Occupational and = environmental risk factors for brain cancer: a pilot case-control study = in France

=20

Article gratuit !=20

La = Presse=20 M=C3=A9dicale
Volume 39, num=C3=A9ro 2
pages e35-e44 (f=C3=A9vrier=20 2010)

Doi : = 10.1016/j.lpm.2009.06.020

Re=C3=A7u=20 le : 6 janvier 2009 ; accept=C3=A9=20 le : 22 juin 2009

Articles = originaux

Occupational and environmental = risk factors=20 for brain cancer: a pilot case-control study in France

Facteurs de risque = professionnels et=20 environnementaux des tumeurs c=C3=A9r=C3=A9brales = malignes : une =C3=A9tude=20 pilote cas-contr=C3=B4le en = France

Val=C3=A9rie Spinelli=20 ¹,=20 Olivier Chinot ²,=20 C=C3=A9cilia Cabaniols ¹,=20 Roch Giorgi ³,=20 Philippe Alla ⁴,=20 Marie-Pascale Lehucher-Michel ^1,=20^5,=20=20

¹ Consultation de Pathologie=20 Professionnelle, Service de M=C3=A9decine et Sant=C3=A9 et = Travail, H=C3=B4pital=20 Timone Adultes, F-13385 Marseille Cedex 05, = France

² Facult=C3=A9 de M=C3=A9decine de=20 Marseille-Universit=C3=A9 de la M=C3=A9diterran=C3=A9e, = INSERM 0359 Assistance=20 Publique H=C3=B4pitaux de Marseille-H=C3=B4pital de la = Timone unit=C3=A9 de=20 Neuro-Oncologie, F-13385 Marseille cedex 05,=20 France

³ LERTIM, Facult=C3=A9 de = M=C3=A9decine, F-13005=20 Marseille, France

⁴ Service de Neurologie, = H=C3=B4pital des Arm=C3=A9es=20 Sainte Anne, F-83000 TOULON, France

⁵ EA3279. =C3=89valuation = hospitali=C3=A8re et sant=C3=A9=20 per=C3=A7ue. Universit=C3=A9 de la m=C3=A9diterran=C3=A9e. = F-13385 Marseille cedex 05,=20 France

Marie-Pascale=20 Lehucher-Michel, Consultation de Pathologie = Professionnelle=20 H=C3=B4pital Timone Adultes 264, rue Saint Pierre =E2=80=93 = 13385 Marseille Cedex=20 05.


	Summary

Introduction

The = increased=20 incidence of malignant primary brain tumors (MPBT) reported = in=20 several studies could be due to environmental factors. To = estimate=20 the chemical and physical risk factors of these tumors in=20 southeastern France, a pilot case-control study that = included all=20 new MPBT cases diagnosed in 2005 in the main brain cancer = treatment=20 centers in the western section of the = Provence-Alpes-C=C3=B4te d=E2=80=99Azur=20 (PACA) region.

Material and = Methods

Age-, = sex-, and=20 hospital-matched controls were selected from the = neurosurgery=20 department of the same hospital. An occupational physician, = using a=20 standardized questionnaire, collected information on = suspected risk=20 factors of MPBT in a face-to-face interview at the hospital = of all=20 case and control subjects. Data collected included jobs = held,=20 various exposures throughout working life, and leisure time=20 activities.

Results

The = study included=20 122 cases and 122 controls. No particular job was identified = as a=20 major risk factor for brain cancer. Risk was significantly = higher=20 among those who used glue (OR=3D17.58, 95% CI 1.75 = =E2=80=93 176.62)=20 during leisure activities and significantly lower among = those=20 residing near cellular telephone towers (OR=3D0.49, 95% CI 0.26 = =E2=80=93=20 0.92).

Discussion

Several = new=20 hypotheses about the effects of cellular telephone towers = and=20 chemical exposure merit further analytic studies.


	R=C3=A9sum=C3=A9

Introduction

L=E2=80=99augmentation de=20 l=E2=80=99incidence des tumeurs malignes = c=C3=A9r=C3=A9brales primitives (TMCP)=20 rapport=C3=A9e dans plusieurs =C3=A9tudes pourrait =C3=AAtre = due =C3=A0 des facteurs=20 environnementaux. Afin d=E2=80=99estimer les facteurs de = risques chimiques=20 et physiques des tumeurs c=C3=A9r=C3=A9brales malignes = primitives (TCMP) dans=20 le sud-est de la France, une =C3=A9tude pilote, = cas-contr=C3=B4le, a inclus=20 tous les nouveaux cas de TCMP diagnostiqu=C3=A9s en = 2005 dans les=20 principaux centres du secteur ouest de la r=C3=A9gion = Provence-Alpes-C=C3=B4te=20 d=E2=80=99Azur (PACA).

M=C3=A9thodes

Les cas = et les=20 contr=C3=B4les appareill=C3=A9s selon le sexe et = l=E2=80=99=C3=A2ge ont =C3=A9t=C3=A9 recens=C3=A9s dans=20 le d=C3=A9partement de neurochirurgie du m=C3=AAme centre = hospitalier. Un=20 sp=C3=A9cialiste en m=C3=A9decine du travail a collect=C3=A9 = les informations sur=20 les facteurs de risques suspect=C3=A9s de TMCP =C3=A0 = travers un=20 interrogatoire individuel et en utilisant un questionnaire = identique=20 pour tous les cas et les t=C3=A9moins. Les donn=C3=A9es sur = la profession et=20 sur les diff=C3=A9rentes expositions ont =C3=A9t=C3=A9 = recueillies en tenant compte=20 de l=E2=80=99ensemble du cursus professionnel et des=20 loisirs.

