Agent Orange in War Medicine: An Aftermath Myth

1998 ◽  
Vol 28 (4) ◽  
pp. 715-724 ◽  
Author(s):  
Lennart Hardell ◽  
Mikael Eriksson ◽  
Olav Axelson
Keyword(s):  
Malignant Tumors ◽  
Epidemiological Studies ◽  
Agent Orange ◽  
Royal Commission ◽  
International Agency ◽  
Cancer Risks ◽  
Phenoxy Herbicides ◽  
Recent Classification ◽  
War Medicine

Since the late 1970s several epidemiological studies have appeared linking exposure to phenoxy herbicides or chlorophenols to some malignant tumors. Most of these compounds are contaminated with dioxins and dibenzofurans; for example, 2,3,7,8-tetrachlorodibenzo- p-dioxin (TCDD) is a contaminant of 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), a component of Agent Orange which was sprayed in Vietnam during the war. The results of some of the epidemiological studies on cancer risks associated with exposure to these compounds have been manipulated and misinterpreted, particularly by the Australian Royal Commission on the Use and Effects of Chemical Agents on Australian Personnel in Vietnam. Furthermore, a book on Australian war history entitled Medicine at War, commissioned by the Federal Government, reiterates several of these misinterpretations, despite available contrary evaluations from Australian and U.S. authorities. These remarkable and confusing circumstances in the scientific process are considered also in the light of the recent classification of TCDD as carcinogenic to humans, Group 1, by a Working Group at the International Agency for Research on Cancer in Lyon, France.

scholarly journals O1A.6 The carcinogenicity of pesticides used in new zealand

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A4.2-A4
Author(s):  
Andrea ‘t Mannetje
Keyword(s):  
New Zealand ◽  
Environmental Protection ◽  
Environmental Protection Agency ◽  
Agricultural Sector ◽  
Intervention Strategy ◽  
Epidemiological Studies ◽  
Regulatory Agencies ◽  
International Agency ◽  
Active Ingredients

IntroductionYearly over 3000 tonnes of pesticide active ingredients are applied in New Zealand agriculture. Since the 1980’s, epidemiological studies have reported increased risks of lymphopoietic cancers in agricultural sectors with high pesticide use. Here we aim to estimate the number and total volume of currently used pesticides in New Zealand that are known or suspected human carcinogens, in order to inform interventions.MethodsFor each of the pesticide active ingredients most commonly used in New Zealand, the carcinogenicity classification of three regulatory agencies (The New Zealand Environmental Protection Authority [NZ-EPA], the US Environmental Protection Agency [US-EPA], and the European Chemicals Agency [EU]) were extracted, as well as the classification of the International Agency for Research on Cancer (IARC) Monograph Programme. Total tonnes of active ingredients that are known or suspected human carcinogens was calculated for each classification.ResultsNone of the pesticides used in New Zealand are classified as known human carcinogens by any of the three regulatory agencies or IARC. Annually New Zealand uses 148–756 tonnes of active pesticide ingredients that are classified as suspected human carcinogens by the three regulatory agencies. If also including the pesticides classified by IARC as possible or probable human carcinogens, the upper estimate doubles to 1475 tonnes, representing half of the total volume of pesticide active ingredients used in New Zealand agriculture. The percentage and volume of active ingredients classified as suspected carcinogens by the three regulatory agencies was highest for the fungicides (8%–60%; 72–540 tonnes), followed by herbicides (3%–10%; 60–200 tonnes), and insecticides (8%, 16 tonnes).ConclusionsAlthough no known human carcinogens are used as pesticides, New Zealand’s high use of pesticides that are suspected carcinogens requires a greater awareness of the presence of potential carcinogens in the agricultural sector and the development of an intervention strategy to reduce cancer risk.

scholarly journals Neuropathic pain

2021 ◽  
pp. 58-64
Author(s):  
V. A. Koriachkin ◽  
A. P. Spasova ◽  
V. V. Khinovker
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Correct Diagnosis ◽  
Epidemiological Studies ◽  
Chronic Neuropathic Pain ◽  
Official Document ◽  
Adequate Treatment ◽  
Pain Syndromes ◽  
Recent Classification

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods.

