Nasopharyngeal carcinoma (NPC) has a unique and complex etiology that is not completely understood. Although NPC is rare in most populations, it is a leading form of cancer in a few well-defined populations, including natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. The distinctive racial/ethnic and geographic distribution of NPC worldwide suggests that both environmental factors and genetic traits contribute to its development. This review aims to summarize the current knowledge regarding the epidemiology of NPC and to propose new avenues of research that could help illuminate the causes and ultimately the prevention of this remarkable disease. Well-established risk factors for NPC include elevated antibody titers against the Epstein-Barr virus, consumption of salt-preserved fish, a family history of NPC, and certain human leukocyte antigen class I genotypes. Consumption of other preserved foods, tobacco smoking, and a history of chronic respiratory tract conditions may be associated with elevated NPC risk, whereas consumption of fresh fruits and vegetables and other human leukocyte antigen genotypes may be associated with decreased risk. Evidence for a causal role of various inhalants, herbal medicines, and occupational exposures is inconsistent. Other than dietary modification, no concrete preventive measures for NPC exist. Given the unresolved gaps in understanding of NPC, there is a clear need for large-scale, population-based molecular epidemiologic studies to elucidate how environmental, viral, and genetic factors interact in both the development and the prevention of this disease.

https://cebp.aacrjournals.org/content/cebp/15/10/1765.full.pdf

The enigmatic epidemiology of nasopharyngeal carcinoma.

In a follow–up to the 2011 United Nations (UN) high level political declaration on non-communicable diseases (NCDs) [1], the World Health Assembly, in 2012, endorsed a new health goal (the “25 by 25 goal”), which focuses on reduction of premature deaths from COPD and other NCDs by 25% by the year 2025 [2]. Despite this initiative, experts have reported that COPD remains a growing [3], but neglected global epidemic [4]. The World Health Organization (WHO) estimated that there were about 62 million people with moderate to severe COPD in 2002, with the total number of COPD cases predicted to increase to about 200 million in 2010 [5,6]. According to the 2010 Global Burden of Disease (GBD) study, COPD was responsible for about 5% of global disability–adjusted life years – DALYs (76.7 million) – and 5% of total deaths (2.9 million) [7,8]. COPD is currently rated the fourth most common specific cause of death globally and predicted to be the third by 2030, in the absence of interventions that address the risks – especially tobacco smoking, exposures to combustion products of biomass fuels and environmental pollution [9,10].

The burden of COPD has been reported to be high in some high–income countries (HIC), particularly due to high prevalence of smoking in these settings [11]. For example, between years 2000 and 2010, about 4%–10% of adults were diagnosed with non–reversible and progressive airway obstruction (a basic feature of COPD) in population–based surveys across many European countries, with smoking indicated as a major risk [12]. The WHO has estimated that in many HIC up to 73% of COPD deaths are related to tobacco smoking [6]. The European Union (EU) reported that the direct cost from COPD was over 38.6 billion Euros in 2005, representing about 3% of total health care expenditure [13,14]. In the United States (US), over 2.7 million adults were estimated to have COPD in 2011, with about 135 000 deaths reported [15]. In 2010, the US government spent nearly US$ 49.9 billion on COPD, including 29.5 billion spent on direct health care, 8.0 billion on indirect morbidity and 12.4 billion on indirect mortality costs, respectively [15].

Meanwhile, it has been estimated that despite a high prevalence of COPD in some HIC, 90% of COPD deaths still occur in low– and middle–income countries (LMIC)in the future

[4] and 40% of these deaths are attributable to smoking [6]. The burden in LMIC has been comparatively high owing to relatively low COPD awareness, challenges with COPD diagnosis and increased exposures to additional risk factors, especially combustion products of biomass fuels [16]. Salvi and colleagues reported that about 3 billion people globally are exposed to smoke from biomass fuel, compared to 1 billion people who smoke tobacco globally [17]. In many developing countries COPD is neglected by governments, physicians, experts and the pharmaceutical industry, although it's been identified as an important public health problem [4].

In the last two decades, the Burden of Obstructive Lung Disease (BOLD) initiative has been collecting country–specific data on the prevalence, risk factors and socioeconomic burden of COPD, using standardized and tested methods for conducting COPD surveys in the general population [18]. This is expected to provide governments of many nations with country–specific evidence on which to develop policy on COPD prevention and management [18]. As noted above, this initiative is yet to take a full effect in many LMIC [19]. In addition, spirometry (the gold standard for COPD diagnosis) is not widely available in many LMIC [16]. Even when it is there, professionals in LMIC are often not being trained properly on how to use spirometers or interpret spirometry results. There is concern that COPD burden has been underestimated, owing to over–reliance on doctor’s diagnosis, with many diagnoses not being based on spirometry and international diagnostic guidelines [20]. The lack of routine COPD data collation and effective health information management system in many LMIC also implies that these settings could have been grossly under–represented in global burden of COPD estimates [11].

