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Akbarialiabad H, Grant-Kels JM, Murrell DF. A Call for Action: Formalin Exposure and Broader Occupational Hazards and Assessing the Risk of Glioblastoma in Clinician Scientists. Clin Dermatol 2024:S0738-081X(24)00082-8. [PMID: 38825061 DOI: 10.1016/j.clindermatol.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Physicians and surgeons have a 3-fold increased risk of glioblastoma compared to population controls. We discuss the potential role of dermatology neurotoxin and carcinogenic occupational exposure, particularly to formalin/formaldehyde, how to reduce those exposures, and the ethical imperative for dermatologists to protect themselves, their staff, and their patients.
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Affiliation(s)
- Hossein Akbarialiabad
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA.
| | - Dedee F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia; Department of Dermatology, St George Hospital, Sydney, NSW, Australia
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Anderson NJ, Smith CK, Foley MP. Work-related injury burden, workers' compensation claim filing, and barriers: Results from a statewide survey of janitors. Am J Ind Med 2022; 65:173-195. [PMID: 34897753 PMCID: PMC9300089 DOI: 10.1002/ajim.23319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness. METHODS Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages. RESULTS There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims. CONCLUSIONS Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.
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Affiliation(s)
- Naomi J. Anderson
- Washington State Department of Labor & Industries Olympia Washington USA
| | - Caroline K. Smith
- Washington State Department of Labor & Industries Olympia Washington USA
| | - Michael P. Foley
- Washington State Department of Labor & Industries Olympia Washington USA
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Francis SS, Ostrom QT, Cote DJ, Smith TR, Claus E, Barnholtz-Sloan JS. The Epidemiology of Central Nervous System Tumors. Hematol Oncol Clin North Am 2022; 36:23-42. [PMID: 34801162 DOI: 10.1016/j.hoc.2021.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article reviews the current epidemiology of central nervous system tumors. Population-level basic epidemiology, nationally and internationally, and current understanding of germline genetic risk are discussed, with a focus on known and well-studied risk factors related to the etiology of central nervous system tumors.
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Affiliation(s)
- Stephen S Francis
- Department of Neurological Surgery, Division of Neuro and Molecular Epidemiology, University of California San Francisco School of Medicine, 1450 3rd Street, HD442, San Francisco, CA 94158, USA.
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, 571 Research Drive, MSRB-1, Rm 442, Durham, NC 27710, USA
| | - David J Cote
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, 1200 N State Street, Suite 3300, Los Angeles, CA 90033, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Avenue, Boston, MA 02115, USA
| | - Elizabeth Claus
- Department of Neurosurgery, Yale University, Yale School of Public Health, Brigham and Women's Hospital, 60 College Street, New Haven, CT 06510, USA
| | - Jill S Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology, Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), NCI Shady Grove, 9609 Medical Center Dr, Rockville, MD 20850, USA
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Mendes Pereira V, Nicholson P, Cancelliere NM, Liu XYE, Agid R, Radovanovic I, Krings T. Feasibility of robot-assisted neuroendovascular procedures. J Neurosurg 2021; 136:992-1004. [PMID: 34560642 DOI: 10.3171/2021.1.jns203617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Geographic factors prevent equitable access to urgent advanced neuroendovascular treatments. Robotic technologies may enable remote endovascular procedures in the future. The authors performed a translational, benchtop-to-clinical study to evaluate the in vitro and clinical feasibility of the CorPath GRX Robotic System for robot-assisted endovascular neurointerventional procedures. METHODS A series of bench studies was conducted using patient-specific 3D-printed models to test the system's compatibility with standard neurointerventional devices, including microcatheters, microwires, coils, intrasaccular devices, and stents. Optimal baseline setups for various procedures were determined. The models were further used to rehearse clinical cases. Subsequent to these investigations, a prospective series of 6 patients was treated using robotic assistance for complex, wide-necked intracranial saccular aneurysms between November 2019 and February 2020. The technical success, incidence of periprocedural complications, and need for conversion to manual procedures were evaluated. RESULTS The ideal robotic setup for treatment of both anterior and posterior circulation aneurysms was determined to consist of an 80-cm guide catheter with a 115-cm-long intermediate catheter, a microcatheter between 150 and 170 cm in length, and a microwire with a minimum length of 300 cm. All coils, intrasaccular devices, and stents tested were compatible with the system and could be advanced or retracted safely and placed accurately. All 6 clinical procedures were technically successful, with all intracranial steps being performed robotically with no conversions to manual intervention or failures of the robotic system. There were no procedure-related complications or adverse clinical outcomes. CONCLUSIONS This study demonstrates the feasibility of robot-assisted neurointerventional procedures. The authors' results represent an important step toward enabling remote neuroendovascular care and geographic equalization of advanced endovascular treatments through so-called telestroke intervention.
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Affiliation(s)
- Vitor Mendes Pereira
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and.,2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Patrick Nicholson
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Nicole M Cancelliere
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Xiao Yu Eileen Liu
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Ronit Agid
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and
| | - Ivan Radovanovic
- 2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Timo Krings
- 1Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto; and.,2Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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Claus EB, Cannataro VL, Gaffney SG, Townsend JP. Environmental and sex-specific molecular signatures of glioma causation. Neuro Oncol 2021; 24:29-36. [PMID: 33942853 PMCID: PMC8730771 DOI: 10.1093/neuonc/noab103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The relative importance of genetic and environmental risk factors in gliomagenesis remains uncertain. Methods Using whole-exome sequencing data from 1105 adult gliomas, we evaluate the relative contribution to cancer cell lineage proliferation and survival of single-nucleotide mutations in tumors by IDH mutation subtype and sex. We also quantify the contributions of COSMIC cancer mutational signatures to these tumors, identifying possible risk exposures. Results IDH-mutant tumors exhibited few unique recurrent substitutions—all in coding regions, while IDH wild-type tumors exhibited many substitutions in non-coding regions. The importance of previously reported mutations in IDH1/2, TP53, EGFR, PTEN, PIK3CA, and PIK3R1 was confirmed; however, the largest cancer effect in IDH wild-type tumors was associated with mutations in the low-prevalence BRAF V600E. Males and females exhibited mutations in a similar set of significantly overburdened genes, with some differences in variant sites—notably in the phosphoinositide 3-kinase (PI3K) pathway. In IDH-mutant tumors, PIK3CA mutations were located in the helical domain for females and the kinase domain for males; variants of import also differed by sex for PIK3R1. Endogenous age-related mutagenesis was the primary molecular signature identified; a signature associated with exogenous exposure to haloalkanes was identified and noted more frequently in males. Conclusions Cancer-causing mutations in glioma primarily originated as a consequence of endogenous rather than exogenous factors. Mutations in helical vs kinase domains of genes in the phosphoinositide 3-kinase (PI3K) pathway are differentially selected in males and females. Additionally, a rare environmental risk factor is suggested for some cases of glioma—particularly in males.
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Affiliation(s)
- Elizabeth B Claus
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.,Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Stephen G Gaffney
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Jeffrey P Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.,Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
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Laroche E, L’Espérance S. Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2519. [PMID: 33802629 PMCID: PMC7967542 DOI: 10.3390/ijerph18052519] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
Firefighters are exposed to carcinogens that may increase their risk of developing many types of occupational cancer. Many systematic reviews (SRs) have been produced with sometimes conflicting conclusions. In this overview of reviews, we aim to assess the conclusion consistency across the available systematic reviews on the cancer risk in firefighters. Literature searches were conducted in several indexed databases and grey literature to retrieve systematic reviews aiming to evaluate cancer incidence or cancer mortality in firefighters. Results from included SRs were analyzed according to the tumour site. Out of 1054 records identified by the search in the databases, a total of 11 SRs were ultimately included. The original studies (n = 104) analyzed in the SRs were published between 1959 and 2018. The results consistently reported a significant increase in the incidence of rectal, prostate, bladder and testicular cancers as well as mesothelioma and malignant melanoma in firefighters compared to the general population. The SRs also indicate that death rates from rectal cancer and non-Hodgkin's lymphoma are higher among firefighters. Consistent SR results suggest that several types of cancer may be more frequent in firefighters than in the general population.
