It’s time to shift the burden of proof, from scientists, back to the chemical industry
Video published on 5 June 2019, by UCSF Program on Reproductive Health and the Environment.
And how to reduce exposure to toxic chemicals worldwide ?
It’s time to shift the burden of proof, from scientists, back to the chemical industry
Video published on 5 June 2019, by UCSF Program on Reproductive Health and the Environment.
Sans, c’est mieux ! Heureusement des alternatives (bio) existent !
Cancer, stérilité, autisme… Le Professeur Sultan témoigne sur les impacts santé des perturbateurs endocriniens. Or, certains cosmétiques “classiques” en contiennent !
Relationship between vulvar symptoms and incidence of vulvar cancer in women referred to a rapid access clinic
We performed a study to estimate incidence of vulvar cancer in women with vulvar symptoms (irritation, pain, bleeding +/− presence of lesion) referred to a secondary care, rapid‐access clinic.
Prospective data collection of all direct referrals from a primary to a secondary care gynecological oncology clinic from 2011 to 2016, for women with suspicious vulvar symptoms.
32/393 (8.1%) women had vulvar cancer, and 24/393 (6.1%) had a premalignant lesion. Multivariate logistic regression showed that women referred without a specific lesion had considerably lower odds of a diagnosis of vulvar cancer than those with a lesion (OR=0.11, 95% CI: 0.03–0.49). In total, 30/234 (12.8%) women with a vulvar lesion (mass or ulcer), had vulvar cancer, compared with 2/159 (1.3%) of those referred without a lesion (these patients had vulvar irritation and bleeding but had a visible lesion on examination). None of the 140 women with irritation alone, in the absence of a visible lesion or bleeding, had pre‐invasive disease or cancer.
Presence of a vulvar lesion, especially if painful/bleeding, has a high positive predictive value for vulvar cancer and 12.8% of women presenting with any vulvar lesion to secondary care had cancer.
Overall, 32/393 (8.1%) women referred with vulvar symptoms were diagnosed with a malignancy and a further 24/393 (6.1%) were diagnosed with a pre‐malignant lesion. The presence of a suspicious vulvar lesion, especially if symptomatic, was associated with a cancer diagnosis in 30/234 (12.8%) women. Unless the lesion is obviously benign (which in this series included: sebaceous inclusion cyst; urethral caruncle; inspissated sebaceous material trapped under the clitoral hood; and ecchymosis on a background of lichen sclerosus), a rapid‐access clinic referral is appropriate to exclude a malignancy in these women. A larger cohort would be required to stratify risk by age. However, as the incidence of vulvar cancer is increasing, especially in younger women, it would be important not to dismiss suspicious symptoms based on age alone.
Women without a visible lesion were extremely unlikely to have cancer, based on this cohort of patients (<1.3% depending on whether presence of lesion was defined by patient/primary care [0/159] vs secondary care (2/159). However, these findings would need to be applied to a larger population to test this hypothesis and with wider generalization to other healthcare populations. One strength of this dataset is that the population is well‐defined and relatively stable, so re‐referrals, subsequently diagnosed with a cancer, would have been referred back to the same clinic. In the present series, six women were re‐referred during the study period (one woman was seen three times and five women were seen twice). None of these women had a cancer diagnosis. Unfortunately, we were not able to define an average lead time from onset of symptoms to diagnosis from our data, since this was not reliably recorded.
Many women with symptoms of vulvar soreness and irritation, in the absence of a specific lesion, were diagnosed with an inflammatory condition; half had lichen sclerosus or lichen planus. Primary care physicians should be reassured that, in the absence of a suspicious lesion, a cancer diagnosis or a pre‐malignant condition was unlikely. As per dermatology guidelines, if there are classical signs of lichen sclerosis, a diagnostic biopsy is not needed if there is a response to high‐potency topical steroids. Women whose symptoms do not start to improve after 2–3 weeks of treatment, should be re‐assessed and referred if symptoms persist or a lesion develops.
