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Liu, Yunwei, Ning Qin, Weigang Liang, Xing Chen, Rong Hou, Yijin Kang, Qian Guo, Suzhen Cao, and Xiaoli Duan. "Polycycl. Aromatic Hydrocarbon Exposure of Children in Typical Household Coal Combustion Environments: Seasonal Variations, Sources, and Carcinogenic Risks." International Journal of Environmental Research and Public Health 17, no. 18 (September 8, 2020): 6520. http://dx.doi.org/10.3390/ijerph17186520.
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Polycyclic aromatic hydrocarbon (PAH) emissions from the combustion of household solid coal for cooking and heating cause great harm to public health in China, especially in less developed areas. Children are one of the most susceptible population groups at risk of indoor air pollutants due to their immature respiratory and immune systems. However, information on PAH exposure of children is limited due to limited monitoring data. In this study, we aimed to assess the seasonal differences of PAHs in classrooms, analyze the pollutant sources, and calculate the incremental lifetime cancer risk attributable to PAHs in Shanxi Provence. A typical school using household coal combustion in Shanxi Province was selected. Fine particulate matter (PM2.5)samples were collected by both individual samplers and fixed middle-flow samplers during the heating and non-heating seasons in December 2018 and April 2019. The PAH concentrations in PM2.5 samples were analyzed by a gas chromatograph coupled to a mass spectrometer. The results showed that PAH concentrations in PM2.5 varied between 89.1 ng/m3 in the heating season and 1.75 ng/m3 in the non-heating season. The mean concentrations of benzo[a]pyrene (BaP), a carcinogenic marker of PAHs, were 10.3 and 0.05 ng/m3 in the heating and non-heating seasons, respectively. Source allocation analysis of individual portable and passive samplers revealed that the main contributors during heating and non-heating seasons were coal combustion and gasoline sources, respectively. According to the results of a Monte Carlo simulation, the incremental lifetime cancer risk values from the inhalation of PAHs in the heating and non-heating seasons were 3.1 × 10−6 and 5.7 × 10−8, respectively. The significant increase in PAHs and the incremental lifetime cancer risk in the heating season indicates that children are more exposed to health threats in winter. Further PAH exposure control strategies, including reducing coal usage and promoting clean fuel applications, need to be developed to reduce the risk of PAH-induced cancer.
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Li, Chaocan, Xiaopeng Zhang, Xuqin Wang, Xinbo Zhang, Shigang Liu, Ting Yuan, Weigui Qu, and Youjun Zhang. "Distribution Characteristics and Potential Risks of Polycyclic Aromatic Hydrocarbon (PAH) Pollution at a Typical Industrial Legacy Site in Tianjin, North China." Land 11, no. 10 (October 15, 2022): 1806. http://dx.doi.org/10.3390/land11101806.
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Polycyclic aromatic hydrocarbon (PAH) pollution in the soil of industrial legacy sites is a prominent problem when reusing urban land. To estimate the potential risks of PAHs, this study investigated 16 priority PAHs in the soil at different depths in a typical decommissioned industrial site in Tianjin. PAH concentrations were determined via gas chromatography-(tandem) quadrupole mass spectrometry. Incremental lifetime cancer risk (ILCR) assessment was applied to assess the potential risks to the population after land reconstruction. The total concentrations of PAHs in the soil at different depths ranged from 38.3 ng·g−1 to 1782.5 ng·g−1, which were below the risk control standard for soil contamination of development land (GB 36600-2018). Low-ring (two-three ring) PAHs exhibit a dominant component, and the variations in PAH compositions were closely related to the former production units and soil properties. Compared to silty clay layers, PAHs tended to accumulate in the permeable miscellaneous fill layers. Incremental lifetime cancer risk assessment values associated with different exposure pathways for children, adolescents, and adults were calculated. The results showed potential carcinogenic risks for people of varying ages in this area, but they were still acceptable. In general, this legacy site can meet the demands of sustainable land development.
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Tsoi, D. T., M. Inoue, C. M. Kelly, S. Verma, and K. Pritchard. "Cost-effectiveness analysis of oncotype DX-guided treatment in early breast cancer." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e11536-e11536. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11536.
