL is the result of synergistic interaction between environmental, infectious, geographical and genetic risk factors. It is recommended to use of local models in ecological studies.
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Affiliation(s)
- Sajjad Rahimi Pordanjani
- Epidemiology, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Epidemiology, Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran.
| | - Amir Kavousi
- Workplace Health Promotion Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Babak Mirbagheri
- Center for Remote Sensing and GIS Research, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran.
| | - Abbas Shahsavani
- Air Quality Health and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Koorosh Etemad
- Epidemiology, Department of Epidemiology, School of Public Health and Safety Shahid Beheshti, University of Medical Sciences, Tehran, Iran.
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Rahimi Pordanjani S, Kavousi A, Mirbagheri B, Shahsavani A, Etemad K. Temporal trend and spatial distribution of acute lymphoblastic leukemia in Iranian children during 2006-2014: a mixed ecological study. Epidemiol Health 2020; 42:e2020057. [PMID: 32777882 PMCID: PMC7871159 DOI: 10.4178/epih.e2020057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The present study investigated the spatiotemporal epidemiological status of acute lymphoblastic leukemia (ALL), the most common childhood cancer, in Iran. METHODS Using an exploratory mixed design, this ecological study examined 3,769 under-15 children with ALL recorded in the National Cancer Registry of Iran during 2006-2014. Data were analyzed using the Mann-Whitney U test, the Getis-Ord general G (GOGG) index, optimized hot spot analysis, and Pearson correlation coefficients (PCC) at a significance level of 0.05. RESULTS The average annual incidence of the disease was 2.25 per 100,000 under-15 children, and the cumulative incidence rate (CIR) was 21.31 per 100,000 under-15 children. Patients' mean age was 5.90 years (standard deviation, 3.68), and the peak incidence was observed among 2-year to 5-year-olds. No significant difference was found in mean age between boys and girls (p=0.261). The incidence of ALL was more common during spring and summer than in other seasons. The GOGG index was 0.039 and significant (p<0.001). Hot spots were identified in south, central, and eastern Iran and cold spots in the north and west of Iran. The PCC between the CIR and latitude was negative (r=-0.507; p=0.003) but that between the CIR and longitude was positive (r=0.347; p=0.055). CONCLUSIONS The incidence of ALL in Iranian children was lower than that observed in developed countries, but showed an increasing trend. It can be argued that the incidence of ALL is due to synergistic interactions between environmental, infectious, geographical, and genetic risk factors.
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Affiliation(s)
- Sajjad Rahimi Pordanjani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Kavousi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Workplace Health Promotion Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Mirbagheri
- Center for Remote Sensing and GIS Research, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran
| | - Abbas Shahsavani
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Miyatake J, Inoue H, Serizawa K, Morita Y, Espinoza JL, Tanaka H, Shimada T, Tatsumi Y, Ashida T, Matsumura I. Synchronous Occurrence of Mycosis Fungoides, Diffuse Large B Cell Lymphoma and Acute Myeloid Leukemia. Intern Med 2018; 57:1445-1453. [PMID: 29321428 PMCID: PMC5995719 DOI: 10.2169/internalmedicine.9668-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with mycosis fungoides (MF), the most common subtype of primary cutaneous T-cell lymphoma, have an increased risk of developing secondary malignancies. We herein report two rare cases of MF concurring with diffuse large B cell lymphoma (B lymphoid lineage) and acute myeloid leukemia (myeloid lineage) in two otherwise healthy elderly patients. Potential etiologic factors, including the impact of the therapy-associated inflammatory response on the development of secondary tumors in patients with MF, are discussed. Further clinical, experimental and genetic studies are needed to elucidate possible physiopathogenic associations among the three concurrent malignancies occurring in the cases presented here.
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MESH Headings
- Aged
- Female
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Mycosis Fungoides/therapy
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
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Affiliation(s)
- Junichi Miyatake
- Department of Hematology, Sakai Hospital Kindai University Faculty of Medicine, Japan
| | - Hiroaki Inoue
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Kentarou Serizawa
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Yasuyoshi Morita
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - J L Espinoza
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Hirokazu Tanaka
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Takahiro Shimada
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Yoichi Tatsumi
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Takashi Ashida
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
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Residential exposure to solar ultraviolet radiation and incidence of childhood hematological malignancies in France. Cancer Causes Control 2015; 26:1339-49. [PMID: 26169300 DOI: 10.1007/s10552-015-0629-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/01/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Few studies have investigated the relationship between solar ultraviolet radiation (UV) and childhood hematological malignancies (CHM). This study addresses the associations between residential UV exposure at diagnosis and the incidence of types and subtypes of CHM, by age and gender, in France, over a long period, on the fine scale of the 36,326 Communes that constitute mainland France. METHODS The 9,082 cases of acute leukemia and 3,563 cases of lymphoma diagnosed before the age of 15 years from 1990 to 2009 were provided by the French National Registry of Childhood Hematological Malignancies. The incidence of CHM was calculated by Commune, year, age and gender and expressed as the standardized incidence ratio (SIR). UV data from 1988 to 2007 were extracted from the EUROSUN database. RESULTS The annual daily average UV exposure of the children ranged from 85.5 to 137.8 J/cm(2). For each additional 25 J/cm(2), there was a significant increase in precursor B-cell acute lymphoblastic leukemia (PBC-ALL) in children aged less than 5 years (SIR 1.18; 95% CI 1.10-1.27). Further analysis of PBC-ALL in the young children suggested a better fit of models with a threshold, with the risk increasing above 100 J/cm(2), for which the SIR was 1.24 (95% CI 1.14-1.36) for a 25 J/cm(2) increase. The results remained stable in analyses stratifying by deprivation index or degree of urbanization of the Communes. CONCLUSION The study suggests that higher residential UV exposure may be positively associated with a higher incidence of PBC-ALL in early childhood.
