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Chromosomal aberrations in lymphocytes of healthy subjects and risk of cancer.


There is evidence that increased frequency of chromosomal aberration Noun 1. chromosomal aberration - any change in the normal structure or number of chromosomes; often results in physical or mental abnormalities
chromosomal anomaly, chromosonal disorder, chrosomal abnormality
 (CA) in peripheral blood lymphocytes Peripheral Blood Lymphocytes (PBL): These are the mature lymphocytes (small white immune cells) that are found circulating in the blood, as opposed to organs, such as the lymph nodes, spleen, thymus, liver or bone marrow. These cells consist of T cells, NK cells and B cells.  is a predictor of cancer, but further data are needed to better characterize CA as marker of cancer risk. From the archives of 15 laboratories we gathered cytogenetic cytogenetic /cy·to·ge·net·ic/ (-je-net´ik)
1. pertaining to chromosomes.

2. pertaining to cytogenetics.


cytogenetic

pertaining to or originating from the origin and development of the cell.
 records of 11,834 subjects who were free of cancer at the moment of blood drawing and who underwent cytogenetic examination for preventive purposes in the Czech Republic Czech Republic, Czech Česká Republika (2005 est. pop. 10,241,000), republic, 29,677 sq mi (78,864 sq km), central Europe. It is bordered by Slovakia on the east, Austria on the south, Germany on the west, and Poland on the north.  during 1975-2000. We linked these records to the national cancer registry A cancer registry is a systematic collection of data about cancer and tumor diseases. The data is collected by Cancer Registrars. Cancer Registrars capture a complete summary of patient history, diagnosis, treatment, and status for every cancer patient in the United States, and , revealing a total of 485 cancer cases. Subjects were classified according to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 the percentiles of CA distribution within each laboratory as low (0-33rd percentile), medium (34-66th percentile), and high (66-100th percentile). Subjects were further classified by occupational exposure and by subclass In programming, to add custom processing to an existing function or subroutine by hooking into the routine at a predefined point and adding additional lines of code.

subclass - derived class
 of CA. We found a significant association between the overall cancer incidence and the presence of chromosome-type aberrations [relative risk (RR) for high vs. low CA level = 1.24; 95% confidence interval confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%.
 (CI), 1.03-1.50] but not chromatid-type aberrations. Stomach cancer showed a strong association with frequency of total CA (RR = 7.79; 95% CI, 1.01-60.0). The predictivity of CA observed in subjects exposed to various classes of carcinogens Carcinogens
Substances in the environment that cause cancer, presumably by inducing mutations, with prolonged exposure.

Mentioned in: Colon Cancer, Rectal Cancer
 did not significantly differ from the group of nonexposed subjects. This study contributes to validation of CA as a predictive marker of cancer risk, in particular, of stomach cancer; the association between CA frequency and cancer risk might be limited to chromosome-type aberrations. Key words: cancer risk, chromosomal aberrations, cohort study A cohort study is a form of longitudinal study used in medicine and social science. It is one type of study design.

In medicine, it is usually undertaken to obtain evidence to try to refute the existence of a suspected association between cause and disease; failure to refute
, cytogenetic assay, molecular epidemiology molecular epidemiology Molecular medicine An evolving field that combines the tools of standard epidemiology–case studies, questionnaires and monitoring of exposure to external factors with the tools of molecular biology–eg, restriction endonucleases, . doi:10.1289/ehp.6925 available via http://dx.doi.org/[Online 2 February 2005]

**********

The frequency of chromosomal aberrations (CAs) in human peripheral blood lymphocytes (PBLs) measured with the conventional cytogenetic assay in metaphase metaphase /meta·phase/ (met´ah-faz) the second stage of cell division (mitosis or meiosis), in which the chromosomes, each consisting of two chromatids, are arranged in the equatorial plane of the spindle prior to separation.  cells has routinely been used for several decades as a tool to monitor occupational and environmental exposures to genotoxic genotoxic /ge·no·tox·ic/ (je´no-tok?sik) damaging to DNA: pertaining to agents known to damage DNA, thereby causing mutations, which can result in cancer.

ge·no·tox·ic
adj.
 carcinogens. There is ample evidence of the value of this biomarker for the identification of occupational and environmental hazards (Albertini et al. 2000; Bonassi et al. 2005; Carrano and Natarajan 1988; Rossner et al. 1995; Sram and Binkova 2000; Waters et al. 1999). However, the concept of chromosomal damage as a biomarker of early carcinogenic carcinogenic

having a capacity for carcinogenesis.
 effects rests on the evidence of an association between biomarker frequency and cancer risk, in addition to that of an association between biomarker and exposure to genotoxic agents.