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e11536 Background: Some early breast cancer patients with hormone receptor positive (HR+) disease may benefit from adjuvant chemotherapy in addition to hormonal therapy. Most guidelines recommend the addition of adjuvant chemotherapy for majority of women, leading to overtreatment causing considerable morbidity and cost. There has been recent incorporation of gene expression analysis to help aid in adjuvant chemotherapy decision making. We evaluated the cost-effectiveness of Oncotype DX-guided treatment as compared to treatment guided by Adjuvant! Online program. Methods: A Markov model was developed to compare the cost- effectiveness of treatment guided by either Oncotype DX or Adjuvant! Online in a cohort of 50-year-old women with HR+, lymph node negative breast cancer over a lifetime horizon. We assumed women assessed to be high risk all received chemotherapy followed by tamoxifen, and that those assessed to be low risk received tamoxifen only. The model took a health care payer's perspective with results reported in 2008 Canadian dollars ($). Event rates, costs and utilities were derived from the literature. Both costs and benefits were discounted at 5%. Sensitivity analysis for key parameters in the model was conducted. Outcome measures were life year gained, quality- adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Results: For a 50-year-old woman, Oncotype DX-guided treatment was associated with an incremental lifetime cost of $4,200 and a gain in 0.067 QALY, with an ICER of $61,800/QALY compared with treatment guided by Adjuvant! ICER was positively correlated to the cost of Oncotype DX and the age of patients. Results were most sensitive to probabilities relating to risk categorization and recurrence rate. Conclusions: Relative to Adjuvant!-guided treatment, Oncotype DX-guided treatment appears cost-effective with an ICER of $61,800/QALY from a Canadian health care perspective. [Table: see text]
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Zhang, Hui, Jia Jia Zhao, Ai Min Song, and Ming Wei Song. "Health Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in the Pearl River Delta." Applied Mechanics and Materials 260-261 (December 2012): 631–36. http://dx.doi.org/10.4028/www.scientific.net/amm.260-261.631.
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The objective of this study was to quantify PAHs exposure level for different resident groups and to estimate the incremental lifetime cancer risk for people in the Pearl River Delta. A multimedia/multipathway exposure model recommended by USEPA was employed in this study. Results indicated that the average cancer risk of exposure to PAH16 was 2.63×10-5 a-1 and the loss of life expectancy was 163.48 minutes. Considering the large amounts of PAHs emitted into the ambient environment in China and the loss of life expectancy, it is extremely important to take a preliminary health risk assessment of citizens exposed to PAHs in the Pearl River Delta.
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Ehrhardt, Matthew J., Zachary J. Ward, Qi Liu, Aeysha Chaudhry, Anju Nohria, William Border, Joy M. Fulbright, et al. "Cost-Effectiveness of the International Late Effects of Childhood Cancer Guideline Harmonization Group Screening Guidelines to Prevent Heart Failure in Survivors of Childhood Cancer." Journal of Clinical Oncology 38, no. 33 (November 20, 2020): 3851–62. http://dx.doi.org/10.1200/jco.20.00418.
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PURPOSE Survivors of childhood cancer treated with anthracyclines and/or chest-directed radiation are at increased risk for heart failure (HF). The International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms, but evidence supporting its frequency and cost-effectiveness is limited. PATIENTS AND METHODS Using the Childhood Cancer Survivor Study and St Jude Lifetime Cohort, we developed a microsimulation model of the clinical course of HF. We estimated long-term health outcomes and economic impact of screening according to IGHG-defined risk groups (low [doxorubicin-equivalent anthracycline dose of 1-99 mg/m2 and/or radiotherapy < 15 Gy], moderate [100 to < 250 mg/m2 or 15 to < 35 Gy], or high [≥ 250 mg/m2 or ≥ 35 Gy or both ≥ 100 mg/m2 and ≥ 15 Gy]). We compared 1-, 2-, 5-, and 10-year interval-based screening with no screening. Screening performance and treatment effectiveness were estimated based on published studies. Costs and quality-of-life weights were based on national averages and published reports. Outcomes included lifetime HF risk, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000 per QALY gained were considered cost-effective. RESULTS Among the IGHG risk groups, cumulative lifetime risks of HF without screening were 36.7% (high risk), 24.7% (moderate risk), and 16.9% (low risk). Routine screening reduced this risk by 4% to 11%, depending on frequency. Screening every 2, 5, and 10 years was cost-effective for high-risk survivors, and every 5 and 10 years for moderate-risk survivors. In contrast, ICERs were > $175,000 per QALY gained for all strategies for low-risk survivors, representing approximately 40% of those for whom screening is currently recommended. CONCLUSION Our findings suggest that refinement of recommended screening strategies for IGHG high- and low-risk survivors is needed, including careful reconsideration of discontinuing asymptomatic left ventricular dysfunction and HF screening in low-risk survivors.
