Excess Cancer Risk Research Articles

Calculation the Excess Lifetime Lung Cancer Risk and Human Health Risk Assessment by Inhalation of Radon Gas in the Health Centers of Al–Hay City in Wasit, Iraq Using LR-115 Detector

In this paper, the technology used to measure radon concentrations in 8 health centers of Al- Hay city in Wasit, Iraq (December 2019) is one of the types of solid state nuclear track detectors, LR-115. After that, the annual effective dose rate and the excess lifetime cancer risk were calculated for the selected positions in the study area. The detectors were exposed to radon for 45 days, the etched detectors, using an optical microscope, to calculate the track densities, essentially depend on the alpha ray emitted from radon which later on easy converted to radon concentration values. Radon concentration ranges are from (183.47±22.93 to 17.15±2.14) Bq/m3 with a mean of (100.483Bq/m3), which lower than the appropriate radon levels recommended by ICRP "International Commission on Radiological Protection". The readings of "Excess Lifetime Cancer Risk" (ELCR), which ranges from 3.9 ×10-3 to 8.05 ×10-3 with an average value of 0.53% showing that human health is not under risk even it does not develop any lung cancer while human inhale the radon.

Adolescent Cardiorespiratory Fitness and Risk of Cancer in Late Adulthood: Nationwide Sibling-Controlled Cohort Study.

To investigate whether the higher risks of certain cancers associated with high cardiorespiratory fitness can be explained by increased detection and unobserved confounders. Nationwide sibling-controlled cohort study of adolescents. Sweden. 1 124 049 men of which 477 453 were full siblings, who underwent mandatory military conscription examinations between 1972 and 1995 at a mean age of 18.3 years. Hazard ratios (HR) and 95% confidence intervals (CI) of overall cancer diagnosis and cancer mortality, and 14 site-specific cancers (diagnosis or death), as recorded in the Swedish National Patient Register or Cause of Death Register until 31 December 2023, modelled using flexible parametric regressions. Participants were followed until a median (maximum) age of 55.9 (73.5) years, during which 98 410 were diagnosed with cancer and 16 789 had a cancer-related death (41 293 and 6908 among full siblings respectively). The most common cancers were non-melanoma skin (27 105 diagnoses & 227 deaths) and prostate cancer (24 211 diagnoses & 869 deaths). In cohort analysis, those in the highest quartile of cardiorespiratory fitness had a higher risk of prostate (adjusted HR 1.10; 95% CI: 1.05 to 1.16) and skin cancer (e.g., non-melanoma HR 1.44; 1.37 to 1.50) compared to those in the lowest quartile, which led to a higher risk of any type of cancer diagnosis (HR 1.08; 1.06 to 1.11). However, those in the highest quartile had a lower risk of cancer mortality (HR 0.71; 0.67 to 0.76). When comparing full siblings, and thereby controlling for all behavioural, environmental, and genetic factors they share, the excess risk of prostate (HR 1.01; 0.90 to 1.13) and skin cancer (e.g., non-melanoma HR 1.09; 0.99 to 1.20) attenuated to the null. In contrast, the lower risk of overall cancer mortality was still statistically significant after control for such shared confounders (HR 0.78; 0.68 to 0.89). For other site-specific cancers, the influence of such confounding tended to vary, but none showed the same excess risk as prostate and non-melanoma skin cancer. The association between high levels of adolescent cardiorespiratory fitness and excess risk of some cancers, such as prostate and non-melanoma skin cancer, appears to be fully explained by unobserved confounders shared between full siblings. However, the protective association with cancer mortality persists even after control for such confounding.

The risk of developing cancer of the digestive organs (excluding intestines) in the South Urals Population Exposed to Radiation Cohort

Evaluation of the low dose effect on population health is still a relevant issue. It requires further studies to improve our understanding of these effects. To solve this problem, it is important to conduct studies of the late effects of radiation exposure with direct risk estimation in the population that combines all strata of the society: people of different sex, age, initial health status, social and economic status. Moreover, this population should be sizeable and has been followed up for a long-term period. This manuscript is the first to present the findings of the analysis of the incidence risk of cancer of all the digestive organs, excluding intestines, and stomach cancer taken separately in members of the Southern Urals Population Exposed to Radiation Cohort depending on the dose accumulated in the stomach over the period from 1956 through 2018. This cohort is comprised of individuals exposed in the Southern Urals in two radiation accidents (on the Techa River and in the East-Urals Radioactive Trace) over the period from 01.01.1950 through 31.12.1960. The cohort also includes those who were born during this period; they could have additional in utero exposure or have exposed parents. The population was affected by long-term combined exposure (external and internal) at the low-to-medium soft tissue dose range (up to 1.1 Gy). The size of the incidence cohort was 47,282 people. Over the follow-up period 01.01.1956-31.12.2018, the number of person-years made up 1 292 930; mean dose to the stomach was 47 mGy, maximum – 1,132 mGy. Excess relative risk of the cancer incidence of the digestive organs was assessed using the Poisson regression analysis. Calculations were performed using the EPICURE Statistical software package. Excess relative risk for stomach cancer with a 2-year minimal, was 0.98/Gy (р=0.026), for all cancers of the digestive organs, excluding intestines, – 0.58/Gy, р=0.06. There was no significant modification of the effect by non-radiation factors. These values of excess relative risk do not disagree with the results of similar studies in the Japanese cohort of the atomic bomb survivors who were compatible in terms of age but had acute exposure at higher doses. No significant dose dependence of the cancer incidence of the oral cavity, esophagus, liver, or pancreas was detected at this stage.