The hypothesis of a positive association between the frequency of CAs in PBLs and the risk of cancer at different sites has been supported---besides theoretical considerations (Cheng and Loeb 1993; Mitelman 2000; Sorsa et al. 1992; Yunis 1983)--by numerous clinical observations, in particular, of patients suffering from hereditary chromosome breakage syndromes chromosome breakage syndrome Any of a group of inherited diseases in which chromosomes are more ↑ fragile–eg, ataxia-telangiectasia, Bloom syndrome, Fanconi syndrome, and xeroderma pigmentosum, resulting in ↑ susceptibility to certain Cas  (Mathur et al. 2000) and several other precancerous precancerous /pre·can·cer·ous/ (-kan´ser-us) pertaining to a pathologic process that tends to become malignant.

pre·can·cer·ous
adj.
 conditions such as preleukemic states of adult T-cell leukemia Human T cell leukemia/lymphotropic virus type 1 (HTLV-1) is believed to be the cause of several diseases, including adult T cell leukemia/lymphoma (ATLL), a rare cancer of the immune system's own T-cells.  (Nishino 1988), dysplastic nevus syndrome dysplastic nevus syndrome
n.
An atypical nevus, usually larger than 5 millimeters in diameter with variable pigmentation and ill-defined borders, marked by melanocytic dysplasia and associated with an increased risk for the development of nonfamilial
 (Caporaso et al. 1987), or nevoid nevoid /ne·void/ (ne´void) resembling a nevus.

ne·void
adj.
Resembling a nevus.



nevoid

resembling a nevus.
 basal-cell syndrome (Shafei-Benaissa et al. 1998). Case-series and case-control studies have reported a significant increase in the frequency of aberrant aberrant /ab·er·rant/ (ah-ber´ant) (ab´ur-ant) wandering or deviating from the usual or normal course.

ab·er·rant
adj.
1.
 cells in untreated cancer patients (Abarbanel et al. 1991; Barrios Barrios is a name of Hispanic origin. The name may refer to: Persons
  • Agustín Barrios (1885–1944), Paraguayan guitarist and composer
  • Arturo Barrios (born 1962), Mexican long-distance runner and former world record holder
 et al. 1988, 1991; Dave et al. 1995; Dhillon and Dhillon I998; Dhillon et al. 1996; Gebhart et al. 1993; Trivedi et al. 1998), but these studies have been subject to criticism because of small sample sizes and not accounting for the inherent reverse causality bias, that is, when the biomarker may be affected by the disease.

More conclusive evidence CONCLUSIVE EVIDENCE. That which cannot be contradicted by any other evidence,; for example, a record, unless impeached for fraud, is conclusive evidence between the parties. 3 Bouv. Inst. n. 3061-62.  on the association between CA and cancer comes from prospective cohort studies (Bonassi et al. 2004). An increased risk of cancer incidence was observed in individuals classified as having high CA frequency in a Nordic cohort (Hagmar et al. 1994, 1998), in an Italian cohort (Bonassi et al. 1995), and, limited to chromosome-type aberrations (CSAs) in a nested case-control study A nested case-control study is a type of study design where new case controls are applied into cohorts which were defined before the study begins.

Compared with case-control study, nested case-control study can reduce 'recall bias' and temporal ambiguity, and compared with
 carried out in Taiwan (Liou et al. 1999). In a case-control study nested within the joint Nordic and Italian cohorts, the association between CA frequency and risk of cancer was not modified by sex, age, cigarette smoking, occupational exposure, or time since the cytogenetic assay (Bonassi et al. 2000).

