Treatment for breast cancer and blood levels of chlorinated hydrocarbons.
Treatment for breast cancer and blood levels of chlorinated hydrocarbons.
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发表时间：
1996-06
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通讯作者：
M. Gammon;Mary S. Wolff;A. I. Neugut;M. Terry;J. Britton;Ellen Greenebaum;H. Hibshoosh;B. Levin-B.-Le
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作者：
M. Gammon;Mary S. Wolff;A. I. Neugut;M. Terry;J. Britton;Ellen Greenebaum;H. Hibshoosh;B. Levin-B.-Le
小型研究检验了暴露在高浓度氯代烃环境中的妇女患乳腺癌的风险是否会增加，这一点在治疗前采集的乳房脂肪组织或外周血中进行了测量，但结果相互矛盾。对于一项以人群为基础的病例对照研究，采集预处理血液是一项劳动密集型工作。另一种选择是在乳腺癌治疗开始后，像对照组一样，在面谈时采集患者的血液(治疗后的血液)。目前尚不清楚治疗是否会影响血液中有机氯1，1-二氯-2，2-二(对氯苯基)乙烯(DDE)或多氯联苯(PCbs)的水平。这项研究的目的是确定在新诊断的乳腺癌患者中，治疗前和治疗后的血液样本是否产生了对DDE和多氯联苯累积暴露的显著不同估计。采集了22名年龄在45-87岁的新诊断为浸润性疾病的非禁食妇女在乳腺癌治疗前后的2毫升血液样本。治疗被定义为大手术(乳房切除或结节切除)、放疗、激素(他莫昔芬)或化疗。治疗前后的血液样本在盲法配对中检测DDE和多氯联苯。报告的浓度(以体积为基础)根据估计的总血脂进行了调整。对于DDE，未调整[0.99 ng/ml；95%可信区间(CI)，-0.36至2.34 ng/ml]和调整后(0.05微克/克脂肪；95%可信区间，-0.04至0.13微克/克脂肪)水平的平均差异很小。对于多氯联苯，未调整的平均值(0.68 ng/ml；95%可信区间，0.05~1.3 ng/ml)和校正后的均值差异(0.070微克/克脂肪；95%可信区间，-0.009~0.149微克/克脂肪)具有边缘统计学意义。除了接受化疗的患者[n=5；15.8%(DDE)，29.4%(多氯联苯)]外，脂类调整的有机氯水平的平均百分比变化在治疗组之间没有显著差异。调整后的平均值差异也随着治疗前和治疗后抽血时间的增加而增加。在包括治疗、年龄、种族、分期和两次抽血时间在内的多个回归模型中，只有化疗似乎可以预测调整前后DDE或PCbs水平的百分比变化(P分别为0.10和0.06)。在治疗前3个月内抽取的治疗后血液样本，除化疗开始后抽取的血液样本外，对乳腺癌患者的DDE身体负担水平提供了类似的衡量标准。使用治疗后采集的血液样本而不是治疗前采集的血液样本来表征多氯联苯水平，可能会导致对暴露的错误分类。
Small studies have examined, with conflicting results, whether breast cancer risk is increased among women exposed to high levels of chlorinated hydrocarbons, as measured in breast fat tissue or peripheral blood collected prior to treatment (pretreatment blood). For a population-based, case-control study, collection of pretreatment blood is a labor-intensive effort. An alternative is to collect blood from cases at interview, as is done for controls, after breast cancer treatment has commenced (posttreatment blood). It is unknown whether treatment affects blood levels of the organochlorines 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) or polychlorinated biphenyls (PCBs). The purpose of this study was to determine whether pretreatment versus posttreatment blood samples yielded significantly different estimates of cumulative exposure to DDE and PCBs among newly diagnosed breast cancer patients. Two-ml blood samples were collected prior to and after treatment for breast cancer from 22 nonfasting women, ages 45-87 years, newly diagnosed with invasive disease. Treatment was defined as major surgery (mastectomy or node removal), radiation, hormones (tamoxifen), or chemotherapy. Pretreatment and posttreatment blood samples were assayed for DDE and PCBs in blinded, matched pairs. The reported concentrations (volume basis) were adjusted for estimated total plasma lipids. For DDE, mean differences in unadjusted [0.99 ng/ml; 95% confidence interval (CI), -0.36 to 2.34 ng/ml] and lipid-adjusted (0.05 microgram/g lipid; 95% CI, -0.04 to 0.13 microgram/g lipid) levels were small. For PCBs, the unadjusted (0.68 ng/ml; 95% CI, 0.05 to 1.30 ng/ml) and adjusted (0.070 microgram/g lipid; 95% CI, -0.009 to 0.149 microgram/g lipid) mean differences were of borderline statistical significance. The mean percent change in lipid-adjusted organochlorine levels did not vary substantially between treatment groups, except for those patients receiving chemotherapy [n = 5; 15.8% (DDE), 29.4% (PCBs)]. Adjusted mean differences also increased with increasing time between the pretreatment and posttreatment blood draws. In multiple regression models that included treatment, age, race, stage, and time between blood draws, only chemotherapy appeared to predict the percent change in adjusted pretreatment and posttreatment levels of DDE or PCBs (P = 0.10 and 0.06, respectively). Posttreatment blood samples drawn within 3 months of pretreatment samples, with the exception of those drawn after the commencement of chemotherapy, provide similar measures of DDE body burden levels among breast cancer cases. The use of blood samples collected after treatment, rather than before treatment, for characterizing PCB levels may lead to misclassification of exposure.