Renal cell cancer correlated with occupational exposure to trichloroethene

Abstract

Green and Lash (1999) commented, in a letter to the editor, on our paper reporting an increased incidence of renal cell cancer in workers exposed to high concentrations of trichloroethene over extended periods of time (Vamvakas et al. 1998). Unfortunately, because of irregular handling of the letter by the editorial management of the journal, we were not in a position to follow common practice, that is to respond immediately and in the same issue (see footnote).We do not accept the statement at the outset of Green and Lash's letter that signi®cant methodological¯aws make our results unreliable. Rather, we regard their criticism as unsubstantiated, for following reasons.

Trichloroethylene and cancer: epidemiologic evidence.

“…Nonetheless, the difference between this reported OR and the average risk in the Tier I cohort studies is striking. It may, in part, reflect differences in exposures between biomarker studies (generally < 40 ppm) (18,24) and subjects in this study (66) who experienced narcotic symptoms, which can occur only at much higher exposure levels [e.g., 200 mL/m3, Stopps (106)]. These findings are also supported by the results of Dosemeci et al (68).…”

“…In all of these studies, there are concerns about selection bias, blinding of investigators or interviewers, and particularly exposure characterization. Some studies use job titles to infer exposure (60,63,67), one compares dry cleaning workers to laundry workers (59), others assess risk to subjects exposed to general classes of solvents (57,63), and still other studies ask about exposure to specific agents or used more sophisticated exposure characterizations ( Elevated odds ratios for kidney cancer are found for four different exposure classifications: degreasing agents (including TCE ) (60,61,66), solvents (61,63,65), the iron/ steel industry (likely including exposure to degreasing agents or solvents) (58,(62)(63)(64)(65), and dry cleaners/laundry workers (60,64,65). A few studies assesses TCE exposure specifically (66,68,84 (66), is hospitalbased using accident victims as controls.…”

Epidemiologic characteristics and risk factors for renal cell cancer

“…All three of these studies reported strikingly elevated relative risks for renal cell cancer associated with TCE exposure. [167][168][169] The fi ndings contrast starkly with results from other investigations, and several serious methodological shortcomings of these studies have been noted, [170][171][172] limiting any conclusion that can be drawn. To date, seven occupational cohort studies have evaluated the relationship between TCE exposure and specifi c types of cancer.…”

Selenium (Se), Blood Glutathione Peroxidases and DNA Damage in Chronic Kidney Disease Patients on Hemodialysis and After Kidney Transplantation - The Effect of Se Supplementation

“…Iseki et al (1993) and Vamvakas et al (1998) have shown that at the end-stage of CKD, the incidence of malignancies is higher than in the general population.. Kuroda et al (1988) showed that in patients with diagnosed cancer of different sites (larynx, lung, stomach, liver, genitourinary tract) plasma Se concentration accounted for 99 ng/mL, whereas in the control group it was 145 ng/mL (P < 0.001). The evaluation of 15 extensive surveys indicated that in 10 surveys (72 484 patients at the ESKD) the cancer risk (the observed number of cancers compared with the expected number) was 7.6 (Vamvakas et al, 1998). In the majority of cases, tumors of kidney, prostate, liver and uterus were recorded.…”

“…In the majority of cases, tumors of kidney, prostate, liver and uterus were recorded. Although the pathogenic mechanisms of the enhanced incidence of cancer in CKD patients have not as yet been elucidated, Vamvakas et al (1998) suggest that the impaired function of the immune system, reduced antioxidant capacity together with the increased ROS generation involved in DNA molecule damage and depression of DNA are the most essential factors. The diminished DNA antioxidative defense of the body leads to an intensified attack of free radicals on DNA molecules and finally to the development of malignant diseases (Ames, 1989).…”