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Affiliation(s)
- Elena Laroche
- School of Administration Sciences, Université TELUQ, Quebec, QC G1K 9H6, Canada;
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Bjørklund G, Pivina L, Dadar M, Semenova Y, Chirumbolo S, Aaseth J. Mercury Exposure, Epigenetic Alterations and Brain Tumorigenesis: A Possible Relationship? Curr Med Chem 2020; 27:6596-6610. [DOI: 10.2174/0929867326666190930150159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/11/2019] [Accepted: 08/30/2019] [Indexed: 12/09/2022]
Abstract
The risk assessment of mercury (Hg), in both wildlife and humans, represents an increasing
challenge. Increased production of Reactive Oxygen Species (ROS) is a known Hg-induced
toxic effect, which can be accentuated by other environmental pollutants and by complex interactions
between environmental and genetic factors. Some epidemiological and experimental studies
have investigated a possible correlation between brain tumors and heavy metals. Epigenetic modifications
in brain tumors include aberrant activation of genes, hypomethylation of specific genes,
changes in various histones, and CpG hypermethylation. Also, Hg can decrease the bioavailability
of selenium and induce the generation of reactive oxygen that plays important roles in different
pathological processes. Modification of of metals can induce excess ROS and cause lipid peroxidation,
alteration of proteins, and DNA damage. In this review, we highlight the possible relationship
between Hg exposure, epigenetic alterations, and brain tumors.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| | | | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj, Iran
| | | | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, Brumunddal, Norway
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Ramoutar DN, Thakur Y, Batta V, Chung V, Liu D, Guy P. Orthopaedic Surgeon Brain Radiation During Fluoroscopy: A Cadaver Model. J Bone Joint Surg Am 2020; 102:e125. [PMID: 33208643 DOI: 10.2106/jbjs.19.01053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this study were to quantify exposure of the surgeon's brain to radiation during short cephalomedullary (SC) nailing, to extrapolate lifetime dose, and to determine the effects of personal protective equipment (PPE) on brain dose. METHODS Two cadaveric specimens were used: (1) a whole cadaveric body representing the patient, with a left nail inserted to act as the scatter medium, and (2) an isolated head-and-neck cadaveric specimen representing a surgeon, with radiation dosimeters placed in specific locations in the brain. The "patient" cadaver's left hip was exposed in posteroanterior and lateral radiographic planes. Measurements were performed without shielding of the head-and-neck specimen and then repeated sequentially with different PPE configurations. An average surgeon career was estimated to be 40 years (ages 25 to 65 years) with the caseload obtained from the department's billing data. RESULTS The mean radiation dose to the surgeon brain without PPE was 3.35 µGy (95% confidence interval [CI]: 2.4 to 4.3) per nail procedure. This was significantly reduced with use of a thyroid collar (2.94 µGy [95% CI: 1.91 to 3.91], p = 0.04). Compared with use of the thyroid collar in isolation, there was no significant additional reduction in radiation when the collar was used with leaded glasses (2.96 µGy [95% CI: 2.15 to 3.76], p = 0.97), with a lead cap (3.22 µGy [95% CI: 2.31 to 4.13], p = 0.55), or with both (2.31 µGy [95% CI: 1.61 to 3.01], p = 0.15). The extrapolated lifetime dose over 40 working years for SC nailing without PPE was 2,146 µGy (95% CI: 1,539 to 2,753), with an effective dose of 21.5 µSv. CONCLUSIONS The extrapolated cumulative lifetime radiation to a surgeon's brain from SC nailing based on our institution's workload and technology is low and comparable with radiation during a one-way flight from London to New York. Of note, we studied only one of many fluoroscopy-aided procedures and likely underestimated total lifetime exposure if exposures from other procedures are included. This study also demonstrates that thyroid collars significantly reduce brain dose for this procedure whereas other head/neck PPE such as lead caps appear to have minimal additional effect. This study provides a methodology for future studies to quantify brain dose for other common orthopaedic procedures. CLINICAL RELEVANCE This study, based on our institutional data, demonstrates that although the lifetime brain dose from SC nailing is low, thyroid collars significantly reduce this dose further. As such, in accordance with the "as low as reasonably achievable" radiation exposure principle, radiation safety programs and individual surgeons should consider use of thyroid collars in this setting.
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Affiliation(s)
- Darryl Nilesh Ramoutar
- Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Yogesh Thakur
- Department of Radiology, Faculty of Medicine (Y.T.), and Division of Orthopaedic Trauma, Department of Orthopaedics (P.G.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Vineet Batta
- Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vivian Chung
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Danmei Liu
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Department of Radiology, Faculty of Medicine (Y.T.), and Division of Orthopaedic Trauma, Department of Orthopaedics (P.G.), University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
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Saad EB, Slater C, Inácio LAO, Santos GVD, Dias LC, Camanho LEM. Catheter Ablation for Treatment of Atrial Fibrillation and Supraventricular Arrhythmias Without Fluoroscopy Use: Acute Efficacy and Safety. Arq Bras Cardiol 2020; 114:1015-1026. [PMID: 32638895 PMCID: PMC8416121 DOI: 10.36660/abc.20200096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/08/2020] [Indexed: 01/01/2023] Open
Abstract
Fundamento O uso da radiação ionizante em procedimentos médicos está associado a riscos significativos à saúde dos pacientes e da equipe de saúde. Objetivos Avaliar a segurança e a eficácia aguda da ablação por cateter para tratamento da fibrilação atrial (FA) e arritmias supraventriculares (SVTs), utilizando uma abordagem exclusivamente não fluoroscópica, guiada por eco intracardíaco (ICE) e mapeamento 3D. Métodos 95 pts (idade média 60 ± 18 anos, 61% do sexo masculino) programados para ablação de FA (69 pts, 45 FA paroxística e 24 FA persistente) ou SVTs (26 pts – 14 reentrada nodal, 6 Wolf-Parkinson-White [WPW], 5 flutter atrial direito [AD], 1 taquicardia atrial). Nove pacientes (9,5%) tinham marcapasso definitivo ou dispositivos de ressincronização com desfibrilador. Dois sistemas de mapeamento eletroanatômico foram utilizados – CARTO (65%) e NAVx (35%), bem como cateteres de ICE disponíveis – Acunav e ViewFlex. Resultados O isolamento das veias pulmonares (VPs), bem como todos os outros alvos que precisavam de ablação em ambos os átrios, foram alcançados e adequadamente visualizados. Não foram observados derrames pericárdicos, complicações trombóticas ou outras intercorrências nesta série. Punções transseptais difíceis (19 pacientes – 20%) foram realizadas sem fluoroscopia em todos os casos. Não foi utilizada fluoroscopia de backup, e nenhum vestuário de chumbo foi necessário. Avaliações detalhadas dos marcapassos após o procedimento não mostraram nenhum dano aos eletrodos, deslocamentos ou mudanças de limiar. Conclusões Uma estratégia de ablação por cateter sem uso de radiação para FA e outras arritmias atriais é segura e eficaz quando guiada pela utilização adequada do ICE e do mapeamento 3D. Diversos sítios em ambos os átrios podem ser alcançados e adequadamente ablacionados sem a necessidade de fluoroscopia de backup. Não foram observadas complicações. (Arq Bras Cardiol. 2020; 114(6):1015-1026)
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Affiliation(s)
- Eduardo B Saad
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Charles Slater
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | | | - Gustavo Vignoli Dos Santos
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
| | - Lucas Carvalho Dias
- Serviço de Arritmias e Estimulação Cardíaca Artificial, Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil
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Ison GR, Allahwala U, Weaver JC. Radiation Management in Coronary Angiography: Percutaneous Coronary Intervention for Chronic Total Occlusion at the Frontier. Heart Lung Circ 2019; 28:1501-1509. [DOI: 10.1016/j.hlc.2019.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/10/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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Howell AE, Zheng J, Haycock PC, McAleenan A, Relton C, Martin RM, Kurian KM. Use of Mendelian Randomization for Identifying Risk Factors for Brain Tumors. Front Genet 2018; 9:525. [PMID: 30483309 PMCID: PMC6240585 DOI: 10.3389/fgene.2018.00525] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 02/06/2023] Open
Abstract
Gliomas are a group of primary brain tumors, the most common and aggressive subtype of which is glioblastoma. Glioblastoma has a median survival of just 15 months after diagnosis. Only previous exposure to ionizing radiation and particular inherited genetic syndromes are accepted risk factors for glioma; the vast majority of cases are thought to occur spontaneously. Previous observational studies have described associations between several risk factors and glioma, but studies are often conflicting and whether these associations reflect true casual relationships is unclear because observational studies may be susceptible to confounding, measurement error and reverse causation. Mendelian randomization (MR) is a form of instrumental variable analysis that can be used to provide supporting evidence for causal relationships between exposures (e.g., risk factors) and outcomes (e.g., disease onset). MR utilizes genetic variants, such as single nucleotide polymorphisms (SNPs), that are robustly associated with an exposure to determine whether there is a causal effect of the exposure on the outcome. MR is less susceptible to confounding, reverse causation and measurement errors as it is based on the random inheritance during conception of genetic variants that can be relatively accurately measured. In previous studies, MR has implicated a genetically predicted increase in telomere length with an increased risk of glioma, and found little evidence that obesity related factors, vitamin D or atopy are causal in glioma risk. In this review, we describe MR and its potential use to discover and validate novel risk factors, mechanistic factors, and therapeutic targets in glioma.
