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COHORT OF WOMEN LIVING IN OR NEAR A HIGHLY INDUSTRIALIZED AREA OF KANAWHA RIVER VALLEY IN WEST VIRGINIA: ENDOMETRIOSIS AND BLOOD LEVELS OF DIOXIN AND DIOXIN-LIKE CHEMICALS
Citation:
DILIBERTO, J. J., L. Sirinek, J. Becker, D. Jude, W. Turner, B. Burkhalter, L. Haws, J. Tachovsky, R. B. LANDY, T. Hughes, AND L. S. Birnbaum. COHORT OF WOMEN LIVING IN OR NEAR A HIGHLY INDUSTRIALIZED AREA OF KANAWHA RIVER VALLEY IN WEST VIRGINIA: ENDOMETRIOSIS AND BLOOD LEVELS OF DIOXIN AND DIOXIN-LIKE CHEMICALS. Presented at 30th International Symposium on Halogenated Persistent Organic Pollutants, San Antonio, TX, September 12 - 17, 2010.
Impact/Purpose:
To evaluate the impact of potentially high background dioxin exposure on body burdens in women of reproductive age living in the Kanawha River Valley area and the relationship between the concentration of dioxins in their serum and the incidence of endometriosis
Description:
Introduction Historical releases of dioxin and dioxin-like chemicals with subsequent impacts to environmental media in the Kanawha River Valley (KRV) of West Virginia have been well documented.' The bulk of dioxin found in this area appears to be derived from the production of 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) and the disposal of associated wastes that occurred between ]948 and 1969. More than thirty years after production of 2,4,5-T was stopped, dioxins are still present in the soils, groundwater, and river water in portions of the Kanawha Valley, and high levels of dioxins have been detected in sediments of the Kanawha River and at outfall locations on the river. In addition, medical providers in the KRV region had observed a high incidence of young women being diagnosed with endometriosis. The objective of the present study was to evaluate the possibility of an association between serum concentrations of dioxin and dioxin-like chemicals and the presence or absence ofendometriosis as determined at the time of surgery in a cohort of women living in the area of the KRV. Materials and Methods The study was performed at Marshall University Medical Center (Huntington, WV). All relevant procedures were performed under Marshall University IRB approval, in accordance with 45 CFR 46.110(A)(8)(a). Physicians in the Department of Obstetrics and Gynecology recruited the patients, obtained informed consent, and performed surgical and diagnostic procedures. A detailed medical history, an environmental exposure questionnaire, and a blood (serum) sample were obtained from each of the study participants. The age of the participants ranged from 20 to 59. The test group consisted of patients undergoing diagnostic laparoscopy for endometriosis, or patients who had previously been diagnosed as having endometriosis and were undergoing hysterectomy or other related surgery for endometriosis. The control group was age-matched to the test group, and consisted of similar number ofeither symptomatic patients, undergoing diagnostic laparoscopy with negative findings, or asymptomatic patients, undergoing elective laparoscopy and laparotomy for other reasons, and confirmed to be free of endometriosis. Serum samples were analyzed by high-resolution gas chromatography/isotope-dilution high-resolution mass spectrometry for dioxin and dioxin-like chemicals.2-7 Results were reported on a whole-weight and lipid-adjusted basis and as international toxicity equivalents (WH02005 TEQs).8 Serum concentrations in the KRV cohort were compared to the general U.S. population based on data available in the National Health and Nutrition Examination Survey (NHANES).9,10 Statistical data summaries for the NHANES 2003-2004 dataset were generated using the "survey"package in"Rversion 2.9.1. 11 ,12 Confidence intervals around theme an were also used to compare NHANES and KRV datasets. Principal components analysis (PCA) was performed on the KRV cohort and was used to compare the fingerprints associated with the seventeen 2,3,7,8-dioxin/furan congeners and thirteen dioxin-like PCBs for the KRV participants with and without a diagnosis of endometriosis. 13 Regression analysis using logistic regression modeling was conducted on the KRV data to assess the potential association between endometriosis and serum TEQ. Results and Discussion. This study evaluated the impact of potentially high background dioxin exposure on body burdens in women of reproductive age living in or near KRV and the relationship between the women's dioxins serum levels and endometriosis. Through our comparisons to NHANES, PCA and regression analysis, we have shown that the KRV participants are comparable to the United States general population. Distributions and means of TEQ were found to be similar to or lower than a national representation of women aged 20-59 years old. As such, this study demonstrates that living in an area with high levels of contamination is not necessarily reflected in the body burden for this class of chemicals. This finding is consistent with that from another recent study that investigated the impact of exposures to dioxin contamination in a community on body burden. 14, 15 In addition, the results of the PCA demonstrate that KRV participants with and without a diagnosis ofendometriosis were not differentiable based on their PCDD/F and/or PCB congener profiles, indicating that endometriosis is not likely related to serum TEQ. Finally, logistic regression models indicated that endometriosis does not appear to be associated with levels ofdioxin and dioxin-like chemicals in serum, body mass Index (BMI), or age.