## Po ly chlorina te d biphen yls (PCBs)

Re nnae Anderson, M.D . July 8, 2014

## INTR ODUCTION

• Univ ersity of Miami • Wa shingto n Univ ersity School of Medicine • Johns Hopkins Departmen t of Pa thology (AP

/CP /SP Fe llowship)

## In tr oduction

• Hampton Ro ads Virginia • Elkton, Maryland • Burlingto n, North Carolina • Columbia, Maryland • Surgical P athologis t • Multidisciplinary Te am Member • Cancer Committe e Member • College of American Pa thologis t

## OBJE CT IVE S

• Updat e curr en t EP

A Classification of PCBs fr om pr obable human ca rc inogen t o known human ca rc inogen (cancer - ca using agent) • Change handling of PCBs t o r eflect classification as known human ca rc inogen within July 1, 2014 action t o pack age, transport, tr ea t and dispose of PCBs

## Americ an Cancer Society **Es timated 2014 New cases**  • 1,665,540 **Es timated 2014 deaths**  • 585,720

## CANCER PREV

ALENCE
• NCI: Jan 1, 2014: 14.5 million Americans with his to ry of c ancer wer e aliv e • AC S and NCI: ByJan 1, 2024 population of ca ncer survivors pr oject ed t o incr ease t o almos t 19 million (9.3 males; 9.6 females) • Aging (life e xpect ancy 2010 78.7 ye ars), population gr owth, impr oved therapy

## CENTER F OR DISE ASE C ONTR OL
• 2 nd mos t co mmon cause of death in US ( 1 in 4 deaths) • 2010 Heart Disease: 597,689 Cancer: 574,743 Chr onic Lower R espir ato ry Disease 138,080

## CANCER E CO NOMICS:NCI STUDY
• 2020: Medical Expenditur es for cancer $158 billion (in 2010 dollar s) • Ref lects an incr ease of 27 per cen t over 2010 • If newly developed tools for cancer diagnosis, tr eatment and follow - up continue to be mor e ex pensive Medical e xpenditur es pr oject ed to $207 billion • Highes t cos ts: Br eas t cancer (16.5 billion), color ect al (14 billion) and lymphoma (12 billion)

## Observat ions
• Multiple ca ncers • Yo unger ages

## Br eas t Malignancies SEER (NCI) age adjus te d dat a in females: New cases per 100,000 between 2003 and 2011 (range 126.9 to 130.5) Deaths: 2003 t o 2011 (25.3 down t o 21.9)

## BRE AST MALIGNANCIE S
• 2006 - 2010 New cases per 100,000 by s tate : 109 - 140 (New Me xico , W ashingto n D.C ) • Lowes t incidence EP

A R egions: 4, 6, 8, 9 • Highes t incidence EP

A R egions: 1, 2, 3, 10

## RT KNET

.O RG (since 2000) **EP A R**  **egions (low): 4,6,8,9** • Agg # handler s: 287,363 • Agg # with penalties: 4030 • #handler s/#penalties= 71.3 **EP A R**  **egions (high): 1,2,3,10** • Agg # handler s: 263,371 • Agg # with penalties: 2733 • #handler s/#penalties=96.3

### PCB and Br eas t c ancer be fo re ag e 50
• Cohn: Exposur e t o PCB congeners measur ed shortly aft er giving birth and subsequen t risk of mat ernal br eas t cancer befor e age 50; Breas t Cancer R es T

reat: 2012 • Net association of PCB e xposur e w as nearly a thr eefold incr ease in risk for early br eas t ca ncer

## Non Hodgkin L

ymphoma
• SEER dat a 1975 - 2011 per 100,000: 11.1 to 21.1 (2010) • Deaths: 5.6 t o 7.7 (2002) • Since 2003 Deaths: 7.4 t o 6.1 (2010)

## Non Hodgkin L

ymphoma
• Fr eeman; Plasma Lev els of P oly chlorinat ed Biphen yls, Non - Hodgkin L ymphoma, and Causation: Journal of Environmen ta l and Public Health: 2012 • Met a - analysis of r esults of pr eviously published ca se - co ntr ol st udies t o assess st re ngth of association between NHL and PCBs • Ov erall r esults indicat e a s tr ong general causal association between NHL and PCB e xposur e

## Non Hodgkin L

ymphoma
• Incidence of NHL is rising mor e rapidly than incidence of virtually all other human ca ncers • High degr ee of c orr elation w as also observe d fo r other cancers (br eas t, liv er and bile duct, kidney , skin, soft tissue and heart)

## Melanoma
• SEER 1975 - 2011 per 100,000: 7.9 t o 23.8 (2010) • Deaths: 2.1 (1975) to 2.8 (2009)

## Melanoma
• Lauby - Secr et an et al: Car cinogenicity of poly chlorinat ed biphen yls and polybr ominat ed biphen yls: The Lancet Oncology: Mar ch 2013 • In te rnational Agency for R esear ch on Cancer (IARC) Ly on Fr ance - 26 e xperts fr om 12 co untries

## Melanoma
• Wo rking gr oup consider ed mor e than 70 independen t epidemiological s tudies : • Concluded ther e is suf

ficien t evidence (melanoma) in humans fo r the car cinogenicity of PCBs • Incr eased risk s for non - Hodgkin lymphoma and br eas t cancer wer e also r eport ed

## CO NCL USION
• Updat e curr en t EP

A Classification of PCBs fr om pr obable human ca rc inogen t o known human ca rc inogen (cancer - ca using agent) • Change handling of PCBs t o r eflect classification as known human ca rc inogen within July 1, 2014 action t o pack age, transport, tr ea t and dispose of PCBs