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Ehrhardt, Matthew J., Zachary J. Ward, Qi Liu, Aeysha Chaudhry, Anju Nohria, William L. Border, Leslie L. Robison, et al. "Cost-effectiveness of screening guidelines to prevent heart failure in childhood cancer survivors: A report from the Childhood Cancer Survivor Study (CCSS)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10052. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10052.
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10052 Background: Childhood cancer survivors treated with anthracyclines or chest radiation therapy (RT) are at risk for left ventricular dysfunction (LVD) and subsequent heart failure (HF). The International Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms for LVD, but evidence supporting its frequency and cost-effectiveness is limited. Methods: Using data from the CCSS, we developed a microsimulation model of the clinical course of LVD and HF to estimate long-term health and economic outcomes associated with screening for IGHG-defined risk groups (low [anthracycline 1-99 mg/m2 and/or RT < 15 Gy], moderate [100 to < 250 mg/m2 or 15 to < 35 Gy], high [≥ 250 mg/m2 or ≥ 35 Gy or (≥ 100 mg/m2 and ≥ 15 Gy)]). We compared 1, 2, and 5-year interval-based screening to no screening. Screening performance and pharmacological treatment effectiveness were based on published studies. Costs and quality of life weights were based on US averages and published studies. Outcomes included lifetime HF risk, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000/QALY gained were considered cost-effective. Results: Among the IGHG risk groups, the lifetime HF risk in the absence of screening was 37% (high), 25% (moderate) and 17% (low). Screening every 2 or 5 years was cost-effective for the high-risk group, and every 5 years for the moderate-risk group. In contrast, routine screening may not be cost-effective for the low risk group, representing ~40% of those for whom screening is currently recommended. Conclusions: Our findings can inform screening guidelines and suggest that LVD/HF surveillance for low-risk survivors warrants careful consideration. [Table: see text]
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Bamuwamye, Michael, Patrick Ogwok, Vivian Tumuhairwe, Richard Eragu, Henriettah Nakisozi, and Patrick Engeu Ogwang. "Human Health Risk Assessment of Heavy Metals in Kampala (Uganda) Drinking Water." Journal of Food Research 6, no. 4 (June 3, 2017): 6. http://dx.doi.org/10.5539/jfr.v6n4p6.
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Levels of aluminium, arsenic, cadmium, chromium, copper, iron, mercury, manganese, nickel, lead and zinc in tap water, groundwater-fed protected spring and bottled water were determined. The cancer and non-cancer risks associated with ingestion of heavy metals (HM) were also assessed for both children and adults. Forty seven water samples obtained from five divisions of Kampala city were analyzed using atomic absorption spectrophotometry. Cancer and non-cancer risks were determined using incremental lifetime cancer risk (ILCR) and non-carcinogenic hazard quotient (HQ), respectively. Lead content was higher than permissible limits (PL) according to East African Standard, World Health Organization, European Union and United States Environmental Protection Agency (USEPA). Arsenic showed minor exceedances above guideline values in tap water and groundwater-fed protected spring, whereas mercury, manganese and nickel were higher than PL. Levels of aluminium, cadmium, chromium, copper, iron, and zinc were below the PL. The lifetime risk of developing cancer through the oral route was greater than the USEPA acceptable level for both children and adults, revealing that exposure to HM in drinking water posed an unacceptable potential cancer risk. Arsenic contributed ca. 90% of the ILCR in tap water and groundwater-fed protected spring. The combined non-cancer risk of the HM expressed as hazard index (HI) was greater than one, with values for children being higher than those for adults. Lead contribution towards HI was in all cases above 90%. These results demonstrate the presence of alarming non-cancer risks for children.
