Abstract
An unusual cluster of 8 breast cancer and 8 other malignant tumor cases (ovarian, uterus, lung, colon and brain tumors and malignant melanoma) developed in a period of 12 years among 98 nurses exposed to ethylene oxide (EtOx) for 5–15 years in a unit using gas sterilizer in a hospital of the archiepiscopal city of Eger, Hungary. EtOx concentration in air samples of the working area varied from 5 to 150 mg/m3. The question was, if there was any causal relationship between the elevated incidence of breast cancer and the EtOx exposure, the other possibility was, that this cluster appeared accidentally. EtOx is a human carcinogen, however, no increased breast cancer incidence in EtOx-exposed subjects was reported in the literature. We followed up for two consecutive years the 27 non cancer patients, EtOx-exposed nurses and 11 unexposed hospital controls with the aid of a multiple genotoxicology monitor including chromosomal aberration, sister-chromatide exchange, HPRT point mutation and DNA repair studies. The results were compared with data from 30 local historical controls, 48 historical controls from Budapest, 14 hospital controls and 9 EtOx exposed nurses from Budapest. Significantly high chromosome aberration yields (especially chromosome type exchanges) were alike detected in EtOx-exposed and the two other control groups in Eger. These results could not be interpreted as a consequence of EtOx exposure only, since in the EtOx-exposed group from Budapest, beside an increased total aberration frequency, the obtained exchange type aberration yields were as low as the historical controls. A plausible explanation can be the natural low dose radioactivity (222Rn) of the local tap-water due to a specific geological situation in Eger. The spontaneous breast cancer incidence in Hungary doubled in the last 10 years compared with the previous 20 years (1960–1980), especially in Eger. The appearence of the high breast cancer incidence in the hospital of Eger indicates the combined effect of EtOx and a more common local etiologic factor, such as the naturally radioactive tap-water. However, since the reported studies did not involve the investigation either of the genetic predisposition, or the effects of other possible environmental, occupational, and/or life style confounding factors, further studies (partly in progress) are necessary to clarify the importance of these factors.
Similar content being viewed by others
References
WHO: World Health Statistics Annuals 1984-88. UN World Health Organisation, Geneva. 1988.
KSH: Demográfiai Évkönyv 1970. Központi Statisztikai Hivatal, Budapest. 1972. (in Hungarian).
KSH: Demográfiai Évkönyv 1990. Központi Statisztikai Hivatal, Budapest. 1992. (in Hungarian).
Wolff MS: Environmental exposures and breast cancer. In: Accomplishments in cancer research 1996. (Eds: Fortner JG and Sharp PA), Lippincott - Raven Publ, Philadelphia-New York, 1997, pp. 136–144.
Tokunaga M, Land CE, Tokuoka S, et al.: Incidence of female breast cancer among atomic bomb survivors, 1950–1985. Radiation Res 138:208–223, 1994.
Tompa A, Major J, Jakab MG: Environmental genotoxicity and breast cancer risk in Hungary. Cancer Res. submitted for publication. (1999).
Hagmar L, Brögger A, Hansteen I-L, et al.: Cancer risk in humans predicted by increased levels of chromosomal aberrations in lymphocytes: Nordic study group on the health risk of chromosome damage. Cancer Res 54:2919–2922, 1994.
Bonassi S, Abbondandolo A, Camurri L, et al.: Are chromosome aberrations in circulating lymphocytes predictive of future cancer onset in humans? Preliminary results of an Italian cohort study. Cancer Genet Cytogenet 79:133–135, 1995.
Brusick DJ: Value of short-term mutagenicity tests in human population monitoring. In: Chemical mutagenesis, human population monitoring and genetic risk assessment. Progress in Mutation Research, Vol 3. (Eds: Bora KC, Douglas GR and Nestmann ER), Elsevier Biomedical Press, Amsterdam-Oxford-New York, 1982, pp. 261–274.