Epidemiology of Primary Brain Tumors in the Province of Catania during the 2003–2016 Period

2021 ◽  
Vol 55 (6) ◽  
pp. 473-483
Author(s):  
Chaima Chebil ◽  
Farid Boumediene ◽  
Calogero E. Cicero ◽  
Cristina Rascunà ◽  
Alessia Di Prima ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Malignant Tumors ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Epidemiological Studies ◽  
Primary Brain Tumors ◽  
Male Ratio ◽  
Classification Of Diseases ◽  
Log Linear

<b><i>Introduction:</i></b> Primary brain tumors (PBTs) account for approximately 2% of all cancers and are associated with significant morbidity and mortality. However, only few epidemiological studies focus on PBTs in Italy. The aim of this study was to evaluate incidence, temporal trend, and survival rate of all PBTs in the province of Catania during the study period. <b><i>Methods:</i></b> All patients diagnosed with PBTs in the province of Catania during the 2003-2016 were identified through the local cancer registry. All cases were classified by histology according to 2007 WHO classification of central nervous system tumors, using the International Classification of Diseases for Oncology, 3rd edition codes. The incidence rate (IR) was calculated for all PBTs and by gender, histology, age-groups, and behavior. Trend analysis was performed using a piecewise log-linear model. <b><i>Results:</i></b> A total of 3,819 cases were identified with a female/male ratio of 1.45. The IR for all PBTs was 25.3/100,000 person-years (95% confidence interval 24.5–26.1). Most PBTs were nonmalignant (59.5%, IR = 15.0) with a female predominance. Conversely, malignant tumors (32.4%, IR = 8.2) were more common among men, with a female/male ratio of 0.9. The most frequently reported histology was meningioma (39.0%, IR = 9.8), followed by glioblastoma (11.6%, IR = 2.9). A peak of incidence was found in the 75–84 years age-group, with an IR of 77.6/100,000 person-years. Overall, no increase in incidence was observed along the study period. <b><i>Conclusions:</i></b> The IR of PBTs in the province of Catania is close to incidence reported worldwide. Further studies on risk factors are necessary.

scholarly journals Outcome Assessment in Epidemiological Studies of Low-Dose Radiation Exposure and Cancer Risks: Sources, Level of Ascertainment, and Misclassification

2020 ◽  
Vol 2020 (56) ◽  
pp. 154-175 ◽  
Author(s):  
Martha S Linet ◽  
Mary K Schubauer-Berigan ◽  
Amy Berrington de González
Keyword(s):  
Outcome Assessment ◽  
Low Dose ◽  
International Classification Of Diseases ◽  
Epidemiological Studies ◽  
Cancer Risks ◽  
Low Dose Radiation ◽  
Loss To Follow Up ◽  
Classification Of Diseases

Abstract Background Outcome assessment problems and errors that could lead to biased risk estimates in low-dose radiation epidemiological studies of cancer risks have not been systematically evaluated. Methods Incidence or mortality risks for all cancers or all solid cancers combined and for leukemia were examined in 26 studies published in 2006–2017 involving low-dose (mean dose ≤100 mGy) radiation from environmental, medical, or occupational sources. We evaluated the impact of loss to follow-up, under- or overascertainment, outcome misclassification, and changing classifications occurring similarly or differentially across radiation dose levels. Results Loss to follow-up was not reported in 62% of studies, but when reported it was generally small. Only one study critically evaluated the completeness of the sources of vital status. Underascertainment of cancers (“false negatives”) was a potential shortcoming for cohorts that could not be linked with high-quality population-based registries, particularly during early years of exposure in five studies, in two lacking complete residential history, and in one with substantial emigration. False positives may have occurred as a result of cancer ascertainment from self- or next-of-kin report in three studies or from enhanced medical surveillance of exposed patients that could lead to detection bias (eg, reporting precancer lesions as physician-diagnosed cancer) in one study. Most pediatric but few adult leukemia studies used expert hematopathology review or current classifications. Only a few studies recoded solid cancers to the latest International Classification of Diseases or International Classification of Diseases for Oncology codes. These outcome assessment shortcomings were generally nondifferential in relation to radiation exposure level except possibly in four studies. Conclusion The majority of studies lacked information to enable comprehensive evaluation of all major sources of outcome assessment errors, although reported data suggested that the outcome assessment limitations generally had little effect on risk or biased estimates towards the null except possibly in four studies.