Polycyclic aromatic hydrocarbons (PAHs) in fish (Clarias gariepinus) of southwestern rivers, Nigeria: Occurrence, distribution, and potential human exposure risks

This study was undertaken to analyze Polycyclic aromatic hydrocarbons (PAHs) in fish (Clarias gariepinus) from six major rivers within southwest Nigeria to assess the ecotoxicological and human health risks. The average concentrations of total PAH (∑PAH) ranged from 12.18 to 49.12 µg/g and from 10.35 to 38.09 µg/g during the dry and wet seasons, respectively, and the ranges were significantly higher than the prescribed WHO (0.001 µg/g) and European Union (0.002 µg/g) recommended safe levels for human consumption. The low molecular weight PAHs (2–3 rings) dominated the profile, suggesting petrogenic sources. Phenanthrene remains the highest contributor to PAH intake across all locations and seasons. The toxicity equivalent quotients (TEQ), which represents the sum of B(a)P equivalent concentration [B(a)Peq] ranged from 0.851 to 2.014 μg BaP/g with a slightly higher range of 1.046–2.763 μg BaP/g during the dry and wet seasons, respectively. Across both seasons, the estimated hazard quotient (HQ) and hazard index (HI) were found to be < 1, suggesting consumption of Clarias gariepinus has no non-carcinogenic risks. The estimated excess cancer risk value (1.55×10−2 to 5.03×10−2) from consumption of C gariepinus exceeded all regulatory guideline values for potential cancer risk. The excess cancer risk, predominated by B(a,h)A (0.0194 µg/g) and B(a)P (0.0163 µg/g) suggests a greater risk of exposure during the wet season. The study showed no human health risk due to PAHs in Clarias gariepinus obtained from southwestern rivers in Nigeria. However, due to bioaccumulation, policies that will ensure regular monitoring of PAHs in seafood are recommended to maintain a sustainable ecosystem.

Exposure to second-hand smoke and breast cancer risk in non-smoking women: a comprehensive systematic review and meta-analysis.

Through the use of an innovative method to identify original publications, we conducted ameta-analysis of all epidemiological studies evaluating the association between second-hand smoke (SHS) exposure and breast cancer risk among female non-smokers published in English up to October 2022. Pooled relative risks (RR) were obtained through the use of random-effects models. Dose-response relationships were derived using log-linear functions. Out of 73 identified eligible studies, 63 original articles were included in the meta-analysis. The pooled RR for breast cancer for overall exposure to SHS was 1.24 (95% confidence interval, CI, 1.15-1.34, number of articles, n = 52). Regarding the setting of exposure, RRs were 1.17 (95% CI 1.08-1.27, n = 37) for SHS exposure at home, 1.03 (95% CI 0.98-1.08, n = 15) at the workplace, 1.24 (95% CI 1.11-1.37, n = 16) at home or workplace, and 1.45 (95% CI 1.16-1.80, n = 13) for non-specified settings. The risk of breast cancer increased linearly with higher duration (RR 1.29;95% CI 1.04-1.59 for 40 years of SHS exposure, n = 12), intensity (RR 1.38;95% CI 1.14-1.67 for 20 cigarettes of SHS exposure per day, n = 6), and pack-years (RR 1.50;95% CI 0.92-2.45 for 40 SHS pack-years, n = 6) of SHS exposure. This meta-analysis shows a statistically significant excess risk of breast cancer in women exposed to SHS.

Risk and Prognosis of Cancer in Patients with Obstructive Uropathy Compared with the General Danish Population.