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Sunlight, vitamin D and the prevention of cancer: a systematic review of epidemiological studies. Eur J Cancer Prev 2013; 18:458-75. [PMID: 19730382 DOI: 10.1097/cej.0b013e32832f9bb1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The number of studies reporting beneficial effects of sunlight and vitamin D on several types of cancer with a high mortality rate is growing rapidly. Present health recommendations on sun exposure are mainly based on the increased risks for skin cancer. We reviewed all published studies concerning cancer and sun exposure and vitamin D, respectively, excluding those about skin cancer. Most identified ecological, case-control and prospective studies on the incidence and mortality of colorectal, prostate, breast carcinoma and non-Hodgkin lymphoma reported a significantly inverse association with sun exposure. The results of the included studies on the association between cancer risk and vitamin D were much less consistent. Only those studies that prospectively examined the 25-hydroxyvitamin D serum levels in relation to risk of colorectal cancer are homogeneous: they all reported inverse associations, although not all reaching statistical significance. The results of the intervention studies are suggestive of a protective role of high doses of vitamin D in cancer, but they have been criticized in the literature. We, therefore, conclude that there is accumulating evidence for sunlight as a protective factor for several types of cancer. The same conclusion can be made concerning high vitamin D levels and the risk of colorectal cancer. This evidence, however, is not conclusive, because the number of (good quality) studies is still limited and publication biases cannot be excluded. The discrepancies between the epidemiological evidence for a possible preventive effect of sunlight and vitamin D and the question of how to apply the findings on the beneficial effects of sunlight to (public) health recommendations are discussed.
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Wong KY, Tai BC, Chia SE, Kuperan P, Lee KM, Lim ST, Loong S, Mow B, Ng SB, Tan L, Tan SY, Tan SH, Tao M, Wong A, Wong GC, Seow A. Sun exposure and risk of lymphoid neoplasms in Singapore. Cancer Causes Control 2012; 23:1055-64. [DOI: 10.1007/s10552-012-9974-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/16/2012] [Indexed: 12/23/2022]
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Mohr SB, Garland CF, Gorham ED, Grant WB, Garland FC. Ultraviolet B and incidence rates of leukemia worldwide. Am J Prev Med 2011; 41:68-74. [PMID: 21665065 DOI: 10.1016/j.amepre.2011.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 04/08/2011] [Accepted: 04/12/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recent research has suggested a relationship between vitamin D deficiency and risk of leukemia. PURPOSE Using data from the UN cancer database, GLOBOCAN, this study will determine whether a relationship exists for latitude and ultraviolet B (UVB) irradiance with incidence rates of leukemia in 175 countries. METHODS Multiple regression was used to analyze the independent association between UVB and age-adjusted incidence rates of leukemia in 139 countries in 2002. This study controlled for dietary data on intake of energy from animal sources and per capita healthcare expenditures. The analyses were performed in 2009. RESULTS People residing in the highest-latitude countries had the highest rates of leukemia in both men (R(2)=0.34, p<0.0001) and women (R(2)=0.24, p<0.0001). In men, UVB was independently inversely associated with leukemia incidence rates (p≤0.001), whereas animal energy consumption (p=0.02) and per capita healthcare expenditures (p≤0.0001) were independently positively associated (R(2) for model=0.61, p≤0.0001). In women, UVB adjusted for cloud cover was independently inversely associated with leukemia incidence rates (p≤0.01), whereas animal energy consumption (p≤0.05) and per capita healthcare expenditures (p=0.0002) were independently positively associated (R(2) for model=0.51, p<0.0001). CONCLUSIONS Countries with low UVB had higher age-adjusted incidence rates of leukemia. This suggests the possibility that low serum 25-hydroxyvitamin D status, because of lower levels of UVB, somehow might predict the development of leukemia.