In the Czech Republic, the evaluation of CA frequency in PBLs has been included since 1975 in regular medical checkups of workers exposed to selected occupational hazards, making it feasible to identify a cohort of individuals for prospective follow-up for cancer in order to confirm the results of the studies from Nordic countries, Italy, and Taiwan. The large number of individuals with CA measurements and the detailed cytogenetic records allowed us to test the hypothesis that specific cytogenetic end points may be linked to the incidence of cancer at specific anatomical sites, thus expanding our preliminary results, in particular, those concerning a group of miners exposed to radon (Smerhovsky et al. 2001, 2002).

Materials and Methods

Study population. The study was approved by the ethical committee of the National Institute of Public Health (Prague) and consisted of subjects examined in the period between 7 May 1975 and 7 April 2000. An overall number of 22,427 cytogenetic analyses were obtained from 15 collaborating cytogenetic laboratories. We excluded 1,387 (6.2%) results with either incomplete data on subjects' identification or based on fewer than 100 metaphases; we also excluded 257 assays corresponding to 117 subjects with a diagnosis of cancer before the date of the first assay. Therefore, 11,991 subjects and 20,783 results were available for analysis. Many of the subjects included in the study were repeatedly examined [3,305 subjects (27.6%) underwent two or more analyses]. However, because subjects in the highest CA level at first analysis were more frequently reexamined, in all subsequent analyses we used the result of the first cytogenetic assay for all subjects. Finally, we restricted all of the analyses to subjects having 100 metaphases evaluated to avoid those subjects with ad hoc For this purpose. Meaning "to this" in Latin, it refers to dealing with special situations as they occur rather than functions that are repeated on a regular basis. See ad hoc query and ad hoc mode.  ascertainment often due to unusual exposures, leaving 11,834 subjects in the study, which contributed 113,967 person-years to the total follow-up time.

Most subjects (n = 9,776, 82.6%) underwent cytogenetic testing because of occupational exposure to known or suspected genotoxic agents. A smaller group (n = 1,913) included subjects who were involved as controls in biomonitoring studies. Subjects were stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers.

strat·i·fied
adj.
Arranged in the form of layers or strata.
 into five groups according to most important occupational exposures. For 1.2% (n = 145) of the participants, we were not able to establish the reason for the cytogenetic analysis, and these subjects were added to the group classified as "other exposures."

Cytogenetic analysis. The cytogenetic analysis was carried out in 15 cytogenetic laboratories of the Czech Public Health Service. All laboratories used the same protocol for the whole study period. We used the conventional Hungerford method on short-term cultures for 50 hr, with all cells being in the first division. Peripheral blood peripheral blood Cardiology Blood circulating in the system/body  was collected by venopuncture into heparinized tubes, and whole blood cultures were established within 24 hr from the blood collection. Tubes with heparinized blood were kept at 4-8[degrees]C until use. Cultures were set up in RPMI RPMI Rapid Prototyping & Manufacturing Institute
RPMI Roswell Park Memorial Institute
RPMI Royal Park Memorial Institute (culture medium) 
 1640 medium supplemented with 20% calf serum and 1% phytohemagglutinin phytohemagglutinin /phy·to·hem·ag·glu·ti·nin/ (-hem?ah-glldbomact´in-in) a hemagglutinin of plant origin.

phy·to·he·mag·glu·ti·nin
n.
Abbr.
. Two hours before harvesting, colchicin was added. Cells were collected by centrifugation Centrifugation

A mechanical method of separating immiscible liquids or solids from liquids by the application of centrifugal force. This force can be very great, and separations which proceed slowly by gravity can be speeded up enormously in centrifugal
, resuspended in a prewarmed hypotonic hypotonic /hy·po·ton·ic/ (-ton´ik)
1. denoting decreased tone or tension.

2. denoting a solution having less osmotic pressure than one with which it is compared.
 solution (0.075 M KCl) for 20 min, and fixed in acetic acetic /ace·tic/ (ah-se´tik) (ah-set´ik) pertaining to vinegar or its acid; sour.

acetic

pertaining to vinegar or its acid; sour.
 acid/methanol (1:3, vol/vol) on slides. These were air dried and stained with 5% Giemsa solution (pH 6.8). Slides from each culture were numbered and blindly scored. At least 100 well-spread metaphases with 46 [+ or -] 1 centromeres were examined (Bavorova et al. 1989; Rossner et al. 1998). Total CAs were subclassified as CSAs (including chromosome-type breaks, ring chromosomes, marker chromosomes, and dicentrics) and chromatidtype aberrations (CTAs; including chromatidtype breaks and chromatid chromatid (krō`mətəd): see chromosome; crossing over.  exchanges) (Hagmar et al. 2004). Gaps were not scored as aberrations.