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Affiliation(s)
- Amy Elizabeth Howell
- Brain Tumour Research Centre, Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom
| | - Jie Zheng
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Philip C. Haycock
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Caroline Relton
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard M. Martin
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kathreena M. Kurian
- Brain Tumour Research Centre, Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom
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Solenova LG, Nekrasova LA. Healthcare workers: occupational carcinogenic factors and cancer risk. ADVANCES IN MOLECULAR ONCOLOGY 2018. [DOI: 10.17650/2313-805x-2018-5-3-25-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The number of healthcare workers is over two million in Russia. Many of them are exposed to hazardous physical, chemical and biological occupational factors acting along with psychological strain. The results of large epidemiological studies carried out in various countries revealed greater cancer risk in physicians and nurses: cancer of the breast, skin, brain and other sites. Higher cancer risk of lung, breast, uterine, ovary, brain is considered to be associated with ionizing radiation. The female healthcare workers who handle antineoplastic drugs showed a greater risk of birth defects in offspring, spontaneous abortions and breast cancer. In Russia, the growing number of accidents among healthcare workers following transmission of infection by carcinogenic biological factors such as HBV and HIV is observed. Higher risk of reproductive impairments, hyperplasia of the breast and uterine tissues, breast cancer are revealed in nurses working the night shift. In Russia, there is lack of epidemiological studies of cancer risk among healthcare workers, the number of medical personal exposed to occupational carcinogens is unknown. That all does not show the actual situation in our country and does not allow setting priorities in cancer prevention among medical workers.
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Affiliation(s)
- L. G. Solenova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - L. A. Nekrasova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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13
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Abdelrahman MA, Abu Alfwares A, Alewaidat H, Alhasan M, Rawashdeh MA, Al Mousa DS. Compliance With Radiation Protection Practices Among Radiologists. HEALTH PHYSICS 2018; 115:338-343. [PMID: 30045113 DOI: 10.1097/hp.0000000000000886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Radiologists are at higher risk of adverse health effects due to their occupational radiation exposure; therefore, applying protection techniques is imperative. Studies on radiologists' compliance in this regard are scarce. We aimed to assess compliance with radiation safety practices among radiologists. METHODS Questionnaires were distributed to radiologists in tertiary hospitals. The questionnaire was designed to assess compliance in three domains: using personal protective devices, using exposure-reduction techniques during fluoroscopic exposures, and using personal dose-monitoring devices. Descriptive analysis of the compliance was performed. RESULTS Sixty-two radiologists were included in the analysis. Use of leaded aprons and thyroid shields was commonplace, whereas only 3.2% ever use leaded eyeglasses. About half of the radiologists always considered reducing the time of exposure and avoided exposure by the primary beam, and the other half did that sometimes. Most of the radiologists (66.1%) always complied with reducing the number of unnecessary exposures, and the rest only complied sometimes. Most of the radiologists (93.5%) always used single personal dose-monitoring devices, most commonly at the neck level over the collar. There was no difference in compliance between different sexes, position descriptions, hospital types, hospital sizes, or years of experience. CONCLUSION Future compliance improvement strategies for radiologists should focus on use of thyroid shields and leaded eyeglasses and use of exposure-reduction techniques during fluoroscopic operations.
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Affiliation(s)
- Mostafa A Abdelrahman
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Abu Alfwares
- Department of Legal Medicine, Toxicology, and Forensic Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Haytham Alewaidat
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mustafa Alhasan
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A Rawashdeh
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Dana S Al Mousa
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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The role of income in brain tumor patients: a descriptive register-based study : No correlation between patients' income and development of brain cancer. Med Oncol 2018. [PMID: 29532282 PMCID: PMC5847626 DOI: 10.1007/s12032-018-1108-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Socioeconomic status (SES) and its association with cancer in general have been thoroughly studied in the last decades. Several studies have shown associations between SES and many types of cancer such as lung cancer, breast cancer, and prostate cancer. For gliomas, no clear occupational or exposure risk factors have been identified, although some possible risk factors such as use of cellular telephone are still controversial. The aim in the present study is to analyze whether there is an association between SES and development of brain cancer. Data from 1999 through 2013 were collected from the Swedish Cancer Registry and from the National Statistics of Sweden. Age-standardized incidence rates for people with different income were calculated using linear regression model. A total of 11,892 patients were included, of which 5675 were meningiomas, 1216 low-grade gliomas, and 5001 high-grade gliomas. No clear trend between increasing incidence rates and higher income was seen in neither of the investigated brain tumor histologies. In conclusion, the results should be interpreted with caution, but there does not seem to be a correlation in this material between increased income and development of brain cancer.
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Bencsik A, Lestaevel P, Guseva Canu I. Nano- and neurotoxicology: An emerging discipline. Prog Neurobiol 2018; 160:45-63. [DOI: 10.1016/j.pneurobio.2017.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 09/10/2017] [Accepted: 10/20/2017] [Indexed: 12/12/2022]
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Orme NM, Rihal CS, Gulati R, Holmes DR, Lennon RJ, Lewis BR, McPhail IR, Thielen KR, Pislaru SV, Sandhu GS, Singh M. Occupational health hazards of working in the interventional laboratory: a multisite case control study of physicians and allied staff. J Am Coll Cardiol 2015; 65:820-826. [PMID: 25720626 DOI: 10.1016/j.jacc.2014.11.056] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND The occupational hazards of working in the interventional laboratory have been inadequately studied for physicians and remain unaddressed for nonphysician personnel. OBJECTIVES This study sought to determine whether the prevalence of work-related musculoskeletal pain, cancer, and other medical conditions is higher among physicians and allied staff who work in interventional laboratories compared with employees who do not. METHODS Mayo Clinic employees who work in affiliated hospitals with interventional cardiology or interventional radiology laboratories took an electronic survey. Results were stratified on the basis of self-reported occupational exposure to procedures that involve radiation. RESULTS There were 1,543 employees (mean age 43 ± 11.3 years, 33% male) who responded to the survey (response rate of 57%), and 1,042 (67.5%) reported being involved with procedures utilizing radiation. These employees reported experiencing work-related pain more often than the control group before (54.7% vs. 44.7%; p < 0.001) and after adjustment for age, sex, body mass index, pre-existing musculoskeletal conditions, years in profession, and job description (odds ratio: 1.67; 95% confidence interval: 1.32 to 2.11; p < 0.001). Musculoskeletal pain varied significantly by job description, with the highest incidence reported by technicians (62%) and nurses (60%) followed by attending physicians (44%) and trainees (19%; p < 0.001). There was no difference in cancer prevalence between groups (9% vs. 9%; p = 0.96). CONCLUSIONS Musculoskeletal pain is more common among healthcare workers who participate in interventional procedures and is highest in nonphysician employees. The diagnosis of cancer in employees who participate in procedures that utilize radiation was not elevated when compared to controls within the same departments, although any conclusion regarding causality is limited by the cross-sectional nature of the study, as well as the low overall prevalence of malignancy in our study group.