Some global and regional estimates of COPD burden have been published [1,21–23]. However, despite the fact that COPD is now prevalent in both HIC and LMIC, experts have raised concerns that reliable estimates of COPD prevalence are still few in many parts of the world. Moreover, many of the estimates are based on varying definitions and diagnostic criteria of COPD [9]. Also, some of the current estimates were reported before the BOLD surveys in several countries, thereby failing to account for the additional spirometry–based epidemiological data from the BOLD surveys. There is a need for a revised and updated estimate of COPD prevalence across world regions. We conducted a systematic review of COPD prevalence based on spirometry data across world regions. Our aim was to provide global and regional prevalence rates of COPD that could facilitate adequate policy response in these regions.

/pdf/global-and-regional-estimates-of-copd-prevalence-systematic-hk9qdazoi3.pdf

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis.

2005년 담배규제기본협약이 발효된 후 현재 2009년 현재 164개국이 그 협약에 비준한 상태이다. 비준국들은 기준 협약이 정한 기준에 맞추어 담배규제와 관련한 국내법적 조치들을 취하고 있다. 미국의 경우에도 2009년 6월 가족금연 및 담배규제법을 제정하여 통과시킴으로써 담배규제에 관한 새로운 전기를 맞게 되었다. 미국의 가족 금연 및 담배규제법의 중심적인 내용은 FDA에게 담배규제에 관한 포괄적인 권한을 부여하고, 담배수요를 억제하기 위한 조치로서 담배제조업자 및 수입업자로 하여금 보건부 장관에게 담배성분 및 첨가물 등에 대한 구체적인 정보를 제공하도록 하고 있다. 또한 담배포장 및 표시 규제와 관련하여 소비자를 오도할 수 있는 표시를 금지하는 한편, 담배광고 판촉 등에 대한 규제 권한을 연방의회에 부여하고 있다. 그리고 담배공급 감소조치로서는 불법담배의 거래를 방지하기 위해 라벨링, 검사, 기록 등을 유지하도록 하고 특히 기존의 법안들이 미성년자의 담배 구매 및 판매를 줄이기에는 미흡한 점이 있음을 인식하고 이 법안에서 보다 구체적이고 포괄적으로 규제를 강화하였다. 우리나라의 경우에도 기본협약의 비준국가로서 국내법적 조치를 취할 의무를 부담하고 있는데, 담배규제법안을 마련함에 있어 미국을 비롯한 다른 나라의 입법례들을 참고할 필요가 있다. 또한 담배규제법안의 규정방향을 정함에 있어서 몇 가지 고려해야 할 법적 쟁점들이 있다. 우선 흡연권의 기본권성 인정 여부와 관련하여 그 흡연권의 기본권성을 부정하는 입장에 섬으로써 담배와 관련한 규제의 정당성을 부여받을 수 있고, 또한 담배사업은 현 세대 뿐만 아니라 미래세대에 유해한 영향을 미치는 것으로 헌법적으로 보호받을 가치가 없는 것이다. 따라서 담배광고에 대한 포괄적인 금지 조치를 취하는 것이 우리 헌법적 원칙에 위배된다고 할 수 없다. 그리고 현행 담배사업법과 국민건강증진법으로 이원화되어 있는 법을 담배규제법안으로 일원화함으로써 담배규제를 효율적이고 통일적으로 수행해나갈 수 있을 것으로 기대된다. 이러한 기본적 사항들을 염두에 두고서 담배규제법안을 마련함에 있어서 미국 등 외국의 법들을 참고하여 보다 구체적이고 명확하게 담배규제를 할 수 있는 법안을 마련하여야 할 것이다.

미국의 가족금연 및 담배규제법(Family Smoking Prevention and Tobacco Control Act) 제정을 통해 본 우리의 입법과제

