Residential proximity to industrial facilities and risk of non-Hodgkin lymphoma.

Industrial pollution has been suspected as a cause of non-Hodgkin lymphoma (NHL), based on associations with chemical exposures in occupational studies. We conducted a case-control study of NHL in four SEER regions of the United States, in which residential locations of 864 cases and 684 controls during the 10 years before recruitment were used to characterize proximity to industrial facilities reporting chemical releases to the Environmental Protection Agency's Toxics Release Inventory (TRI). For each of 15 types of industry (by 2-digit SIC code), we evaluated the risk of NHL associated with having lived within 2 miles of a facility, the distance to the nearest facility (miles categories of < or =0.5, >0.5-1.0, >1.0-2.0, >2 [referent]), and the duration of residence within 2miles (years categories of 10, 1-9, 0 [referent]), using logistic regression. Increased risk of NHL was observed in relation to lumber and wood products facilities (SIC 24) for the shortest distance of residential proximity (< or =0.5 mile: odds ratio [OR]=2.2, 95% confidence interval [CI]: 0.4-11.8) or the longest duration (10 years: OR=1.9, 95% CI: 0.8-4.8); the association with lumber facilities was more apparent for diffuse large B-cell lymphoma (lived within 2 miles: OR=1.7, 95% CI: 1.0-3.0) than for follicular lymphoma (OR=1.1, 95% CI: 0.5-2.2). We also observed elevated ORs for the chemical (SIC 28, 10 years: OR=1.5, 95% CI: 1.1-2.0), petroleum (SIC 29, 10 years: OR=1.9, 95% CI: 1.0-3.6), rubber/miscellaneous plastics products (SIC 30, < or =0.5mile: OR=2.7, 95% CI: 1.0-7.4), and primary metal (SIC 33, lived within 2miles: OR=1.3, 95% CI: 1.0-1.6) industries; however, patterns of risk were inconsistent between distance and duration metrics. This study does not provide strong evidence that living near manufacturing industries increases NHL risk. However, future studies designed to include greater numbers of persons living near specific types of industries, along with fate-transport modeling of chemical releases, would be informative.

Occupation/industry and risk of non-Hodgkin's lymphoma in the United States.

AIMS: To identify occupations and industries associated with non-Hodgkin's lymphoma (NHL) in a large population-based, case-control study in the USA. METHODS: Cases (n = 1189) of histologically confirmed malignant NHL ages 20-74 were prospectively identified in four geographic areas covered by the National Cancer Institute SEER Program. Controls (n = 982) were selected from the general population by random digit dialling (<65 years of age) and from residents listed in Medicare files (65-74 years of age). Odds ratios and 95% confidence intervals for occupations and industries were calculated by unconditional logistic regression analyses, adjusting for age, gender, ethnicity and study centre. Further analyses stratified for gender and histological subtype were also performed. RESULTS: Risk of NHL was increased for a few occupations and industries. Several white collar occupations, with no obvious hazardous exposures, had elevated risks, including purchasing agents and buyers, religious workers, physical therapists and information clerks. Occupations with excesses that may have exposures of interest include launderers and ironers, service occupations, food/beverage preparation supervisors, hand packers and packagers, roofing and siding, leather and leather products, transportation by air, nursing and personal care facilities, and specialty outpatient clinics. Significantly decreased risks of NHL were found for a number of occupations and industries including post-secondary teachers and chemical and allied products. CONCLUSIONS: The results of this study suggest that several occupations and industries may alter the risk of NHL. Our results support previously reported increased risks among farmers, printers, medical professionals, electronic workers and leather workers. These findings should be evaluated further in larger studies that have the power to focus on specific exposures and histological subtypes of NHL.

Degreasing and risk of non-Hodgkin lymphoma.

OBJECTIVE: To investigate the relationship between selected solvent-related workplace tasks (degreasing, painting, gluing, stripping paint, staining) and risk of non-Hodgkin lymphoma (NHL). METHODS: We analysed occupational data from a large population-based case-control study of NHL conducted in the USA. For participants reporting occupations with possible exposure to organic solvents, job-specific interview modules were administered to elicit in-depth information on solvent-related workplace tasks and other exposure-related factors (225 cases, 189 controls). Unconditional logistic regression models were fit to calculate odds ratios (ORs) and 95% CI for average frequency, maximal frequency and cumulative number of hours having performed each task. Individuals with jobs rated as unexposed to organic solvents in the workplace (180 cases, 213 controls) were used as a reference group. RESULTS: We observed an increased risk of NHL among subjects in the highest category of maximal degreasing frequency (>520 h/year: OR 2.1, 95% CI 0.9 to 4.9, trend test p = 0.02). We found similar associations for the highest levels of average frequency and, among men, cumulative number of hours. Other solvent-related tasks were not associated with NHL. CONCLUSION: Findings from this case-control analysis of solvent-related tasks suggest that frequent degreasing work may be associated with an elevated risk of NHL.