R=C3=A9sultats

Sur les = 122 cas inclus, aucune profession n=E2=80=99a = =C3=A9t=C3=A9 trouv=C3=A9e comme =C3=A9tant=20 un facteur de risque majeur de tumeur c=C3=A9r=C3=A9brale = maligne. Une=20 augmentation significative du risque a =C3=A9t=C3=A9 = d=C3=A9cel=C3=A9e pour=20 l=E2=80=99utilisation de colles (OR=3D17.58, 95 % CI = 1.75 =E2=80=93=20 176.62) au cours des loisirs et une diminution significative = du=20 risque a =C3=A9t=C3=A9 mise en =C3=A9vidence concernant le = lieu de r=C3=A9sidence pr=C3=A8s=20 d=E2=80=99une antenne d=E2=80=99=C3=A9mission de = t=C3=A9l=C3=A9phones cellulaires (OR=3D0.49, 95 % CI 0.26 = =E2=80=93=20 0.92).

Discussion

De = nouvelles=20 recherches sur les effets des antennes de = t=C3=A9l=C3=A9phones cellulaires et=20 des expositions chimiques m=C3=A9riteraient = d=E2=80=99=C3=AAtre effectu=C3=A9es par des=20 =C3=A9tudes analytiques.

Plan	Masquer le=20 plan

Patients = and=20 methods (+)

Study=20 population

Data=20 collection

Exposure=20 definition

Residential=20 setting

Statistical=20 analysis

Results (+)

General=20 characteristics of the population

Occupational=20 activities

Chemical=20 exposure

Radiation=20 exposure

Environment=20 and habitat

Discussion

Conflicts of=20 interests

What was known

=E2=80=A2	The cause of the increased = incidence of=20 brain cancer over the past 3 decades in industrialized = countries is unknown. Data from the International = Agency for=20 Research on Cancer (IARC) failed to support the = hypothesis=20 that occupational exposure is a major risk factor for=20 gliomas.
=E2=80=A2	Suspected risk factors include = pesticides,=20 metals, polycyclic aromatic hydrocarbons, = solvents,=20 ionizing radiation, and electromagnetic=20 fields.
=E2=80=A2	No French study has investigated = the=20 associations between brain cancer, occupational = sectors, and=20 environmental factors, including potential = leisure-time=20 exposure.

What this study adds

=E2=80=A2	No association was found between = any of the=20 occupational sectors suspected of association with = brain=20 cancer and an elevated risk of brain = cancer.
=E2=80=A2	Glue use in leisure activities = was=20 associated with an increased risk of brain cancer, and = living=20 near cellular telephone towers was found to be=20 protective.
=E2=80=A2	Further epidemiologic studies = should=20 analyze exposure during leisure activity as well as=20 occupational and environmental=20 exposure.

The past three decades have seen an = increase in=20 the incidence of malignant primary brain tumors (MPBT) in=20 industrialized countries, especially gliomas in adults and = still=20 more particularly, in the elderly ^{[1Chakrabarti I.,=20
Cockburn M., Cozen W., Wang Y.P.,=20
Preston-Martin S. A population-based description of=20
glioblastoma multiforme in Los Angeles County, 1974-1999=20
Cancer 2005 ; 104 : =
2798-2806

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
2Fleury A.,=20
Menegoz F., Grosclaude P., Daures J.P.,=20
Henry-Amar M., Raverdy N., et al. Descriptive =
epidemiology=20
of cerebral gliomas in France Cancer 1997 ; =
15 :=20
1195-1202 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
3Hess K.R.,=20
Broglio K.R., Bondy M.L. Adult glioma incidence =
trends in=20
the United States, 1977-2000 Cancer 2004 ; =
101 :=20
2293-2299 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
4Kaneko S.,=20
Nomura K., Yoshimura T., Yamaguchi N. Trend =
of brain=20
tumor incidence by histological subtypes in Japan: =
estimation from=20
the Brain Tumor Registry of Japan, 1973-1993 J=20
Neurooncol 2002 ; 60 : 61-69 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
5Mattei JF, Haigner=C3=A9 C. Mission =

interminist=C3=A9rielle pour la lutte contre le cancer. Plan =
cancer:=20
2003-2007. Available at cliquez ici . Accessed october 2,=20
2009.

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 6Preston-Martin S.,=20
Lewis S., Winklemann R., Borman B., =
Auld J.,=20
Pearce N. Descriptive epidemiology of primary cancer of =
the=20
brain, cranial nerves and cranial meninges in New Zealand,=20
1948-88 Cancer Causes Control 1993 ; 4 :=20
529-538 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Improvements in=20 diagnostic methods, especially imaging, help to explain this = phenomenon ^{[2Fleury A.,=20
Menegoz F., Grosclaude P., Daures J.P.,=20
Henry-Amar M., Raverdy N., et al. Descriptive =
epidemiology=20
of cerebral gliomas in France Cancer 1997 ; =
15 :=20
1195-1202 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
3Hess K.R.,=20
Broglio K.R., Bondy M.L. Adult glioma incidence =
trends in=20
the United States, 1977-2000 Cancer 2004 ; =
101 :=20
2293-2299 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
4Kaneko S.,=20
Nomura K., Yoshimura T., Yamaguchi N. Trend =
of brain=20
tumor incidence by histological subtypes in Japan: =
estimation from=20
the Brain Tumor Registry of Japan, 1973-1993 J=20
Neurooncol 2002 ; 60 : 61-69 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
5Mattei JF, Haigner=C3=A9 C. Mission =

interminist=C3=A9rielle pour la lutte contre le cancer. Plan =
cancer:=20
2003-2007. Available at cliquez ici . Accessed october 2,=20
2009.

