Polychlorinated biphenyls (PCBs)

Rennae Anderson, M.D.

July 8, 2014
INTRODUCTION

• University of Miami 

• Washington University 

School of Medicine

• Johns Hopkins 

Department of 

Pathology (AP/CP/SP 

Fellowship)
Introduction

• Hampton Roads Virginia

• Elkton, Maryland

• Burlington, North 

Carolina

• Columbia, Maryland

• Surgical Pathologist

• Multidisciplinary Team 

Member

• Cancer Committee 

Member

• College of American 

Pathologist
OBJECTIVES

• Update current EPA Classification of PCBs from 

probable human carcinogen to known human 

carcinogen (cancer-causing agent)

• Change handling of PCBs to reflect 

classification as known human carcinogen 

within July 1, 2014 action to package, 

transport, treat and dispose of PCBs 
American Cancer Society

Estimated 2014 New cases

• 1,665,540

Estimated 2014 deaths

• 585,720
CANCER PREVALENCE

• NCI: Jan 1, 2014: 14.5 million Americans with 

history of cancer were alive

• ACS and NCI: By Jan 1, 2024 population of 

cancer survivors projected to increase to 

almost 19 million (9.3 males; 9.6 females)

• Aging (life expectancy 2010 78.7 years), 

population growth, improved therapy 
CENTER FOR DISEASE CONTROL

• 2

nd most common cause of death in US ( 1 in 4 

deaths)

• 2010

Heart Disease: 597,689

Cancer: 574,743

Chronic Lower Respiratory Disease 138,080
CANCER ECONOMICS:NCI STUDY

• 2020: Medical Expenditures for cancer $158 

billion (in 2010 dollars)

• Reflects an increase of 27 percent over 2010

• If newly developed tools for cancer diagnosis, 

treatment and follow-up continue to be more 

expensive Medical expenditures projected to 

$207 billion

• Highest costs: Breast cancer (16.5 billion), 

colorectal (14 billion) and lymphoma (12 billion)
Observations

• Multiple cancers

• Younger ages
Breast Malignancies

SEER (NCI) age adjusted data in females: 

New cases per 100,000 between 2003 and 

2011 (range 126.9 to 130.5)

Deaths: 2003 to 2011 (25.3 down to 21.9)
BREAST MALIGNANCIES

• 2006-2010 New cases per 100,000 by state: 

109-140 (New Mexico, Washington D.C)

• Lowest incidence EPA Regions: 4, 6, 8, 9 

• Highest incidence EPA Regions: 1, 2, 3, 10
RTKNET.ORG (since 2000)

EPA Regions (low): 4,6,8,9

• Agg # handlers: 287,363

• Agg # with penalties: 4030

• #handlers/#penalties= 71.3

EPA Regions (high): 1,2,3,10

• Agg # handlers: 263,371

• Agg # with penalties: 2733

• #handlers/#penalties=96.3
PCB and Breast cancer before age 50

• Cohn: Exposure to PCB congeners measured 

shortly after giving birth and subsequent risk 

of maternal breast cancer before age 50; 

Breast Cancer Res Treat: 2012

• Net association of PCB exposure was nearly a 

threefold increase in risk for early breast 

cancer
Non Hodgkin Lymphoma

• SEER data 1975-2011 per 100,000: 11.1 to

21.1 (2010)

• Deaths: 5.6 to 7.7 (2002)

• Since 2003 Deaths: 7.4 to 6.1 (2010) 
Non Hodgkin Lymphoma

• Freeman; Plasma Levels of Polychlorinated 

Biphenyls, Non-Hodgkin Lymphoma, and 

Causation: Journal of Environmental and 

Public Health: 2012

• Meta-analysis of results of previously 

published case-control studies to assess 

strength of association between NHL and PCBs

• Overall results indicate a strong general causal 

association between NHL and PCB exposure
Non Hodgkin Lymphoma

• Incidence of NHL is rising more rapidly than 

incidence of virtually all other human cancers

• High degree of correlation was also observed 

for other cancers (breast, liver and bile duct, 

kidney, skin, soft tissue and heart)
Melanoma 

• SEER 1975-2011 per 100,000: 7.9 to 23.8 

(2010)

• Deaths: 2.1 (1975) to 2.8 (2009)
Melanoma

• Lauby-Secretan et al: Carcinogenicity of 

polychlorinated biphenyls and 

polybrominated biphenyls: The Lancet 

Oncology: March 2013

• International Agency for Research on Cancer 

(IARC) Lyon France- 26 experts from 12 

countries
Melanoma

• Working group considered more than 70 

independent epidemiological studies :

• Concluded there is sufficient evidence 

(melanoma) in humans for the carcinogenicity 

of PCBs

• Increased risks for non-Hodgkin lymphoma 

and breast cancer were also reported
CONCLUSION

• Update current EPA Classification of PCBs from 

probable human carcinogen to known human 

carcinogen (cancer-causing agent)

• Change handling of PCBs to reflect 

classification as known human carcinogen 

within July 1, 2014 action to package, 

transport, treat and dispose of PCBs