Abstract
The objective of this study was to identify occupational exposures that might be etiologically linked to an unusual cluster of ten cases of Hodgkin's disease. The cases were identified within the active workforce of a large chemical manufacturing firm over a 23-year period by the medical director of the facilities. Based on comparison with regional cancer incidence rates, the standardized incidence ratio for Hodgkin's disease was 497 (95% confidence interval: 238–915) for the period from the construction of the facilities in 1966 through early 1992. A nested case-control study was undertaken with 200 controls selected according to case-cohort sampling. Simultaneously, efforts were initiated to confirm and characterize each case more fully. Occupational exposures were identified and categorized using process, work history, medical record, and industrial hygiene data. Tissue slides were available for eight cases and a second review confirmed the diagnosis of Hodgkin's disease. For one case, a final diagnosis of large-cell anaplastic lymphoma was determined after histology review. Among 214 different chemical agents studied, eight were identified to which three or more of the cases had been exposed prior to the date of their initial diagnosis. Exposure odds ratios were statistically elevated for five of these agents; dose-response evaluations for two of the agents, ethylene oxide and benzene, failed to provide additional support for a causal relationship. In conclusion, although several statistical associations were identified, no substance emerged as a likely candidate for explaining the observed Hodgkin's disease cluster.
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Aksoy M (1980) Different types of omalignancies due to occupational exposure to benzene: a review of recent observations in Turkey. Environ Res 23:181–190
Breslow NE, Day NE (1980) Statistical methods in cancer research, vol 1. The analysis of case-control studies. International Agency on Cancer, Lyon, France
Fiore BJ, Hanrahan LP, Anderson HA (1990) State Health Department response to disease cluster reports: a protocol for investigation. Am J Epidemiol 132:S14-S22
Glaser SL (1990) Spatial clustering of Hodgkin's disease in the San Francisco Bay area. Am J Epidemiol 132:S167-S177
Glaser SL (1991) Black-white differences in Hodgkin's disease incidence in the United States by age, sex, histology subtype and time. Int J Epidemiol 20:68–75
Lubin JM (1983) A reformulation of the serially additive expected dose method for occupational cohort date. Am J Epidemiol 118:592–598
Lubin JM, Gail MH (1984) Biased selection of controls for casecontrol analyses of cohort studies. Biometrics 40:63–75
Prentice RL (1986) A case-cohort design for epidemiologic cohort studies and disease prevention trials. Biometrika 73:1–11
Shore RE, Gardner MJ, Pannett B (1993). Ethylene oxide: an assessment of the epidemiological evidence on carcinogenicity. Br J Ind Med 50:971–997
Stayner L, Steenland K, Greife A, et al. (1993) Exposure response analysis of cancer mortality in a cohort of workers exposed to ethylene oxide. Am J Epidemiol 138:787–798
Vianna NJ, Polan A (1979). Lymphomas and occupational benzene exposure. Lancet I:1394–1395
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Swaen, G.M.H., Slangen, J.M.M., Ott, M.G. et al. Investigation of a cluster of ten cases of Hodgkin's disease in an occupational setting. Int. Arch Occup Environ Heath 68, 224–228 (1996). https://doi.org/10.1007/BF00381432
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DOI: https://doi.org/10.1007/BF00381432