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Hillner, B. E., J. M. Kirkwood, M. B. Atkins, E. R. Johnson, and T. J. Smith. "Economic analysis of adjuvant interferon alfa-2b in high-risk melanoma based on projections from Eastern Cooperative Oncology Group 1684." Journal of Clinical Oncology 15, no. 6 (June 1997): 2351–58. http://dx.doi.org/10.1200/jco.1997.15.6.2351.
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PURPOSE Interferon alfa-2b (IFN) in a randomized clinical trial (E1684) prolonged relapse-free and total survival in high-risk resected melanoma. However, the costs and toxicities of IFN are barriers to its widespread use. This study was undertaken to analyze the projected costs and long-term benefits of IFN by combining prospectively collected data on IFN actual dosage, time of recurrence, and survival with secondary data on long-term melanoma recurrence risks to project the cost-effectiveness of adjuvant IFN compared with observation. PATIENTS AND METHODS Two hypothetical cohorts of 50-year-old melanoma patients whose mean IFN dosage and clinical results were directly taken from E1684 were included in the study. Melanoma recurrence risks beyond 5 years were derived from international databases. Melanoma recurrence care costs and quality-of-life adjustments, when considered, were based on expert consensus. End points were incremental costs, life-years gained, and cost per life-year gained with and without quality-of-life adjustments. RESULTS The IFN cohort was projected to have an increased (undiscounted) survival of 0.52 years at 7 years and 1.90 years over a lifetime. The projected incremental cost (in 1996 United States dollars) per life-year gained in the IFN cohort ranged from $13,700 after 35 years to $32,600 at 7 years, the median follow-up of E1684. Using assigned quality-of-life values for IFN and recurrence, the lifetime cost per quality adjusted life-year increased to $15,200. Even if treatment costs for recurrence were excluded, the lifetime incremental cost per life-year gained was $21,600. CONCLUSION The cost and toxicity of IFN must be balanced against its projected benefits in high-risk melanoma. The derived cost-effectiveness and cost-utility ratios for IFN were comparable to other cancer interventions for which cost-effectiveness analysis has been performed.
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Room, Shahzada Amani, Chia En Lin, Shih Yu Pan, Ta Chih Hsiao, Charles C. K. Chou, and Kai Hsien Chi. "Incremental Lifetime Cancer Risk of PAHs in PM2.5 via Local Emissions and Long-Range Transport during Winter." Aerosol and Air Quality Research 23 (2023): 220319. http://dx.doi.org/10.4209/aaqr.220319.
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Bamuwamye, Michael, Patrick Ogwok, Vivian Tumuhairwe, Richard Eragu, Henriettah Nakisozi, and Patrick E. Ogwang. "Dietary Content and Potential Health Risks of Metals in Commercial Black Tea in Kampala (Uganda)." Journal of Food Research 6, no. 6 (September 23, 2017): 1. http://dx.doi.org/10.5539/jfr.v6n6p1.
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Tea (Camellia sinensis (L.) Kuntze) is among the most widely consumed non-alcoholic beverages. It is a rich source of essential dietary elements mainly potassium and manganese. Tea may also contain toxic metals such as cadmium and lead which pose a threat to human health because of their toxicity. Twenty samples of commercial black tea in Kampala city were randomly obtained and analysed for potassium, sodium, aluminium, arsenic, cadmium, chromium, copper, iron, mercury, manganese, nickel, lead and zinc using Atomic Absorption Spectrophotometry. Human health risks due to exposure to toxic elements from daily consumption of tea were determined using incremental lifetime cancer risk and non-cancer hazard quotient. Metal contents of black tea sold in Kampala were below international regulatory limits. The estimated daily intake of the elements in two grams of black tea was below the recommended values. Hazard quotient and hazard index were within acceptable range. Total cancer risk levels for all the teas were also within United States Environmental Protection Agency (USEPA) acceptable range. Daily consumption of one cup containing two grams of black tea over a lifetime will promote consumer overall health and wellbeing.