The overall incidence of vulvar cancer in this series was slightly lower than in those in the literature. This is perhaps surprising, as the local population is relatively elderly; in the 2011 census 29.1% of West Somerset were aged 65 years or over compared with a UK average of 16.4%. However, this series is nearly 10‐fold larger than those previously published, so may reflect the increased statistical power of this study. It may also reflect a difference in local referral patterns and criteria, since women may be referred to a general gynecology clinic or a dermatologist in other areas. One study from an urban area in the South East of England looked at cancer diagnosis rates in women referred to a gynecologic fast‐track clinic. They included a total of 335 women referred to secondary care. Only 18 women had symptoms suggestive of vulvar cancer, of whom only two (11.1%) were diagnosed with vulvar cancer. A similar study, also from the South East of England, included only 13 women with vulvar symptoms and found a positive predictive value of a cancer diagnosis of 15.4% in this subset. A further series of women with suspected gynecologic malignancy, also from the South East of England, included 1105 women referred to secondary care. Forty‐four of these women were referred with suspected vulvo‐vaginal cancer and 13.6% were diagnosed with a malignancy.
These data help to differentiate between those who should be referred via a fast‐track clinic and those who could be treated more conservatively for vulvar symptoms, and could help to inform national guidance—including future updates of NICE guidelines. Further data would be required to determine whether these data had wider applicability in other, more diverse populations, and these data are limited by the secondary care focus of this study. It would be interesting to compare rates of women presenting with vulvar symptoms in a primary care population with secondary care referrals and cancer incidence in that population over the same time period to provide evidence for triage of those requiring rapid assessment. This is important in the face of the increasing incidence of vulvar cancer, due to changes in demographics and HPV prevalence.
Finally, many women delay presentation and may have significant symptoms for many months, due to fear, embarrassment or lack of awareness of vulvar conditions generally, and vulvar cancer in particular. Many women in our series had inappropriate treatment for vulvar skin conditions or suspicious lesions with low potency steroids, topical estrogens, anti‐fungal agents, antibiotics, or no treatment at all for prolonged periods. This may be due to ‘home remedy’ self‐treatment (possibly fueled by lack of knowledge and advertisements for ‘intimate itching’), avoidance of doctors, or reluctance to use adequate courses of high potency topical steroids, by both physicians and the women affected. Research is also needed to inform us about barriers to presentation, especially in older women, who are most at risk of vulvar cancers, and to improve health education for this under‐resourced area.
Feature image credit @DiggerGraham (see below).
Unconventional oil and gas development and risk of childhood leukemia: Assessing the evidence
The widespread distribution of unconventional oil and gas (UO&G) wells and other facilities in the United States potentially exposes millions of people to air and water pollutants, including known or suspected carcinogens. Childhood leukemia is a particular concern because of the disease severity, vulnerable population, and short disease latency. A comprehensive review of carcinogens and leukemogens associated with UO&G development is not available and could inform future exposure monitoring studies and human health assessments.
The objective of this analysis was to assess the evidence of carcinogenicity of water contaminants and air pollutants related to UO&G development.
We obtained a list of 1177 chemicals in hydraulic fracturing fluids and wastewater from the U.S. Environmental Protection Agency and constructed a list of 143 UO&G-related air pollutants through a review of scientific papers published through 2015 using PubMed and ProQuest databases.
We assessed carcinogenicity and evidence of increased risk for leukemia/lymphoma of these chemicals using International Agency for Research on Cancer (IARC) monographs.
The majority of compounds (> 80%) were not evaluated by IARC and therefore could not be reviewed. Of the 111 potential water contaminants and 29 potential air pollutants evaluated by IARC (119 unique compounds), 49 water and 20 air pollutants were known, probable, or possible human carcinogens (55 unique compounds). A total of 17 water and 11 air pollutants (20 unique compounds) had evidence of increased risk for leukemia/lymphoma, including benzene, 1,3-butadiene, cadmium, diesel exhaust, and several polycyclic aromatic hydrocarbons.
Though information on the carcinogenicity of compounds associated with UO&G development was limited, our assessment identified 20 known or suspected carcinogens that could be measured in future studies to advance exposure and risk assessments of cancer-causing agents.
Our findings support the need for investigation into the relationship between UO&G development and risk of cancer in general and childhood leukemia in particular.
Interview de Vandana Shiva, Brut, Février 2019
Selon Vandana Shiva, des multinationales s’enrichissent en vendant des médicaments pour soigner des maladies qu’elles ont elles-mêmes provoquées.
