Assessing Cancer Risk Associated with Aquatic Polycyclic Aromatic Hydrocarbon Pollution Reveals Dietary Routes of Exposure and Vulnerable Populations

Characterization and health risk assessment of n-alkanes and PAHs in sediments from Shalateen (Halayeb Triangle), Egyptian Red Sea Coast

In this paper, the concentrations, origins, and carcinogenic potential of n-alkanes and polycyclic aromatic hydrocarbons (PAHs) collected from Shalateen sediments (Sh), Red Sea, Egypt were discussed. Individual n-alkanes has fluctuated from a minimum of 17.7 μg/g dw recorded for C-9 at Sh-54 to a maximum of 2.02 × 104 μg/g dw recorded for C-12 at Sh-B1. Total n-alkanes have fluctuated from 252-1.41 × 104 μg/g with a mean of 4.84 × 104 μg/g dw. C-12 had the highest average value, and C-19 had the lowest. The total ΣPAH concentrations in sediments from Shalateen as determined by gas chromatography-mass spectrometry/mass spectrometry (GC-MS/MS) ranged from 43.2 to 270 ng/g dw (averaging 95.2 ng/g dw). Carbon preference index (CPI) values were <1, consistent with the prevalence of even-C alkanes vs. the odd-C homologues. High molecular weight (HMW) PAHs were the most abundant substances affecting the collected samples. The cancer risk ranged from 2.25 × 10-5 to 4.78 × 10-2, indicating a moderate cancer risk associated with PAHs. The primary sources of PAHs in sediments included emissions from burning gasoline and diesel, biomass, and natural gas. The current study is considered one of the most important and unique with regard to the amounts and distributions of n-alkanes and PAHs in sediments along the coasts of Shalateen. It is the first baseline data documentation (GC MS/MS approach) of n-alkanes and PAHs in the Shalateen region.

Distribution, composition and risk assessment of hydrocarbon residue in surficial sediments of El-Dakhla, El-Kharga and El-Farafra oases, Egypt

This work examined the polycyclic aromatic hydrocarbons (PAHs) and n-alkanes quantities, sources, and hazards in sediments collected from the Egyptian Western Desert Oases namely: Dakhla, Kharga and Farafra oases. The n-alkane (C9-C20) residue concentrations have ranged from 0.66 to 2417.91 µg/g recorded for the three Oases. On the other hand, the total n-alkane ranged from 448.54 µg/g to 8442.60 µg/g. Higher carbon preference index (CPI) values (> 1.0) proposed that the natural sources could be the main contributor to n-alkanes in the Oases sediment. GC-MS/MS (selected reaction monitoring (SRM) method) was used for the determination of the ΣPAHs concentrations in the studied sediments. The ΣPAHs concentrations (ng/g, dry weight) in the studied three Oases varied from 10.18 to 790.14, 10.55 to 667.72, and from 38.27 to 362.77 for the Kharga, Dakhla and Farafra Oases, respectively. The higher molecular weight PAHs were the most abundant compounds in the collected samples. Assessing potential ecological and human health issues highlighted serious dangers for living things and people. All the investigated PAHs had cancer risk values between 1.43 × 10-4 and 1.64 × 10-1, this finding suggests that PAHs in the samples under study pose a moderate risk of cancer. The main sources of PAHs in this study are biomass, natural gas, and gasoline/diesel burning emissions.