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Pongpiachan, Siwatt. "Incremental Lifetime Cancer Risk of PM2.5 Bound Polycyclic Aromatic Hydrocarbons (PAHs) before and after the Wildland Fire Episode." Aerosol and Air Quality Research 16, no. 11 (2016): 2907–19. http://dx.doi.org/10.4209/aaqr.2015.01.0011.
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Shaver, Amy L., Theresa A. Tufuor, Jing Nie, Shauna Ekimura, Keri Marshall, Susan Hazels Mitmesser, and Katia Noyes. "Cost-Effectiveness of Nutrient Supplementation in Cancer Survivors." Cancers 13, no. 24 (December 14, 2021): 6276. http://dx.doi.org/10.3390/cancers13246276.
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Cancer patients are at risk for malnutrition; the aim of this study was to provide a cost-effectiveness analysis of dietary supplementation in cancer survivors. We estimated prevalence of supplementation, hospitalization rates, quality of life (QOL), cost of care and mortality among cancer survivors. We built a decision analytic model to simulate life-long costs of health care and supplementation and QOL among cancer survivors with and without supplementation. Cost of supplements was derived from national pharmacy databases including single- and multivitamin formularies. One-way and probabilistic sensitivity analysis were performed to evaluate the robustness of the incremental cost-effectiveness ratio (ICER) to changes in supplementation costs and duration. The study cohort represented the national cancer survivor population (average age 61 years, 85% white, 52% male, and 94% insured). Hospitalization rates for supplement users and non-users were 12% and 21%, respectively. The cost of hospitalization was $4030. Supplementation was associated with an additional 0.48 QALYs (10.26 vs. 9.78) at the incremental cost of $2094 ($236,933 vs. $234,839) over the remaining lifetime of survivors (on average 13 years). Adequate nutrition provides a cost-effective strategy to achieving potentially optimum health. Further studies are needed to determine the effects of specific nutrient doses and supplementation on long-term outcomes per cancer type.
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Georgaki, Maria-Nefeli, Marianna Charalambous, Nerantzis Kazakis, Michael A. Talias, Charalampos Georgakis, Theodora Papamitsou, and Christina Mytiglaki. "Chromium in Water and Carcinogenic Human Health Risk." Environments 10, no. 2 (February 18, 2023): 33. http://dx.doi.org/10.3390/environments10020033.
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Understanding the extent of human health risks with an emphasis on carcinogenesis development attributable to potentially toxic chemicals is critical to effective prevention and mitigation strategies. Chromium (Cr), mainly the hexavalent chromium (Cr (VI)), is a chemical associated with cancer when found in drinking water, making it a major public health issue. This study assessed a possible carcinogenic human health risk among the general population due to exposure to total or hexavalent chromium. We performed a systematic review of the international scientific literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol to determine the human risk of cancer mortality and morbidity. In total, 76 articles were checked for eligibility, 13 of which were included in the final systematic review. Only scientific articles from January 2000 to November 2022 published on PubMed were included. Data from both epidemiological ecological studies (Relative Risk and Rate Ratio—RR and Standardized Mortality Rate—SMR) and epidemiological case studies (Lifetime Cancer Risk—LCR, Incremental Lifetime Cancer Risk—ILCR, Cancer Risk—CR, Hazard Quotient—HQ, Hazard Index—HI, Health Risk Assessment—HRA, Disability-Adjusted Life Year—DALY, and Chronic Daily Intake Index—CDI) were included for the overall assessment of carcinogenicity in the general population. According to most articles, there is credible evidence that hexavalent chromium via water is indicated as a major contributor to the global burden of cancer in humans. Some of them emphasize malignant neoplasms in the lung, liver, stomach, and genitourinary system. Although the health index data of the case studies are based on a limited number of samples, they raise concerns about the possibility of an increase in the degree of carcinogenesis. However, there are significant limitations due to the lack of information on the dose and duration of exposure in the target group. Further research involving extensive analysis of the association of the two variables is needed, which depends on more complete information extraction and advanced methodologies.
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Wong, Florence Lennie, Janie M. Lee, Wendy M. Leisenring, Joseph Philip Neglia, Rebecca M. Howell, Susan A. Smith, Kevin C. Oeffinger, et al. "Efficacy and cost-effectiveness of breast cancer (BC) screening in female survivors of childhood Hodgkin lymphoma (HL)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6593. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6593.