In industrial workers, formaldehyde exposure has been associated with cancer of the nasal cavities, nasopharynx, prostate, lung, and pancreas; however, these associations are inconsistent and remain controversial. Animals exposed to formaldehyde show excesses of nasal cancer. In an extended follow-up of a large cohort of formaldehyde-exposed workers, the authors evaluated mortality from solid cancers (1,921 deaths) among 25,619 workers (865,708 person-years) employed in 10 US formaldehyde-producing or -using facilities through 1994. Exposure assessment included quantitative estimates of formaldehyde exposure. Standardized mortality ratios and relative risks were calculated. Compared with that for the US population, mortality from solid cancers was significantly lower than expected among subjects exposed and nonexposed to formaldehyde (standardized mortality ratios = 0.91 and 0.78, respectively). Relative risks for nasopharyngeal cancer (nine deaths) increased with average exposure intensity, cumulative exposure, highest peak exposure, and duration of exposure to formaldehyde (p-trend = 0.066, 0.025, <0.001, and 0.147, respectively). Formaldehyde exposure did not appear to be associated with lung (744 deaths), pancreas (93 deaths), or brain (62 deaths) cancer. Although relative risks for prostate cancer (145 deaths) were elevated for some measures of formaldehyde exposure, the trend was inconsistent. In this cohort of formaldehyde-industry workers, some evidence was found of an exposure-response relation with mortality from nasopharyngeal cancer (based on small numbers) but not for cancers of the pancreas, brain, lung, or prostate.

/pdf/mortality-from-solid-cancers-among-workers-in-formaldehyde-kjcytdx4kz.pdf

Mortality from Solid Cancers among Workers in Formaldehyde Industries

Aspartame is a methyl ester of a dipeptide used as a synthetic nonnutritive sweetener in over 90 countries worldwide in over 6000 products. The purpose of this investigation was to review the scientific literature on the absorption and metabolism, the current consumption levels worldwide, the toxicology, and recent epidemiological studies on aspartame. Current use levels of aspartame, even by high users in special subgroups, remains well below the U.S. Food and Drug Administration and European Food Safety Authority established acceptable daily intake levels of 50 and 40 mg/kg bw/day, respectively. Consumption of large doses of aspartame in a single bolus dose will have an effect on some biochemical parameters, including plasma amino acid levels and brain neurotransmitter levels. The rise in plasma levels of phenylalanine and aspartic acid following administration of aspartame at doses less than or equal to 50 mg/kg bw do not exceed those observed postprandially. Acute, subacute and chronic toxicity studies with aspartame, and its decomposition products, conducted in mice, rats, hamsters and dogs have consistently found no adverse effect of aspartame with doses up to at least 4000 mg/kg bw/day. Critical review of all carcinogenicity studies conducted on aspartame found no credible evidence that aspartame is carcinogenic. The data from the extensive investigations into the possibility of neurotoxic effects of aspartame, in general, do not support the hypothesis that aspartame in the human diet will affect nervous system function, learning or behavior. Epidemiological studies on aspartame include several case-control studies and one well-conducted prospective epidemiological study with a large cohort, in which the consumption of aspartame was measured. The studies provide no evidence to support an association between aspartame and cancer in any tissue. The weight of existing evidence is that aspartame is safe at current levels of consumption as a nonnutritive sweetener.

/pdf/aspartame-a-safety-evaluation-based-on-current-use-levels-2xa9v8yatl.pdf

Aspartame: A Safety Evaluation Based on Current Use Levels, Regulations, and Toxicological and Epidemiological Studies

Background: About 30% of college students have smoked hookah tobacco. Although most students perceive this product to be innocuous and non-addictive, hookah tobacco increases the risk for disease and nicotine dependence. Currently, the US Food and Drug Administration (FDA) does not regulate the manufacture, distribution, or sale of hookah tobacco. Objective: Empirical literature pertaining to hookah tobacco smoking is reviewed with a focus on the implications for regulatory policy. Methods: PubMed, PsycINFO, and Scopus databases were searched to locate articles published in English. The literature search combined several key words including “hookahs”, “college”, “advertising”, “health effects”, and “health policy”. Results: Smoking hookah tobacco may play a role in the initiation of smoking among tobacco-naive college students and may portend persistent smoking among those who have smoked cigarettes. College students are typically nondaily, social smokers. They do not perceive that their heightene...

https://www.tandfonline.com/doi/pdf/10.3109/00952990.2015.1043738

Review of hookah tobacco smoking among college students: policy implications and research recommendations

Objectives: To assess the possible relationship between formaldehyde exposure and mortality risk from pharyngeal cancer (PC), in particular nasopharyngeal cancer (NPC). Methods: Subjects were 7328 workers employed at a plastics-producing plant (1941-1984). Vital status for 98% of the cohort and cause of death for 95% of 2872 deaths were determined. Reconstructed exposures to formaldehyde, particulates and pigment were used to compute several exposure measures. Standardized mortality ratios (SMRs) were computed for several demographic, work history and formaldehyde exposure variables. In a nested case-control study, seven cases of NPC and 15 cases of other PC were matched on race, sex, age and year of birth to four controls from the cohort. Among interviewed subjects, lifetime smoking history was determined using respondents or proxies for all but one control subject. Results: Statistically significant 2.23-fold and fivefold excesses for PC and NPC, respectively, were observed. Fivefold range NPC excesses ...

