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Department of Environmental and Occupational Health [J. A. H., P. E. T.], Department of Epidemiology [P. E. T.], and Department of Biostatistics [R. H. Z.], Rollins School of Public Health, Emory University, Atlanta, Georgia 30322; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California 94109 [E. A. H., P. M. B.]; National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341 [J. W. B., V. L. B., L. L. N.]; Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, [S. A. K.]; and Environmental Health Department, Harvard School of Public Health [S. A. K., L. M. A.], Boston, Massachusetts 02115
Occupational exposure to
p,p'-dichlorodiphenyl-trichloroethane (DDT) has been
associated with increased pancreatic cancer risk. We measured
organochlorine levels in serum obtained at the study enrollment from
108 pancreatic cancer cases and 82 control subjects aged 32–85 years
in the San Francisco Bay Area between 1996 and 1998. Cases were
identified using rapid case-ascertainment methods; controls were
frequency-matched to cases on age and sex via random digit dial and
random sampling of Health Care Financing Administration lists. Serum
organochlorine levels were adjusted for lipid content to account for
variation in the lipid concentration in serum between subjects. Median
concentrations of p,p'-dichlorodiphenyldichloroethylene
(DDE, 1290 versus 1030 ng/g lipid; P = 0.05), polychlorinated biphenyls (PCBs; 330 versus 220
ng/g lipid; P < 0.001), and
trans-nonachlor (54 versus 28 ng/g lipid;
P = 0.03) were significantly greater among cases
than controls. A significant dose-response relationship was observed
for total PCBs (P for trend < 0.001). Subjects in
the highest tertile of PCBs (
360 ng/g lipid) had an odds ratio (OR)
of 4.2 [95% confidence interval (CI) = 1.8–9.4] compared to
the lowest tertile. The OR of 2.1 for the highest level of
p,p'-DDE (95% CI = 0.9–4.7) diminished (OR =
1.1; 95% CI = 0.4–2.8) when PCBs were included in the model.
Because pancreatic cancer is characterized by cachexia, the impact of
this on the serum organochlorine levels in cases is difficult to
predict. One plausible effect of cachexia is bioconcentration of
organochlorines in the diminished lipid pool, which would lead to a
bias away from the null. To explore this, a sensitivity analysis was
performed assuming a 10–40% bioconcentration of organochlorines in
case samples. The OR associated with PCBs remained elevated under
conditions of up to 25% bioconcentration.
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