Toward a multi-country monitoring system of reproductive health in the context of Endocrine Disrupting Chemical exposure

Abstract

Introduction Evidence for the impact of EDCs on human reproductive health is growing and human biomonitoring studies prove the biological exposure of the general population to EDCs. Overall, the available data suggests a significant impairment of human reproductive health, possibly caused by EDC exposure. Our aim is to confirm or not this global impairment using epidemiologic surveillance at a wide scale and, if so, to acknowledge the involvement of EDC exposure or other factors. Methods We founded a multidisciplinary network named HURGENT aiming at designing an international monitoring system for reproductive health indicators. We conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure It was based upon two international reports: the annex 1 of the recent report published by the European Commission for regulatory aims and the 2012 WHO-UNEP report on the state of the science on EDCs. Results A set of core indicators were found with the highest scores according to the WoE approach: prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome (TDS), precocious puberty incidence and reproductive hormone levels. Conclusions Not only sentinel health endpoints, but also diseases with high burdens in public health are prioritized indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system. The next steps would consist of making positive choices and validation of indicators. Feasibility issues will be addressed including measurement and collecting methods, existing database exploitation, possible adaptations for existing databases, or de novo data collection. In depth knowledge of the existing databases in the participating countries and multidisciplinary collaborations will be required.