Polycyclic aromatic hydrocarbons (PAHs) in surface sediments from Greece: Occurrence, sources and risk assessment

This study examines the occurrence of Polycyclic aromatic hydrocarbons (PAHs) in sediment samples collected from three areas (Saronikos Gulf, Piraeus harbor, Heraklion) across the Hellenic coastline, while PAHs distribution, sources and ecotoxicological risk are evaluated. According to the detected concentrations of PAHs, the most contaminated area was Piraeus (ΣPAHs: 125 to 2720 ng/g dw), followed by Saronikos Gulf (ΣPAHs: 21.4-1820 ng/g dw) and Heraklion (4.10-230 ng/g dw). Most sampling sites clearly show evidence for "combustion" in the source, whereas the data from Piraeus harbor indicate petroleum contamination as well. The calculated Toxic Equivalence Quotient (TEQ) and Mutagenic Equivalence Quotient (MEQ) values for Saronikos Gulf and Heraklion reveal low, or no, adverse health effects to exposed biota, while the pollution picture in Piraeus port indicates that BaP is the main contributor to carcinogenic and mutagenic risk. Risk assessment regarding dermal uptake of PAHs corroborated a negligible risk.

Polycyclic aromatic hydrocarbons (PAHs) in a sediment core from Lake Taihu and their associations with sedimentary organic matter

Sediment core is the recorder of polycyclic aromatic hydrocarbon (PAH) pollutions and the associated sedimentary organic matter (SOM), acting as crucial supports for pollution control and environmental management. Here, the sedimentary records of PAHs and SOM in the past century in Lake Taihu, China, were reconstructed from a 50-cm sediment core. On the one hand, the presence of PAHs ranged from 8.99 to 199.2 ng/g. Vertically, PAHs declined with the depth increased, and the sedimentation history of PAHs was divided into two stages with a discontinuity at 20 cm depth. In composition, PAHs in the sediment core were dominated by three-ring PAHs (44.6% ± 9.1%, mean ± standard deviation), and were followed by four-ring (27.0% ± 3.3%), and five-ring (12.1% ± 4.0%) PAHs. In toxicity assessment, the sedimentary records of benzo[a]pyrene-based toxic equivalency were well described by an exponential model with R-square of 0.95, and the environmental background toxic value was identified as 1.62 ng/g. On the other hand, different components of SOM were successfully identified by n-alkane markers (p < 0.01) and the variations of SOM were well explained (84.6%). A discontinuity of SOM was recognized at 22 cm depth. Association study showed that the sedimentary PAHs were associated with both anthropogenic and biogenic SOM (p < 0.05) with explained variances for most individual PAHs of 60%. It indicated the vertical distributions of PAHs were driven by sedimentary SOM. Therefore, environmental processes such as biogenic factors should attract more attentions as well as PAH emissions to reduce the impacts of PAHs.

Evaluation of polycyclic aromatic hydrocarbons in sediments of Balsas River Mouth, Pacific Coast, Mexico: Sources, risks, and genotoxicity

Polycyclic aromatic hydrocarbons (PAHs) were assessed in sediments (n = 7) collected from the mouth of the Balsas River, Pacific Coast, Mexico. The total PAH levels ranged between 142.1 and 3944.07 μg kg^-1 in the summer and 137.65-3967.38 μg kg^-1 in the winter, probably reflecting the anthropogenic activities of the region. Calculation of the four analytical ratios of [Anthracene/(Anthracene + Phenanthrene)]: [Fluoranthene/(Fluoranthene + Pyrene)], [Fluoranthene/Pyrene: Fluoranthene/(Fluoranthene + Pyrene)], [Indeno [123-cd]Pyrene/(Indeno [123-cd]Pyrene + Benzo [ghi]Perylene)]: [Benzo [a]anthracene/(Benzo [a]Anthracene + Chrysene)], and [Anthracene/Phenanthrene]: [Fluoranthene/(Fluoranthene + Pyrene)] revealed a mixed PAH source, from petroleum and biomass combustion. Significant statistical correlations (r² = 0.90) between the 4 and 5 ringed PAHs denote that adsorption is the principal mechanism for accumulation in sedimentary archives. Ecotoxicological indices (Mean Effect Range Medium Quotient and Mean Probable Effect Level Quotient) indicated moderate pollution with adverse biological impacts on ambient benthonic organisms. The calculations of Toxicity Equivalent Quotient and Mutagen Equivalent Quotient values proposed that the region is highly polluted by mutagenic and carcinogenic PAH compounds. The genotoxic evaluation of Lutjanus guttatus (Spotted rose snapper) presented significant DNA damage and discrepancies in Ethoxyresorufin-O-Deethylase activity. Based on the toxicological and genotoxicological evaluation of PAHs in sediments, the region was observed to be largely impacted from biological damage.