Pharyngeal cancer mortality among chemical plant workers exposed to formaldehyde.

Extensive research is conducted to evaluate the safety and efficacy of candidate drugs prior to marketing and distribution, but few epidemiological studies have examined the occupational health of production workers who manufacture these drugs This paper reviewed the occupational health research published during 1973-2014 regarding adverse health outcomes in pharmaceutical manufacturing workers Most investigations were prompted by suspected disease clusters Workers generally had a better mortality experience than their referent populations, but they experienced adverse health outcomes including cancer, endocrine dysfunction, cancer, and liver disease However, most studies lacked detailed occupational exposure data, and they failed to identify the chemicals used in drug manufacture, including the active pharmaceutical ingredients (APIs) Integrated occupational health research is needed to evaluate exposures and long-term health outcomes among these workers Since manufacturing operations are frequently outsourced to plants in Asia, this research could inform mitigation measures to protect production workers in this global industry

/pdf/health-hazards-in-the-pharmaceutical-industry-jd457cipn1.pdf

Health Hazards in the Pharmaceutical Industry

OBJECTIVE The prevalence of obstructive lung disease is rising in the United States, particularly among those of African descent. Rates of ventilatory impairment and reported respiratory symptoms were examined in a cross-sectional study of urban Nigerian civil servants who are in transition to a westernized lifestyle. DESIGN 410 civil servants (235 men, 175 women) aged 30-69 years in Benin City, Nigeria (West Africa) were recruited for a cross-sectional study on respiratory health and compared to 3,397 African Americans enrolled in NHANES III between 1988 and 1994. METHODS Forced vital capacity (FVC), expiratory flow rate in 1 sec (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were measured by spirometry. Demographic characteristics and respiratory symptoms were ascertained by questionnaire. RESULTS Nigerians had lower age and height adjusted FVC and FEV1 than African Americans in both genders, independent of smoking and respiratory disease. However, relative lung function was better among Nigerians. Fewer Nigerians had an age-adjusted FEV1/FVC ratio below 0.70 than African Americans (10.54 vs 14.10/100 men, 6.29 vs 8.67/100 women). Overall, Nigerians had a lower age-adjusted prevalence of any self-reported respiratory symptoms than African Americans (3.65 vs 22.90/100 men, 4.57 vs 35.38/100 women). Similarly, Nigerians had a lower age-adjusted prevalence of current smoking than African Americans (10.82 vs 46.50/100 in men and 0 vs 30.93/100 in women). CONCLUSIONS Urban Nigerians who have limited exposure to cigarette smoke and who work in a non-industrial setting have a low prevalence of obstructive lung disease.

Differences in rates of obstructive lung disease between Africans and African Americans.

OBJECTIVE This longitudinal investigation examined the hypothesis that subjective experience during consumption of preferred drugs mediates the association of transmissible risk for substance use disorder (SUD) measured in childhood and adolescence, and SUD diagnosis in adulthood. Transmissible risk denotes the psychological characteristics having intergenerational continuity between parents and their biological children. METHODS The transmissible liability index (TLI) was administered to four hundred eighty-three 10 to 12-year-old boys (baseline). Follow-up evaluations were conducted when the boys attained 12-14, 16, 19, and 22 years of age, using age-specific versions of the TLI. Frequency of consumption of the participants' three most preferred drugs, affect on an ordinary day, affect while under influence of the preferred substances, and presence/absence of current SUD were assessed at 22 years of age. RESULTS Consumption frequency of preferred drugs among boys mediates the association of transmissible risk during childhood, and adolescence and SUD diagnosis in adulthood. Severity of negative affect on a drug-free day predicts frequency of consumption of preferred drugs, which, in turn, predicts severity of negative affect during the drug use event. Neither affect on a drug-free day nor affect during the drug use event mediates the association of transmissible risk and SUD. CONCLUSIONS Affect on drug-free days, and while under influence of preferred substances, covary with consumption frequency; however, affect is not related to transmissible SUD risk or SUD outcome.

/pdf/longitudinal-modeling-of-the-association-between-3czbx5fa8a.pdf

Irene M Gathuru

Papers

Review of hookah tobacco smoking among college students: policy implications and research recommendations

Pharyngeal cancer mortality among chemical plant workers exposed to formaldehyde.

Health Hazards in the Pharmaceutical Industry

Differences in rates of obstructive lung disease between Africans and African Americans.

Longitudinal Modeling of the Association Between Transmissible Risk, Affect During Drug Use and Development of Substance Use Disorder.