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Affiliation(s)
- Nicholas M Orme
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Bradley R Lewis
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Ian R McPhail
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kent R Thielen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Mandeep Singh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
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Mutations of the human interferon alpha-2b gene in brain tumor patients exposed to different environmental conditions. Cancer Gene Ther 2015; 22:246-61. [DOI: 10.1038/cgt.2015.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/10/2015] [Accepted: 02/12/2015] [Indexed: 01/24/2023]
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Collins JJ, Bender TJ, Bonner EM, Bodner KM, Kreft AM. Brain Cancer in Workers Employed at a Laboratory Research Facility. PLoS One 2014; 9:e113997. [PMID: 25493437 PMCID: PMC4262372 DOI: 10.1371/journal.pone.0113997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/02/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An earlier study of research facility workers found more brain cancer deaths than expected, but no workplace exposures were implicated. METHODS Adding four additional years of vital-status follow-up, we reassessed the risk of death from brain cancer in the same workforce, including 5,284 workers employed between 1963, when the facility opened, and 2007. We compared the work histories of the brain cancer decedents in relationship to when they died and their ages at death. RESULTS As in most other studies of laboratory and research workers, we found low rates of total mortality, total cancers, accidents, suicides, and chronic conditions such as heart disease and diabetes. We found no new brain cancer deaths in the four years of additional follow-up. Our best estimate of the brain cancer standardized mortality ratio (SMR) was 1.32 (95% confidence interval [95% CI] 0.66-2.37), but the SMR might have been as high as 1.69. Deaths from benign brain tumors and other non-malignant diseases of the nervous system were at or below expected levels. CONCLUSION With the addition of four more years of follow-up and in the absence of any new brain cancers, the updated estimate of the risk of brain cancer death is smaller than in the original study. There was no consistent pattern among the work histories of decedents that indicated a common causative exposure.
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Affiliation(s)
- James J. Collins
- Health and Human Services, Saginaw Valley State University, University Center, Michigan, United States of America
| | - Thomas John Bender
- Health Services/Epidemiology, The Dow Chemical Company, Midland, Michigan, United States of America
| | - Eileen M. Bonner
- Health Services, The Dow Chemical Company, Collegeville, Pennsylvania, United States of America
| | - Kenneth M. Bodner
- Epidemiology, Kelly Services, South Lake Tahoe, California, United States of America
| | - Alisa M. Kreft
- EH&S Delivery Expertise, The Dow Chemical Company, Bristol, Pennsylvania, United States of America
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Socioeconomic status and glioblastoma risk: a population-based analysis. Cancer Causes Control 2014; 26:179-185. [PMID: 25421378 DOI: 10.1007/s10552-014-0496-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Socioeconomic status (SES) is associated with risk of various cancer types because of correlation between SES and causal factors or increased case ascertainment, or both. Studies evaluating the association between glioblastoma and occupational or SES factors have yielded inconsistent results. We evaluated the association between SES and glioblastoma risk using a large, population-based cancer registry dataset. METHODS Data of the Surveillance, Epidemiology, and End Results Program were used to evaluate the impact of SES on glioblastoma risk. SES was divided into quintiles on the basis of census tract of residence. Census tracts are small, geographically defined areas with relatively homogeneous population characteristics. RESULTS Higher SES was strongly associated with increased risk of glioblastoma (p < .001). Relative to persons living in census tracts of the lowest SES quintile, the highest SES quintile had a rate ratio of 1.45 (95 % CI 1.39-1.51) (p < .001). Similar associations were seen in population subgroups defined by age, sex, and race. CONCLUSIONS The strong association between higher SES and greater glioblastoma risk is unlikely to represent an ascertainment effect because glioblastoma is rapidly progressive and ultimately fatal. A number of previously proposed glioma risk factors may be correlated with SES, including atopy and allergy rates, cellular telephone use, and body morphometric measures. Further research is needed to define the mechanism of this association.
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Koifman S, Malhão TA, Pinto de Oliveira G, de Magalhães Câmara V, Koifman RJ, Meyer A. Cancer mortality among Brazilian dentists. Am J Ind Med 2014; 57:1255-64. [PMID: 25164308 DOI: 10.1002/ajim.22369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies have variably shown excess risks of elected cancers among dentists. METHODS National Brazilian mortality data were used to obtain mortality patterns among dentists between 1996 and 2004. Cancer mortality odds ratios (MORs) and cancer proportional mortality ratios for all cancer sites were calculated, using the general population and physicians and lawyers as comparison groups. RESULTS Female dentists from both age strata showed higher risks for breast, colon-rectum, lung, brain, and non-Hodgkin lymphoma. Compared to physicians and lawyers, higher MOR estimates were observed for brain cancer among female dentists 20-49 yr. Among male dentists, higher cancer mortality was found for colon-rectum, pancreas, lung, melanoma, and non-Hodgkin lymphoma. Higher risk estimates for liver, prostate, bladder, brain, multiple myeloma and leukemia were observed among 50-79 yr old male dentists. DISCUSSION If confirmed, these results indicate the need for limiting occupational exposures among dentists in addition to establishing screening programs to achieve early detection of selected malignant tumors.
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Affiliation(s)
- Sergio Koifman
- Department of Epidemiology and Quantitative Methods; National School of Public Health; Oswaldo Cruz Foundation; Rio de Janeiro Brazil
| | - Thainá Alves Malhão
- Institute for Studies in Collective Health; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Gisele Pinto de Oliveira
- Institute for Studies in Collective Health; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | | | - Rosalina Jorge Koifman
- Department of Epidemiology and Quantitative Methods; National School of Public Health; Oswaldo Cruz Foundation; Rio de Janeiro Brazil
| | - Armando Meyer
- Institute for Studies in Collective Health; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
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Gandhi S, Felini MJ, Ndetan H, Cardarelli K, Jadhav S, Faramawi M, Johnson ES. A Pilot Case-Cohort Study of Brain Cancer in Poultry and Control Workers. Nutr Cancer 2014; 66:343-50. [DOI: 10.1080/01635581.2013.878734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Karadag B, Ikitimur B, Durmaz E, Avci BK, Cakmak HA, Cosansu K, Ongen Z. Effectiveness of a lead cap in radiation protection of the head in the cardiac catheterisation laboratory. EUROINTERVENTION 2013; 9:754-6. [DOI: 10.4244/eijv9i6a120] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wilk A, Waligórski P, Lassak A, Vashistha H, Lirette D, Tate D, Zea AH, Koochekpour S, Rodriguez P, Meggs LG, Estrada JJ, Ochoa A, Reiss K. Polycyclic aromatic hydrocarbons-induced ROS accumulation enhances mutagenic potential of T-antigen from human polyomavirus JC. J Cell Physiol 2013; 228:2127-38. [PMID: 23558788 DOI: 10.1002/jcp.24375] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 03/28/2013] [Indexed: 01/28/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) are the products of incomplete combustion of organic materials, which are present in cigarette smoke, deep-fried food, and in natural crude oil. Since PAH-metabolites form DNA adducts and cause oxidative DNA damage, we asked if these environmental carcinogens could affect transforming potential of the human Polyomavirus JC oncoprotein, T-antigen (JCV T-antigen). We extracted DMSO soluble PAHs from Deepwater Horizon oil spill in the Gulf of Mexico (oil-PAHs), and detected several carcinogenic PAHs. The oil-PAHs were tested in exponentially growing cultures of normal mouse fibroblasts (R508), and in R508 stably expressing JCV T-antigen (R508/T). The oil-PAHs were cytotoxic only at relatively high doses (1:50-1:100 dilution), and at 1:500 dilution the growth and cell survival rates were practically unaffected. This non-toxic dose triggered however, a significant accumulation of reactive oxygen species (ROS), caused oxidative DNA damage and the formation of DNA double strand breaks (DSBs). Although oil-PAHs induced similar levels of DNA damage in R508 and R508/T cells, only T-antigen expressing cells demonstrated inhibition of high fidelity DNA repair by homologous recombination (HRR). In contrast, low-fidelity repair by non-homologous end joining (NHEJ) was unaffected. This potential mutagenic shift between DNA repair mechanisms was accompanied by a significant increase in clonal growth of R508/T cells chronically exposed to low doses of the oil-PAHs. Our results indicate for the first time carcinogenic synergy in which oil-PAHs trigger oxidative DNA damage and JCV T-antigen compromises DNA repair fidelity.
