title: Comparison of questionnaire data and analyzed dioxin concentrations as a measure of exposure in soft-tissue sarcoma studies.
abstract: Soft-tissue sarcoma is one of the few specific tumors thought to be caused by polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and specifically TCDD. Evidence is, however, based on questionnaire-based case-control studies, and on very few cancer cases in cohort studies at high occupational exposures to chlorophenols or chlorophenoxy acid herbicides with dioxin impurities. Recall bias has been suspected to influence the reporting of exposure, but this possibility has never been adequately put to test. In the present study 87 cancer patients and 308 controls answered a questionnaire asking their exposure to wood preservatives, fungicides and herbicides, and insecticides, and their PCDD/F concentrations were also measured. After matching for age and area 67-69 sarcoma patients and 153-156 controls were available for the study depending on the chemical group, 1-3 controls for each sarcoma patient. Sarcoma patients reported exposure to these chemicals significantly more often than controls did, odds ratios were 6.7 for wood preservatives (p=0.02), 16 for fungicides and herbicides (p=0.01), and 4.9 for insecticides (p=0.06). There was no association, when the analysis was based on measured PCDD/F concentrations (odds ratios close to 1). Although it is not possible to exclude the role of the main chemical as the cause with certainty, the results indicate that recall bias is very likely in previous studies. Thus the causality between contaminant PCDD/Fs and soft tissue sarcoma cannot be considered proven.
authors.affiliation: Department of Health Security, National Institute for Health and Welfare, Kuopio, FI-70701, Finland. Electronic address: jouko.tuomisto@thl.fi.
authors.forename: Jouko
authors.initials: J
authors.lastname: Tuomisto
authors.affiliation: Department of Health Security, National Institute for Health and Welfare, Kuopio, FI-70701, Finland.
authors.forename: Riikka
authors.initials: R
authors.lastname: Airaksinen
authors.affiliation: Department of Health Security, National Institute for Health and Welfare, Kuopio, FI-70701, Finland; Department of Public Health, University of Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Pekkanen
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Tukiainen
authors.affiliation: Department of Health Security, National Institute for Health and Welfare, Kuopio, FI-70701, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kiviranta
authors.affiliation: Department of Public Health Solutions, National Institute for Health and Welfare, Kuopio, FI-70701, Finland.
authors.forename: Jouni T
authors.initials: JT
authors.lastname: Tuomisto
mesh_terms: D016022:Case-Control Studies; D002733:Chlorophenols / Q000633:toxicity; D015331:Cohort Studies; D004147:Dioxins / Q000008:administration & dosage / Q000633:toxicity*; D004781:Environmental Exposure / Q000009:adverse effects*; D006540:Herbicides / Q000633:toxicity; D006801:Humans; D007306:Insecticides / Q000633:toxicity; D016273:Occupational Exposure / Q000009:adverse effects; D012509:Sarcoma / Q000139:chemically induced* / Q000175:diagnosis; D011795:Surveys and Questionnaires
chemical_list: D002733:Chlorophenols; D004147:Dioxins; D006540:Herbicides; D007306:Insecticides
keywords: Carcinogenicity; Case-control studies; Dioxin; PCDD/F; Risk assessment; Soft-tissue sarcoma