Cancer incidence and mortality. Information on the incidence of cancer and cause-specific mortality of members of the cohort was obtained from the National Cancer Registry for the period 1 May 1975 through 31 May 2001 (end of follow-up) and coded according to the International Classification of Diseases, 9th Revision [ICD-9; World Health Organization (WHO) 1975]. The link between our records and the database of the cancer registry was based on unique personal identification numbers. In the case of uncertainty, we checked the relevant code in records kept by employers. The overall number of cancer cases was 485, including 32 cases of carcinoma in situ carcinoma in situ
n.
A neoplasm whose cells are localized in the epithelium and show no tendency to invade or metastasize to other tissues.


Carcinoma in situ 
. A total of 257 subjects were excluded because of the onset of cancer before the date of assay.

Statistical methods. To standardize for interlaboratory variability, subjects were classified according to the percentiles of CA distribution within each laboratory as low (0-33rd percentile), medium (34-66th percentile), or high (67-100th percentile). Given the low absolute frequency of CTAs and CSAs, subjects were classified according to presence or absence of these aberrations.

We used the Cox regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender.  (Cox and Oakes 1990) to model the association between cancer incidence and CA frequency. All models included age at first test and sex; time from the first test was included as a time-dependent variable. In addition, tobacco smoking (yes/no/ex-smoker) and occupational exposure (recoded in six classes) were included as potential confounders. Routine diagnostic tests did not detect any substantial violation of underlying assumptions of the Cox regression. We used SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance.  for Windows (SPSS Inc., Chicago, IL, USA) and Stata statistical software (Stata Corporation, College Station, TX, USA) for all analyses.

Results

The major descriptive characteristics of the cohort are presented in Table 1, stratified according to occupational exposure. Total CA frequency, CTAs, and CSAs were significantly higher (p < 0.001) in the group occupationally exposed to ionizing radiation i·on·i·zing radiation
n.
High-energy radiation capable of producing ionization in substances through which it passes.


Ionizing radiation 
 compared with unexposed referents.

A small but not statistically significant increase in relative risk (RR) was observed for total cancer incidence in subjects with medium and high levels of CAs when compared with the low levels, whereas a significant 24% increase in RR [95% confidence interval (CI), 3-50%] was found in subjects bearing one or more CSAs (Table 2).

In the analysis of specific cancer sites, we found a significant association between a high level of CAs and cancer of digestive organs (RR = 1.86; 95% CI, 1.05-3.28), particularly for stomach cancer, with an RR of 7.79 (95% CI, 1.01-60.03). A significant increase in the RR of cancers of other and unspecified sites was found in subjects with CSAs.

In the groups defined by occupational exposure, we did not observe significant associations between CA frequency and RR of all cancers (Table 3). The only significant finding was the increased risk of all cancers among workers exposed to polyclic aromatic hydrocarbons with CSAs (RR = 1.56; 95% CI, 1.01-2.41).

The cross-tabulation of occupational exposures with selected cancer sites produced significant findings only for cancers of digestive organs. The small number of cases limited this analysis, although a stronger association between chromosomal damage and cancers of digestive organs was evident among workers exposed to ionizing radiation, where no cases were found in the lowest CA frequency group, whereas three and nine were found in the medium and high groups, respectively. This skewed distribution Skewed distribution

Probability distribution in which an unequal number of observations lie below (negative skew) or above (positive skew) the mean.
 of cases made it impossible to estimate RRs, but the test of linear trend was highly significant (p < 0.01).

