Occupational and Environmental Exposures Associated with Testicular Germ Cell Tumours: Systematic Review of Prenatal and Life-Long Exposures

<div><p>Background</p><p>Testicular germ cell tumours (TGCT) are the most common cancers in men aged between 15 and 44 years and the incidence has increased steeply over the past 30 years. The rapid increase in the incidence, the spatial variation and the evolution of incidence in migrants suggest that environmental risk factors play a role in TGCT aetiology. The purpose of our review is to summarise the current state of knowledge on occupational and environmental factors thought to be associated with TGCT.</p> <p>Methods</p><p>A systematic literature search of PubMed. All selected articles were quality appraised by two independent researchers using the ‘Newcastle-Ottawa Quality Assessment Scale’.</p> <p>Results</p><p>After exclusion of duplicate reports, 72 relevant articles were selected; 65 assessed exposure in adulthood, 7 assessed parental exposures and 2 assessed both. Associations with occupation was reported for agricultural workers, construction workers, firemen, policemen, military personnel, as well as workers in paper, plastic or metal industries. Electromagnetic fields, PCBs and pesticides were also suggested. However, results were inconsistent and studies showing positive associations tended to had lower quality ranking using the assessment scale (p=0.02).</p> <p>Discussion</p><p>Current evidence does not allow concluding on existence of any clear association between TGCT and adulthood occupational or environmental exposure. The limitations of the studies may partly explain the inconsistencies observed. The lack of association with adulthood exposure is in line with current hypotheses supporting the prenatal origin of TGCT. Future research should focus on prenatal or early life exposure, as well as combined effect of prenatal and later life exposure. National and international collaborative studies should allow for more adequately powered epidemiological studies. More sophisticated methods for assessing exposure as well as evaluating gene–environment interactions will be necessary to establish clear conclusion.</p> </div

Standardized hospitalisation ratios (SHRs) and 95% confidence intervals (CIs) for diseases of the central nervous system among 420 095 subscribers to cellular telephones in Denmark, 1982–1995, followed up through 31 December 2003.

*<p>Time since first subscription to a cellular telephone.</p

Year of first subscription to a cellular telephone for the 420 095 members of the Danish retrospective cohort of cellular telephone subscribers between 1982 and 1995.

<p>Year of first subscription to a cellular telephone for the 420 095 members of the Danish retrospective cohort of cellular telephone subscribers between 1982 and 1995.</p

Flow diagram of identified articles published between 1990 and 2012.

<p>Flow diagram of identified articles published between 1990 and 2012.</p

Standardized hospitalisation ratios (SHRs) and 95% confidence intervals (CIs) for migraine and vertigo among 420 095 subscribers to cellular telephones in Denmark, 1982–1995, followed up through 31 December 2003.

*<p>Time since first subscription to a cellular telephone.</p

Additional file 1: of Mortality of populations potentially exposed to ionising radiation, 1953–2010, in the closed city of Ozyorsk, Southern Urals: a descriptive study

Mortality in the 3-plants workers (green), other Ozyorsk residents (orange) and national figures of Soviet Union and Russian Federation (blue) between 1953 and 2010, by sex for all adults (18-74 years old) and for younger adults (18-49 years old), with indication of year 1985-1987 (anti-alcohol campaign), 1991 (start of political transition), 2005 (start of 2 anti-alcohol campaign) for A - Deaths from infectious and parasitic diseases (ICD-9 codes 001-139), B - Deaths from lip, oral cavity and pharynx cancers (ICD-9 codes 140-149), C - Deaths from digestive organ and peritoneum cancers (ICD-9 codes 150-159), D - Deaths from stomach cancer (ICD-9 code 151), E - Deaths from rectum, rectosigmoid junction and anal cancer (ICD-9 code 154), F - Deaths from liver cancer (ICD-9 code 155), G - Deaths from pancreas cancer (ICD-9 code 157), H - Deaths from respiratory and intrathoracic organ cancers (ICD-9 code 160-165), I- Deaths from trachea, bronchus and lung cancers (ICD-9 code 162), J - Deaths from larynx cancers (ICD-9 code 161), K - Deaths from pleural cancers (ICD-9 code 163), L - Deaths from bone, connective tissue, skin and breast cancers (ICD-9 codes 170-175), M - Deaths from breast cancers, among women (ICD-9 code 174), N - Deaths from genitourinary organs cancers (ICD-9 codes 179-189), O - Deaths from cancers of other and unspecified sites (ICD-9 codes 190-199), P - Deaths from malignant neoplasms of lymphatic and haemopoietic tissue (ICD-9 codes 200-208), Q - Deaths from multiple myelomas (ICD-9 codes 203), R- Deaths from leukemia (ICD-9 codes 204-208), S- Deaths from ischemic heart disease (ICD-9 codes 410-414), T - Deaths from cerebrovascular disease (ICD-9 codes 430-438), U - Deaths from respiratory diseases (ICD-9 codes 460-519), V - Deaths from diseases of the digestive system (ICD-9 codes 520-579), W - Deaths from diseases of the genito-urinary system (ICD-9 codes 580-629). Solid line indicates the rate. Shaded area indicates the 95 % confidence interval for graphs C, S and T. For the other graphs, upper limits of 95 % confidence intervals are truncated to maximum ASR value displayed on scale for graphical reasons (graphs A, D, F, G, H, I, L, M, N O, P, R, U, V, W) or the confidence interval is not shown (graphs B, E, J, K, Q). Abbreviation: ASR: age standardized rate. (DOCX 202 kb

Adjusted rate ratios for Multiple Sclerosis with different first symptoms among private subscribers to mobile phones in Denmark, 1987–1995, followed up through 2004.

<p>Adjusted rate ratios for Multiple Sclerosis with different first symptoms among private subscribers to mobile phones in Denmark, 1987–1995, followed up through 2004.</p

Adjusted rate ratios for Multiple Sclerosis among private subscribers to mobile phones in Denmark, 1987–1995, followed up through 2004.

<p>Adjusted rate ratios for Multiple Sclerosis among private subscribers to mobile phones in Denmark, 1987–1995, followed up through 2004.</p

Risk of death among Multiple Sclerosis patients with private subscriptions to mobile phones in Denmark. 1987–1995, followed up through 2004.

<p>Risk of death among Multiple Sclerosis patients with private subscriptions to mobile phones in Denmark. 1987–1995, followed up through 2004.</p

Figure 1

<p>Mobile phone subscription penetration in the Danish population by age in 1990 and 1995.</p