METASTATIC LESION OF THE SPINE: DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT

2019 ◽  
Vol 65 (6) ◽  
pp. 868-876
Author(s):  
Anton Yarikov ◽  
Anton Yermolaev ◽  
Igor Smirnov ◽  
Anton Denisov ◽  
Olga Perlmutter ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Epidemiological Studies ◽  
Metastatic Lesion ◽  
Spinal Cord Damage ◽  
Metastatic Lesions ◽  
Spinal Lesions ◽  
Cancer Pathology ◽  
Surgical Methods ◽  
The Stability ◽  
Methods Of Treatment

Epidemiological studies show an increase in the number of people with cancer. Bone metastases are a frequent manifestation of generalized cancer, because it is in malignant tumors of the spine more often than other bones of the skeleton becomes a target for metastasis. The article describes in detail the methods of diagnosis of spinal lesions in cancer pathology. Particular attention is paid to the scales reflecting the severity of the patient’s condition, the degree of spinal cord damage, the severity of pain in metastasis to the spine, the prognosis of survival in oncovertebrology and evaluation of the stability of the spine in metastatic lesions. Further, the paper presents non-radical (decompression, vertebroplasty) and radical (spondylectomy, corporectomy) surgical methods of treatment

scholarly journals Aspartame and cancer – new evidence for causation

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Philip J. Landrigan ◽  
Kurt Straif
Keyword(s):  
Public Health ◽  
Cancer Risk ◽  
Malignant Tumors ◽  
Daily Intake ◽  
Immunohistochemical Analysis ◽  
International Agency ◽  
Advisory Group ◽  
Malignant Neoplasms ◽  
Acceptable Daily Intake ◽  
New Findings

Abstract Background Aspartame is one of the world’s most widely used artificial sweeteners and is an ingredient in more than 5000 food products globally. A particularly important use is in low-calorie beverages consumed by children and pregnant women. The Ramazzini Institute (RI) reported in 2006 and 2007 that aspartame causes dose-related increases in malignant tumors in multiple organs in rats and mice. Increased cancer risk was seen even at low exposure levels approaching the Acceptable Daily Intake (ADI). Prenatal exposures caused increased malignancies in rodent offspring at lower doses than in adults. These findings generated intense controversy focused on the accuracy of RI’s diagnoses of hematopoietic and lymphoid tissue tumors (HLTs). Critics made the claim that pulmonary lesions observed in aspartame-exposed animals were inflammatory lesions caused by Mycoplasma infection rather than malignant neoplasms. Methods To address this question, RI subjected all HLTs from aspartame-exposed animals to immunohistochemical analysis using a battery of markers and to morphological reassessment using the most recent Internationally Harmonized Nomenclature and Diagnostic (INHAND) criteria. Findings This immunohistochemical and morphological re-evaluation confirmed the original diagnoses of malignancy in 92.3% of cases. Six lesions originally diagnosed as lymphoma (8% of all HLTs) were reclassified: 3 to lymphoid hyperplasia, and 3 to chronic inflammation with fibrosis. There was no evidence of Mycoplasma infection. Interpretation These new findings confirm that aspartame is a chemical carcinogen in rodents. They confirm the very worrisome finding that prenatal exposure to aspartame increases cancer risk in rodent offspring. They validate the conclusions of the original RI studies. These findings are of great importance for public health. In light of them, we encourage all national and international public health agencies to urgently reexamine their assessments of aspartame’s health risks - especially the risks of prenatal and early postnatal exposures. We call upon food agencies to reassess Acceptable Daily Intake (ADI) levels for aspartame. We note that an Advisory Group to the International Agency for Research on Cancer has recommended high-priority reevaluation of aspartame’s carcinogenicity to humans.

scholarly journals A new biological triangle in cancer: intestinal microbiota, immune checkpoint inhibitors and antibiotics

2021 ◽  
Author(s):  
Jie Zhang ◽  
Zhujiang Dai ◽  
Cheng Yan ◽  
Wenjie Zhang ◽  
Daorong Wang ◽  
...  
Keyword(s):  
Intestinal Microbiota ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Malignant Tumors ◽  
Checkpoint Inhibitors ◽  
Epidemiological Studies ◽  
Term Survival ◽  
Checkpoint Inhibitor Therapy ◽  
Rational Use Of Antibiotics

AbstractCancer immunotherapy has revolutionized the treatment of many malignant tumors. Although immune checkpoint inhibitors (ICIs) can reactivate the anti-tumor activity of immune cells, sensitivity to immune checkpoint inhibitor therapy depends on the complex tumor immune processes. In recent years, numerous researches have demonstrated the role of intestinal microbiota in immunity and metabolism of the tumor microenvironment, as well as the efficacy of immunotherapy. Epidemiological studies have further demonstrated the efficacy of antibiotic therapy on the probability of patients' response to ICIs and predictability of the short-term survival of cancer patients. Disturbance to the intestinal microbiota significantly affects ICIs-mediated immune reconstitution and is considered a possible mechanism underlying the development of adverse effects during antibiotic-based ICIs treatment. Intestinal microbiota, antibiotics, and ICIs have gradually become important considerations for the titer of immunotherapy. In the case of immunotherapy, the rational use of antibiotics and intestinal microbiota is expected to yield a better prognosis for patients with malignant tumors.