In order to evaluate if the inclusion of tumors in situ In place. When something is "in situ," it is in its original location.  (n = 32) or nonmelanoma skin cancers nonmelanoma skin cancer 1 Basal cell carcinoma, see there 2 Squamous cell cancer, see there 3. Skin adnexal carcinoma 4. Cutaneous lymphoma  (n = 70) may have affected the association between cancer risk and chromosome damage because of detection bias, we fitted models with and without these cases. The model without these cases showed a little stronger association that was still not significant ([RR.sub.medium] = 1.27; 95% CI, 0.97-1.67; [RR.sub.high] = 1.22; 95% CI, 0.93-1.59).

Discussion

The role of some chemicals and ionizing radiation in inducing DNA DNA: see nucleic acid.
DNA
 or deoxyribonucleic acid

One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes.
 double-strand breaks that, if not repaired, are transformed into CAs during cell division is well established (Bryant 1998; Natarajan 1993; Obe et al. 2002; Palitti 1998; Savage 1998). Measuring the frequency of chromosomal damage in humans exposed to occupational and environmental clastogens has been a priority in public health studies for decades, and an increased level of CAs in population groups is currently interpreted as evidence of genotoxic exposure and early biologic effects on DNA (Albertini et al. 2000; Sram 1981; Sram et al. 1983; Waters et al. 1999). However, before using CAs as a marker of cancer risk, it is essential to establish not only the presence of an association with exposure but also the link with cancer occurrence (WHO 2001).

The results from this study contribute important evidence on CAs as a predictive cancer biomarker. One strength of these findings is the homogeneity of cytogenetic protocols in the laboratories included in the study, which should have reduced the misclassification due to technical variability. Furthermore, the size of this cohort, which is more than double the size of the combined Nordic-Italian cohorts (Hagmar et al. 1998), allows the analysis of specific cancer sites, the study of interaction with occupational exposures, and the evaluation of subclasses of CAs.

The association between the total frequency of CAs and all cancer incidence was quantitatively lower than that reported in previous studies (Hagmar et al. 1998, 2004), at least regarding the risk for those subjects in the highest tertile of the distribution of CA frequency. A possible explanation of this finding is the implementation of preventive interventions after the detection of a subject with a high CA level. In the Czech Republic, CA surveying was part of a systematic effort to provide an early detection of occupational damages, and subjects with a CA frequency of [greater than or equal to] 4% were included in a program that was intended to reduce the risks for these individuals. An alternative explanation is that the association between CA frequency and cancer risk is weaker than previously considered.

Our results on the predictivity of CA subclasses support early data from Taiwan (Liou et al. 1999) because a significant increase of incidence is described only for CSAs and not for CTAs. These findings are in agreement with the evidence that a double-strand break--which is a consolidated early event of carcinogenesis--is the primary lesion for CSAs, and that agents that produce double-strand breaks, such as ionizing radiation and radiomimetic ra·di·o·mi·met·ic
adj.
Affecting living tissue as does radiation.



radiomimetic

producing effects similar to those of ionizing radiations.
 clastogenic chemicals, create CSAs (Pfeiffer et al. 2000). Such a difference was not detected in the combined analysis of the Nordic and Italian cohorts (Hagmar et al. 2004).

The association between CA frequency and risk of specific cancers did not reveal a great variability, and positive associations might have been generated by multiple comparisons; however, the increase in cancers of digestive organs, and most notably stomach cancer, is a potentially important observation--that requires confirmation.

The presence of interaction between exposure to carcinogens and the predictivity of CAs has been another issue largely debated in the literature. The presence of a stronger association between CA frequency and risk of cancer in radon-exposed workers than in other workers or controls, which has been already reported (Smerhovsky et al. 2002), is not consistent with the findings of the Nordic and Italian cohorts, in which the association between increased CA frequency and cancer risk appeared to be independent from exposure to carcinogens or smoking habit (Bonassi et al. 2000). The findings from the present study were not conclusive in this direction because the predictivity of CA frequency observed in subjects exposed to various classes of carcinogens did not significantly differ from the group of nonexposed subjects. However, when the group of digestive cancers was cross-tabulated by occupational exposure, a significant association was seen only in the group of workers exposed to ionizing radiation. To better disentangle the interaction between radiation, CAs, and cancer, we further broke down CA subclasses in chromosome breaks and exchanges, and interestingly, the events mostly associated with digestive cancer incidence were exchanges, both chromatid exchanges (p < 0.01) and chromosome exchanges (p < 0.05).

