Document ykQ2xxVO0my9zKBndBR7z2BQX

Fi3N-26-i696 10:3a CQNDEft yI3TA 3FTYHLTI-H-tNU 281 586 3476 P.02-04 tot / CaMtrrn. 2>~a0099n C 1997 Witey-Liss, Inc. OCCUPATIONAL EXPOSURE TO POLYVINYL CHLORIDE AS A RISK FACTOR FOR TESTICULAR CANCER EVALUATED IN A CASE-CONTROL STUDY Lennart Hxsnau.'*. Carl-GOran Ohuon j and MU Fmdkksoh* 'Dtpartmant of Oncology Ortbra Mtdieal Canttr, drtbro Sweden 'Department if Occupational and EnvironmanuU Madicina, &rabro Medico/ Ctnimr, cirwbra. Sweden 'Department if Occupational and Envinoiunantal Medicine, Ctoiwnny HoipitoL Linkppinp, Swtdan Occupational exposures worm eaeaeied In a ceie control study on testicular cancer using aoWtodministaeod question naires. In total, annoon mn obtained tor 141 (91%) caaoa and ] 11 (97%) controls. Of the ease*, 101 hod seminoma and 47 had embryonal toatlcular cancar. An inaraaaad odds rado (OR) was /bund far expeaura to aatyvlmd chloride (PVC) yielding an OR of Id (9S% confldoaca intarwal, 1.4-12). The risk Increased tortbor If cases with aetf repartad cryptorchl- dtam or g>ehMswero excluded Ste ofthe 7 aepasart cases had seminoma. Caposure to other types of plastics did not signiftesntiy Increase the risk at testicular eancor. lea /. Cancer 73:S2I-S30, 1997. C 1997 Wllff-Litt Inc. TABtX 1 - BtSPSUXETO SVC, SOS CAMS AW COWTHOU 9M OMMt ttpMMI i Mim IVwef 1930 6 1931 4 1939 12 IMS 1 1947 3 1933 0.01 193d 2 1952 (LS 1931 2 I9S7 1992 Saataotna 1967 1919 Seminoma 1977 I9S9 Scminetat 1963 1991 Sendnema 1969 1991 Senunom* 1971 1969 Embryonal 1974 1992 Seminoma 1964 Control 1979 Control The Swedish *go-Adjusted incidence of tesocular cancer in creased by lift tnatuUly during the time period 1974-93, with a ligniflcoM 9Sft confidence Inmval (National Board of Ktahh and Welfare, 1997). This is the matt common Cancer among young men. The etiology is pooriy undamped. Oypterchlditm is tbs only established risk factos. and the risk has been reported to be increased also tor the dnsrenrienr teens (Tiendenar ti aL 1979: Schottsnfeldetai., 1980). Commoarfiktoetoa tor both crypcarehidism tad testicular cancer have thus been suggested (Hendanoa at oL, 1979). Rnthennorn. same prenatal risk factors nem to be common for both cryptotcbidlsm sad testicular cancer such is high levels of sanogsas in the flm ouacsttr (Cosgrove aL. 19T7-. BcTTBorin at aL. 1981). high body weight of the moth* and low birth weight (Depus. 1984? Borkowits ataL 1993). premiaira bttth (Depuo. 1988). hypospadla (Anonymous. 1991) and inguinal hernia (Swerdlow atoL. 1983; Mori ttoL, 1997). PtenataLaxposuras have been diacusied to be of etiological signidcaaea. Exposure to aoow environmental polltusoa widi estrogenic potsocy have been at special coaaam during meant years (Tbjtpari cteL. 1999). Testicular cancer baa bean aiaodewd with amplefreeor ia rgnculture and oU and natural gas extraction (Mills tt aL. 19S4). In professiosali and adminisimwts (Hayes at oL 1990: Swerttow at aL, 1991; Vbn dm Eadm r aL, 1991). Exposure to toe solvent dlmethyUbraenude has horn Mini mrd to be oas risk tocmr (Ducatman. 1989). Wthmraptifenuodnciii rontrol study on tesdculg cancer md Ufetlra# oacupatiMal histories with msnristsd exposene. Ws teport here our msulti (dating to job histories ui ton plastics Industry. Remits tor other onmiparicna end sxpomra will bn nportad sepnrassly. SUtmiML AND MBI800S Com ascertatoiMRr Patiestts srith smttenlar osaesr 30-73 yaam old sod mportnd m the Swedish Cancer Registry during the time period 1919-1992 were idendfled. Stoss the atoa of dw Invnripdoe am m eeaeae -"yH sod Occuprttonal axpoamaa, yoaagar subjects wem BOtioctodsd.The rams a era Bring in ton middle end northern pam of Sweden. The physicians at 170 inclriant eesae were contacted and asked tor pemiMtoa to toctode the pedant In d snidy. Seven padeno warn judged not to be eligible, md the wady thus encompassed 193 caeca. 