To examine whether obstructive uropathy is associated with increased risk of cancer and whether mortality differs between patients with cancer with and without obstructive uropathy. In a nationwide population-based Danish cohort study including 37,275 adult patients with a first-time hospital-related diagnosis of obstructive uropathy in 1996 to 2022, we assessed cumulative cancer incidence (risk) and standardized incidence ratios (SIR). Furthermore, we compared the mortality of 7,485 patients diagnosed with cancer after obstructive uropathy diagnosis with that of 69,785 patients with cancer without obstructive uropathy matched by age, sex, cancer site, stage, and calendar year of cancer diagnosis. The 3-month risk of cancer after an obstructive uropathy diagnosis was 9.6%. The 3-month SIR was 34.2 [95% confidence interval (CI), 33.1-35.4] while the 1 to <5 year SIR was 1.2 (95% CI, 1.1-1.3). The 3-month SIRs were 82.7 (95% CI, 79.3-86.2) for urological cancer, 88.8 (95% CI, 79.8-98.5) for gynecological cancer, and 13.9 (95% CI, 12.0-15.9) for colorectal cancer. After 1 year of follow-up, the excess number of urological cancers decreased to 0.1 per 100 person-years, whereas we observed no excess risk of gynecological and colorectal cancers. The 5-year all-cause mortality following cancer was 64.1% (95% CI, 62.9-65.2) in patients with an obstructive uropathy diagnosis before cancer diagnosis and 53.2% (95% CI, 52.9-53.6) in those without. A first-time diagnosis of obstructive uropathy can be a clinical marker of underlying undiagnosed cancer and elevated mortality in relation to any cancer diagnosed after obstructive uropathy. These findings can inform the follow-up recommendations for obstructive uropathy.

Assessment of polycyclic aromatic hydrocarbon (PAH) profiles in heat-processed meat and fish: a study on health risk evaluation

The profiles of polycyclic aromatic hydrocarbons (PAHs) in selected heat-processed meat and fish were evaluated to determine the potential health risk associated with consumption. The samples were analysed using a gas Chromatography-Mass spectrometer. Different concentrations of individual PAHs were detected in the samples, with the smoked samples having the highest concentrations. The total PAHs (mg/kg) in smoked samples were 2.763 ± 0.185 (game meat), 1.618 ± 0.102 (mackerel fish), and 1.718 ± 0.129 (catfish), whereas levels (mg/kg) in grilled samples were 0.771 ± 0.049 (chicken) and 0.911 ± 0.053 (fish). The total carcinogenic PAH (PAH7) concentrations (mg/kg) in grilled chicken and fish and smoked (game meat, mackerel fish, and catfish) samples were 0.231, 0.294, 0.440, 0.309, and 0.332, while their total PAH8 concentrations were 0.356, 0.371, 0.537, 0.465, and 0.476 respectively. The non-carcinogenic PAH risk estimations, both individually (hazard quotient) and cumulatively (hazard index), were below 1 in all the samples. The mean concentrations of PAH markers B[a]P and the PAH4 were above the EU limits in both the smoked and the grilled samples tested. This implies that exposure to high levels of these PAHs through regular consumption of these products may increase the risk of developing certain types of cancer and other health issues. The smoked fishes has the lowest MOE values for the PAH8 compared to the other samples. The margin of exposures (MOEs), carcinogenic toxic equivalent (TEQ), and excess cancer risk (ECR) also indicated that frequent consumption of smoked fish (mackerel or catfish) by an adult of 70 kg body weight above the reported intake rate of 0.0019 kg/AME/day for a prolonged period may have higher cancer risks than in other samples. Smoked game meat had the highest PAH16 level, but indicated a relatively lower risk level, possibly because of its relatively low intake rate (0.0004 kg/AME/day).

Exposure to volatile organic compounds in offices and in residential and educational buildings in the European Union between 2010 and 2023: A systematic review and health risk assessment

Chronic exposure to indoor volatile organic compounds (VOCs) can result in several adverse effects including cancers. We review reports of levels of VOCs in offices and in residential and educational buildings in the member states of the European Union (EU) published between 2010 and 2023. We use these data to assess the risk to population health by estimating lifetime exposure to indoor VOCs and resulting non-cancer and cancer risks and, from that, the burden of cancer attributable to VOC exposure and associated economic losses. Our systematic review identified 1783 articles, of which 184 were examined in detail, with 58 yielding relevant data. After combining data on VOC concentrations separately for EU countries and building types, non-cancer and cancer risks were assessed in terms of hazard quotient and lifetime excess cancer risk (LECR) using probabilistic Monte Carlo Simulations. The LECR was used to estimate disability adjusted life years (DALYs) from VOC-related cancers and associated costs. We find that the LECR associated with formaldehyde exposure was above the acceptable risk level (ARL) in France and Germany and that of from exposure to benzene was also above the ARL in Spanish females. The sum of DALYs and related costs/1,000,000 population/year from exposure to acetaldehyde, benzene, formaldehyde, tetrachloroethylene, and trichloroethylene were 4.02 and €41,010, respectively, in France, those from exposure to acetaldehyde, benzene, carbon tetrachloride, formaldehyde, and trichloroethylene were 3.91 and €39,590 in Germany, and those from exposure to benzene were 0.1 and €1030 in Spain. Taken as a whole, these findings show that indoor exposure to VOCs remains a public health concern in the EU. Although the EU has set limits for certain VOCs, further measures are needed to restrict the use of these chemicals in consumer products.