In conclusion, this study confirms previous reports of an association between the extent of chromosomal damage and the risk of cancer. In contrast to most previous reports, this association appeared to be limited to the presence of CSAs, and the magnitude of the excess risk might be lower than previously described. An original result of this analysis concerns the presence of a stronger association between CA frequency and cancers of the digestive tract digestive tract
n.
See alimentary canal.


Digestive tract
The organs that perform digestion, or changing of food into a form that can be absorbed by the body.
. Also, the higher risks found in the group exposed to ionizing radiation is a peculiar finding of this cohort and deserves a deeper insight.

Furthermore, the possibility that the implementation of occupational preventive programs focused on workers with high CA frequency might have modified their risk of cancer is a plausible explanation of these results, and it will be further evaluated with ad hoc studies, reconstructing occupational lives of subjects with the highest frequency of CA at their first cytogenetic analysis.
Table 1. Distribution of subjects in the cohort by age at first test,
sex, duration of follow-up, cancer frequency, and frequency of CAs.

Occupational          No. of          Mean age
exposure             subjects   at first test (years)

Ionizing radiation        676           40.3
Cytostatic drugs        2,150           36.5
Polyclic aromatic
  hydrocarbons          2,241           39.4
Aromatic amines           851           40.3
Other exposures         4,031           38.0
Nonexposed              1,913           36.2
Total cohort           11,862           38.0

Occupational            Sex      Mean years   Cancer
exposure             (% males)   since test   cases (%)

Ionizing radiation        70.4      11.6       57 (8.4)
Cytostatic drugs          12.8       7.4       61 (2.8)
Polyclic aromatic
  hydrocarbons            86.1      10.1      108 (4.8)
Aromatic amines           57.8       9.0       28 (3.3)
Other exposures           58.7      10.7      170 (4.2)
Nonexposed                55.2       8.8       61 (3.2)
Total cohort              55.6       9.6      485 (4.1)

                          Median (25th-75th Percentiles)

Occupational
exposure                  CAs            CTAs            CSAs

Ionizing radiation   2.5 (1.5-4.0)   2.0 (1.0-3.0)   1.0 (0.0-2.0)
Cytostatic drugs     2.0 (1.0-3.0)   1.3 (1.0-2.0)   0.0 (0.0-1.0)
Polyclic aromatic
  hydrocarbons       2.0 (1.0-3.5)   1.5 (1.0-2.4)   1.0 (0.0-1.0)
Aromatic amines      2.0 (1.3-3.0)   1.8 (1.0-3.0)   0.6 (0.0-1.0)
Other exposures      2.0 (1.0-3.0)   1.0 (1.0-2.0)   0.5 (0.0-1.0)
Nonexposed           2.0 (1.0-3.0)   1.0 (0.5-2.01   0.0 (0.0-1.0)
Total cohort         2.0 (1.0-3.0)   1.0 (1.0-2.0)   0.5 (0.0-1.0)

Table 2. Results from the multivariate Cox regression analysis
of CA frequency (total and by subclass) and cancer incidence.

                                             Incident cases
                                             (by tertile of
                                            CA distribution)

                                 ICD-9
Cancer site                       code     Low   Medium   High

Lip, oral cavity, and pharynx    140-149     4        1      9
Digestive organs                 150-159    16       31     48
  Stomach                        151         1        3     12
  Colon, rectum                  153-154    13       24     22
Respiratory and intrathoracic
    organs                       160-165    19       22     38
  Trachea, bronchus, and lung    162        18       21     34
Bone, connective tissue, skin,
    and breast                   170-175    31       51     46
  Skin (nonmelanoma)             173        20       25     25
  Breast                         174         9       19     11
Genitourinary organs             179-189    33       45     40
  Uterus                         179-182    15       19     16
  Prostate                       185         3        2      7
  Bladder                        188         6        3      4
Other and unspecified sites      190-199     5       12      8
Lymphatic and hematopoietic
  tissue                         200-208     5       11     10
Total cancers                    140-208   113      173    199