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
6Preston-Martin S.,=20
Lewis S., Winklemann R., Borman B., =
Auld J.,=20
Pearce N. Descriptive epidemiology of primary cancer of =
the=20
brain, cranial nerves and cranial meninges in New Zealand,=20
1948-88 Cancer Causes Control 1993 ; 4 :=20
529-538 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 7Polendak A.P. =

Interpretation of secular increases in incidence rates for =
primary=20
brain cancer in Connecticut adults, 1965-1988=20
Neuroepidemiology 1996 ; 15 :=20
51-56

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Between 1983 and=20 1990, the incidence of malignant astrocytomas in the = population=20 older than 65 years increased at a rate of 5% a year In = France=20 ^{[2Fleury A.,=20
Menegoz F., Grosclaude P., Daures J.P.,=20
Henry-Amar M., Raverdy N., et al. Descriptive =
epidemiology=20
of cerebral gliomas in France Cancer 1997 ; =
15 :=20
1195-1202 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = The US National=20 Institute of Environmental Health Sciences reports that 70% = of=20 cancers are due to environmental factors, including = lifestyle,=20 occupation, diet, and rural or urban residence. It is = suspected that=20 risk factors for glioma might include numerous chemical and = physical=20 agents, among them, pesticides ^{[8Bohnen N.I.,=20
Kurland L.T. Brain tumor and exposure to pesticides in =
humans:=20
a review of the epidemiologic data J Neurol =
Sci 1995 ;=20
132 : 110-121 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 9Lee W.J., =
Colt J.S.,=20
Heineman E.F., McComb R., Weisenburger D.D.,=20
Lijinsky W., et al. Agricultural pesticide use and risk =
of=20
glioma in Nebraska, United States Occup Environ =
Med 2005=20
; 62 : 786-792 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = metals ^{[10Schlehofer B.,=20
Hettinger I., Ryan P., Blettner M.,=20
Preston-Martin S., Little J., et al. Occupational =
risk=20
factors for low and high grade glioma: results from an =
international=20
case control study of adult brain tumours Int J=20
Cancer 2005 ; 113 : 116-125 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = polycyclic=20 aromatic hydrocarbons (PAHs) ^{[11Buffler P.A., =

Kelsh M., Chapman P., Wood S., Lau E.,=20
Golembesky A., et al. Primary brain tumor mortality at =
a=20
petroleum exploration and extraction research facility J =
Occup=20
Environ Med 2004 ; 46 : 257-270 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 12Cocco P.,=20
Heineman E.F., Dosemeci M. Occupational risk =
factors for=20
cancer of the central nervous system among US women Am J =
Ind=20
Med 1999 ; 36 : 70-76 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences]}, = solvents=20 ^{[13Rodvall Y.,=20
Ahlbom A., Spannare B., Nise G. Glioma and=20
occupational exposure in Sweden, a case-control study =
Occup=20
Environ Med 1996 ; 53 : 526-532 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = ionizing=20 radiation, and electromagnetic fields ^{[14Grayson J.K. =
Radiation=20
exposure, socioeconomics status, and brain tumor risk in the =
US Air=20
Force: a nested case-control study Am J =
Epidemiol 1996 ;=20
143 : 480-486

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 15Hardell L.,=20
Mild K.H., Pahlson A. Ionizing radiation, cellular =

telephones and the risk for brain tumours Eur J Cancer=20
Prev 2001 ; 10 : 523-529 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = An increased risk=20 has been reported for metal industries ^{[13Rodvall Y.,=20
Ahlbom A., Spannare B., Nise G. Glioma and=20
occupational exposure in Sweden, a case-control study =
Occup=20
Environ Med 1996 ; 53 : 526-532 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = agriculture=20 ^{[16Khuder S.A.,=20
Mutgi A.B., Schaub E.A. Meta-analyses of brain =
cancer and=20
farming Am J Ind Med 1998 ; 34 : =
252-260 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 17Loyant V.,=20
Jaffre A., Breton J., Baldi I., =
Vital A.,=20
Chapon F., et al. Screening of TP53 mutations by DHPLC =
and=20
sequencing in brain tumors from patients with an =
occupational=20
exposure to pesticides or organic solvents=20
Mutagenesis 2003 ; 20 : =
365-373

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = the=20 electrical/electronics industry ^{[18Leeka I. Kheifets. Electric and =
magnetic=20
field exposure and brain cancer: a review. =
Bioelectromagnetics,=20
2001; Suppl 5: S120-S131.

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = and textile=20 manufacturing ^{[19Heineman E.F.,=20
Gao Y.T., Dosemeci M., McLaughlin J.K. =
Occupational=20
risk factors for brain tumors among women in Shanghai, =
China J=20
Occup Environ Med 1995 ; 37 : 288-293 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = The cause of this=20 increase in gliomas remains unknown ^{[2Fleury A.,=20
Menegoz F., Grosclaude P., Daures J.P.,=20
Henry-Amar M., Raverdy N., et al. Descriptive =
epidemiology=20
of cerebral gliomas in France Cancer 1997 ; =
15 :=20
1195-1202 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 20Ahsan H.,=20
Neugut A.I., Bruce J.N. Trends in incidence of =
primary=20
malignant brain tumors in USA, 1981-1990 Int J=20
Epidemiol 1995 ; 24 : =
1078-1885

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = An international=20 case-control study coordinated by the International Agency = for=20 Research on Cancer (IARC) from 1980 through 1991 studied=20 occupational risk factors for gliomas; its results did not = support=20 the hypothesis that occupational exposure is a major risk = factor=20 ^{[10Schlehofer B.,=20
Hettinger I., Ryan P., Blettner M.,=20
Preston-Martin S., Little J., et al. Occupational =
risk=20
factors for low and high grade glioma: results from an =
international=20
case control study of adult brain tumours Int J=20
Cancer 2005 ; 113 : 116-125 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Over the past=20 decade, no study in France has examined potential exposure = during=20 leisure activity in assessing the associations between MPBT, = occupational sectors, and environmental factors. We = conducted a=20 pilot study in southeastern France of incident cases of = adult MPBT=20 to measure the distribution of these tumors according to=20 occupational sector and leisure-time exposures. We evaluated = the=20 correlations between MPBT and carcinogenic chemical = exposures.