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Affiliation(s)
- Anna Wilk
- Neurological Cancer Research at Stanley S Scott Cancer Center, New Orleans, Louisiana, USA
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Management of Patient and Staff Radiation Dose in Interventional Radiology: Current Concepts. Cardiovasc Intervent Radiol 2013; 37:289-98. [DOI: 10.1007/s00270-013-0685-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/28/2013] [Indexed: 01/07/2023]
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Smilowitz NR, Balter S, Weisz G. Occupational hazards of interventional cardiology. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:223-8. [DOI: 10.1016/j.carrev.2013.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol 2013; 111:1368-72. [PMID: 23419190 DOI: 10.1016/j.amjcard.2012.12.060] [Citation(s) in RCA: 349] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/24/2022]
Abstract
Physicians performing interventional procedures are chronically exposed to ionizing radiation, which is known to pose increased cancer risks. We recently reported 9 cases of brain cancer in interventional cardiologists. Subsequently, we received 22 additional cases from around the world, comprising an expanded 31 case cohort. Data were transmitted to us during the past few months. For all cases, where possible, we endeavored to obtain the baseline data, including age, gender, tumor type, and side involved, specialty (cardiologist vs radiologist), and number of years in practice. These data were obtained from the medical records, interviews with patients, when possible, or with family members and/or colleagues. The present report documented brain and neck tumors occurring in 31 physicians: 23 interventional cardiologists, 2 electrophysiologists, and 6 interventional radiologists. All physicians had worked for prolonged periods (latency period 12 to 32 years, mean 23.5 ± 5.9) in active interventional practice with exposure to ionizing radiation in the catheterization laboratory. The tumors included 17 cases (55%) of glioblastoma multiforme (GBM), 2 astrocytomas (7%), and 5 meningiomas (16%). In 26 of 31 cases, data were available regarding the side of the brain involved. The malignancy was left sided in 22 (85%), midline in 1, and right sided in 3 operators. In conclusion, these results raise additional concerns regarding brain cancer developing in physicians performing interventional procedures. Given that the brain is relatively unprotected and the left side of the head is known to be more exposed to radiation than the right, these findings of disproportionate reports of left-sided tumors suggest the possibility of a causal relation to occupational radiation exposure.
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INTEROCC case-control study: lack of association between glioma tumors and occupational exposure to selected combustion products, dusts and other chemical agents. BMC Public Health 2013; 13:340. [PMID: 23587105 PMCID: PMC3637633 DOI: 10.1186/1471-2458-13-340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/08/2013] [Indexed: 12/20/2022] Open
Abstract
Background The aim was to investigate possible associations between glioma (an aggressive type of brain cancer) and occupational exposure to selected agents: combustion products (diesel and gasoline exhaust emissions, benzo(a)pyrene), dusts (animal dust, asbestos, crystalline silica, wood dust) and some other chemical agents (formaldehyde, oil mist, sulphur dioxide). Methods The INTEROCC study included cases diagnosed with glioma during 2000–2004 in sub-regions of seven countries. Population controls, selected from various sampling frames in different centers, were frequency or individually matched to cases by sex, age and center. Face-to-face interviews with the subject or a proxy respondent were conducted by trained interviewers. Detailed information was collected on socio-economic and lifestyle characteristics, medical history and work history. Occupational exposure to the 10 selected agents was assessed by a job exposure matrix (JEM) which provides estimates of the probability and level of exposure for different occupations. Using a 25% probability of exposure in a given occupation in the JEM as the threshold for considering a worker exposed, the lifetime prevalence of exposure varied from about 1% to about 15% for the different agents. Associations between glioma and each of the 10 agents were estimated by conditional logistic regression, and using three separate exposure indices: i) ever vs. never; ii) lifetime cumulative exposure; iii) total duration of exposure. Results The study sample consisted of 1,800 glioma cases and 5,160 controls. Most odds ratio estimates were close to the null value. None of the ten agents displayed a significantly increased odds ratio nor any indication of dose–response relationships with cumulative exposure or with duration of exposure. Conclusion Thus, there was no evidence that these exposures influence risk of glioma.
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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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Neta G, Stewart PA, Rajaraman P, Hein MJ, Waters MA, Purdue MP, Samanic C, Coble JB, Linet MS, Inskip PD. Occupational exposure to chlorinated solvents and risks of glioma and meningioma in adults. Occup Environ Med 2012; 69:793-801. [PMID: 22864249 PMCID: PMC3850418 DOI: 10.1136/oemed-2012-100742] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Chlorinated solvents are classified as probable or possible carcinogens. It is unknown whether exposure to these agents increases the risk of malignant or benign brain tumours. Our objective was to evaluate associations of brain tumour risk with occupational exposure to six chlorinated solvents (i.e., dichloromethane, chloroform, carbon tetrachloride, 1,1,1-trichloroethane, trichloroethylene and perchloroethylene). METHODS 489 glioma cases, 197 meningioma cases and 799 controls were enrolled in a hospital-based case-control study conducted at three U.S.A. hospitals in Arizona, Massachusetts and Pennsylvania. Information about occupational history was obtained through a detailed inperson interview that included job-specific modules of questions such that the interview was tailored to each individual's particular work history. An industrial hygienist assessed potential solvent exposure based on this information and an exhaustive review of the relevant industrial hygiene literature. Unconditional logistic regression models were used to calculate OR and 95% CI for each solvent for ever/never, duration, cumulative, average weekly and highest exposure. RESULTS Overall, we found no consistent evidence of an increased risk of glioma or meningioma related to occupational exposure to the six chlorinated solvents evaluated. There was some suggestion of an association between carbon tetrachloride and glioma in analyses restricted to exposed subjects, with average weekly exposure above the median associated with increased risk compared with below the median exposure (OR = 7.1, 95% CI 1.1 to 45.2). CONCLUSIONS We found no consistent evidence for increased brain tumour risk related to chlorinated solvents.
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Affiliation(s)
- Gila Neta
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, EPS, Room 7092, 6120 Executive Boulevard, Bethesda, MD 20852-7244, USA.