                                            Total Cas (a)
                                            (by tertile of
                                           CA distribution)

                                  [RR.sub.medium]      [RR.sub.high]
Cancer site                          (95% CI)            (95% CI)

Lip, oral cavity, and pharynx    0.23 (0.03-2.06)    1.89 (0.55-6.50)
Digestive organs                 1.47 (0.80-2.70)    1.86 (1.05-3.28)
  Stomach                        2.25 (0.23-21.66)   7.79 (1.01-60.03)
  Colon, rectum                  1.41 (0.72-2.79)    0.94 (0.47-1.89)
Respiratory and intrathoracic
    organs                       0.87 (0.47-1.61)    1.02 (0.58-1.80)
  Trachea, bronchus, and lung    0.87 (0.46-1.64)    0.96 (0.54-1.74)
Bone, connective tissue, skin,
    and breast                   1.29 (0.132-2.01)   1.08 (0.68-1.73)
  Skin (nonmelanoma)             0.97 (0.54-1.75)    0.89 (0.49-1.63)
  Breast                         1.60 (0.72-3.55)    0.97 10.40-2.36)
Genitourinary organs             1.05 (0.67-1.66)    0.82 (0.51-1.32)
  Uterus                         1.02 (0.52-2.01)    0.94 (0.46-1.92)
  Prostate                       0.49 (0.08-3.10)    1.23 (0.29-5.28)
  Bladder                        0.38 (0.09-1.53)    0.34 (0.09-1.27)
Other and unspecified sites      1.94 (0.68-5.54)    1.17 (0.38-3.64)
Lymphatic and hematopoietic
  tissue                         1.70 (0.59-4.91)    1.49 (0.50-4.44)
Total cancers                    1.17 (0.92-1.48)    1.13 (0.89-1.43)

                                          [RR.sub.[greater than
                                         or equal to 1]] (95% CI)

                                     CTAS (b)
                                  ([greater than     CTAS (b)([greater
                                   or equal to]      than or equal to]
Cancer site                          1 vs. 0)            1 vs. 0)

Lip, oral cavity, and pharynx    1.61 (0.36-7.33)   1.98 (0.61-6.42)
Digestive organs                 1.20 (0.69-2.09)   1.46 (0.94-2.27)
  Stomach                        1.43 (0.32-6.30)   2.79 (0.79-9.83)
  Colon, rectum                  1.12 (0.56-2.22)   1.16 (0.68-1.99)
Respiratory and intrathoracic
    organs                       0.86 (0.49-1.50)   1.26 (0.78-2.03)
  Trachea, bronchus, and lung    0.84 (0.48-1.50)   1.27 (0.77-2.10)
Bone, connective tissue, skin,
    and breast                   1.19 (0.75-1.90)   0.81 (0.62-1.26)
  Skin (nonmelanoma)             1.01 (0.56-1.83)   0.81 (0.50-1.30)
  Breast                         0.97 (0.44-2.13)   1.05 (0.54-2.05)
Genitourinary organs             0.93 (0.59-1.46)   1.17 (0.80-1.71)
  Uterus                         0.89 (0.45-1.74)   1.32 (0.74-2.34)
  Prostate                       0.81 (0.21-3.16)   0.70 (0.20-2.41)
  Bladder                        0.78 (0.21-2.88)   0.70 (0.23-2.11)
Other and unspecified sites      0.99 (0.37-2.68)   3.91 (1.33-11.54)
Lymphatic and hematopoietic
  tissue                         0.66 (0.28-1.58)   1.73 (0.75-4.04)
Total cancers                    1.02 (0.81-1.28)   1.24 (1.03-1.50) *

(a) Reference level: lowest tertile of CA distribution.
(b) Reference level: subjects with "0" CTAs or CSAs. * p < 0.05.

Table 3. Results from the multivariate Cox regression analysis
of CA frequency (total and by subclass) and total cancer
incidence by occupational exposure.