Ethylene Oxide in Southeastern Louisiana's Petrochemical Corridor: High Spatial Resolution Mobile Monitoring during HAP-MAP.

Ethylene oxide ("EtO") is an industrially made volatile organic compound and a known human carcinogen. There are few reliable reports of ambient EtO concentrations around production and end-use facilities, however, despite major exposure concerns. We present in situ, fast (1 Hz), sensitive EtO measurements made during February 2023 across the southeastern Louisiana industrial corridor. We aggregated mobile data at 500 m spatial resolution and reported average mixing ratios for 75 km of the corridor. Mean and median aggregated values were 31.4 and 23.3 ppt, respectively, and a majority (75%) of 500 m grid cells were above 10.9 ppt, the lifetime exposure concentration corresponding to 100-in-one million excess cancer risk (1 × 10-4). A small subset (3.3%) were above 109 ppt (1000-in-one million cancer risk, 1 × 10-3); these tended to be near EtO-emitting facilities, though we observed plumes over 10 km from the nearest facilities. Many plumes were highly correlated with other measured gases, indicating potential emission sources, and a subset was measured simultaneously with a second commercial analyzer, showing good agreement. We estimated EtO for 13 census tracts, all of which were higher than EPA estimates (median difference of 21.3 ppt). Our findings provide important information about EtO concentrations and potential exposure risks in a key industrial region and advance the application of EtO analytical methods for ambient sampling and mobile monitoring for air toxics.

Health risk assessment due to uranium contamination in groundwater: MATLAB based Monte-Carlo simulations

ABSTRACT Uranium contamination is a growing concern due to its inherent toxicity, which poses a significant threat to human health. The health risk assessment due to uranium contamination in groundwater of Mansa district, Punjab (India) is investigated. The LED LF-2a Fluorimeter model by Quantalase (Indore) was used for measurement of uranium concentration in groundwater collected in October 2021 from twenty-six locations. A comparison is conducted between the deterministic and probabilistic approaches since the deterministic approach might either underestimate or exaggerate the risk estimation. Monte-Carlo simulations are used to curtail the associated uncertainties in the data. The simulations are carried out in MATLAB for risk assessment and sensitivity analysis. The deterministic and probabilistic approaches are used to calculate hazard quotient, excess cancer risk and annual effective dose. Using probabilistic approach, the hazard quotient for male and female at 5th percentile is 4.36 and 3.81, respectively. Similarly, the hazard quotient for male and female at 95th percentile is 38.95 and 34.26, respectively. The mean hazard quotient is 18.45 and 15.68 for male and female, respectively, using deterministic approach. The hazard quotient is greater than 1 for both genders (male and female) and excess cancer risk is also higher than 10−4 using both deterministic and probabilistic approaches. The annual effective dose using deterministic approach is 0.23 mSv year−1 whereas using probabilistic approach, the 5th and 95th percentile is 0.56 mSv year−1 and 4.33 mSv year−1, respectively. The sensitivity analysis indicated that the overall risk is more sensitive to concentration of uranium in groundwater and the exposure frequency. This study emphasises on the hazards posed to humans by the ingestion of uranium contaminated groundwater, hence stressing the urgency for taking actions to protect the population of the study area.

Renal cell carcinoma and risk of second primary cancer: A Danish nationwide cohort study.

To examine the risk of second primary cancer in patients with incident renal cell carcinoma (RCC). We identified all patients diagnosed with incident RCC during 1995-2019, using population-based Danish medical registries. Patients were followed from the date of RCC diagnosis until any second primary cancer diagnosis, death, emigration, or December 31, 2019, whichever came first. We computed the absolute risk, standardized incidence ratio (SIR), and excess absolute risk of second primary cancer, with 95% confidence intervals (CIs), among patients with RCC compared to the general population. The absolute 1- and 20-year risks of any second primary cancer were 2.8% and 17.8%, respectively. Within 1 year after RCC diagnosis, we detected 20 excess cancer cases per 1000 person-years (PY) (SIR, 2.3; 95% CI: 2.1-2.6). Moreover, we detected an additional four excess cancer cases per 1000 PY during 1 to <5 years of follow-up (SIR, 1.3; 95% CI: 1.2-1.4), and 6 per 1000 PY beyond 5 years of follow-up (SIR, 1.4; 95% CI: 1.3-1.5). The sustained elevated cancer risk beyond 1 year of follow-up was mainly attributed to excess risk of lung and bladder cancer. The risk of second primary cancer was higher in 2006-2019 than in 1995-2005, but only during the first year of follow-up. Patients with incident RCC have a sustained 40% elevated long-term risk of second primary cancer, compared with the general population. This increased risk is mainly attributed to lung and bladder cancer.