Polycyclic aromatic hydrocarbons (PAHs): Updated aspects of their determination, kinetics in the human body, and toxicity

Polycyclic aromatic hydrocarbons (PAHs) are legacy pollutants of considerable public health concern. Polycyclic aromatic hydrocarbons arise from natural and anthropogenic sources and are ubiquitously present in the environment. Several PAHs are highly toxic to humans with associated carcinogenic and mutagenic properties. Further, more severe harmful effects on human- and environmental health have been attributed to the presence of high molecular weight (HMW) PAHs, that is PAHs with molecular mass greater than 300 Da. However, more research has been conducted using low molecular weight (LMW) PAHs). In addition, no HMW PAHs are on the priority pollutants list of the United States Environmental Protection Agency (US EPA), which is limited to only 16 PAHs. However, limited analytical methodologies for separating and determining HMW PAHs and their potential isomers and lack of readily available commercial standards make research with these compounds challenging. Since most of the PAH kinetic data originate from animal studies, our understanding of the effects of PAHs on humans is still minimal. In addition, current knowledge of toxic effects after exposure to PAHs may be underrepresented since most investigations focused on exposure to a single PAH. Currently, information on PAH mixtures is limited. Thus, this review aims to critically assess the current knowledge of PAH chemical properties, their kinetic disposition, and toxicity to humans. Further, future research needs to improve and provide the missing information and minimize PAH exposure to humans.

Midwakh: Assessment of Levels of Carcinogenic Polycyclic Aromatic Hydrocarbons and Nicotine in Dokha Tobacco Smoke

Midwakh, which originated in the Middle East, has started to spread globally with different brands commercialized online and in local stores across Europe and the USA. Dokha is the tobacco used in midwakh. To this day, risk of midwakh smoking is poorly understood. Three different types of dokha were evaluated in this study, classified as cold, medium, and hot using gas chromatography-mass spectrometry (GC-MS). The concentrations of nicotine and polycyclic aromatic hydrocarbons (PAHs) in raw and smoked dokha samples were measured, and the results were compared to data in the literature on different types of tobacco products. PAH concentrations were used to estimate the toxic equivalency quotient, daily exposures, incremental lifetime cancer risk, and hazard quotient. The level of nicotine in raw dokha exceeded by far the levels reported in cigarettes, cigar, waterpipe, and chewing tobacco. Although only a portion of the nicotine is released into the smoke, the amount of nicotine in dokha smoke exceeded those reported for cigarettes. Two PAHs were found in raw dokha at trace amounts and 12 PAHs were detected in dokha smoke in amounts that exceeded those reported for cigarette smoke. The PAHs distribution showed a specific pattern in the smoke and a higher risk factor than that obtained for cigarettes and other tobacco products. Dokha products present a potential higher risk and immediate action should be taken to avoid its global consumption.

Assessing potential risks of aquatic polycyclic aromatic compounds via multiple approaches: A case study in Jialing and Yangtze Rivers in downtown Chongqing, China