Soft tissue sarcoma and non-Hodgkin's lymphoma in relation to phenoxyherbicide and chlorinated phenol exposure in western Washington.

A population-based case-control study was conducted in western Washington State to evaluate the relationship between occupational exposure of men aged 20-79 to phenoxyacetic acid herbicides and chlorinated phenols and the risks of developing soft tissue sarcoma (STS) and non-Hodgkin's lymphoma (NHL). Occupational histories and other data were obtained by personal interviews for 128 STS cases and 576 NHL cases, diagnosed between 1981 and 1984, and for 694 randomly selected controls without cancer. Among the study subjects with any past occupational exposure to phenoxyherbicides, the estimated relative risk and 95% confidence interval of developing STS was 0.80 (0.5-1.2), and of developing NHL, 1.07 (0.8-1.4). Risk estimates of developing STS and NHL associated with past chlorophenol exposure were 0.99 (0.7-1.5) and 0.99 (0.8-1.2), respectively. No increasing risk of either cancer was associated with overall duration or intensity of chemical exposure or with exposure to any specific phenoxyherbicide per se. However, estimated risks of NHL were elevated among men who had been farmers, 1.33 (1.03-1.7), forestry herbicide applicators, 4.80 (1.2-19.4), and for those potentially exposed to phenoxyherbicides in any occupation for 15 years or more during the period prior to 15 years before cancer diagnosis, 1.71 (1.04-2.8). Increased risks of NHL were also observed among those with occupational exposure to organochlorine insecticides, such as DDT [1.82 (1.04-3.2)] and organic solvents [1.35 (1.06-1.7)], and to other chemicals typically encountered in the agricultural, forestry, or wood products industries. These results demonstrate small but significantly increased risks of developing NHL in association with some occupational activities where phenoxyherbicides have been used in combination with other types of chemicals, particularly for prolonged periods. They do not demonstrate a positive association between increased cancer risks and exposure to any specific phenoxyherbicide product alone. Moreover, these findings provide no evidence of increased risks of developing NHL associated with chlorinated phenol exposure or of developing STS associated with exposure to either class of chemical.

A prospective study of demographics, diet, and prostate cancer among men of Japanese ancestry in Hawaii.

Prostate cancer incidence was prospectively studied among 7999 men of Japanese ancestry who were first examined between 1965 and 1968 and then followed through 1986. During this surveillance period, 174 incident cases of prostate cancer were recorded. Prostate cancer was not associated with any measure of socioeconomic status, including amount of education, type of occupation, and type of residence. There was also no relationship with the number of children, as a surrogate measure of sexual activity. Increased consumption of rice and tofu were both associated with a decreased risk of prostate cancer, while consumption of seaweeds was associated with an increased risk of prostate cancer. There was no relationship between prostate cancer and the intake of various nutrients, including total fat and total protein. Etiological implications of these associations are discussed, but more research is needed on these dietary factors and the subsequent development of prostate cancer before any firm conclusions can be drawn.

A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption.

From 1965 to 1968 in Hawaii, 7990 American men of Japanese ancestry were interviewed and examined in a cohort study. The intake of 20 separate foods in a food frequency questionnaire and the intake of carbohydrate and other nutrients, based on a 24-h diet recall history, were recorded. Since then, 150 incident cases of stomach cancer have been identified. Although men with stomach cancer (cases) consumed pickles and ham/bacon/sausages more often and fruits and fried vegetables less often than men without cancer (noncases), none of the differences was statistically significant. Current cigarette smokers had an increased risk (relative risk = 2.7; 95% confidence interval = 1.8 to 4.1) compared with nonsmokers, but there was no dose-response effect with heavier cigarette smoking. The consumption of alcohol, either from beer, spirits, or wine, did not affect the incidence of stomach cancer. The failure to detect an association with dietary foods in this study may be due to the omission of many oriental foods in the questionnaire and the limitations of the 24-h diet recall history.

The influence of subsequent neoplasms on incidence trends in childhood cancer.