L’écologiste Vandana Shiva dénonce le “cartel du poison”, Brut, Février 2019.
The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies
Currently laws and regulations governing nanotechnology are fragmented and do not take account of the unique properties of nanomaterials, the effect of which on humans and the environment are not yet fully understood, argue researchers in a new study.
In the study, a network of European researchers propose a new universal regulatory framework that deals specifically with nanomaterials. The framework should help policymakers, organisations and researchers evaluate the risks of any existing materials and new nanomaterials entering the market. It should also help SMEs and large companies use safer products and processes, limit the potential adverse effects of nanomaterials on workers and consumers, reduce the cost of insurance and reduce the risk of governments having to pay out money in the future due to unforeseen accidents or diseases.
Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials.
The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology.
Evaluating gas chromatography with a halogen-specific detector for the determination of disinfection by-products in drinking water
DBPs come in many classes and are chemically diverse, making them challenging to monitor. Swedish researchers have evaluated a new method for the simultaneous determination of a broader range of DBPs than typically possible using other available techniques. The method uses gas chromatography (a laboratory technique that separates and analyses vaporisable compounds in a mixture), together with a halogen-specific detector (XSD). Having been tested in real water samples from two municipal waterworks in Sweden, the method has been optimised for the simultaneous determination of a wide range of neutral DBPs.
The occurrence of disinfection by-products (DBPs) in drinking water has become an issue of concern during the past decades. The DBPs pose health risks and are suspected to cause various cancer forms, be genotoxic, and have negative developmental effects. The vast chemical diversity of DBPs makes comprehensive monitoring challenging. Only few of the DBPs are regulated and included in analytical protocols. In this study, a method for simultaneous measurement of 20 DBPs from five different structural classes (both regulated and non-regulated) was investigated and further developed for 11 DBPs using solid-phase extraction and gas chromatography coupled with a halogen-specific detector (XSD). The XSD was highly selective towards halogenated DBPs, providing chromatograms with little noise. The method allowed detection down to 0.05 μg L−1 and showed promising results for the simultaneous determination of a range of neutral DBP classes. Compounds from two classes of emerging DBPs, more cytotoxic than the “traditional” regulated DBPs, were successfully determined using this method. However, haloacetic acids (HAAs) should be analyzed separately as some HAA methyl esters may degrade giving false positives of trihalomethanes (THMs). The method was tested on real water samples from two municipal waterworks where the target DBP concentrations were found below the regulatory limits of Sweden.
Doctor payments drove scripts for cancer drugs from Pfizer, Novartis and more: study
New study showed that physicians who received payments over three consecutive years and tied to a specific drug boosted their prescriptions of that product.
Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown.
Materials and Methods
We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013–2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)‐designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict‐of‐interest policies were associated with the strength of the payment‐prescribing association. We used modified Poisson regression to control confounding by other physician characteristics.
Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58–2.07), CML (RR 1.22, 95% CI 1.08–1.39), and lung (RR 1.69, 95% CI 1.58–1.82), but not prostate (RR 0.97, 95% CI 0.93–1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict‐of‐interest policies were not consistently associated with the direction of prescribing change.
The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing.
Implications for Practice
Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company’s drug.
Presention of the management of gynecological cancers
The FIGO Committee for Gynecologic Oncology is pleased to present the third edition of the FIGO Cancer Report. Since 2012, this report has been presented triennially in the current format, which aims to present the state of the art management of gynecological cancers in our endeavor to ensure women worldwide receive an acceptable standard of care. The excellent readership of the previous edition encouraged us to produce an updated edition. A series of carefully reviewed and presented articles covers each of the gynecologic cancers. Chapters on pathology, targeted therapy, psychosexual health, and end‐of‐life care have been updated. New chapters have been added on surgical anatomy in gynecologic oncology, essential surgical skills for gynecologic oncologists, enhanced recovery after surgery, role of imaging in endometrial cancer, and cancer in pregnancy. This edition is Open Access to ensure wide dissemination. The 2015 edition of the Cancer Report was translated into Portuguese and Spanish, and the 2018 edition will also be translated to ensure greater readership.