To better evaluate the potential risks of aquatic polycyclic aromatic compounds (PACs), multiple approaches have been implemented in this study to assess the human health and ecological risks of parent, nitrated and oxygenated polycyclic aromatic hydrocarbons (PAHs, NPAHs and OPAHs) in the surface water of Jialing and Yangtze Rivers in downtown Chongqing in southwestern China. The concentrations of ∑PAHs (334 ± 125 ng L^-1) were much higher than those of ∑OPAHs (20.2 ± 7.49 ng L^-1) in the two rivers, while NPAHs were barely detected. Concentrations of detected PACs were higher in wet season than dry season, probably resulted from the elevated particle input due to heavy rainfall in wet season. Concentrations of PAHs were higher in the particulate phase than dissolved phase, while OPAHs levels showed a reverse pattern. The partition coefficients (K_p) of PACs in the water-SPM (suspended particulate matter) system were mainly affected by SPM concentrations and octanol/water partition coefficients of specific PACs. Human health risks calculated from non-probabilistic risk assessment model and probabilistic risk assessment model based on Monte Carlo simulation showed similar data pattern with slight difference in absolute values. Both models revealed potential or even severe human health risks contributed mainly by dermal exposure to aquatic PACs in this study. Furthermore, these models also manifested that infant stage was highly sensitive for PAC exposure. Sensitivity analysis indicated that health risk results was most sensitive to Benzo[a]pyrene equivalent toxic concentration (BaP_eq), followed by showering time and daily water intake volume. Levels of ecological risks and contributions of individual PACs differed from models based on different quality values. The adequacy of toxicity data was crucial for the reliability of ecological risk assessment.

Occupational exposures to particulate matter and PM2.5-associated polycyclic aromatic hydrocarbons at the Agbogbloshie waste recycling site in Ghana

Electronic waste (e-waste) disposal and recycling activities such as burning and smelting can emit particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), and other pollutants that expose workers and nearby communities. At informal e-waste recycling facilities, both emission controls and protective measures for workers are absent. This study characterizes personal exposures (breathing zone) of PM and PAHs of e-waste workers at the large Agbogbloshie e-waste site in Accra, Ghana. We collected gravimetric and optical measurements of PM2.5 and PM10 using shift samples for workers and for an age- and gender-matched reference population. PM2.5 filters were analyzed for 26 PAHs using gas chromatography/mass spectroscopy. Among e-waste workers, PM2.5 and PM10 concentrations were 99 ± 56 and 218 ± 158 µg/m3 (median ± interquartile range, optical measurements), respectively; these levels were 78 and 57% higher, respectively, than levels measured at a fixed site that was centrally located at the waste site. In the reference community, breathing zone PM2.5 and PM10 levels were lower, 49 ± 20 and 131 ± 108 µg/m3, respectively, and the fraction of coarse PM was larger. We detected all 26 target PAHs, of which naphthalene and phenanthrene were the most abundant. PAH concentrations were weakly correlated to PM levels, but PAH abundances, representing the fraction of PAH mass to the total PM2.5 mass collected, were strongly and inversely correlated to PM levels, suggesting multiple and different sources of PAHs and PM that affected exposures. Both PM and PAH levels were elevated for workers performing burning and dismantling, and both exceeded standards or risk-based guidelines, e.g., lifetime excess cancer risks for several PAHs were in the 10-4 to 10-6 range, indicating the need to reduce emissions as well as provide respiratory protection. The study emphasizes the importance of using personal and shift samples to accurately characterize worker exposure.

Metabolic Syndrome and Endocrine Disrupting Chemicals: An Overview of Exposure and Health Effects

Increasing prevalence of metabolic syndrome (MetS) is causing a significant health burden among the European population. Current knowledge supports the notion that endocrine-disrupting chemicals (EDCs) interfere with human metabolism and hormonal balance, contributing to the conventionally recognized lifestyle-related MetS risk factors. This review aims to identify epidemiological studies focusing on the association between MetS or its individual components (e.g., obesity, insulin resistance, diabetes, dyslipidemia and hypertension) and eight HBM4EU priority substances (bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, polycyclic aromatic hydrocarbons (PAHs), pesticides and heavy metals (cadmium, arsenic and mercury)). Thus far, human biomonitoring (HBM) studies have presented evidence supporting the role of EDC exposures on the development of individual MetS components. The strength of the association varies between the components and EDCs. Current evidence on metabolic disturbances and EDCs is still limited and heterogeneous, and mainly represent studies from North America and Asia, highlighting the need for well-conducted and harmonized HBM programmes among the European population. Rigorous and ongoing HBM in combination with health monitoring can help to identify the most concerning EDC exposures, to guide future risk assessment and policy actions.

