Serum Dioxin Concentrations and Endometriosis: A Cohort Study in Seveso, Italy. (Research Articles)

By Eskenazi, Brenda; Mocarelli, Paolo et al. | Environmental Health Perspectives, July 2002 | Go to article overview

Serum Dioxin Concentrations and Endometriosis: A Cohort Study in Seveso, Italy. (Research Articles)


Eskenazi, Brenda, Mocarelli, Paolo, Warner, Marcella, Samuels, Steven, Vercellini, Paolo, Olive, David, Needham, Larry L., Patterson, Donald G., Jr., Brambilla, Paolo, Gavoni, Nicoletta, Casalini, Stefania, Panazza, Stefania, Turner, Wayman, Gerthoux, Pier Mario, Environmental Health Perspectives


Dioxin, a ubiquitous contaminant of industrial combustion processes including medical waste incineration, has been implicated in the etiology of endometriosis in animals. We sought to determine whether dioxin exposure is associated with endometriosis in humans. We conducted a population-based historical cohort study 20 years after the 1976 factory explosion in Seveso, Italy, which resulted in the highest known population exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Participants were 601 female residents of the Seveso area who were [less than or equal to] 30 years old in 1976 and had adequate stored sera. Endometriosis disease status was defined by pelvic surgery, current transvaginal ultrasound, pelvic examination, and interview (for history of infertility and pelvic pain). "Cases" were women who had surgically confirmed disease or an ultrasound consistent with endometriosis. "Nondiseased" women had surgery with no evidence of endometriosis or no signs or symptoms. Other women had uncertain status. To assess TCDD exposure, individual levels of TCDD were measured in stored sera collected soon after the accident. We identified 19 women with endometriosis and 277 nondiseased women. The relative risk ratios (RRRs) for women with serum TCDD levels of 20.1-100 ppt and > 100 ppt were 1.2 [90% confidence interval (CI) = 0.3-4.5] and 2.1 (90% CI = 0.5-8.0), respectively, relative to women with TCDD levels [less than or equal to] 20 ppt. Tests for trend using the above exposure categories and continuous log TCDD were nonsignificant. In conclusion, we report a doubled, nonsignificant risk for endometriosis among women with serum TCDD levels of 100 ppt or higher, but no clear dose response. Unavoidable disease misclassification in a population-based study may have led to an underestimate of the true risk of endometriosis. Key words: dioxin, endometriosis, environmental exposures, epidemiology.

**********

The compound 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin), the most toxic halogenated aromatic hydrocarbon (1), is a ubiquitous contaminant of various industrial and combustion processes, including medical waste incineration. Dioxin is classified as a known human carcinogen (1), and concern about the reproductive toxicity of dioxin has been growing (2). Partially because of this concern, the U.S. Environmental Protection Agency and the World Health Organization have conducted a reassessment of dioxin, including human health consequences (3,4).

In the past decade, several animal studies have suggested that prenatal and postnatal exposure to dioxin and dioxin-like chemicals may profoundly affect the reproductive systems of both male and female animals perhaps via endocrine disruption (2). Some articles have concluded that dioxin-like compounds may be responsible for the failure of certain animal species to reproduce (5) and for a decrease in human sperm count (6). Another publication has noted high frequencies of endometriosis among infertile women living in Belgium, where breast milk concentrations of dioxin are among the highest in the world (7). The etiology of endometriosis is unknown (8). An association of dioxin with endometriosis is of public health significance because the estimated prevalence of endometriosis ranges from 1 to 10% in women of reproductive age (8) and because endometriosis is associated with significant costs for hospitalization and workdays lost (8).

Experimental animal evidence supports the association of endometriosis and exposure to dioxin-like chemicals. In 1993, Rier et al. (9) reported a dose-response relation between TCDD levels (5 and 25 ppt) in feed and the incidence and severity of endometriosis in 6- to 10-year-old adult rhesus monkeys, diagnosed a decade after dosing ceased. TCDD has also promoted the survival and growth of surgically induced endometrial implants in nonhuman primates (10) and in mice (11-13), but not in rats (12). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Serum Dioxin Concentrations and Endometriosis: A Cohort Study in Seveso, Italy. (Research Articles)
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.