Haut de page - Plan de l'article

Patients and=20 methods

Study=20 population

This pilot case-control study = included all new=20 cases of adult MPBT diagnosed between January 2005 and = December 2005=20 in the public reference hospitals of Marseilles (district of = Bouches-du-Rh=C3=B4ne) and Sainte Anne=E2=80=99s Hospital in = Toulon (district of=20 Var). These hospitals are the principal reference centers = for brain=20 cancer in the western part of the Provence-Alpes-C=C3=B4te = d=E2=80=99Azur (PACA)=20 and provide the therapeutic management for almost 85% of the = incidental cases of MPBT in this geographic area. To be = eligible for=20 the study, patients had to be 18 years old at the time of = diagnosis.=20 Inclusion criteria for potential case subjects included = diagnosis of=20 previously untreated glioma, grade II to IV according to WHO = criteria ^{[21Kleihues P, Cavenee WK. (Eds): =
World Health=20
Organization Classification of Tumours of the Nervous =
System. Lyon,=20
WHO/IARC 2000.

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Because they=20 affect mainly children, pilocytic astrocytomas (WHO grade I) = were=20 excluded, as were recurrences of previous MPBT. For each = case, one=20 control, matched for age (within 5 years) and gender and=20 hospitalized for reasons unrelated to cancer, was randomly = selected=20 from the neurosurgery department of the same hospitals. An=20 additional inclusion criterion for cases and controls was = that they=20 reside in the western half of PACA.

Data=20 collection

The neuro-oncologists contributing to = this=20 study recruited participants. Patients were included only = after they=20 furnished fully informed consent. The diagnosis of MPBT was = provided=20 by pathology findings at the time of stereotactic biopsy or = tumor=20 removal and based on the WHO classification. Because the = elderly=20 (>70 years) may represent up to 20% of the population = with=20 high-grade glioma, incidence is higher in this age bracket, = and a=20 significant proportion of these patients may not be = considered for=20 surgery because of their significant morbidity-mortality = risk, we=20 included these patients, especially because the increase in = MPBT=20 incidence concerns precisely this age bracket. Most case = subjects=20 were interviewed after surgery and before tumor progression. = An=20 occupational physician collected information on suspected = risk=20 factors for MPBT through a face-to-face interview at the = hospital,=20 as soon as the patient=E2=80=99s health permitted (and no = later than 3=20 months after surgery). All cases and controls were = interviewed with=20 the same method and according to the same standardized=20 questionnaire. At the same time, the occupational physician = checked=20 all items completed by the patient in a preliminary = self-assessment=20 questionnaire. Data on jobs and various exposures covered = lifelong=20 occupational history and leisure time habits. The interview = took an=20 average of 30minutes.=20 Information was collected on any history of cancer = treatment,=20 exposure to medical ionizing irradiation, computer use, = cell-phone=20 use, occupational history of exposure to chemical and = physical=20 agents (ionizing and non-ionizing irradiation), and chemical = exposure during leisure activities (for example, painting,=20 do-it-yourself home repair, and gardening). Job titles were=20 subsequently classified according to the International = Standard=20 Classification of Occupations (ISCO-88).

Exposure=20 definition

Chemical=20 exposures

Occupational history data included = the=20 start/end dates of each job and a detailed description of = the tasks,=20 including the intensity and period of chemical exposure. We=20 established a list of substances known to cause glioma = (nitroso=20 compound) or highly suspected of causing brain cancer (for = example,=20 pesticides, metals, PAHs, and solvents) and of all = substances=20 known to cause occupational cancer or environmental cancers, = such as=20 asbestos. During the interview, we inquired as precisely as = possible=20 into the circumstances of exposure to these substances. = Furthermore,=20 chemical exposure during leisure activities such as = do-it-yourself=20 home repair, painting, and gardening was evaluated according = to the=20 same methods. Patients were asked to explain in detail the = nature of=20 exposure, how the material was used, what protective = clothing was=20 worn, and whether ventilation was provided (protective = devices).=20 They estimated the exposure for each hazard as number of = days per=20 week, per month, or per year. Then an exposure score based = both on=20 duration and on the intensity of exposure was defined by the = same=20 expert in occupational disease for both sources of chemical = exposure=20 (occupational and leisure activities). For each risk factor = studied,=20 the duration of exposure was expressed as a full-time year=20 equivalent, allowing correction for part-time workers by = making the=20 assumption of a cumulative risk function (2 years of = part-time=20 exposure being equivalent to one year full-time). The = duration was=20 then classified into three groups (< 2 years, 2-10 = years,>10 years). Finally, the = expert,=20 masked to case-control status, classified all cases and = controls in=20 three broad classes according to their global occupational = history=20 and global leisure exposure. These classes were: no or = slight=20 exposure, moderate exposure, and high exposure. For the high = exposure class, details of chemical exposure were obtained = by=20 questions based on a list previously collected of primary = substances=20 suspected of causing brain cancer or classified as = carcinogenic by=20 IARC. Similarly, subjects detailed exposure from a = non-exhaustive=20 list of the principal chemical agents related to three = leisure=20 activities: do-it-yourself home repair, gardening, and=20 painting.

Radiation=20 exposure

Cell phone use was categorized = according to the=20 duration of the monthly subscription (< 2hours, 2 to 6hours and>6hours per month) and = years of use=20 (< 2 years, 2 to 6 years and more than 6 years). = Cumulative=20 cell-phone use was evaluated in hour-years (number of hours = of=20 subscription per month X number of years of use). The = categories=20 were no or little use (=E2=89=A4 4 hour-years), moderate (4 = to 36=20 hour-years), and high (=E2=89=A5 36 hour-years).

The subjects evaluated the amount of = time they=20 spent using a computer during leisure time and at work over = the past=20 five years. Computer time was assessed in hours per day = (none, less=20 than, or 4 or more hours/day) for occupational use and in = hours per=20 week for leisure time (none, less than, or 5 or more=20 hours/week).

Exposure to medical ionizing = radiation was=20 evaluated mainly for the head and neck region during the = past five=20 years. Patients were asked if they had had radiography, = computed=20 tomography (CT) or scintigraphy, besides examinations = related to the=20 disease for which they were currently hospitalized. = Radiotherapy was=20 considered for all the parts of the body, but radiotherapy = on the=20 head and neck region was always explicitly specified.