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Ruder AM, Waters MA, Carreón T, Butler MA, Calvert GM, Davis-King KE, Waters KM, Schulte PA, Mandel JS, Morton RF, Reding DJ, Rosenman KD. The Upper Midwest Health Study: industry and occupation of glioma cases and controls. Am J Ind Med 2012; 55:747-55. [PMID: 22715102 DOI: 10.1002/ajim.22085] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Understanding glioma etiology requires determining which environmental factors are associated with glioma. Upper Midwest Health Study case-control participant work histories collected 1995-1998 were evaluated for occupational associations with glioma. "Exposures of interest" from our study protocol comprise our a priori hypotheses. MATERIALS AND METHODS Year-long or longer jobs for 1,973 participants were assigned Standard Occupational Classifications (SOC) and Standard Industrial Classifications (SIC). The analysis file includes 8,078 SIC- and SOC-coded jobs. For each individual, SAS 9.2 programs collated employment with identical SIC-SOC coding. Distributions of longest "total employment duration" (total years worked in jobs with identical industry and occupation codes, including multiple jobs, and non-consecutive jobs) were compared between cases and controls, using an industrial hygiene algorithm to group occupations. RESULTS Longest employment duration was calculated for 780 cases and 1,156 controls. More case than control longest total employment duration was in the "engineer, architect" occupational group [16 cases, 10 controls, odds ratio (OR) 2.50, adjusted for age group, sex, age and education, 95% confidence interval (CI) 1.12-5.60]. Employment as a food processing worker [mostly butchers and meat cutters] was of borderline significance (27 cases, 21 controls, adjusted OR: 1.78, CI: 0.99-3.18). CONCLUSIONS Among our exposures of interest work as engineers or as butchers and meat cutters was associated with increased glioma risk. Significant associations could be due to chance, because of multiple comparisons, but similar findings have been reported for other glioma studies. Our results suggest some possible associations but by themselves could not provide conclusive evidence.
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Affiliation(s)
- Avima M Ruder
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
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Picano E, Vano E, Domenici L, Bottai M, Thierry-Chef I. Cancer and non-cancer brain and eye effects of chronic low-dose ionizing radiation exposure. BMC Cancer 2012; 12:157. [PMID: 22540409 PMCID: PMC3495891 DOI: 10.1186/1471-2407-12-157] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 04/27/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND According to a fundamental law of radiobiology ("Law of Bergonié and Tribondeau", 1906), the brain is a paradigm of a highly differentiated organ with low mitotic activity, and is thus radio-resistant. This assumption has been challenged by recent evidence discussed in the present review. RESULTS Ionizing radiation is an established environmental cause of brain cancer. Although direct evidence is lacking in contemporary fluoroscopy due to obvious sample size limitation, limited follow-up time and lack of focused research, anecdotal reports of clusters have appeared in the literature, raising the suspicion that brain cancer may be a professional disease of interventional cardiologists. In addition, although terminally differentiated neurons have reduced or mild proliferative capacity, and are therefore not regarded as critical radiation targets, adult neurogenesis occurs in the dentate gyrus of the hippocampus and the olfactory bulb, and is important for mood, learning/memory and normal olfactory function, whose impairment is a recognized early biomarker of neurodegenerative diseases. The head doses involved in radiotherapy are high, usually above 2 Sv, whereas the low-dose range of professional exposure typically involves lifetime cumulative whole-body exposure in the low-dose range of < 200 mSv, but with head exposure which may (in absence of protection) arrive at a head equivalent dose of 1 to 3 Sv after a professional lifetime (corresponding to a brain equivalent dose around 500 mSv). CONCLUSIONS At this point, a systematic assessment of brain (cancer and non-cancer) effects of chronic low-dose radiation exposure in interventional cardiologists and staff is needed.
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Affiliation(s)
- Eugenio Picano
- Institute Clinical Physiology of the National Research Council CNR, 56124, Pisa, Italy
| | - Eliseo Vano
- San Carlos University Hospital, Complutense University, Medical Physics Service, Madrid, Spain
| | - Luciano Domenici
- Neuroscience Institute of the National Research Council, CNR, Pisa, and Scienze e Tecnologie Biomediche Department, L'Aquila University, Pisa, Italy
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Karolinska, Sweden
| | - Isabelle Thierry-Chef
- Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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Roguin A, Goldstein J, Bar O. Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature. EUROINTERVENTION 2012; 7:1081-6. [DOI: 10.4244/eijv7i9a172] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND The cancer risk of female nurses has been examined in several studies, but none has addressed the risk of male nurses, although they may be exposed to the same carcinogens as female nurses. In this register-based cohort study, we explored cancer incidence among male Danish nurses. METHODS We identified 3369 male nurses from the files of the Danish Nurses Association and followed them up from 1980 to 2003 in the Danish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals were calculated on the basis of standardized national rates. We compared the nurses with 3369 other male employees matched to the nurses by year of birth on social variables (vital and marital status). FINDINGS We observed 90 cancers in the cohort, with significantly increased SIRs for sarcomas and decreased SIRs for cancers of the respiratory system. When the cohort was stratified by educational generation and birth cohort, we observed significantly elevated relative risks for cancers of the brain and nervous system among the youngest nurses and for sarcomas among nurses in all educational generations and those born between 1945 and 1954. CONCLUSION The overall risk for cancer among male Danish registered nurses is similar to that of the general male Danish population. The high SIRs observed for cancers of the brain and nervous system merit further attention. The high relative risks for sarcomas and connective tissue tumours reflect a large proportion of cases of Kaposi sarcoma, which is probably not occupationally related.
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Affiliation(s)
- T K Kjaer
- Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark.
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Occupational Health Hazards in the Interventional Laboratory: Time for a Safer Environment. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.jradnu.2010.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Samkange-Zeeb F, Schlehofer B, Schüz J, Schlaefer K, Berg-Beckhoff G, Wahrendorf J, Blettner M. Occupation and risk of glioma, meningioma and acoustic neuroma: results from a German case-control study (interphone study group, Germany). Cancer Epidemiol 2010; 34:55-61. [PMID: 20061201 DOI: 10.1016/j.canep.2009.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several epidemiological studies have investigated the association between occupation and brain tumour risk, but results have been inconclusive. We investigated the association between six occupational categories defined a priori: chemical, metal, agricultural, construction, electrical/electronic and transport, and the risk of glioma, meningioma and acoustic neuroma. METHODS In a population-based case-control study involving a total of 844 cases and 1688 controls conducted from 2000 to 2003, detailed information on life-long job histories was collected during personal interviews and used to create job calendars for each participant. Job title, job activity, job number, and the starting and ending dates of the activity were recorded for all activities with duration of at least 1 year. Reported occupational activities were coded according to the International Standard Classification of Occupations 1988 (ISCO 88). For the analyses we focused on six a priori defined occupational sectors, namely chemical, metal, agricultural, construction, electrical/electronic and transport. Multiple conditional logistic regression analysis was used to estimate odds ratios and their 95% confidence intervals. RESULTS Most of the observed odds ratios were close to 1.0 for ever having worked in the six occupational sectors and risk of glioma, meningioma and acoustic neuroma. Sub-group analyses according to duration of employment resulted in two elevated odds ratios with confidence intervals excluding unity. CONCLUSIONS We did not observe an increased risk of glioma or meningioma for occupations in the agricultural, construction, transport, chemical, electrical/electronic and metal sectors. The number of 'significant' odds ratios is consistent with an overall 'null-effect'.