                                  No. of
Occupational exposure            subjects

Ionizing radiation                    676
Cytostatic drugs                    2,150
Polyclic aromatic hydrocarbons      2,241
Aromatic amines                       851
Other exposures                     4,031
Nonexposed                          1,913
Total                              11,862

                                     Total CAs (a) (by tertile of
                                           CA distribution)

                                 [RR.sub.medium]     [RR.sub.high]
Occupational exposure                (95% CI)           (95% CI)

Ionizing radiation               1.42 (0.61-3.33)   1.39 (0.61-3.16)
Cytostatic drugs                 1.09 (0.57-2.07)   0.96 (0.50-1.85)
Polyclic aromatic hydrocarbons   1.27 (0.73-2.25)   1.39 (0.82-2.34)
Aromatic amines                  1.85 (0.59-5.80)   1.29 (0.41-4.07)
Other exposures                  1.04 (0.71-1.53)   0.86 (0.58-1.26)
Nonexposed                       1.23 (0.68-2.22)   1.55 (0.80-3.01)
Total                            1.17 (0.92-1.48)   1.13 (0.88-1.43)

                                 [RR.sub.[greater than or equal to] 1]]
                                                 (95% CI)

                                     CTAs (b)
                                 ([greater than          CSAs (b)
                                  or equal to]       ([greater than or
Occupational exposure                1 vs. 0)        equal to] 1 vs. 0)

Ionizing radiation               1.35 (0.62-2.89)   1.17 (0.65-2.10)
Cytostatic drugs                 0.95 (0.50-1.79)   1.33 (0.79-2.25)
Polyclic aromatic hydrocarbons   1.20 (0.70-2.04)   1.56 (1.01-2.41)
Aromatic amines                  1.06 0.31-3.61)    0.84 (0.40-1.78)
Other exposures                  0.83 (0.57-1.29)   1.17 (0.85-1.61)
Nonexposed                       1.13 (0.63-2.03)   1.33 (0.80-2.21)
Total                            1.02 (0.81-1.28)   1.24 (1.03-1.50) *

(a) Reference level: lowest tertile of CA distribution.
(b) Reference level: subjects with "0" CTAs or CSAs. * p < 0.05.


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Pavel Rossner, (1) Paolo Boffetta, (2) Marcello Ceppi, (3) Stefano Bonassi, (3) Zdenek Smerhovsky, (1) Karel Landa, (4) Dagmar Juzova, (4) and Radim J. Sram (1)

(1) Department of Genetic Ecotoxicology The term ecotoxicology was coined by Truhaut in 1969, who defined it as "the branch of toxicology concerned with the study of toxic effects, caused by natural or synthetic pollutants, to the constituents of ecosystems, animal (including human), vegetable and microbial, in an , Institute of Experimental Medicine, Academy of Sciences of the Czech Republic The Academy of Sciences of the Czech Republic Czech: Akademie věd České republiky, abbr. AV ČR , and Health Institute of Central Bohemia, Prague, Czech Republic; (2) International Agency for Research on Cancer The International Agency for Research on Cancer (IARC, or CIRC in its French acronym) is an intergovernmental agency forming part of the World Health Organisation of the United Nations.

Its main offices are in Lyon, France.
, Lyon, France; (3) Epidemiology and Biostatistics, National Cancer Research Institute, Genova, Italy; (4) Center of Industrial Hygiene and Occupational Diseases, National Institute of Public Health, Prague, Czech Republic

Address correspondence to R.J. Sram, Department of Genetic Ecotoxicology, Institute of Experimental Medicine AS CR and Health Institute of Central Bohemia, Videnska 1083, 142 20 Prague 4, Czech Republic. Telephone: 420-241-062-596. Fax: 420-241-062-785. E-mail: sram@biomed.cas.cz

We thank Z. Zudova, Z. Pokorna, J. Mareckova, N. Hola, D. Hurychova, I. Mohyluk, D. Beniskova, J. Fischerova, L. Dobias, M. Kejzlar, J. Salandova, J. Kasparkova, H. Lehocka, and A. Cirek for providing cytogenetic data.

The project was funded by the European Commission European Commission, branch of the governing body of the European Union (EU) invested with executive and some legislative powers. Located in Brussels, Belgium, it was founded in 1967 when the three treaty organizations comprising what was then the European Community  (contract QLK4-2000-00628).

The authors declare they have no competing financial interests.

Received 19 December 2003; accepted 2 February 2005.
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