A list drawn up beforehand, detailing = the main=20 occupational sectors and the types of radiation associated = with=20 them, was used to inquire about occupational exposure to = radiation.=20 For ionizing radiation it highlighted medical and = paramedical=20 occupations, research and nuclear technology, and some = industries=20 (for example, gammagraphy and sterilization). For = non-ionizing=20 radiation it distinguished extremely low frequency = electromagnetic=20 fields (electric wiring, magnets), radiofrequency = electromagnetic=20 fields (telecommunications, electrothermics), and = ultraviolet and=20 infrared radiations.

Residential=20 setting

To assess chemical exposure related = to=20 residential environment, subjects were asked whether t they = lived=20 near (< 500m) any chemical plants, vineyards, = agricultural=20 fields, or dump sites. Exposure to radiation was assessed by = question about high-tension cables, cell phone towers, = airports, and=20 highways.

Statistical=20 analysis

We used exposure odds ratios (OR), = and 95%=20 confidence intervals (CI), to determine whether the risk = factors=20 considered were associated with an increased risk of = developing=20 MPBT. The unconditional logistic regression included the = matching=20 covariates of age and gender. Other adjustments were used to = take=20 potential confounders into account. All analyses used SPSS = software=20 version 13.0 (SPSS Inc, Chicago, IL, USA).

Haut de page - Plan de l'article

Results

General = characteristics of the=20 population

We identified 162 eligible cases that = met the=20 study criteria: 5 (3%) refused to participate, 20 (12.3%) = died=20 before the interview, and 21 (12.9%) dropped out. Complete=20 questionnaires were obtained for 116 patients (71.6%) and = incomplete=20 questionnaires (only the preliminary self-administered=20 questionnaire) for 6 patients (3.7%), who died or dropped = out before=20 the interview. Data for 122 cases (complete and incomplete=20 questionnaires) were analyzed (72 men and 50 women). = Overall, 51.9%=20 of case subjects and 90.2% of control subjects completed the = preliminary questionnaire themselves; the others were helped = by=20 family members. During the risk factors interview, 98% of = case=20 patients responded themselves, and all control patients. Table=20 I summarizes the characteristics of the study = population,=20 including gender, age, cancer treatment, smoking habits, = histology=20 of MPBT, and glioma grade. The causes of hospitalization for = the 122=20 controls were herniated intervertebral disk, intracranial = aneurysm,=20 neurological traumatism requiring surgery, and epidural = hematoma. No=20 control patients had active cancer. The median age for all = patients=20 was 57 years (range: 20.4-86.3).

Occupational=20 activities

Table=20 II shows the ORs for the risk of MPBT among cases and = controls=20 according to the job they held longest among the different=20 occupational categories. When they had worked in several = jobs for=20 the same length of time, the latest job was taken into = account.=20 Because some subjects had never worked, occupational = information was=20 available from only 111 cases and 110 controls. None of the = pooled=20 ORs for the occupational categories reached statistical=20 significance, although a trend towards significance was = observed for=20 clerks (OR: 2.28; 95% CI: 0.85 =E2=80=93 6.09). The same = analyses, based on=20 the last job held and on the principal job held during the = past 10=20 years, did not show any increased risk (data not = shown).

Chemical=20 exposure

Exposure levels include all chemical = exposures=20 that occurred during occupational history and leisure time=20 activities. ORs for the risks of MPBT according to global = chemical=20 exposure during occupational and leisure-related activities = are=20 reported in Table=20 III. An inverse association was observed between = moderate global=20 chemical exposure and the risk of MPBT (OR=3D0.25, 95% CI 0.10 = =E2=80=93 0.58). For=20 high-level exposure, no significant association was = observed, nor=20 could odds ratios be calculated for individual agents, = because of=20 the small numbers involved. Details nonetheless suggested = that more=20 cases than controls used fertilizer, insecticide, solvents, = paint,=20 wood, and glue.

Details of chemical exposure during = leisure=20 time are set forth in Table=20 IV. We evaluated specific exposures from the list of = chemical=20 agents used in leisure-time activities and found a = significantly=20 increased risk associated with glue use (OR: 17.58; CI: 1.75 = =E2=80=93=20 176.62) and a significantly decreased risk associated with = natural=20 fertilizer (OR=3D0.21, 95% IC 0.06 = =E2=80=93=20 0.72).

Radiation=20 exposure

Table=20 V summarizes the intensity of cell-phone and computer = use. This=20 estimate covers the past five years for each. Overall = computer=20 exposure was not significantly associated with brain cancer. = Occupational computer exposure less than four hours per day = (OR=3D1.93, 95% CI 1.03 3.65) = was=20 significantly associated with MPBT. No significant risk was = observed=20 with the use of cell phone.

Exposure to occupational and medical = radiation=20 is presented in Table=20 VI. Few patients reported exposure to either = electromagnetic=20 fields or ionizing radiation. None of the occupational = sectors where=20 radiation exposure was probable were significantly = associated with=20 an increased odds ratio for developing intracranial brain = tumors. An=20 inverse association with CT (OR=3D0.18, 95% CI 0.08 = =E2=80=93 0.40) was=20 observed.

Environment and=20 habitat

Table=20 VII reports the chemical and physical exposures near = subjects=E2=80=99=20 homes (<500 meters). No significant risk factor was = observed,=20 although a trend was noted for chemical plants. An inverse=20 association with cell phone towers (OR=3D0.49, 95% CI 0.26 = =E2=80=93 0.92) was=20 observed.

