Miriam Moseson

Epidemiology of Malignant Melanoma: Pigmentary Traits, Ultraviolet Radiation, and the Identification of High-Risk Populations

We report on a case-control study begun in 1979 to identify factors responsible for the observed high incidence of malignant melanoma among Caucasians. Interview data were collected on a comprehensive set of risk factors, including pigmentary characteristics, ultraviolet light exposure, family history, reproductive factors, drug use, ethnicity, smoking and dietary history, and chemical exposures. Quantification of risk factors was emphasized, whereas previous case-control studies had relied on qualitative assessments of exposure. A profile of high-risk individuals was to be developed for the purpose of identifying a subpopulation at whom future monitoring for malignant melanoma could be directed. In this report we present results for a subset of the available risk factor data, including pigmentary traits, sun exposure, and family history variables. Because of current interest in the relationship between fluorescent light exposure and melanoma risk (Beral et al. 1982; Maxwell and Elwood 1983; Pasternack et al. 1983) we include these data as well. The remaining risk factors will be analyzed in detail in subsequent reports.

Skin Cancer after X-Ray Treatment for Scalp Ringworm

Abstract Shore, R. E., Moseson, M., Xue, X., Tse, Y., Harley, N. and Pasternack, B. S. Skin Cancer after X-Ray Treatment for Scalp Ringworm. Radiat. Res. 157, 410–418 (2002). Some 2,224 children given X-ray therapy for tinea capitis (ringworm of the scalp) have been followed for up to 50 years to determine cancer incidence, along with a control group of 1,380 tinea capitis patients given only topical medications. The study found a relative risk (RR) of 3.6 (95% confidence interval, 2.3–5.9) for basal cell skin cancer (BCC) of the head and neck among irradiated Caucasians (124 irradiated cases and 21 control cases), in response to a scalp dose of about 4.8 Gy. No melanomas of the head and neck have been seen, and only a few squamous cell carcinomas. About 40% of irradiated cases have had multiple BCCs, for a total of 328 BCCs. Although 25% of both the irradiated and control groups are African-American, only 3 skin cancers have been seen among them, all in the irradiated group, indicating the importance of susceptibility to UV radiation as a cofactor. Light complexion, severe sunburning and North European ancestry were predictive of BCC risk in the irradiated group, but chronic sun exposure was not. Children irradiated at young ages had the highest BCC risk. The RR for BCC risk is approximately constant with time since exposure, suggesting that risk will probably last for a lifetime.

Tumors and other diseases following childhood x-ray treatment for ringworm of the scalp (Tinea capitis).

Abstract— The objective of the study is to characterize the risk of tumors from radiation exposure to the head and neck. A cohort of 2,224 children given x-ray treatment and 1,380 given only topical medications for ringworm of the scalp (tinea capitis) during 1940–1959 have been followed up for a median of 39 y to determine tumor incidence. Follow-ups were by mail/telephone questionnaire, with 84–88% of the original cohort followed and with medical verification of diseases of interest. Sixteen intracranial tumors [7 brain cancers, 4 meningiomas, and 5 acoustic neuromas (vestibular schwannomas)] occurred in the x-irradiated group following an average brain dose of about 1.4 Gy, compared to 1 acoustic neuroma in the control group. The standardized incidence ratio (SIR) for brain cancer was 3.0 [95% confidence interval (CI): 1.3, 5.9]. Even though the dose to the thyroid gland was only about 60 mGy, 2 thyroid cancers were found in the irradiated group vs. none among controls, and 11 vs. 1 thyroid adenomas were found in the respective groups. Following an average dose of about 4 Gy to cranial marrow, 8 cases of leukemia (SIR = 3.2, CI: 1.5, 6.1) were observed in the irradiated group and 1 in the control group. There was also a suggestive excess of blood dyscrasias. There was no difference between the groups in the frequency of other cancers of the head and neck (excluding nonmelanoma skin cancer) or in total mortality.

Personal and occupational exposure to organic solvents and risk of non-Hodgkin's lymphoma (NHL) in women (United States)

Objectives: The authors assessed whether home and occupational exposure to organic solvents is associated with risk of NHL in women.Methods: A population-based, incidence case-control study was conducted in upstate New York, involving 376 NHL cases and 463 population controls selected from the Medicare beneficiary files and State driver’s license records. Exposure information was obtained by telephone interview. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using an unconditional logistic regression model, adjusting for a number of risk factors for NHL.Results: Overall, history of exposure to organic solvents was not associated with the risk of NHL. A statistically significant increase in risk associated with occupational exposure was observed only for the subjects whose first exposure occurred before 1970 (OR=1.87, 95% CI 1.03–3.40). When occupational and home exposures to paint thinners/turpentine were combined and analyzed together, the risk of NHL associated with any exposure, compared to no exposure at either job or home, was a statistically significantly increased (OR=1.46, 95% CI: 1.05–2.03). This observation was more pronounced for B-cell lymphoma and for low-grade lymphoma with ORs of 1.52 (95 CI: 1.08–2.14) and 2.20 (95% CI; 1.42–3.41), respectively.Conclusions: The results of this case-control study do support of a major role of organic solvents in the development of NHL among women currently living in the US. However, relatively intensive exposure in past occupations and use of paint thinners/turpentine may deserve further investigation.

Pesticide Product Use and Risk of Non-Hodgkin Lymphoma in Women

A population-based, incidence case–control study was conducted among women in upstate New York to determine whether pesticide exposure is associated with an increase in risk of non-Hodgkin lymphoma (NHL) among women. The study involved 376 cases of NHL identified through the State Cancer Registry and 463 controls selected from the Medicare beneficiary files and state driver’s license records. Information about history of farm work, history of other jobs associated with pesticide exposure, use of common household pesticide products, and potential confounding variables was obtained by telephone interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model. The risk of NHL was doubled (OR = 2.12; 95% CI, 1.21–3.71) among women who worked for at least 10 years at a farm where pesticides were reportedly used. When both farming and other types of jobs associated with pesticide exposure were combined, there was a progressive increase in risk of NHL with increasing duration of such work (p = 0.005). Overall cumulative frequency of use of household pesticide products was positively associated with risk of NHL (p = 0.004), which was most pronounced when they were applied by subjects themselves. When exposure was analyzed by type of products used, a significant association was observed for mothballs. The associations with both occupational and household pesticides were particularly elevated if exposure started in 1950–1969 and for high-grade NHL. Although the results of this case–control study suggest that exposure to pesticide products may be associated with an increased risk of NHL among women, methodologic limitations related to selection and recall bias suggest caution in inferring causation.

Estrogen Receptors and Response to Surgical Adjuvant Chemotherapy for Breast Cancer – Hypothesized Relationship to Tumor Stroma

Some possible explanations are considered for the better response to surgical adjuvant chemotherapy in premenopausal than in postmenopausal breast cancer patients. Mean estrogen receptor (ER) concentration is lower in premenopausal women. It is proposed that ER-negative women tend to respond more favorably to chemotherapy for breast cancer because higher estrogen levels in this group may induce hydrolytic enzymes which break down the stromal barrier to the tumor, resulting in a less viscous, less fibrous stroma, and an increased vascular supply. These conditions may facilitate the diffusion of chemotherapeutic agents to the interior of a tumor. This hypothesis can be investigated utilizing existing data gathered in clinical trials of adjuvant chemotherapy.