A comprehensive study on the spatial and temporal variation of BTEX and asbestos in the northwest of Iran: Human risk assessment

Substances like asbestos and other air pollutants, such as BTEX (benzene, toluene, ethylbenzene, and xylene), are hazardous compounds due to their adverse effects on human health. This study aims to investigate the levels, seasonal variations, spatial distribution, potential sources, and associated health risks associated with BTEX compounds and asbestos fibers in the ambient air of Tabriz. Air samples were taken at 16 different locations during the 2020–2021 period. Glass containers with charcoal were used for sample collection, and the BTEX content was determined using the GC-FID method. Phase-contrast microscopy (PCM) analysis was conducted with a low-volume peripheral pump for asbestos fiber sampling. The results showed that the average concentration of ∑BTEX was 37.94 and 27.98 μg/m3 in autumn and spring, respectively. The same parameter was 2.26 and 1.68 f/L for asbestos in the autumn and winter, respectively. The contribution of BTEX to ozone formation potential (OFP) in the research area showed that xylene and toluene were the major contributors to ozone production in different seasons. The risk of exposure to benzene compounds was 24 × 10−4 in children and 55.9 × 10−4 in adults, while the risk of exposure to ethylbenzene was 3.78 × 10−4 in children and 3.25 × 10−4 in adults. The estimated lifetime cancer risk was found to be the highest for benzene, followed by ethylbenzene. The estimated cancer risk for benzene and ethylbenzene exceeded the threshold values set by EPA, which signals a significant carcinogenic risk due to exposure to these substances in the ambient air of Tabriz. According to the EPA guidelines, the low carcinogenicity risk levels are between 10−4 and 10−6. According to the findings for the exposure to asbestos fibers, the maximum values of excess cancer risk (ECR) and estimated lifetime cancer risk (ELCR) were observed in the 16–30 age range across all locations, suggesting increased exposure to asbestos fibers compared to other age groups.

Extended analysis of solid cancer incidence among nuclear industry workers in the UK 1955-2011: comparison of workers first hired in earlier and later periods.

To address points arising from the recent study of nuclear workers in the USA and the International Nuclear Workers Study (INWORKS), concerning the difference in solid cancer risk estimates between those first hired in earlier and later calendar years, subsidiary analyses were conducted on a cohort of 172 452 workers in the National Registry for Radiation Workers (NRRW) from the UK. A total of 18 310 incident first primary solid cancer cases were registered in the period from 1955 until 2011 in the NRRW cohort and workers accrued 5.25 million person-years of follow-up. Incidences rates of all solid cancers combined, lung cancer and solid cancer excluding lung cancer were examined in terms of external radiation doses in the full cohort and in a sub-cohort of workers who had no record of internal exposure monitoring and were defined by the periods of first hire before and after the beginning of the years 1960, 1965 and 1970. All analyses were carried out using Poisson Regression. These analyses demonstrated that only for lung cancer between the pre-1965 and post-1964 periods is there strong evidence for a difference in the risks using the NRRW full cohort. In the other calendar period breakdowns and for the other cancer groups, there is no clear evidence of differences in the risks. The NRRW estimation of risks between recent and early workers is not generally consistent with the US workers cohort or the INWORKS evaluations that later hired workers are at much higher solid cancer risk than earlier hired workers, although INWORKS contains a significant part of the latest updated NRRW cohort as well as the US data. The conclusion that the INWORKS and US study data demonstrate a real difference in excess solid cancer risk from external radiation exposure between earlier and later workers is premature. The results presented here should also be treated with caution because of the limited corroborating evidence from other published studies. Information on internal doses, neutron doses as well as non-radiation factors such as smoking and asbestos exposure would be needed to make definitive inferences.