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Discussion

Numerous occupations and industries = have been=20 inconsistently associated with the risk of brain cancer in=20 epidemiologic studies. The low incidence rates of MPBT make = the=20 debates about these results and the causes of tumors in = adults still=20 more difficult to resolve. In our work, the relatively small = study=20 sample and recall bias related to having brain cancer could = both=20 have affected the assessment of occupational and = environmental risk=20 factors. Similarly, the controls were not a representative=20 cross-section of the population, since they were principally = hospitalized in the neurosurgery department. It might have = been=20 useful to conduct sensitivity analyses by excluding specific = diagnostic subgroups of controls, as in the study by Brenner = et al.=20 ^{[22Brenner A.V., =

Linet M.S., Fine H.A., Shapiro W.R.,=20
Selker R.G., Black P.M., et al. History of =
allergies and=20
autoimmune diseases and risk of brain tumors in adults =
Int J=20
Cancer 2002 ; 99 : 252-259 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = but=20 unfortunately, diagnoses were not always recorded for = controls, and=20 we had fewer participants than did Brenner et al. The lack = of=20 blinding might also have led to differences in interviewing = styles=20 between cases and controls.

Low- and high-grade gliomas have = different=20 natural histories, reflected, in part, by their different = ages at=20 onset. They may therefore involve different carcinogenesis = patterns,=20 possibly influenced by different risk factors. The = well-known=20 difficulties in glioma grading and the relatively small = number of=20 patients in our study justified the global analysis of our=20 population.

Unlike the recent IARC report = ^{[10Schlehofer B.,=20
Hettinger I., Ryan P., Blettner M.,=20
Preston-Martin S., Little J., et al. Occupational =
risk=20
factors for low and high grade glioma: results from an =
international=20
case control study of adult brain tumours Int J=20
Cancer 2005 ; 113 : 116-125 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = our results did=20 not indicate that any job or occupational exposure was a = major risk=20 factor for MPBT development. Skilled agricultural and = fishery=20 workers did not have a significantly elevated brain tumor = risk (OR:=20 1.36; CI: 0.28 =E2=80=93 6.49), but the frequency of this = occupation was low=20 (<=3D5) in both groups, and = the=20 association was not accurately measured. This result is = inconsistent=20 with the meta-analyses of brain cancer and farming by Khuder = et al=20 ^{[16Khuder S.A.,=20
Mutgi A.B., Schaub E.A. Meta-analyses of brain =
cancer and=20
farming Am J Ind Med 1998 ; 34 : =
252-260 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = but agrees with=20 other recent American ^{[23Carozza S.E., =

Wrensch M., Miike R., Newman B., =
Olshan A.F.,=20
Savitz D.A., et al. Occupation and adult gliomas Am =
J=20
Epidemiol 2000 ; 152 : 838-846 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 24Carreon T.,=20
Butler M.A., Ruder A.M., Waters M.A.,=20
Davis-King K., Calvert G.M., et al. Gliomas and =
farm=20
pesticide exposure in women: the Upper Midwest Health =
Study=20
Environ Health Perspect 2005 ; 113 : =
546-551 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]} = and European=20 ^{[25Navas-Acien A.,=20
Pollan M., Gustavsson P., Plato N., =
Occupation=20
exposure to chemicals and risk of gliomas and meningiomas in =

Sweden Am J Ind Med 2002 ; 42 : =
214-227 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]} = studies. The IARC=20 report ^{[10Schlehofer B.,=20
Hettinger I., Ryan P., Blettner M.,=20
Preston-Martin S., Little J., et al. Occupational =
risk=20
factors for low and high grade glioma: results from an =
international=20
case control study of adult brain tumours Int J=20
Cancer 2005 ; 113 : 116-125 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]} = even indicated an=20 inverse association with the =E2=80=9Cagriculture=E2=80=9D = category for women.

An upward trend was highlighted for = clerks (OR:=20 2.28; 95% CI: 0.85 =E2=80=93 6.09), consistently with the = findings of=20 several other studies ^{[26Brownson R.C.,=20
Reif J.S., Chang J.C., Davis J.R. An analysis =
of=20
occupational risks for brain cancer Am J Public=20
Health 1990 ; 80 : 169-172 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section =
R=C3=A9f=C3=A9rences,=20
27McLaughlin J.K.,=20
Malker H.S., Blot W.J., Malker B.K., =
Stone B.J.,=20
Weiner J.A., et al. Occupational risks for intracranial =
gliomas=20
in Sweden J Natl Cancer Inst 1987 ; 78 :=20
253-257

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 28Thomas T.L.,=20
Fontham E.T., Norman S.A., Stemhagen A.,=20
Hoover R.N. Occupational risk factors for brain tumors. =
A=20
case-referent death-certificate analysis Scand J Work =
Environ=20
Health 1986 ; 12 : 121-127 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = The ORs for MPBT=20 associated with chemical occupational exposure was = significantly=20 different from zero. The inverse association observed = between=20 moderate global chemical exposure and the risk of MPBT does = not=20 permit the conclusion that chemical exposure is a risk = factor for=20 brain cancer. On the contrary, it indicates that it is = protective=20 against it. The distribution of occupations showed the same = result=20 since the leading occupation among cases was = =E2=80=9Cclerks=E2=80=9D, who are=20 thought generally to have minimal occupational toxic = exposure.=20 Nevertheless, details about high levels of occupational = exposure=20 showed that cases used slightly more fertilizer, = insecticide, wood,=20 and glue.

The retrospective nature of our study = certainly=20 increased the difficulty of evaluating chemical exposure. = Although=20 self-reports can identify exposure circumstances, e.g. to=20 carcinogens, they are limited by the lack of relative or = objective=20 benchmarks against which working or leisure conditions can = be=20 judged. Bias might have resulted from the greater likelihood = for=20 cases to remember their exposure, compared with controls, as = well as=20 from their potential memory loss due to neurological = damage.