109 with mads semiborai and 34 with embryonal cancer. In iddtlteR the 170 cases. II pedsnii treassd si these hospitals were deceased and wert thus doc included. Control ascertainment Twice as many mala controls as cases won studied. They were templed too the Swedish Population Registry by seleeung the next subject is birth icgutietion older (bom the same year) as the case*. %% wan not able to establish contact with 37 of the 326 control subjects sad therefore die next subjects la the Population Registry fuHUliag ths inehnioa criteria. La., birth regumhoa number sod sex, were used. Assessment afexpeenrr A 22 page gwntionnaire was oteiisd to each case and control Ubame working histories warn requested, as well as specific occupations and acoopedonsi histories. Thereafter, ths qusioonosins were semtiniood by a muted mine, who completed the mswua Ifthese wen unclear or ifihe question wei misunderstood, ustog t standardised protocuL Three Interviews, as well as coding or the fpwsrinnneHes. warn made urhboai knowing whether the subject eras a case or a control. In sll. 44 subjects mpoctsd expoun toplinks, mostly to styiene. Exposures to polyvinyl chloride (PVC) piaattes were eoeAnaad by contact wins the employers or the production managers. Nine subjects reported axposuie to PVC and I were confemed. Far 1 subject, a gate, ths- company could cot be rmarred However, die subject doriy trponrrl PVC exposum is 1937-60 to tbs production of piaedc carpets, end he was thus included strong dw exposed subjects- /obt with pocesdel exposure to FVC were also checked No mlditronai case or control with tuch Cumalsriveexposure was rsfctilrend by multiplying the extern ot exposure. part m day (helf dey OJ, whole day 1) by the ituaber of yean of exposure. The expoenre exant wirintnniy dedasd u 0 no exposure, 1 - low-grade exposure and 2 hitb-gndc expeeare. Cseeect arret laoiisnrsr TilitjaWf. the gemdlsa Csaesr Society mi ets Otesto Carney Caaertl tieeit Cnwielms ^IS^SSSSSJSTOfSStt&Mn Martini Cone. Received 20 Mre 1997; Retired 31 Inly 1997 .ya eD?*** ' / * BFG40754 BFG 00248 CCNDEh YibTH 5r i 'Yrn_ '-n- _ (v 281 588 j47S P. 03^ C-i TESTTCULA* CANCER AND POLYVINVl CHIOMOC BXFOSUR* Tttn-pw)wcTOH>nciweAtBAWcoimcu All SAW NumMH O** a> lesruim cs OS1 o> femfcar OR* CP Polyvinyl chloride 7/3 6j6 1.4-32 tn 3.6 1.1-196 1/2 _ Styrene 4/13 0.0 0.2-2.0 2/15 02 0.I-2J 2/13 1.0 0X-6.4 Uroftune 4/5 IB 0.4-5.6 2/3 1.0 0J-5J 26 32 OJ-37 Acrylate 2/1 3.2 OJ-37 0/1 -- 2/1 32 13-37 Plxute (utupeciriaif) 4/3 A3 O.S-24 1/3 2.5 0J-tt 3/3 66 06-31 1 Number or expand] coKs/eontroli.-'OR, odd* raua CL 93% aouMdica Interval*. gJ9 Statistical methods A conditional logistic regression model Tor matched studies was employed in obtain exact odds ratios (OR) and 93% confidence intervals (Cl) (EGRET. Statistics and Epidemiology Research Corporation. Seattht, WA. 1990). Separate analyses were per formed tor different measures of exposere. The analyses wen made with latency times of I year anti of3 yean. RESULTS Or the 163 cases. 141 (91%) answered the questionnaire compared with 313 (g7%) of the 363 controls Anally enrolled. Thus, of the 170 incident living cases. 87% participated in the study. The mean age fur both cases snd controls was 41 yean (range 3IV73). For cosas with seminoma (n m 101) the mean age was 43 yean (range 30-73). compared with 38 yean (range 30-37) for cases with embryonal cancer (n " 47). A summary of exposure to PVC is shown in Thbta I. An OR of 6.6 (Cl 1.4-33) was obtained for ibis exposure (Table U). Six of the 7 exposed cases had seminoma. For other types of plastics no lignitlcanlly increased risk was found. Only 1 case with exposure to plastic (polystyrene) reported crypuirehidism at a young age. If subject* with self-reported cryptorchidism ware excluded, the risk Increased farther. Thu*, exposure to PVC yielded ao OR of 14.0 (Cl 1.7-114) for all cases of testicular cancer. One case with exposure to PVC repotted that he had had orchitis. If all cases with self-reported orchitis wore excluded, exposure to PVC yielded an OR of 10.0 (Cl 1.2-R7). The ORs for exposure to other types of plastics wen not significantly changed using similar calculations. For cumulative exposure to PVC easea and controls were divided into 2 groups with 3 cases and 2 controls In the lowest exposure group, yielding an OR of 26 (Cl 03-32). to the highest exposure group, with cumulative exposure m3. 