INCIDENCE OF CUTANEOUS T CELL LYMPHOMA AND AIR LEVELS OF BENZENE AND TRICHLOROETHYLENE Open Access

Abstract

Background: The incidence of CTCL has been increasing in the US and this might be due to increased exposure to industrial chemicals. Benzene and TCE are chemicals which are known carcinogens and have been associated with various malignancies. Increased incidence of CTCL has been linked to environmental exposures. This study explores the spatial association of these chemicals to the incidence of CTCL in various states across the US.

Methods: We used CTCL case data from the Surveillance, Epidemiology, and End Results (SEER) program for the years 2000-2016, population data from the U.S. Census and identified benzene and TCE exposure and concentration levels by county in 1996, 1999 and 2002 for all the states under review. We performed Poisson regression on observed cases of CTCL, using benzene and TCE levels and SES variables. We mapped standardized incidence ratios by county to examine spatial patterns. Cluster analyses was conducted at the county level for the states with more than 30 counties.

Results: Clusters of high standardized incidence ratios were identified in several of the states under review. This clustering of SIR was statistically significant in the states of California, Georgia, Iowa, Kentucky and Louisiana. Overall, Poisson regression models depicted an association between the benzene & CTCL incidence but not TCE.

Conclusions: CTCL incidence might be associated with exposure to toxic levels of Benzene and TCE. Further research should also investigate other industrial chemicals causing increased CTCL incidence as well as the spatial association in other states of the US.

Table of Contents

INTRODUCTION.. 1

BACKGROUND.. 3

Benzene and Trichloroethylene. 3

Carcinogenicity of Benzene and Trichloroethylene. 4

MATERIALS AND METHODS. 6

Patient Demographics and CTCL Data. 6

Benzene and TCE Data. 8

Socio Economic Status Data. 8

Spatial Analysis. 9

Statistical Analysis. 9

RESULTS. 11

CTCL and SES Data. 11

Benzene and TCE data. 12

Spatial Analysis. 12

Correlations. 12

Poisson Regression Analysis. 13

DISCUSSION.. 15

Strengths and Weaknesses. 15

Future Directions. 16

REFERENCES. 17

FIGURES. 19

TABLES. 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology Health Sciences, Epidemiology
Keyword	Cutaneous T cell Lymphoma Lymphoma NHL CTCL Non- Hodgkin's Lymphoma
Committee Chair / Thesis Advisor	Dr Mary Jo. Lechowicz, MD, Emory University Dr Jeffrey M Switchenko, PhD, MS, Emory University Dr Kevin Ward, PhD, MPH, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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