To our knowledge, few studies have = assessed the=20 risk factors for brain cancer development in leisure = activities. We=20 found no significant difference in ORs for risk of MPBT = according to=20 global estimated chemical exposure during leisure = activities. Data=20 adjusted for occupational exposure levels showed a = significantly=20 increased risk of MPBT associated with leisure time glue = exposure,=20 although the estimation of the true effect of this factor is = imprecise. This result suggests a potentially carcinogenic = exposure.=20 In 2005, Lee et al. reported significant associations = between some=20 specific agricultural pesticides and glioma incidence = ^{[9Lee W.J., =
Colt J.S.,=20
Heineman E.F., McComb R., Weisenburger D.D.,=20
Lijinsky W., et al. Agricultural pesticide use and risk =
of=20
glioma in Nebraska, United States Occup Environ =
Med 2005=20
; 62 : 786-792 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Exposure to other=20 chemicals, such as solvents ^{[13Rodvall Y.,=20
Ahlbom A., Spannare B., Nise G. Glioma and=20
occupational exposure in Sweden, a case-control study =
Occup=20
Environ Med 1996 ; 53 : 526-532 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]} = or PAHs ^{[11Buffler P.A., =

Kelsh M., Chapman P., Wood S., Lau E.,=20
Golembesky A., et al. Primary brain tumor mortality at =
a=20
petroleum exploration and extraction research facility J =
Occup=20
Environ Med 2004 ; 46 : 257-270 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 12Cocco P.,=20
Heineman E.F., Dosemeci M. Occupational risk =
factors for=20
cancer of the central nervous system among US women Am J =
Ind=20
Med 1999 ; 36 : 70-76 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = has been=20 associated with an increased risk of MPBT. The composition = of the=20 glue was not defined in our study, however, and it can = contain, in=20 particular, solvents. Solvent use during leisure activities = should=20 be considered an important cause of chemical exposure. = Moreover,=20 subjects might be more exposed then, because they might be = less=20 likely to use protective devices than during occupational = exposure.=20 In our study we did not find a significantly increased MPBT = risk=20 associated with pesticide usage; this result is consistent = with=20 recent findings in an American study ^{[29Samanic C.M., =
De=20
Roos A.J., Stewart P.A., Rajaraman P.,=20
Water M.A., Inskip P.D. Occupational exposure to=20
pesticides and risk of adult brain tumors Am J=20
Epidemiol 2008 ; 167 : 976-985 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = The protective=20 effect of natural fertilizer might be due to information = bias or to=20 the adjustment for chemical fertilizer.

A number of studies have looked at = the relation=20 between cell-phone use and brain tumors. Our results did not = show a=20 significant difference in cell-phone use between cases and = controls=20 (Table=20 V), a finding that is in line with those from the recent = studies=20 by Lahkola et al ^{[30Lahkola A.,=20
Auvinen A., Raitanen J. Mobile phone use and risk =
of=20
glioma in North European countries Int J =
Cancer 2007 ;=20
120 : 1769-1775 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]} = (OR=3D0.78; CI: 0.68 = =E2=80=93 0.91) and by the=20 Interphone Study Group (Germany) ^{[31Schuz J., =
Bohler E.,=20
Berg G., Schlehofer B., Hetting I.,=20
Schlaefer K., et al. Cellular phones, cordless phones, =
and the=20
risks of glioma and meningioma (Interphone Study G*roup, =
Germany)=20
Am J Epidemiol 2006 ; 163 : 512-520 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Our assessment is=20 limited by its measurement of the length of telephone = subscriptions=20 rather than actual time of use and by our failure to = distinguish=20 between analog and digital phones. The accumulated dose of=20 radiofrequency in electromagnetic fields was not measured=20 precisely.

The use of computers at home and at = work has=20 become an integral part of life over the past few decades. = This=20 technology is an additional source of exposure to (extremely = low=20 frequency) electromagnetic fields and has been evaluated = only rarely=20 in brain cancer studies. Mezei et al in 2001 showed computer = use to=20 be the main source of exposure to electromagnetic fields (9% = of the=20 global exposure in a day) ^{[32Mezei G.,=20
Kheifets L.I., Nelson L.M., Mills K.M.,=20
Iriye R., Kelsey J.L. Household appliance use and=20
residential exposure to 60-hz magnetic fields J Expo Anal =
Environ=20
Epidemiol 2001 ; 11 : =
41-44

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = In 2003, De Roos=20 et al found that several occupational groups had an elevated = incidence of glioma, including computer programmers and = analysts,=20 unrelated to years in the job or cumulative hours of use = (OR=3D2.0; CI: 1.0 =E2=80=93 = 3.8) ^{[33De Roos A.J., =

Stewart P.A., Linet M.S., Heineman E.F.,=20
Dosemeci M., Wilcosky T., et al. Occupation and =
the risk=20
of adult glioma in the United States Cancer Causes=20
Control 2006 ; 14 : =
139-150

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = Our results did=20 not show a significant difference between the groups for = overall=20 computer exposure. We did, however, find an association for=20 occupational use, and further analytic studies should = explore the=20 significantly increased risk we observed associated with = computer=20 use for less than 4 h/day (OR=3D1.93; CI: 1.03 = =E2=80=93 3.65) (Table=20 V).

Ionizing radiation is a = well-established risk=20 factor for brain tumors, especially at high exposure levels = (e.g.,=20 radiotherapy). The linear-no-threshold hypothesis for cancer = risk=20 supposes that low-level radiation is also carcinogenic. The = low=20 doses of radiation used to treat tinea capitis and skin = hemangioma=20 in children or infants have been associated with an elevated = relative risk of malignant and benign brain tumors ^{[34Karlsson P.,=20
Holmberg E., Lundell M., Mattsson A., =
Holm L.E.,=20
Wallgren A. Intracranial tumors after exposure to =
ionizing=20
radiation during infancy: a pooled analysis of two Swedish =
cohorts=20
of 28,008 infants with skin hemangioma Radiat =
Res 1998 ;=20
150 : 357-364 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 35Preston-Martin S.=20
Epidemiology of primary CNS neoplasms Neurol =
Clin 1996 ;=20
14 : 273-290 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = In our study,=20 exposure to ionizing radiation for medical imaging in the = head and=20 neck region during the past five years had a significant = inverse=20 association with MBPT (OR: 0.18, CI: 0.08 =E2=80=93 0.40). = Possible bias due=20 to the cause of hospitalization in neurosurgical departments = for=20 controls (such as head injury or cerebral hemorrhage) is = improbable,=20 since examinations related to the index hospitalization were = not=20 taken into account. On the other hand, a high proportion of = control=20 patients had undergone CT (29%), much higher than expected = in=20 clinical practice. Our findings differ from those reported = by=20 Hardell et al ^{[15Hardell L.,=20
Mild K.H., Pahlson A. Ionizing radiation, cellular =