Analysis of polycyclic aromatic hydrocarbon intake in the US adult population from NHANES 2005-2014 identifies vulnerable subpopulations, suggests interaction between tobacco smoke exposure and sociodemographic factors

Polycyclic aromatic hydrocarbons (PAHs) are a toxic and ubiquitous class of environmental chemicals, products of fuel combustion from human and natural sources. The objective of this study was to identify vulnerable populations for high PAH exposure and variability, to better understand where to target PAH exposure reduction initiatives. Urinary metabolite data were collected from 9517 individuals from the U.S. CDC National Health and Nutrition Examination Survey years 2005-2014 for four parental PAHs naphthalene, fluorene, phenanthrene, and pyrene. We utilized these urinary biomarkers to estimate PAH intake, and regression models were fit for multiple demographic and lifestyle variables, to determine variable effects, interactions, odds of high versus low PAH intake. Smoking and secondhand smoke exposure accounted for the largest PAH intake rate variability (25.62%), and there were strongest interactions between race/ethnicity and smoking or SHS exposure, reflected in a much greater contribution of smoking to PAH intake in non-Hispanic Whites as compared to other races/ethnicities. Increased odds of high PAH intake were seen in older age groups, obese persons, college graduates, midrange incomes, smokers, and those who were SHS exposed. Among the non-smoking population, effects of other demographic factors lessened, suggesting a highly interactive nature. Our results suggest that there are demographic subpopulations with high PAH intake as a result of different smoking behaviors and potentially other exposures. This has human health, environmental justice, and regulatory implications wherein smoking cessation programs, SHS exposure regulations, and public health initiatives could be better targeted towards vulnerable subpopulations to meaningfully reduce PAH exposures.

Heart development in two populations of Atlantic killifish (Fundulus heteroclitus) following exposure to a polycyclic aromatic hydrocarbon mixture

Historic industrial pollution of the Elizabeth River, Virginia resulted in polycyclic aromatic hydrocarbon (PAH) contamination in sediments. Atlantic killifish (Fundulus heteroclitus) inhabiting the Atlantic Wood (AW) industrial site adapted to complex PAH mixture at this Superfund site. Their embryos have proved highly resistant to cardiac abnormalities indicative of PAH toxicity. In this study, embryos spawned from adults collected at AW and King's Creek (KC), a reference site, were exposed at 24 h post fertilization (hpf) to Elizabeth River Sediment Extract (ERSE), a complex PAH mixture, in a range of concentrations (0, 5.04, 50.45, 100.90, 151.35, or 252.25 µg/L total PAHs). Embryos were processed for histology at 144 hpf to enable evaluations of hearts at tissue and cellular levels. Morphometry and severity scoring were used to evaluate the extent of alterations. Unexposed embryos were similar in both populations. ERSE exposure resulted in multiple changes to hearts of KC embryos but not AW. Alterations were particularly evident in KC embryos exposed to concentrations above 1% ERSE (50.45 µg/L), which had thinner ventricular walls and larger pericardial edema. Individuals with moderate pericardial edema maintained arrangement and proximity of heart chambers, but changes were seen in ventricular myocytes. Severe pericardial edema was prevalent in exposed KC embryos and typically resulted in tube heart formation. Ventricles of tube hearts had very thin walls composed of small, basophilic cells and lacked trabeculae. Edematous pericardial fluid contained small amounts of proteinaceous material, as did controls, and was free of cells. This fluid was primarily unstained, suggesting water influx due to increased permeability. The use of histological approaches provided more specific detail for tissue and cellular effects in hearts of embryos exposed to PAHs and enabled understanding of potential links to later life effects of early life exposure.