4 ease* and no controls were found and no OR coukl be calculatad For polysty rene. ORs of 03 (Q 0.0*3J) and 0.7 (Cl Q.I-3.1) were calculated :n the lowest and die highest exposure groups, respectively. For the other plastic exposures doee-rasponse calculations were not carried out due to law numbers of exposed subjects. The results wen similar, both with l or 3 year latency periods. DBCTJMTON Oniy living cases sod controls were included in the study to fhcilitare the assessment of sxpoaure. Bias might have been Introduced if s riek factor would be tstocinrori with poor prognosis for pedants with testicular cancer. However, them an oo data to support this notion. Significantly increased risk was found far exposure to PVC The induction latency period varied between 11 and 35 yean, with a median time of 22 yean. Six ofthe 7 exposed cues had seminoma. Furthermore, the case with embryonal cancer had a low cumulative exposure. b is unclear why the increased risk wis seen for seminomas only. The chemical composition of PVC includes 2 features. Flat. PVC is the only plastic that contains chlorine, La. about 56% of the molecular weight (Kami. 1993). Second, plnatiriwta, Lt.. addi tives. am usad is PVC mostly diethyl hexyl ptnhalate (DEHP), from 0 to almost 50% of the weight. AlmoK all phthalstre are used in PVC production. Estrogenic effects have been repaired for ptuhalxces (JobUerraL. 1995). The additives Mtphenol A and nonyiphenol are used as antioxi dant] in piaaricx. They are of interest tinea estrogenic potency has been reported In experimental studies for both bitpbeaol A (Krishoen tt oL 1993) sad nonylphenol (Soto ft oL 1991). However, there are used in uvtral types of plastics whereas ws found increased risk for exposure to PVC only. It might be added that in a study of cun of stillbirths or infant depths, some malformations and low birth weight, inewreed risk was found for mother's exposure during pregnancy to PVC but not far other plastics (Ahibarg tt oL, 1987). In eonaluaioa, in our ctte-conaoi study of testicular cancer, a somewhat surprisingly high risk was observed ferexposure to PVC plastics. The thoricomiep of retrospective assessment of exposure by a latf-administered questionnaire are obvious, and spurious association between PVCexposure and seminoma cannot bonded out. Therefore, our results must be reganted is hypothesis generat ing, and they warrant further studies. ACKNOWLEDGEMENTS This work was supposed by gamshero TriehjUpen. Use Swsdiih Cancer Society adthe OrebroCounty Council Raenrch Gamndme. The assistance ofMire L Lonson in dn refaction is acknowledged. REFERENCES AMkooao. a Jx. Bjkom. T. art BOBugS. X. Delivery I in die ptastim industry in gsredre red Norway. A** I. inPuttr.Mot, I ,307-317 (17). Anonymous, Cr Msec a Broscrrrivt tarty of 7300 coosacadve __________I9ftugl loin RadctUnKoapial Qypntrehidisa Study Group. Are*. Ota CWid, 07,192-199 (1993). Isusvnx CJ. Lavmkt. R.K. gesturen. I.H. Onsn. SJL at Houman. LA- MstaresI art sematrt risk Aetna hr esyptoschUim. EpHtmioian 6.137-131 (1993). BatMcnec. t_ Putt. M.C. Drew. RJL. Ron. R.K. Moose. i.W. and HfNOixsGN. OX. Maiamal hermore levels in sashrjettaiiea of crypsor- elud marts: xew-eomirtmtdy. Brit/ Cenex* SO, 379-511 (1900). . Mi).. Baras. K. red HamotlCN. BJS.. Mela gtaimriesiy abnormalities aa 0977). drtthylsdftrtwL / t/reC 117, 230-222 Dirua. R.H., Mtsanwl sod iiaadeari hoars sBUcdns Use risk of etypsreebidisat red rtgrinalharta. Ms. / frrtmWrt.. U, 311-111 (I9M). ovui. R.H.. CtyprtisMdlSM red epWretlelerts snsdy wldt anphnis ae die relationibis w oeant oarreus syttart ^shwtlrt Tanunrtot 17, 101-3OS (IMS). Ducasman. AM- DUerthyKonroaOde, Basal dyes, art lesdcnrtr anew. Lamm 1,911 (1999). Haws. RJ.. MoonaeN Bnowst U Femme LAC Oeam. M, Kasoaiw. J.W.P.F- Koovn. RN. O'CoMrtu, KJ. StmssAN. RX. and Mtunroin. N,, Oecaredes sad risk of anirelsr creser a remonnrt tarty. Ota /. EprtnufllU, 123-431 (1990). BFG40753 BFG 00249