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Affiliation(s)
- F Samkange-Zeeb
- Institute of Medical Biostatistics, Epidemiology and Informatics, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Obere Zahlbacher Strasse 69, 55131 Mainz, Germany
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Spinelli V, Chinot O, Cabaniols C, Giorgi R, Alla P, Lehucher-Michel MP. Occupational and environmental risk factors for brain cancer: a pilot case-control study in France. Presse Med 2009; 39:e35-44. [PMID: 19962851 DOI: 10.1016/j.lpm.2009.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 06/22/2009] [Accepted: 06/22/2009] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The increased incidence of malignant primary brain tumors (MPBT) reported in several studies could be due to environmental factors. To estimate the chemical and physical risk factors of these tumors in southeastern France, a pilot case-control study that included all new MPBT cases diagnosed in 2005 in the main brain cancer treatment centers in the western section of the Provence-Alpes-Côte d'Azur (PACA) region. MATERIAL AND METHODS Age-, sex-, and hospital-matched controls were selected from the neurosurgery department of the same hospital. An occupational physician, using a standardized questionnaire, collected information on suspected risk factors of MPBT in a face-to-face interview at the hospital of all case and control subjects. Data collected included jobs held, various exposures throughout working life, and leisure time activities. RESULTS The study included 122 cases and 122 controls. No particular job was identified as a major risk factor for brain cancer. Risk was significantly higher among those who used glue (OR=17.58, 95% CI 1.75 - 176.62) during leisure activities and significantly lower among those residing near cellular telephone towers (OR=0.49, 95% CI 0.26 - 0.92). DISCUSSION Several new hypotheses about the effects of cellular telephone towers and chemical exposure merit further analytic studies.
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Affiliation(s)
- Valérie Spinelli
- Consultation de Pathologie Professionnelle, Service de Médecine et Santé et Travail, Hôpital Timone Adultes, F-13385 Marseille Cedex 05, France
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Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. Occupational Health Hazards in the Interventional Laboratory: Time for a Safer Environment. J Vasc Interv Radiol 2009; 20:S278-83. [DOI: 10.1016/j.jvir.2009.04.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 09/30/2008] [Accepted: 10/02/2008] [Indexed: 10/20/2022] Open
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Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. Occupational health hazards in the interventional laboratory: time for a safer environment. Catheter Cardiovasc Interv 2009; 73:432-8. [PMID: 19214981 DOI: 10.1002/ccd.21801] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This document is a consensus statement by the major American societies of physicians who work in the interventional laboratory environment. It reviews available data on the prevalence of occupational health risks and summarizes ongoing epidemiologic studies designed to further elucidate these risks. Its purpose is to affirm that the interventional laboratory poses workplace hazards that must be acknowledged, better understood, and mitigated to the greatest extent possible. Vigorous efforts are advocated to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward minimizing operator radiation exposure, eliminating the need for personal protective apparel, and ending the orthopedic and ergonomic consequences of the interventional laboratory work environment.
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Affiliation(s)
- Lloyd W Klein
- Department of Medicine, Rush Medical College, 675 West North Avenue, Suite 202, Melrose Park, IL 60160, USA.
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Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. Occupational health hazards in the interventional laboratory: Time for a safer environment. Heart Rhythm 2009; 6:439-44. [DOI: 10.1016/j.hrthm.2009.01.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Indexed: 11/28/2022]
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Recht LD, Harsh G, Cohen HJ. The rationale for early detection and treatment of brain tumors in survivors of childhood cancer. Oncol Rev 2009. [DOI: 10.1007/s12156-009-0005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, Mauro MA, Goldstein JA. Occupational Health Hazards in the Interventional Laboratory: Time for a Safer Environment. Radiology 2009; 250:538-44. [DOI: 10.1148/radiol.2502082558] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Gliomas account for more than 70% of all brain tumors, and of these, glioblastoma is the most frequent and malignant histologic type (World Health Organization [WHO] grade IV). There is a tendency toward a higher incidence of gliomas in highly developed, industrialized countries. Some reports indicate that Caucasians have a higher incidence than African or Asian populations. With the exception of pilocytic astrocytomas (WHO grade I), the prognosis of glioma patients is still poor. Fewer than 3% of glioblastoma patients are still alive at 5 years after diagnosis, older age being the most significant and consistent prognostic factor of poorer outcome. Gliomas are components of several inherited tumor syndromes, but the prevalence of these syndromes is very low. Many environmental and lifestyle factors including several occupations, environmental carcinogens, and diet have been reported to be associated with an elevated glioma risk, but the only factor unequivocally associated with an increased risk is therapeutic X-irradiation. In particular, children treated with X-irradiation for acute lymphoblastic leukemia show a significantly elevated risk of developing gliomas and primitive neuroectodermal tumors, often within 10 years after therapy. Significant correlation between G:C --> A:T transitions in the TP53 gene and promoter methylation of the O6 -methylguanine-DNA methyltransferase (MGMT) gene in glio-mas have been reported in several studies, suggesting the possible involvement of O6-methylguanine DNA adducts, which may be produced by exogenous or endogenous alkylating agents in the development of gliomas.
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Affiliation(s)
- Hiroko Ohgaki
- Pathology Group, International Agency for Research on Cancer, Lyon, France
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Occupational health hazards in the interventional laboratory: time for a safer environment. J Vasc Interv Radiol 2008; 20:147-52; quiz 53. [PMID: 19062308 DOI: 10.1016/j.jvir.2008.10.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 09/30/2008] [Accepted: 10/02/2008] [Indexed: 11/21/2022] Open
Abstract
This document is a consensus statement by the major American societies of physicians who work in the interventional laboratory environment. It reviews available data on the prevalence of occupational health risks and summarizes ongoing epidemiologic studies designed to further elucidate these risks. Its purpose is to affirm that the interventional laboratory poses workplace hazards that must be acknowledged, better understood, and mitigated to the greatest extent possible. Vigorous efforts are advocated to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward minimizing operator radiation exposure, eliminating the need for personal protective apparel, and ending the orthopedic and ergonomic consequences of the interventional laboratory work environment.
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Stupp R, Reni M, Gatta G, Mazza E, Vecht C. Anaplastic astrocytoma in adults. Crit Rev Oncol Hematol 2007; 63:72-80. [PMID: 17478095 DOI: 10.1016/j.critrevonc.2007.03.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 03/21/2007] [Indexed: 11/23/2022] Open
Abstract
Anaplastic astrocytoma is an uncommon disease in the adult population. Prognosis is influenced by age, symptom duration, mental status and Karnofsky performance status. A truly complete resection, which is a recognized independent prognostic factor, is not possible and recurrence in the surgical cavity is common. Based on randomized data available, chemotherapy has consistently failed to improve the outcome of patients with anaplastic astrocytoma, while a meta-analysis showed a small, but significant improvement in survival favouring the use of chemotherapy. Outside a clinical trial, postoperative radiotherapy (30 x 2 Gy) remains the standard adjuvant therapy for most patients. For elderly patients, the application of treatment is usually based on performance status and neurological function. In recurrent disease, chemotherapy with temozolomide has been proven to be active and well-tolerated in phase II trials, but no comparative phase III trials of other cytotoxic drugs have been conducted.
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Affiliation(s)
- Roger Stupp
- University Hospital (CHUV), Lausanne, Switzerland.
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Simning A, van Wijngaarden E. Literature review of cancer mortality and incidence among dentists. Occup Environ Med 2007; 64:432-8. [PMID: 17259166 PMCID: PMC2078466 DOI: 10.1136/oem.2006.029223] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This review assesses the epidemiological literature describing dentist mortality and cancer incidence risk. In the dental workplace a variety of hazards may have been historically present or currently exist which can impact dentists' long-term health, including their mortality and cancer incidence. The epidemiological literature of dentistry's health outcomes was reviewed with a focus on all cancers combined and cancers of the brain, lung, reproductive organs and skin. Relevant studies were identified using MEDLINE and NIOSHTIC through early 2006 and from references cited in the articles obtained from these databases. Dentist cancer mortality and incidence generally showed a favourable risk pattern for lung cancer and overall cancer occurrence. Nevertheless, several studies reported an increased risk for certain cancers, such as those of the skin and, to a lesser extent, the brain and female breast. These elevated risks may be related to social status or education level, or may alternatively represent the impact of hazards in the workplace. The evidence for an increased mortality or cancer incidence risk among dentists must be interpreted in light of methodological limitations of published studies. Future studies of dentists would benefit from the assessment of specific occupational exposures rather than relying on job title alone.