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Affiliation(s)
- Sharif B Mohr
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, 92093-0631, USA
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Chen W, Clements M, Rahman B, Zhang S, Qiao Y, Armstrong BK. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Cancer Causes Control 2010; 21:1701-9. [DOI: 10.1007/s10552-010-9599-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 05/29/2010] [Indexed: 12/31/2022]
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Lim U, Freedman DM, Hollis BW, Horst RL, Purdue MP, Chatterjee N, Weinstein SJ, Morton LM, Schatzkin A, Virtamo J, Linet MS, Hartge P, Albanes D. A prospective investigation of serum 25-hydroxyvitamin D and risk of lymphoid cancers. Int J Cancer 2009; 124:979-86. [PMID: 19035445 DOI: 10.1002/ijc.23984] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Studies indicate that higher sun exposure, especially in the recent past, is associated with reduced risk of non-Hodgkin lymphoma (NHL). Ultraviolet radiation-derived vitamin D may be protective against lymphomagenesis. We examined the relationship between prediagnostic serum 25-hydroxyvitamin D (25(OH)D) and lymphoid cancer risk in a case-control study nested within the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study cohort (1985-2002) of 29,133 Finnish male smokers (ages 50-69). We identified 270 incident lymphoid cancer cases and matched them individually with 538 controls by birth-year and month of fasting blood draw at baseline. In conditional logistic regression models for 10 nmol/L increments or tertile comparisons, serum 25(OH)D was not associated with the risk of overall lymphoid cancers, NHL (n = 208) or multiple myeloma (n = 41). Odds ratios (OR) for NHL for higher tertiles were 0.75 (95% confidence interval (CI), 0.50, 1.14) and 0.82 (95% CI, 0.53, 1.26). The 25(OH)D-NHL association, however, differed by follow-up duration at diagnosis. Cases diagnosed less than 7 years from the baseline showed an inverse association (OR for highest vs. lowest tertile = 0.43; 95% CI: 0.23, 0.83; p for trend = 0.01), but not later diagnoses (OR = 1.52; 95% CI: 0.82, 2.80; p for trend = 0.17). The inverse association found for close exposure to diagnosis was not confounded by other risk factors for lymphoma or correlates of 25(OH)D. Although our findings suggest that circulating 25(OH)D is not likely associated with overall lymphoid cancer, they indicate a potentially protective effect on short-term risk of NHL.
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Affiliation(s)
- Unhee Lim
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI 96813, USA.
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van der Rhee HJ, de Vries E, Coebergh JWW. Does sunlight prevent cancer? A systematic review. Eur J Cancer 2006; 42:2222-32. [PMID: 16904314 DOI: 10.1016/j.ejca.2006.02.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 02/17/2006] [Indexed: 11/24/2022]
Abstract
Accumulating evidence for beneficial effects of sunlight on several types of cancer with a high mortality rate makes it necessary to reconsider the health recommendations on sun exposure, which are now mainly based on the increased risks for skin cancer. We reviewed all published studies concerning sun exposure and cancer, excluding skin cancer. All selected studies on prostate (3 ecologic, 3 case-control and 2 cohort), breast (4 ecologic, 1 case-control and 2 cohort) and ovary cancer (2 ecologic and 1 case-control) showed a significantly inverse correlation between sunlight and mortality or incidence. Two ecologic, 1 case-control and 2 prospective studies showed an inverse relation between sunlight and colon cancer mortality; 1 case-control study found no such association. Ecologic studies on non-Hodgkin lymphoma (NHL) mortality and sunlight gave conflicting results: early studies showing mostly positive and later studies showing mostly negative correlations. Three case-control studies and 1 cohort study found a significant inverse association between the incidence of NHL and sunlight. The question of how to apply these findings to (public) health recommendations is discussed.
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Affiliation(s)
- H J van der Rhee
- Department of Dermatology, Leyenburg Hospital, Leyweg 275, 2504 LN Den Haag, Zuid-Holland, The Netherlands.
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Fukuda Y, Umezaki M, Nakamura K, Takano T. Variations in societal characteristics of spatial disease clusters: examples of colon, lung and breast cancer in Japan. Int J Health Geogr 2005; 4:16. [PMID: 15953394 PMCID: PMC1177982 DOI: 10.1186/1476-072x-4-16] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 06/14/2005] [Indexed: 11/21/2022] Open
Abstract
Background Spatial analyses and ecological studies are essential for epidemiology and public health. The present study combining these two methods was performed to identify spatial clusters of selected types of cancer in Japan and to determine their societal characteristics focusing on homogeneity among clusters. Results Spatial clusters of high mortality rates of male colon and lung cancer and of female breast cancer were identified by the spatial scan statistic using Japanese municipal data (N = 3360) from 1993 to 1998 and also municipalities were divided into four societal clusters based on socioeconomic indicators and population density (urban-rich, suburban, rural-poor, and clutter). Five, seven, and four mortality clusters were identified for lung, colon and breast cancer, respectively. For colon and breast cancer, most municipalities of all except one cluster were included in a single societal cluster (urban-rich). The municipalities associated with mortality clusters for lung cancer belonged to various societal clusters. Conclusion Increased mortality rates of colon and breast cancer can be explained by homogenous societal characteristics related to urbanisation, although there were exceptional areas with higher mortality rates. The regional variation in lung cancer mortality rate appeared to be due to heterogeneous factors. These findings and the analysis performed in the present study will contribute to both nationwide and region-specific cancer prevention strategies.
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Affiliation(s)
- Yoshiharu Fukuda
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Masahiro Umezaki
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Keiko Nakamura
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
| | - Takehito Takano
- Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo, 113-8519, Japan
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