Serum dioxin concentrations and endometriosis: a cohort study in Seveso, Italy.

Abstract

Dioxin, a ubiquitous contaminant of industrial combustion processes including medical waste incineration, has been implicated in the etiology of endometriosis in animals. We sought to determine whether dioxin exposure is associated with endometriosis in humans. We conducted a population-based historical cohort study 20 years after the 1976 factory explosion in Seveso, Italy, which resulted in the highest known population exposure to 2,3,7,8-tetrachlorodibenzo-(italic)p(/italic)-dioxin (TCDD). Participants were 601 female residents of the Seveso area who were (3/4) 30 years old in 1976 and had adequate stored sera. Endometriosis disease status was defined by pelvic surgery, current transvaginal ultrasound, pelvic examination, and interview (for history of infertility and pelvic pain). "Cases" were women who had surgically confirmed disease or an ultrasound consistent with endometriosis. "Nondiseased" women had surgery with no evidence of endometriosis or no signs or symptoms. Other women had uncertain status. To assess TCDD exposure, individual levels of TCDD were measured in stored sera collected soon after the accident. We identified 19 women with endometriosis and 277 nondiseased women. The relative risk ratios (RRRs) for women with serum TCDD levels of 20.1-100 ppt and >100 ppt were 1.2 [90% confidence interval (CI) = 0.3-4.5] and 2.1 (90% CI = 0.5-8.0), respectively, relative to women with TCDD levels (3/4) 20 ppt. Tests for trend using the above exposure categories and continuous log TCDD were nonsignificant. In conclusion, we report a doubled, nonsignificant risk for endometriosis among women with serum TCDD levels of 100 ppt or higher, but no clear dose response. Unavoidable disease misclassification in a population-based study may have led to an underestimate of the true risk of endometriosis.

Relationship of serum TCDD concentrations and age at exposure of female residents of Seveso, Italy.

“…If these background levels are similar in all zones, individuals with low levels of TCDD might still have substantial total TEQ levels. Our previous studies of health outcomes considered only TCDD exposure (Eskenazi et al 2002a(Eskenazi et al , 2002bMocarelli 2001;Warner et al 2002). Because we considered only TCDD, our results may have underestimated the health effects due to total TEQ exposure.…”

Estimating perchlorate exposure from food and tap water based on US biomonitoring and occurrence data

“…Dioxin and other organochlorine chemicals have been shown to interfere with male and female reproductive development in experimental and wild animals, particularly during gestational exposure (Gao et al, 1999;Grey and Ostby, 1995;Roman et al, 1998;Sonne et al, 2006;Theobald et al, 1997). In studies of women with environmental or accidental exposures, associations between dioxin-like chemical exposures and various reproductive endpoints (Eskenazi et al, 2003;Lawson et al, 2004;Schnorr et al, 2001;Warner et al, 2004 and and endometriosis (Eskenazi et al, 2002;Fierens et al, 2003;Heilier et al, 2005;Hoffman et al, 2007) have been either absent or of unknown significance, though animal studies have demonstrated reproductive effects at high doses (Arisawa et al, 2005;U.S. EPA, 2004).…”

General gynaecology: Association of phthalate esters with endometriosis in Indian women

“…14 Exposure to endocrine-disrupting compounds has been associated with changes in sensitive human reproductive endpoints such as menstruation. [15][16][17] These environmental agents can disrupt endocrine pathways by binding to estrogen and androgen receptors and mimicking or antagonising hormones or by altering hormone function, synthesis or modulation. 18,19 Phthalates are chemicals that are used in the manufacturing of medical supplies, plastic wraps, automobile parts, beverage containers and the linings of metal cans and can act as powerful endocrine disruptors.…”