title: Plasma levels of polychlorinated biphenyls, non-Hodgkin lymphoma, and causation.
abstract: Polychlorinated biphenyls (PCBs) are synthetic chlorinated hydrocarbons that have extensively polluted the environment and bioaccumulated in the food chain. PCBs have been deemed to be probable carcinogens by the Environmental Protection Agency, and exposure to high levels of PCBs has been consistently linked to increased risk of non-Hodgkin lymphoma (NHL). In the present article we present a forensic epidemiologic evaluation of the causal relationship between NHL and elevated PCB levels via application of the Bradford-Hill criteria. Included in the evaluation is a meta-analysis of the results of previously published case-control studies in order to assess the strength of association between NHL and PCBs, resulting in an odds ratio in which the lowest percentile PCB concentration (quartile, quintile, or tertile) has been compared with the highest percentile concentration in the study groups. The weight-adjusted odds ratio for all PCB congeners was 1.43 with a 95% confidence interval of 1.31 to 1.55, indicating a statistically significant causal association with NHL. Because of the lack of an unexposed comparison group, a rationale for the use of a less than 2.0 relative risk causal contribution threshold is presented herein, including an ecologic analysis of NHL incidence and PCB accumulation (as measured by sales volume) over time. The overall results presented here indicate a strong general causal association between NHL and PCB exposure.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, 1234 SW 18th Avenue, Suite 102, Portland, OR 97205, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Freeman
authors.forename: Sean S
authors.initials: SS
authors.lastname: Kohles
mesh_terms: D000465:Algorithms; D015984:Causality; D004785:Environmental Pollutants / Q000097:blood / Q000633:toxicity*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000453:epidemiology*; D011078:Polychlorinated Biphenyls / Q000097:blood / Q000633:toxicity*; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D004785:Environmental Pollutants; D011078:Polychlorinated Biphenyls