A polycyclic aromatic hydrocarbon-enriched environmental chemical mixture enhances AhR, antiapoptotic signaling and a proliferative phenotype in breast cancer cells

Emerging evidence suggests the role of environmental chemicals, in particular endocrine-disrupting chemicals (EDCs), in progression of breast cancer and treatment resistance, which can impact survival outcomes. However, most research tends to focus on tumor etiology and the effect of single chemicals, offering little insight into the effects of realistic complex mixture exposures on tumor progression. Herein, we investigated the effect of a polycyclic aromatic hydrocarbon (PAH)-enriched EDC mixture in a panel of normal and breast cancer cells and in a tumor organoid model. Cells or organoids in culture were treated with EDC mixture at doses estimated from US adult intake of the top four PAH compounds within the mixture from the National Health and Nutrition Examination Survey database. We demonstrate that low-dose PAH mixture (6, 30 and 300 nM) increased aryl hydrocarbon receptor (AhR) expression and CYP activity in estrogen receptor (ER) positive but not normal mammary or ER-negative breast cancer cells, and that upregulated AhR signaling corresponded with increased cell proliferation and expression of antiapoptotic and antioxidant proteins XIAP and SOD1. We employed a mathematical model to validate PAH-mediated increases in AhR and XIAP expression in the MCF-7 ER-positive cell line. Furthermore, the PAH mixture caused significant growth increases in ER-negative breast cancer cell derived 3D tumor organoids, providing further evidence for the role of a natural-derived PAH mixture in enhancing a tumor proliferative phenotype. Together, our integrated cell signaling, computational and phenotype analysis reveals the underlying mechanisms of EDC mixtures in breast cancer progression and survival.

Environmental Quality and Invasive Breast Cancer

Background: Breast cancer is a complex and multifactorial disease, and environmental factors have been suggested to increase its risk. However, prior research has largely focused on studying exposures to one factor/contaminant at a time, which does not reflect the real-world environment.Methods: Herein, we investigate associations between breast cancer and the environmental quality index (EQI), a comprehensive assessment of five domains of environmental quality (air, water, land, sociodemographic, and built environments) at the county level. Breast cancer diagnoses for North Carolina women were obtained from the North Carolina Central Cancer Registry (2009-2014) and the county of residence at the time of diagnosis was linked with the EQI. We evaluated the odds of localized, regional, or distant metastatic breast cancer in categories of environmental quality using women with carcinoma in situ as registry-based controls.Results: Overall environmental quality was generally not associated with invasive breast cancer; however, all breast cancer types tended to be inversely associated with land quality, particularly in more rural communities [distant metastatic breast cancer was 5%-8% more likely (OR, 1.08; 95% confidence interval, 1.02-1.14; P = 0.02) compared with carcinoma in situ].Conclusions: Cumulatively, our results suggest that some broad measures of environmental quality are associated with invasive breast cancer but that associations vary by environmental domain, cancer stage, subtype, and urbanicity.Impact: Our findings suggest that components of land quality (e.g., pesticide applications and animal facilities) warrant additional investigation in relation to invasive breast cancer.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

Nationwide health risk assessment of juvenile exposure to polycyclic aromatic hydrocarbons (PAHs) in the water body of Chinese lakes