An extensive investigation on human risk associated with PAHs in fish and sediment in Bushehr, Northern of Persian Gulf

Here, a comprehensive study was designed to estimate the human risk assessment attributed to exposure of polycyclic aromatic hydrocarbons (PAHs)in sediment and fish in most polluted shore area in north of Persian Gulf. To this end, a total of 20 sediment and inhabitual Fish, as one of most commercial fish, samples were randomly collected from 20 different stations along Bushehr Province coastline. The 16 different components of PAHs were extracted from sediment and edible parts of inhabitual fish and measured with high-performance liquid chromatography (HPLC) and gas chromatography (GC), respectively. In addition, dietary daily intake (DDI) values of PAHs via ingestion Indian halibut and the incremental lifetime cancer risk (ILCR) attributed to human exposure to sediments PAHs via (a) inhalation, (b) ingestion, and (c) dermal contact for two groups of ages: children (1–11 years) and adults (18–70 years) were estimated. The results indicated that all individual PAHs except for Benzo(b)flouranthene (BbF) and Benzo(ghi) perylene (BgP) were detected in different sediment sample throughout the study area with average concentration between 2.275 ± 4.993 mg.kg–1 dw. Furthermore, Naphthalene (Nap) with highest average concentration of 3.906 ± 3.039 mg.kg–1 dw was measured at the Indian halibut. In addition, the human risk analysis indicated that excess cancer risk (ECR) attributed to PAHs in sediment and fish in Asaluyeh with high industrial activities on oil and derivatives were higher the value recommended by USEPA (10−6). Therefore, a comprehensive analysis on spatial distribution and human risk assessment of PAHs in sediment and fish can improve the awareness on environmental threat in order to aid authorities and decision maker to find a sustainable solution.

Abstract SS02-02: Hormone Replacement and Alternatives for Relief of Vasomotor Symptoms in Women at Increased Risk for Breast Cancer

Abstract 70% of women will experience vasomotor symptoms sufficient to impact their quality of life during menopause transition and the early menopause. These symptoms are thought result from neurotransmitter imbalances resulting from ovarian hormone reductions and hypersecretion of gonadotropins. Increases in gonadotropins result in neurotransmitter triggered stimulation of the neurokinin 3 (NK3) receptor and thermoregulatory imbalance. Estrogen deficiency also reduces serotonin which can also trigger increases in hot flashes, and sleep disturbances. Vasomotor symptoms last on the average for 7 years until acclimation to persistent low estrogen levels occurs. Estrogen +/- progestin replacement therapy is associated with the greatest likelihood of vasomotor symptom relief as it reduces gonadotropin and NK3 receptor signaling and increases serotonin. Progestins also increase the neuroinhibitory transmitter gamma-aminobutyric acid (GABA) which improves sleep quality. There continues to be confusion on the part of providers and patients regarding the excess risk of breast cancer and thromboembolic events as these risks are affected by type of agent, route of delivery, age, duration of treatment, and presence of obesity. The majority of placebo controlled randomized clinical trial data on hormone replacement with estrogen or estrogen + a progestin comes from the Women’s Health Initiative (WHI) for women 50-79 in which oral conjugated estrogen (CE) 0.625 mg was used as the estrogen for women without a uterus and medroxyprogesterone acetate (MPA) was added to CE for women with a uterus to protect against endometrial hyperplasia and cancer. The median age at entry to WHI that trial was 63 and a substantial proportion had previously taken hormones. Large longitudinal cohort studies have been helpful in assessing risks in women starting hormones at a more clinically relevant age (45-55) and with hormonal preparations other than oral CE and MPA. Five to seven years of estrogen alone results in minimal if any increased risk for breast cancer. However, combined estrogen+ progestin replacement for women over 50, necessary for women with a uterus, results in an ~ 30 % relative increased risk for breast cancer if taken for up to 5 years and a doubling of risk with 10 years of treatment. So called bioidentical hormones often compounded as oral troches of estradiol, progesterone, and testosterone, are also associated with increased breast cancer risk. Vaginal hormones have not been found to increase risk for breast cancer. Increased risk of thromboembolism is predominately observed in women over 50 using oral as opposed to transdermal preparations. Increased risk for stroke and dementia was observed in the WHI again with oral hormones in women over 65. In the WHI there was no increase in cancer related, cardiovascular or overall mortality with estrogen or estrogen and progestin. For high-risk peri and post-menopausal women with who would like to reduce/alleviate their vasomotor symptoms with no increase in risk for breast cancer there are several options: 1) the tissue selective estrogen complex bazedoxifene (BZA) combined with conjugated estrogen (CE) 2) the non-hormonal option of NK3 receptor antagonists such as fezolinetant ( 3) non-hormonal options of gabapentin, selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine uptake inhibitors (SNRI). BZA and CE and fezolinetant are reported to reduce hot flashes in 70% or more of individuals with paroxetine effectiveness reported as 50%. All three are FDA approved for reduction of vasomotor symptoms. The combination of BZA and CE is also being investigated for breast cancer risk reduction. These agents differ with respect to side effects with increased risk of blood clots for bazedoxifene and conjugated estrogen, increased risk of nausea, diarrhea, and liver dysfunction for fezolinetant and drowsiness and dry mouth for SSRIs. Drug costs may also dramatically affect insurance coverage and patient uptake of a particular strategy. A recent online perusal of a popular site for finding the lowest drug price suggested substantial differences in the cost of drugs for relief of vasomotor symptoms. The approximate cost for a 30- day supply of oral estradiol was $30, estradiol transdermal patches $35, oral progesterone $15, combined estradiol and levonorgestrel transdermal patches $240, oral CE $200, oral CE + medoxyprogesterone acetate $240, and for BZA+ CE $200. For non-hormonal therapies the cost of 30 days of gabapentin was $11, paroxetine $30 and fezolinetant $550. Crandall, Mehta, and Manson JAMA 2023 329:405-420 Collaborative Group on Hormonal Factors in Breast Cancer Lancet 2019 394: 1159-1168 Fabian et al Ca Prev Res 2019 10:711-720 Modi and Dhillo Neuroendocrinology 2019 109:242–248 Citation Format: C. Fabian. Hormone Replacement and Alternatives for Relief of Vasomotor Symptoms in Women at Increased Risk for Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr SS02-02.