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Affiliation(s)
- Adam Simning
- Division of Epidemiology, Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA
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Abstract
Gliomas are a family of primary central nervous system tumors of variable malignancy that are derived from supporting glia (astrocytes, oligodendrocytes, ependymal cells) or their progenitors/stem cells. There are two potential strategies to prevention: preventing gliomas from forming and preventing lower-grade gliomas from developing into higher-grade gliomas. Each would lower time-dependent mortality. Each also depends on an understanding of what causes gliomas so that these factors can be modulated. In this presentation, I will discuss primary prevention, chemoprevention, and screening. I will first focus on the known chromosomal, genetic, and protein changes associated with the different histologic varieties of glioma and the environmental, hereditary, and infectious/viral factors that may promote glioma development and malignant progression. I will discuss a number of clinical scenarios that eventuate from the known genetic patterns of these tumors and the changes in genetic patterns that reflect malignant progression. The basic thinking is that if one could prevent specific gene mutations and/or deletions or gains of specific chromosomes that lead to the development of low-grade (WHO 2) gliomas, then theoretically this would reduce the occurrence of high-grade (WHO 3 and 4) gliomas and hence the almost certain death that now is the fate of most patients with these tumors. In the case of de novo WHO 3 and 4 tumors, being able to prevent or counter specific gene mutations and/or the deletion of specific chromosomes would in itself reduce the occurrence of these gliomas and increase survival. Alternatively, a curative treatment for low-grade glioma that prevents these chromosomal/gene changes would prevent some glioblastomas (WHO 4) from forming and would have the same desired effect on survival. Obviously, for the latter to be achieved, we must also be able to diagnose and treat low-grade gliomas earlier.
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Affiliation(s)
- Victor A Levin
- Neuro-Oncology Unit 431, University of Texas, M.D. Anderson Cancer Center, Houston 77230-1402, USA
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van Wijngaarden E, Dosemeci M. Brain cancer mortality and potential occupational exposure to lead: findings from the National Longitudinal Mortality Study, 1979-1989. Int J Cancer 2006; 119:1136-44. [PMID: 16570286 DOI: 10.1002/ijc.21947] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the association between potential occupational lead exposure and the risk of brain cancer mortality in the National Longitudinal Mortality Study (NLMS), which is a prospective census-based cohort study of mortality among the noninstitutionalized United States population (1979-1989). The present study was limited to individuals for whom occupation and industry were available (n = 317,968). Estimates of probability and intensity of lead exposure were assigned using a job-exposure matrix (JEM). Risk estimates for the impact of lead on brain cancer mortality were computed using standardized mortality ratio (SMR) and proportional hazards and Poisson regression techniques, adjusting for the effects of age, gender and several other covariates. Brain cancer mortality rates were greater among individuals in jobs potentially involving lead exposure as compared to those unexposed (age- and gender-adjusted hazard ratio (HR) = 1.5; 95% confidence interval (CI) = 0.9-2.3) with indications of an exposure-response trend (probability: low HR = 0.7 (95% CI = 0.2-2.2), medium HR = 1.4 (95% CI = 0.8-2.5), high HR = 2.2 (95% CI = 1.2-4.0); intensity: low HR = 1.2 (95% CI = 0.7-2.1), medium/high HR = 1.9 (95% CI = 1.0-3.4)). Brain cancer risk was greatest among individuals with the highest levels of probability and intensity (HR = 2.3; 95% CI = 1.3-4.2). These findings provide further support for an association between occupational lead exposure and brain cancer mortality, but need to be interpreted cautiously due to the consideration of brain cancer as one disease entity and the absence of biological measures of lead exposure.
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Affiliation(s)
- Edwin van Wijngaarden
- Division of Epidemiology, Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
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De Roos AJ, Rothman N, Brown M, Bell DA, Pittman GS, Shapiro WR, Selker RG, Fine HA, Black PM, Inskip PD. Variation in genes relevant to aromatic hydrocarbon metabolism and the risk of adult brain tumors. Neuro Oncol 2006; 8:145-55. [PMID: 16598069 PMCID: PMC1871937 DOI: 10.1215/15228517-2005-003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Genes involved in phase I and phase II regulation of aromatic hydrocarbon-induced effects exhibit sequence variability that may mediate the risk of adult brain tumors. We evaluated associations between gene variants in CYP1A1, CYP1B1, GSTM3, EPHX1, and NQO1 and adult brain tumor incidence. Cases were patients with glioma (n = 489), meningioma (n = 197), or acoustic neuroma (n = 96) diagnosed from 1994 to 1998 at three U.S. hospitals. Controls were 799 patients admitted to the same hospitals for nonmalignant conditions. DNA was extracted from blood samples collected from 1277 subjects, and genotyping was conducted for CYP1A1 I462V, CYP1B1 V432L, EPHX1 Y113H, GSTM3 *A/*B (intron 6 deletion), and NQO1 P187S. The CYP1B1 V432L homozygous variant was associated with decreased risk of meningioma (odds ratio [OR] = 0.6; 95% CI, 0.3-1.0) but not the other tumor types. The GSTM3 *B/*B genotype was associated with increased risk of glioma (OR = 2.3; 95% CI, 1.0-5.2) and meningioma (OR = 3.6; 95% CI, 1.3-9.8). Increased risks associated with GSTM3 *B/*B were observed in younger subjects (age < 50) and older subjects (age > or = 50), in men and women, and within each study site. The magnitude of association for GSTM3 with glioma and meningioma was greater among ever-smokers than among those who had never smoked. None of the other genotypes showed consistent associations with any tumor type. The association with the GSTM3 *B allele, while intriguing, requires replication, and additional research is needed to clarify the function of the GSTM3 alleles studied here.
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Affiliation(s)
- Anneclaire J De Roos
- Fred Hutchinson Cancer Research Center and University of Washington Department of Epidemiology, Seattle, WA 98109, USA.
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Lee WJ, Colt JS, Heineman EF, McComb R, Weisenburger DD, Lijinsky W, Ward MH. Agricultural pesticide use and risk of glioma in Nebraska, United States. Occup Environ Med 2005; 62:786-92. [PMID: 16234405 PMCID: PMC1740883 DOI: 10.1136/oem.2005.020230] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate the risk of the adult glioma associated with farming and agricultural pesticide use, the authors conducted a population based case control study in eastern Nebraska. METHODS Telephone interviews were conducted with men and women diagnosed with gliomas (n = 251) between 1988 and 1993 and controls (n = 498) randomly selected from the same geographical area. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs) for farming and for use of individual and chemical classes of insecticides and herbicides, including pesticides classified as nitrosatable (able to form N-nitroso compounds upon reaction with nitrite). Non-farmers were used as the reference category for all analyses. RESULTS Among men, ever living or working on a farm and duration of farming were associated with significantly increased risks of glioma (> or =55 years on a farm OR = 3.9, 95% CI 1.8 to 8.6); however, positive findings were limited to proxy respondents. Among women, there were no positive associations with farming activities among self or proxy respondents. Specific pesticide families and individual pesticides were associated with significantly increased risks among male farmers; however, most of the positive associations were limited to proxy respondents. For two herbicides and three insecticides, use was positively associated with risk among both self and proxy respondents. Based on a small number of exposed cases, ORs were significantly increased for the herbicides metribuzin (OR = 3.4, 95% CI 1.2 to 9.7) and paraquat (OR = 11.1, 95% CI 1.2 to 101), and for the insecticides bufencarb (OR = 18.9, 95% CI 1.9 to 187), chlorpyrifos (OR = 22.6, 95% CI 2.7 to 191), and coumaphos (OR = 5.9, 95% CI 1.1 to 32). CONCLUSION The authors found significant associations between some specific agricultural pesticide exposures and the risk of glioma among male farmers but not among female farmers in Nebraska; however, most of the positive associations were limited to proxy respondents. These findings warrant further evaluation in prospective cohort studies where issues of recall bias are not a concern.
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Affiliation(s)
- W J Lee
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20852, USA
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