The high emissions of polycyclic aromatic hydrocarbons (PAHs) pose a serious threat to the lake ecosystem and human health, and the human health risk assessment of PAH exposure is expected as an urgent project in China. This paper focused on 44 Chinese lakes in 6 lake zones to investigate the occurrence, composition and source of 19 PAHs in water body and estimate the human health risk under PAH exposure. The "List of PAH Priority Lakes" in China was generated based on the combination of incremental lifetime cancer risk (ILCR) model and Monte Carlo simulation. Our results showed that the Σ₁₇ PAHs ranged from 3.75 ng·L^-1 to 368.68 ng·L^-1 with a median of 55.88 ng·L^-1. Low-ring PAHs were the predominant compounds. PAH profiles varied significantly at lake zone level. Diagnostic ratios showed that PAHs might derive from petroleum and coal or biomass combustion. Benzo[a]pyrene-equivalent toxic concentrations (BaPeq) of the Σ₁₇ PAHs ranged from 0.07 ng·L^-1 to 2.26 ng·L^-1 (0.62 ± 0.52 ng·L^-1, mean ± standard deviation) with a median of 0.47 ng·L^-1. Benzo[a]anthracene (BaA), benzo[a]pyrene (BaP) and benzo[e]pyrene (BeP) were the main toxic isomers. Juvenile exposure to PAHs via oral ingestion (drinking) and dermal contact (showering) had negligible and potential health risks, respectively. Juveniles were the sensitive population for PAH exposure. 15 lakes were screened into the "List of PAH Priority Lakes" in three priority levels: first priority (Level A), moderate priority (Level B) and general priority (Level C). Lake Taihu, Lake Chaohu and Lake Hongze were the extreme priority lakes. Optimizing the economic structures and reducing the combustion emissions in these areas should be implemented to reduce the population under potential health risk of PAHs.

Detrimental association between quadriceps strength and exposure to polycyclic aromatic hydrocarbons in elderly adults

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants primarily from the incomplete combustion of organic materials. Myriads of studies have reported the associations between PAH exposure with several adverse health outcomes. However, no previous study had explored the relationship between PAH exposure with muscle strength in the elderly population. In the present study, we included 473 elderly adults who were obtained from the US National Health and Nutrition Examination Survey (NHANES) (2001-2006). PAH metabolites were measured in urine samples. Muscle strength was determined as the isokinetic strength of the quadriceps. Pertinent variables were analyzed by various standard measurements. The association between PAH exposure and muscle strength was examined using multivariable linear regression models. After fully adjusting for covariables, PAH metabolites had a negative relationship with muscle strength, especially 3-fluorene (β = -0.021, 95% CI: -0.042, 0.000) and 2-fluorene (β = -0.020, 95% CI: -0.034, -0.005). Notably, the relationship remained significant in males, but not in females. PAH exposure is associated with decreased muscle strength in the US elderly population. Further studies are needed to bring to light the underlying mechanisms for these findings. In addition, it is important to provide interventions and determine strategies for treating the adverse impact of PAH exposure on dynapenia. Novelty PAH exposure is associated with decreased muscle strength in elderly adults. The adverse impact remains in males.

Perspectives on Inflammatory Breast Cancer (IBC) Research, Clinical Management and Community Engagement from the Duke IBC Consortium

Inflammatory breast cancer (IBC) is an understudied and aggressive form of breast cancer with a poor prognosis, accounting for 2-6% of new breast cancer diagnoses but 10% of all breast cancer-related deaths in the United States. Currently there are no therapeutic regimens developed specifically for IBC, and it is critical to recognize that all aspects of treating IBC - including staging, diagnosis, and therapy - are vastly different than other breast cancers. In December 2014, under the umbrella of an interdisciplinary initiative supported by the Duke School of Medicine, researchers, clinicians, research administrators, and patient advocates formed the Duke Consortium for IBC to address the needs of patients in North Carolina (an ethnically and economically diverse state with 100 counties) and across the Southeastern United States. The primary goal of this group is to translate research into action and improve both awareness and patient care through collaborations with local, national and international IBC programs. The consortium held its inaugural meeting on Feb 28, 2018, which also marked Rare Disease Day and convened national research experts, clinicians, patients, advocates, government representatives, foundation leaders, staff, and trainees. The meeting focused on new developments and challenges in the clinical management of IBC, research challenges and opportunities, and an interactive session to garner input from patients, advocates, and community partners that would inform a strategic plan toward continuing improvements in IBC patient care, research, and education.