Assessment of Excess Life Cancer Risk from Radon Concentration in Borehole water Samples collected from Katagum LGA, Bauchi State, Nigeria

Radon in potable water has turned out to be an issue of public health concerns, specifically when used immediately from supply for domestic purpose and consumption without any pretreatment. In this study, 222Rn Concentration in 15 water samples collected from ground water sources (borehols) in Katagum local government Bauchi State was determined, using Liquid scintillation counter (Tri-Carb- LSA1000) and the radiological risk was calculated. The study revealed that, 222Rn concentration ranges from 28.44 to 49.61 Bql-1 with mean value of 39.55 Bql-1. These values were found to be higher than the permissible limits set by WHO, USEPA and UNSCEAR. The mean value of annual effective dose due to ingestion for different age categories (adults, children and infants) are 0.29, 0.43 and 0.51 mSvy-1 respectively; and for inhalation the mean is 0.1 mSvy-1. Also, the mean value of excess life cancer risk due to ingestion for different age groups (adults, children and infants) are 0.0010, 0.0015 and 0.0018 respectively while that of inhalation is 0.0003. Thus, this study reveals that borehole water around Katagum Local Government Area Bauchi State is not radiologically safe and there is need for constant monitoring.

The impact of uranium contamination in groundwater on human health: a toxicological risk assessment

ABSTRACT All living beings are exposed to naturally occurring radionuclides. Uranium, a primordial radionuclide forms compounds that are water soluble and enter the human body through food and drinking water. This study conducted a health risk assessment to evaluate the potential dangers associated with consuming uranium through groundwater in the Mansa district of Punjab, India. The uranium concentration varied from 43.43 µg/L to 449.79 µg/L. The biokinetic model of uranium including hair compartment as excretion pathway is used to calculate uranium retention in different organs of the human body. The Pearson correlation and principal component analysis are used for assessing the correlation of uranium with TDS, salinity, conductivity and pH. The high correlation is observed between TDS and uranium. The hazard quotient is 17.42 and excess cancer risk is higher than the permissible limit of 10−4. Owing to the high uranium concentration in Mansa district, periodic monitoring is advised along with clinical investigation of the population.

Assessment of Background Gamma Radiation Levels Across Major Markets in Southern Senatoria District of Cross River State, Nigeria