The purpose of this analysis was to evaluate to what extent subsequent malignant neoplasms account for the increasing rates of cancer occurrence among children. Data from the population-based Surveillance, Epidemiology, and End Results program were used to calculate age-standardized annual incidence rates from 1974-1989 for 10 common cancers among children 14 years of age or younger. Mean rates and linear trends were evaluated using least squares regression, first for all neoplasms and then excluding subsequent neoplasms, to determine if the removal of subsequent neoplasms would attenuate increasing trends. Increasing annual incidence rates were found for all childhood cancers combined, acute lymphoid leukemia, and brain tumors, but not for other cancer types. Excluding subsequent neoplasms from the analysis had a negligible effect on the trends we observed. Although it remains largely undetermined why childhood cancer incidence rates are increasing in the United States, this study presents evidence that subsequent primary neoplasms do not substantively contribute to these observed trends.

Increasing incidence of adenocarcinomas and carcinoid tumors of the small intestine in adults.

Malignant neoplasms of the small intestine are relatively rare and have received little study. We report on trends in the age-adjusted, sex-, and race-specific incidence rates of adenocarcinomas and carcinoid tumors of the small intestine in the United States from 1973 through 1991. Data were derived from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. There were statistically significant increases in the incidence rates of both adenocarcinomas and carcinoid tumors during the time frame of the study. Rates increased most dramatically in black males, with 2- and 4-fold increases in adenocarcinomas and carcinoid tumors, respectively. The only rates that remained relatively unchanged were those of adenocarcinoma among white females. It remains to be determined if changing environmental factors are important causes of these observed trends. If environmental factors are involved in the etiology of small intestine cancers, analytic studies conducted while the disease is increasing in incidence may provide useful insights.

Cigarette smoking and alcohol consumption by parents of children with acute myeloid leukemia: an analysis within morphological subgroups--a report from the Childrens Cancer Group.

Data from a case-control study of childhood acute myeloid leukemia (AML) including 187 matched case-control pairs were examined for evidence of associations between parental cigarette smoking and alcohol consumption and the subsequent development of childhood AML. The cases were stratified by French-American-British morphology in order to evaluate potential differences in risk based on this classification system. There was little evidence of any association between cigarette smoking by parents during the index pregnancy and childhood AML. There was some evidence of an increased risk of AML among children who were diagnosed at or before 2 years of age and whose mothers reported consuming alcohol during their pregnancies (odds ratio, 3.00; 95% confidence interval, 1.23 to 8.35). This finding appeared to be especially pronounced for AML with a monocytic component (M4/M5) (odds ratio, 9.00; 95% confidence interval, 1.25 to 394.5), but a cautious interpretation of these data are advised because of the small number of subjects included in this subgroup analysis. Since this is one of the first case-control studies to evaluate specific French-American-British subtypes of AML, these results may be viewed as generating hypotheses. It is suggested that future studies of childhood AML include: (a) a sufficient number of cases to permit an evaluation of the morphological classification of the cases; and (b) additional questions on the alcohol consumption of the mother during the time of her pregnancy with the index child.

Cancer risk from asbestos in drinking water: summary of a case-control study in western Washington.

We conducted a case-control, interview-based study of the risk of developing cancer from asbestos in drinking water. An area that included Everett, Washington, was selected for the study because of the unusually high concentration of chrysotile asbestos in drinking water from the Sultan River. Through a population-based tumor registry, 382 individuals with cancer of the buccal cavity, pharynx, respiratory system, digestive system, bladder, or kidneys, diagnosed between 1977 and 1980, were identified, and they or their next of kin were interviewed. We conducted validation checks of our interviews, including a comparison with secondary sources. Data on asbestos exposure were collected based on residence and workplace history, and on individual water consumption. Logistic regression was used to estimate cancer risk. We found no convincing evidence for increased cancer risk from imbibed asbestos. Confidence intervals for relative risks for almost all sites included unity. There were significantly elevated risks only for male stomach and male pharyngeal cancer, but these sex-inconsistent results, based on small numbers of cases, are probably due to other factors.

Acute myelocytic leukemia and prior allergies.

The relationship between prior allergies and adult acute myelocytic leukemia was investigated in a population-based case-control study. Based on data from personal interviews of 98 cases and 133 controls, a history of any type of allergy was associated with a significantly decreased risk of acute myelocytic leukemia (OR = 0.35, 95% CI = 0.20-0.60). Risk declined with the total number of specific allergies reported (p less than 0.001), and was reduced in relation to a history of prior asthma, eczema and hives. The implications of these findings in relation to natural immune surveillance against developing neoplasms are discussed.