Major J, Jakab MG, Tompa A: Genotoxicological investigation of hospital nurses occupationally exposed to ethylene-oxide: I. Chromosome aberrations, sister-chromatid exchanges, cell cycle kinetics, and UV-induced DNA synthesis in peripheral blood lymphocytes. Environ Molec Mutagen 27:84–92, 1996.
Agyagási D: Balneological issues at Eger. Balneológia Gyógyfürdügy Gyógyidegenforgalom 1:3–16. 1993. (in Hungarian, abstract in English).
IARC: Cancer: Causes, Occurrence and Control. Chapter 8. Radiation. In: IARC Scientific Publications No 100. (Eds: Tomatis L, Aitio A, Day NE, Haseltine E, Kaldor J, Miller AB, Parkin DM, Riboli E), WHO, IARC, Lyon, 1990, pp. 157–158.
Tompa A, Major J, Jakab MG: Monitoring of benzene-exposed workers for genotoxic effects of benzene: Improved-working- condition-related decrease in the frequencies of chromosomal aberrations in peripheral blood lymphocytes. Mutation Res 304:159–165, 1994.
Moorhead PS, Nowell PC, Mellman, et al.: Chromosome preparations of leukocytes cultured from human peripheral blood. Exp Cell Res 20:613–616, 1960.
Perry P, Wolff S: New Giemsa method for the differential staining of sister chromatids. Nature 258:121–125, 1974.
Carrano AV, Natarajan AT: Considerations for population monitoring using cytogenetic techniques. ICPEMC Publ. No. 14. Mutation Res 204:379–406, 1988.
Müller E, Bertók A: Az egri kórházban elfordult daganatos megbetegedések -higiénés viszonyok, konzekvenciák. Kórház és Orvostechnika 33:17–22, 1995. (in Hungarian).
Lerda D, RizziR: Cytogenetic studies of persons occupationally exposed to ethylene oxide. Mutation Res 281:31–37, 1992.
Major J, Jakab MG, Tompa A: Genotoxicological investigation of hospital nurses occupationally exposed to ethylene-oxide: II. Significance of environmental radon exposure in development of inceased exchange aberration frequencies obtained. Environ Molec Mutagen submitted for publication. 1999.
KSH: Demográfiai Évkönyv 1996. Központi Statisztikai Hivatal, Budapest. 1998. (in Hungarian).
Gombkötő G: Tumor morbidity and mortality among people living in settlements in the vicinity of town Eger. Egészségtudomány 39:154–171, 1995. (in Hungarian, abstract in English)
Gombkötő G, Szeremi M: A Heves megyei lakosság megbetegedési -halálozási viszonyainak elemzése nemzetközi és magyarországi összehasonlításban. NEKAP, Eger, 1997. (in Hungarian).
Kertész M: Data of the Air Quality Monitoring Network IV. 1996 - IX. 1996. Egészségtudomány 41:78–95, 1997. (in Hungarian, abstract in English).
Norman SA, Berlin JA, Soper KA, et al.: Cancer incidence in a group of workers potentially exposed to ethylene oxide. Int J Epidemiol 24:276–284, 1995.
IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Vol. 36. Allyl compounds, Aldehydes, Epoxides and Peroxides. Ethylene oxide. IARC, Lyon. 1988. pp. 198–226.
Bojtor I, Gidáli J, Fehér I, et al.: Comparison of hematological parameters between “normal” population and residents consuming tap water of Ra content. Egészsgtudomány 24:223–235, 1980. (in Hungarian, abstract in English).
Köteles G, Nikl I, Szerbin P, et al.: Az egri egészségügyi problémák sugáregészségügyi vonatkozásai. Kórház- és Orvostechnika 33:92–97, 1995. (In Hungarian).
WHO: World Health Statistics Annuals 1984-88. UN World Health Organisation, Geneva. 1988.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tompa, A., Major, J. & Jakab, M.G. Is breast cancer cluster influenced by environmental and occupational factors among hospital nurses in Hungary?. Pathol. Oncol. Res. 5, 117–121 (1999). https://doi.org/10.1053/paor.1999.0182
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1053/paor.1999.0182