telephones and the risk for brain tumours Eur J Cancer=20
Prev 2001 ; 10 : 523-529 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = who showed a=20 significantly increased risk of brain tumors associated with = diagnostic radiography of the head and neck region (OR; = 1.64, 95%=20 CI: 1.04=E2=80=93 2.58). We also note that Feinendegen = defends the=20 hypothesis of a threshold for exposure to ionizing = radiation, based=20 on adaptive protection at low doses that outweighs the = radiogenic=20 damage ^{[36Feinendegen L.E. Evidence=20
for beneficial low level radiation effects and radiation =
hormesis=20
Br J Radiol 2005 ; 78 : 3-7 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences]}.

Residential environment must also be = considered=20 as a possible cause of chemical or physical exposure. Our = study did=20 not find any effect from domestic electromagnetic fields, = although=20 studies have shown that such exposure is not negligible in=20 comparison to occupational exposure ^{[37Forss=C3=A9n U.M.,=20
Ahlbom A., Feychting M. Relative contribution of=20
residential and occupational magnetic field exposure over=20
twenty-four hours among people living close to and far from =
a power=20
line Bioelectromagnetics 2002 ; 23 :=20
239-244

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 38Van =
Tongeren M.,=20
Mee T., Whatmough P., Borad L., =
Maslanyj M.,=20
Allen S., et al. Assessing occupational and domestic =
ELF=20
magnetic field exposure in the UK adult brain tumour study: =
results=20
of a feasibility study Radiat Prot =
Dosimetry 2004 ;=20
108 : 227-236 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = We considered=20 chemical exposure in the home environment, but found no risk = factors=20 related to it, although a trend towards significance was = observed=20 for chemical plants. Several studies have examined the = association=20 between brain cancer and chemical plants, especially = petrochemical=20 plants ^{[11Buffler P.A., =

Kelsh M., Chapman P., Wood S., Lau E.,=20
Golembesky A., et al. Primary brain tumor mortality at =
a=20
petroleum exploration and extraction research facility J =
Occup=20
Environ Med 2004 ; 46 : 257-270 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
=
R=C3=A9f=C3=A9rences and 39Lewis R.,=20
Rempala G., Dell L.D., Mundt K.A. Vinyl =
chloride and=20
liver and brain cancer at a polymer production plant in =
Louisville,=20
Kentucky J Occup Environ Med 2003 ; 45 :=20
533-537 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}, = but to our=20 knowledge, no reports discuss possible chemical exposure due = to=20 proximity between homes and chemical plants. We found that = more=20 cases subjects lived in urban areas, but this difference was = not=20 significant. Chemical or physical exposures near their homes = (<500 meters) were imprecisely evaluated. Sometime = patients were=20 unable to respond, and many characteristics were not taken = into=20 account, including precise distance, type of industry, and = duration=20 of exposure. These items considered only the longest place = of=20 residence and ignored other possible exposures after moving. = Nevertheless, we observed an inverse association between = MPBT=20 frequency and residence near cell phone towers. This result = may be=20 explained by the fact that there is no electromagnetic field = on the=20 lower part of the base stations, or by the fact that because = cell=20 phone connections are better near towers, the cell phones = emit less=20 radiation ^{[40Rapport Zmirou. Les =
t=C3=A9l=C3=A9phones mobiles, leurs=20
stations de base et la sant=C3=A9. Etat des connaissances et =

recommandations. Rapport au directeur g=C3=A9n=C3=A9ral de =
la sant=C3=A9=20
2001 Available at cliquez ici .

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = However, our=20 study did not take into account the precise location of the=20 residence in relation to the emission area.

Despite many epidemiologic studies = and=20 meta-analyses about brain cancer, the results remain = inconsistent,=20 and the causes of its increased incidence is still unknown. = In our=20 case-control study, no occupational sector suspected of = involvement=20 in brain cancer development was significantly associated = with it. We=20 might thus suppose that occupational exposure is not a major = risk=20 factor, as the study by Schlehofer et al concluded ^{[10Schlehofer B.,=20
Hettinger I., Ryan P., Blettner M.,=20
Preston-Martin S., Little J., et al. Occupational =
risk=20
factors for low and high grade glioma: results from an =
international=20
case control study of adult brain tumours Int J=20
Cancer 2005 ; 113 : 116-125 [cross-ref]

Cliquez ici=20
pour aller =C3=A0 la section=20
R=C3=A9f=C3=A9rences]}. = At the same time,=20 for leisure activities, specific substances, such as glue, = were=20 linked to this risk. Living near cell phone towers had a = protective=20 effect. No definitive conclusions can be reached on the = basis of=20 these results, but several new leads merit further analytic = studies.=20 In particular, further epidemiologic studies of brain = tumors, taking=20 tumor type and grade and age at onset into account, should = include=20 analysis of exposure during leisure activities as well as = during=20 occupational and environmental exposure. Other factors (food = habits,=20 psychological factors, life events, stress, etc.) not = related to=20 chemical or physical exposure and so not considered in this = article,=20 but likely to influence the emergence of the disease, should = be=20 studied.

Haut de page - Plan de l'article

Conflicts of=20 interests

none.

Acknowledgments

We thank Pr B Alliez, Pr F. Grisoli = and Pr H.=20 Dufour for welcoming us into their department and Paul = Lewakowshi=20 for translating the English version of the manuscript, and = we thank=20 Monique Douroux for her technical = help.

Haut de page - Plan de l'article


	References

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