Undeniably, this does not do away with the need for data. The situational analysis done during the tenure of the previous committee had indicated the need to position dedicated data entry managers to get good quality data from low‐ and middle‐income countries (LMICs). However, this project could not find funding. It is apparent that in these days of widespread internet use and mobile health, new methods will have to be found. The Committee initiated a survey to understand changing practices, the results of which will be presented at the XXII FIGO World Congress, held in Rio de Janeiro, Brazil, October 14–19, 2018. It is hoped that increased use of these techniques will bring more insights.
In the last three years, FIGO Gynecologic Oncology Committee members have been actively engaged in organizing and participating in several educational activities including conferences, workshops, and training programs in various countries. They have developed educational aids including handbooks and slide sets. An e‐learning course in collaboration with the Catalan Institute of Oncology (ICO) has been implemented. Cadaver training programs have been initiated for skills development in open and laparoscopic surgery. A smartphone mobile application (free to download and use ofline) for staging and resource‐based management of gynecologic cancers was developed in collaboration with the International Atomic Energy Agency (IAEA).
One of the major objectives of the Committee has been to work with governments to inform policy regarding the implementation of the HPV vaccine program. Members have been engaged in advising various governments during this period. The Committee has collaborated with international and nongovernmental organizations to support this cause in different regions.
By far one of the most challenging tasks undertaken by the Committee was the revision of the staging of cervical cancer. Hitherto staged by clinical methods only, it was insensitive to the advances in technology that had improved the quality of imaging and brought in minimally invasive surgery to facilitate access. However, being a disease largely confined to LMICs, there was widespread belief that a revision would not be applicable where it was needed most. Various rounds of discussions, extensive literature review, interaction, face‐to‐face meetings with the major gynecologic oncology societies internationally, in collaboration with the International Union for Cancer Control (UICC) and the American Joint Commission on Cancer (AJCC), finally resolved the impasse and the 2018 revision now allows the use of imaging and pathology in a way that can be practiced at all levels of resources. The revised staging has been endorsed by the FIGO Executive Board and will be published in the International Journal of Gynecology and Obstetrics (IJGO).
The members of the FIGO Committee for Gynecologic Oncology during this term were: Neerja Bhatla (Chair), India; Kanishka Karunaratne (Co‐Chair), Sri Lanka; Lynette Denny (Immediate Past Chair), South Africa; Seija Grenman (Vice President FIGO, Ex officio member), Finland; Jonathan Berek, USA; Mauricio Cuello Fredes, Chile; Sean Kehoe, UK; Ikuo Konishi, Japan; Alexander Olawaiye, USA; Jaime Prat, Spain; Rengaswamy Sankaranarayanan, France.
Going forward, the Committee will continue its work on FIGO staging, the next cancer to be updated will be cancer of the vulva. FIGO also hopes to work closely with WHO in response to the call for elimination of cervical cancer. Collaboration with the International Agency for Research on Cancer (IARC) will help to gain insights on incidence and survival statistics from different regions to understand the inequities and direct our efforts to promote appropriate education and skills training as we work together to lessen the burden of gynecologic cancers.
There are approximately 40,000 oil fields globally and 6 million people that live or work nearby
Upstream oil extraction, which includes exploration and operation to bring crude oil to the surface, frequently occurs near human populations. There are approximately 40,000 oil fields globally and 6 million people that live or work nearby. Oil extraction can impact local soil, water, and air, which in turn can influence community health. As oil resources are increasingly being extracted near human populations, we highlight the current scope of scientific knowledge regarding potential community health impacts with the aim to help identify scientific gaps and inform policy discussions surrounding oil drilling operations.
In this review, we assess the wide range of both direct and indirect impacts that oil drilling operations can have on human health, with specific emphasis on understanding the body of scientific literature to assess potential environmental and health risks to residents living near active onshore oil extraction sites. From an initial literature search capturing 2236 studies, we identified 22 human studies, including 5 occupational studies, 5 animal studies, 6 experimental studies and 31 oil drilling-related exposure studies relevant to the scope of this review.
The current evidence suggests potential health impacts due to exposure to upstream oil extraction, such as cancer, liver damage, immunodeficiency, and neurological symptoms. Adverse impacts to soil, air, and water quality in oil drilling regions were also identified. Improved characterization of exposures by community health studies and further study of the chemical mixtures associated with oil extraction will be critical to determining the full range of health risks to communities living near oil extraction.