Human exposure to ionizing radiation from natural and artificial sources is unpreventable phenomenon on earth. Radiation profile and dose at for some markets in Cross River State, Nigeria have been ascertained using 451p ion chamber survey meter and the following indices of radiation absorb dose, annual effective dose equivalent, and excess life cancer risk, were calculated. the dose rate measures at the seven market are as follows; Biase 0.02\(\mu\)sv/h to 0.09\(\mu\)sv/h, Akamkpa 0.02\(\mu\)sv/h to 0.09\(\mu\)sv/h, Odukpani 0.02\(\mu\)sv/h to 0.09\(\mu\)sv/h marian market 0.06\(\mu\)sv/h to 0.19\(\mu\)sv/h, Calabar South, 0.05\(\mu\)sv/h to 0.30\(\mu\)sv/h, Akpabuyo 0.02\(\mu\)sv/h to 0.19\(\mu\)sv/h, Bakassi 0.02\(\mu\)sv/h to 0.16\(\mu\)sv/h. The mean value for dose is mean 0.047 \(\pm\) 0.018 for Biase, 0.043 \(\pm\) 0.018 for Akamkpa, 0.043 \(\pm\) 0.017 for Odukpani, 0.110 \(\pm\) 0.036 for Marian, 0.106 \(\pm\) 0.059 sv/h for Calabar South, 0.104 \(\pm\) 0.056 sv/h for Akpabuyo and 0.053 \(\pm\) 0.031 sv/h for Bakassi. Mean values of 0.073 \(\pm\) 0.026msvy-1, 0.067 \(\pm\) 0.029msv/y, 0.095 \(\pm\) 0.08msv/y, 0.158 \(\pm\) 0.072msv/y, 0.134 \(\pm\) 0.114msv/y, 0.159 \(\pm\) 0.084msv/y and 0.223 \(\pm\) 0.654 for AEDE were observed respectively for within the markets. Similarly, 0.259 \(\pm\) 0.092 x 10-3, 0.235 \(\pm\) 0.095 x 10-3, 0.338 \(\pm\) 0.265 x 10-3, 0.552 0.252 x 10-3, 0.470 \(\pm\) 0.397 x 10-3, 0.558 0.29 x 10-3, and 0.265 \(\pm\) 0.097 x 10-3 were recorded for ELCR, with the marketer the AEDE values are with the permissible limit as recommended by the international bodies, the ELCR values are also within permissible limit. The implication of the AEDE &amp; ELCR values is that the markets sides is radiation safe for any radiological health burdens that might arise due to absorb dose from BIR, but the probability of are developing cancer over a life time exposure in market places is high. It’s recommended that periodic BIR monitory and evaluation and radioactive concentration of nuclides in soil and rocks of the area be carried out by local authority.

Excess weight, weight gain, and prostate cancer risk and prognosis: the PROCA-life study.

Studies of excess weight and weight changes throughout adult life for prostate cancer (PCa) risk and prognosis have shown inconsistent results. In a population-based cohort, the Prostate Cancer Study throughout life (PROCA-life), 16,960 healthy men from the prospective cohort Tromsø Study (1994-2016) were included. Body mass index (BMI) and weight were measured at all four attendings, and weight change was calculated as the difference between the first and last of either Tromsø4, Tromsø5 or Tromsø6. Overall, 904 men developed PCa during 16 years of follow-up, and Poisson regression with fractional polynomials was used to investigate trends in incidence. Cox proportional hazard and logistic regression models were used to study associations between measurements of BMI and weight change and PCa risk, severity, and mortality. At study entry, 46% of the participants (median age 44 years) were overweight, and 14% were obese (BMI > 30 kg/m2). We observed a 127% increase in overall age adjusted PCa incidence in the cohort during 1995 through 2019. No overall associations between BMI or weight change and PCa risk were observed. However, in sub-group analysis, weight gain among obese men was associated with a three-fold higher PCa risk (HR 3.03, 95% CI 1.39-6.58) compared with obese men with stable weight. Overweight was associated with lower risk of metastatic cancer (OR 0.48, 95% CI 0.30-0.75) at diagnosis. Men with obesity had higher risk of PCa-specific death (HR 1.72, 95% CI 1.03-2.88), while nonsmoking obese PCa cases had two times higher PCa-specific mortality compared with normal weighted PCa cases (HR 2.10, 95% CI 1.11-3.70). In our cohort, weight gain among obese men was associated with higher risk of PCa, and obesity was associated with higher PCa-specific mortality, especially among nonsmokers. The relationship between weight and risk for PCa remains complicated, and future studies are needed to determine clinical implications.

Epidemiology of myasthenia gravis in France: Incidence, prevalence, and comorbidities based on national healthcare insurance claims data

BackgroundThe European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France have been published. This study aimed to assess the incidence and prevalence rates of myasthenia gravis in France based on data extracted from the French National Health Insurance Claims Database (the SNIIRAM database). MethodsWe conducted a retrospective repeated cross-sectional population study from 2008 to 2018 using a representative sample of the French population (Échantillon généraliste des bénéficiaires) covered by health insurance. We calculated the incidence, prevalence, and sex ratio of MG and screened for comorbidities associated with MG (standardized to the general population). ResultsIn total, 331 MG patients were identified between 2008 and 2018. The average incidence of MG in France was 50 per million person-years, while the mean prevalence was 465 per million people. The female-to-male ratio was 1.33. The Incidence of MG gradually increased from 40years of age for women and 60 for men. Thymoma was present for 5.1% of MG patients and a thymectomy was performed for 4.7%. Thyroid disease was the most prevalent autoimmune comorbidity, affecting approximately 8.5% of cases. MG patients had an increased cancer risk, with a standardized rate ratio of 2.38 (95% CI: 1.64–3.46). ConclusionThe incidence and prevalence rates of MG are significantly higher than those previously reported in the literature and the incidence increases with age. The excess risk of cancer raises concerns for MG patients, in particular, concerning the management of immunosuppressive drugs.