scholarly journals The importance of evaluating specific myeloid malignancies in epidemiological studies of environmental carcinogens

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. A. Mundt ◽  
L. D. Dell ◽  
P. Boffetta ◽  
E. M. Beckett ◽  
H. N. Lynch ◽  
...  
Keyword(s):  
Tobacco Smoking ◽  
Myeloid Leukemia ◽  
Myeloproliferative Neoplasms ◽  
Epidemiological Studies ◽  
Sufficient Evidence ◽  
International Agency ◽  
Environmental Carcinogens ◽  
Epidemiological Evidence ◽  
Myeloid Malignancies ◽  
Chemical Agents

Abstract Introduction Although myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), myeloproliferative neoplasms (MPN) – including chronic myeloid leukemia (CML) – and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are largely clinically distinct myeloid malignancies, epidemiological studies rarely examine them separately and often combine them with lymphoid malignancies, limiting possible etiological interpretations for specific myeloid malignancies. Methods We systematically evaluated the epidemiological literature on the four chemical agents (1,3-butadiene, formaldehyde, benzene, and tobacco smoking, excluding pharmaceutical, microbial and radioactive agents, and pesticides) classified by the International Agency for Research on Cancer as having sufficient epidemiological evidence to conclude that each causes “myeloid malignancies.” Literature searches of IARC Monographs and PubMed identified 85 studies that we critically assessed, and for appropriate subsets, summarized results using meta-analysis. Results Only two epidemiological studies on 1,3-butadiene were identified, but reported findings were inadequate to evaluate specific myeloid malignancies. Studies on formaldehyde reported results for AML and CML – and not for MDS or MPN – but reported no increased risks. For benzene, several specific myeloid malignancies were evaluated, with consistent associations reported with AML and MDS and mixed results for CML. Studies of tobacco smoking examined all major myeloid malignancies, demonstrating consistent relationships with AML, MDS and MPN, but not with CML. Conclusions Surprisingly few epidemiological studies present results for specific myeloid malignancies, and those identified were inconsistent across studies of the same exposure, as well as across chemical agents. This exercise illustrates that even for agents classified as having sufficient evidence of causing “myeloid malignancies,” the epidemiological evidence for specific myeloid malignancies is generally limited and inconsistent. Future epidemiological studies should report findings for the specific myeloid malignancies, as combining them post hoc – where appropriate – always remains possible, whereas disaggregation may not. Furthermore, combining results across possibly discrete diseases reduces the chances of identifying important malignancy-specific causal associations.

scholarly journals Mixed adenoneuroendocrine carcinoma of the hepatic bile duct: a case report and review of the literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sulai Liu ◽  
Zhendong Zhong ◽  
Meng Xiao ◽  
Yinghui Song ◽  
Youye Zhu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Neuroendocrine Tumors ◽  
Radical Surgery ◽  
Malignant Tumors ◽  
World Health ◽  
Ki 67 ◽  
Mixed Adenoneuroendocrine Carcinoma ◽  
Hilar Bile Duct ◽  
Hilar Tumor

Abstract Background The World Health Organization's updated classification of digestive system neuroendocrine tumors in 2010 first proposed the classification of mixed adenoneuroendocrine carcinoma (MANEC). The incidence of biliary malignant tumors with neuroendocrine tumors accounts for less than 1% of all neuroendocrine tumors. Moreover, the incidence of hilar bile duct with MANEC is very rare. Case presentation A 65-year-old female patient came to our hospital for repeated abdominal pain for more than 4 months and skin sclera yellow staining for 1 week. Contrast-enhanced computed tomography imaging and magnetic resonance results suggested a hilar tumor for Bismuth-Corlette Type II. The patient underwent radical surgery for hilar cholangiocarcinoma. Finally, the patient was diagnosed with hilar bile duct MANEC, staged 1 (pT1N0M0) based on the eighth edition of the AJCC. Histopathology showed that the tumor was a biliary tumor with both adenocarcinoma and neuroendocrine carcinoma. No evidence of recurrence and metastasis after 20 months of follow-up. Conclusions We first reported a MANEC that originated in the hilar bile duct. As far as we known, there were few reports of biliary MANEC, and the overall prognosis was poor. We also found that the higher the Ki-67 index, the worse the prognosis of this type of patient. Radical surgery is the most effective treatment.

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