Impact of race in lung cancer: analysis of temporal trends from a surveillance, epidemiology, and end results database.

STUDY OBJECTIVES: We analyzed data from a community-based cancer database over a 26-year period in order to characterize clinicopathologic differences between black and white patients with lung cancer, and to identify relevant temporal trends in incidence and survival. DESIGN, SETTING, AND PATIENTS: Data on demographics, stage, histology, and survival were obtained on all black and white patients with primary bronchogenic carcinoma registered in the community-based metropolitan Detroit Surveillance, Epidemiology, and End Results database from 1973 to 1998. RESULTS: Of 48,318 eligible patients, 23% were black. Lung cancer incidence rates decreased for men of both races from 1985 to 1998, with a greater decline occurring in black men (p < 0.0001). Although incidence rates declined over time for men of both races < 50 years of age, this decrease was greater in white men, resulting in an increase in the racial differential in younger men. Temporal trends in incidence rates were similar for women of both races. The incidence of distant-stage disease was higher among blacks throughout the study period. The incidence of local-stage disease decreased for both races, though this decline was greater in blacks. A significant racial difference in 2-year and 5-year survival rates developed during the study period, due to a distinct lack of improvement in black patients. In a multivariate model, the relative risks of death for black patients, relative to white patients, were 1.24 (p < 0.0001) for local stage, 1.14 (p < 0.0001) for regional stage, and 1.03 (p = 0.045) for distant stage. CONCLUSION: Significant racial differences exist in the incidence and survival rates for lung cancer in metropolitan Detroit. Since 1973, several disturbing trends have developed, particularly with regard to the lack of improvement in overall survival in black patients. Further study is required to determine the factors responsible for these temporal trends.

Effect of age and race on the survival of men with prostate cancer in the Metropolitan Detroit tricounty area, 1973 to 1987.

OBJECTIVES: Reports have demonstrated that African Americans diagnosed with prostate cancer have a poor survival compared with whites. We examined the impact of age, race, and stage of disease on survival for men diagnosed with prostate cancer. METHODS: A retrospective analysis was made of men diagnosed with prostate cancer utilizing the Surveillance, Epidemiology, and End Results Program (SEER) database. A total of 12,907 men (9339 white, 3568 black) diagnosed from January 1, 1973 through December 31, 1987 were included in the study. For each stage of disease, survival experience was examined using Kaplan-Meier and life table methods, followed by analysis using Cox's proportional hazard model. RESULTS: African-American men have a poorer survival than whites for all stages of prostate cancer when the cancer is diagnosed at younger ages. These differences in survival were not demonstrated for men diagnosed with prostate cancer after age 70. CONCLUSIONS: Age and race should be taken into account when assessing the survival of patients with prostate cancer.

Platelet-derived growth factor and risk factors for colorectal cancer.

Platelet-derived growth factor (PDGF) is a potent mitogen for a variety of cells. Abnormal PDGF activity has been reported in many chronic diseases including cancer. Existing data suggest that fluctuations or reset homeostasis in normal growth factor production due to specific agents or changes in cellular environment are potential mechanisms of colonic carcinogenesis. Currently identified risk factors for colorectal cancer include diet, non-steroidal anti-inflammatory drug use, alcohol consumption and physical activity. Certain constituents of diet, including retinoids, fish oils and soybeans, inhibit the activity of PDGF and could reduce paracrine stimulation of the colonic epithelium. Aspirin and physical activity, through reduction in platelet aggregation, may inhibit platelet release of PDGF and lead to reset homeostasis. Alcohol affects platelet aggregation and, depending on consumption patterns, could alter platelet release of PDGF. It is important to determine which of these environmental factors may result in transient effects on growth factor activity and which result in long-term adaptive responses. Further studies could examine the impact of these risk factors on (1) growth factor communication between colonic epithelial cells and fibroblasts in vitro and (2) PDGF concentrations and mitogenic activity in blood and tissue obtained in population-based studies of colorectal cancer.

Risk of injury in African American hospital workers.

Very few data exist that describe the risk of injury in African American health care workers, who are highly represented in health care occupations. The present study examined the risk for work-related injury in African American hospital workers. Hospital Occupational Health Service medical records and a hospital human resource database were used to compare risk of injury between African American and white workers after adjusting for gender, age, physical demand of the job, and total hours worked. Risk of work-related injury was 2.3 times higher in African Americans. This difference was not explained by the other independent variables. Differences in injury reporting, intra-job workload, psychosocial factors, and organizational factors are all potential explanations for racial disparity in occupational injury. More research is needed to clarify these findings.

Consistency of occupational exposure history from pattern and model makers.

This study investigates the consistency of occupational histories reported by the same men in 1985 and again in 1988. Detroit-area pattern and model makers participating in a colorectal cancer screening program that was offered at 3-year intervals completed a career length occupational exposure questionnaire at each screening. Analysis of the data from the 243 men who participated in both screening programs provided the opportunity to examine the consistency with which these workers reported the extent of their exposure to 13 substances commonly found in their work environment. Workers were asked to provide a work history, and for each different pattern or model maker job they had held, to estimate the percentage of time they were exposed to the 13 substances. The data indicated that over the 3-year study period, pattern and model makers were highly consistent in reporting whether or not they were exposed to the 13 substances. In addition, their first estimates of the percentage of time they were exposed to each substance were within 10% of their second estimates more than 70% of the time. This concordance was somewhat diminished after excluding those who reported no exposure. These findings suggest that skilled tradesman can provide occupational exposure information that is likely to be useful for physicians in considering an occupational cause for a presenting health concern.

National cancer clinical trials: children have equal access; adolescents do not.

PURPOSE: To determine whether adolescents with cancer, who in comparison to younger patients have a higher cancer incidence and lower mortality reduction, have equal access to national cancer clinical trials. METHODS: The ethnic/racial distribution of 29,859 subjects < 20 years of age entered onto National Cancer Institute-sponsored clinical trials between January 1, 1991, and June 30, 1994, was compared with the expected distribution of patients of the same age in the United States. RESULTS: The Children's Cancer Group and Pediatric Oncology Group had 29,134 (97.6%) of the total study entries among < 20-year-old subjects during the 3.5 years of surveillance. The adult cooperative groups accounted for < 3% of the clinical trials entries in the 15-19-year age range. When analyzed nationally by region, the under-representation of the older adolescent subjects was universal. From other analyses, the two pediatric cooperative groups were estimated to have registered > 94% of the children < 15 years of age who were expected to have been diagnosed to have cancer, but only 21% of the cancer patients in the 15-19-year age group. CONCLUSIONS: The national pediatric cancer cooperative groups allow the majority of American children < 15 years of age and their families equal opportunity to access clinical cancer trials, regardless of race or ethnicity. Among patients 15-19 years of age, however, > 75% are not being enrolled by any cooperative group sponsored by the National Cancer Institute. Thus, older adolescents are disadvantaged with respect to access to the national clinical trials, regardless of their race or ethnicity.

Use of a template to improve documentation and coding.

BACKGROUND AND OBJECTIVES: Accurate assignment of evaluation and management (E&M) codes is a challenge for physicians. Having guidelines close at hand during patient visits might improve appropriateness and accuracy of E&M coding. We developed a template based on a clinical prediction rule for group A beta-hemolytic streptococcal (GABHS) pharyngitis to improve documentation and coding decisions. METHODS: Fifty office visits for sore throat were documented using templates and were compared with 50 sore throat visits that were documented using progress notes. We counted history and physical examination items and compared the level of service charged to the level of service supported by the note. RESULTS: Significantly more history of present illness and physical examination items were recorded on templates. Decisions related to treatment for patients with a low probability of GABHS were also improved by the templates. Templates had no effect on billing and coding errors. CONCLUSIONS: The template resulted in more-thorough documentation but had no effect on coding and billing errors relative to progress notes.

Body mass and prostatic cancer: a prospective study.

Previous studies have suggested that increased body mass is associated with an increased risk of prostatic cancer, but these studies have been limited by the fact that they were based on a few simple measurements such as height and weight. Similar results were found in a prospective study of the incidence of prostatic cancer in a cohort of Japanese men born in 1900-19 and living in Hawaii. Further evaluation of the extensive anthropomorphic measurements made in this cohort suggested that the association between measures of body mass and prostatic cancer might be accounted for more by lean tissue than by fat tissue. There was a significant positive association of the risk of prostatic cancer with area of muscle in the arm but not with area of fat in the arm. Further research is needed on the biological mechanisms of carcinogenesis that may be related to both lean and fat tissue and the development of prostatic cancer.

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.