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6593 Background: Female childhood HL survivors treated with ≥10 Gy of chest radiation are at high risk of developing BC. The Children’s Oncology Group (COG) guidelines recommend lifetime annual mammography (MAM) and breast Magnetic Resonance Imaging (MRI) starting 8y after chest radiation or age 25, whichever is later, and clinical breast examination (CBE) annually from puberty and semiannually from age 25. Initial model results suggest that CBE adds no survival benefit in this cohort. Digital breast tomosynthesis (DBT) is increasingly replacing digital MAM in clinical practice. Here, we present the efficacy and cost-effectiveness of COG’s imaging-based screening recommendations. Methods: Life-years (LYs), quality-adjusted LYs (QALYs), BC mortality, and costs (2017 U.S.$) were estimated from simulating the lifetimes of 5-million chest-irradiated 25y old HL survivors who underwent BC screening with each of the following strategies: annual digital MAM, MRI, MAM+MRI, annual DBT or DBT+MRI from age 25 onward. Treatment-related BC risk (in-situ and invasive) and non-BC mortality were estimated from female 5y HL survivors in the Childhood Cancer Survivor Study and from U.S. population rates. Test sensitivity was 70-74% for MAM (based on prior HL studies) and 89% for DBT and MRI (based on women at high risk of de novo BC). Costs and quality of life weights were obtained from medical literature. Results: For HL survivors with no screening, lifetime BC risk was 42.7% and BC mortality was 18.1%. BC risk and non-BC mortality were, respectively, 7.4- and 5.2-fold higher at age 50 in HL survivors relative to the general population. Screening at ages 25-74 had similar LY gain and BC mortality reduction compared to lifetime screening; hence, we focused on screening for ages 25-74. For all strategies screening provided LY gain of 0.34-0.47 and reduced BC mortality by 6.7-9.8% compared with no screening; incremental cost-effectiveness ratio (ICER), or cost per QALY gained, for MAM alone was $58,726 and for DBT alone was $62,989. ICER of adding MRI to MAM ($385,285) or to DBT ($513,358) indicated lower cost-effectiveness of supplemental MRI (Table). Conclusions: Annual screening at ages 25-74y in chest-irradiated HL survivors appears beneficial. Using $100K per QALY gained as cost-effectiveness threshold, annual MAM or DBT are more cost-effective, whereas adding MRI to MAM is less cost-effective.[Table: see text]
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Hwang, Jessica P., Danmeng Huang, John M. Vierling, Maria E. Suarez-Almazor, Ya-Chen Tina Shih, Mariana Chavez-MacGregor, Zhigang Duan, et al. "Cost-Effectiveness Analysis of Hepatitis B Virus Screening and Management in Patients With Hematologic or Solid Malignancies Anticipating Immunosuppressive Cancer Therapy." JCO Clinical Cancer Informatics, no. 3 (December 2019): 1–12. http://dx.doi.org/10.1200/cci.18.00097.
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PURPOSE National hepatitis B virus (HBV) screening recommendations for patients with cancer anticipating systemic anticancer therapy range from universal screening to screening based on risk of HBV infection, cancer therapy–specific risk of HBV reactivation, or both. We conducted cost-effectiveness analyses to identify optimal HBV screening strategies. PATIENTS AND METHODS We constructed decision-analytic models to analyze three strategies (no screening, universal screening, and selective screening based on use of an HBV infection risk tool) for hypothetic cohorts of patients anticipating anticancer therapy at high or lower risk for HBV reactivation. Model parameters were drawn from previously published studies, the SEER-Medicare database, and other online resources. Outcomes included lifetime expected cost, quality-adjusted life expectancy, and incremental cost-effectiveness ratio, measured in US dollars required to gain an additional quality-adjusted life-year (QALY). RESULTS For patients at high reactivation risk, universal screening dominated (ie, was cheaper and more effective than) the other two strategies. Universal screening was associated with a gain in life expectancy of 0.01 QALY compared with no screening and cost $76.06 less than no screening and $4.34 less than selective screening. For those at lower reactivation risk, universal screening still dominated selective screening; however, the incremental cost-effectiveness ratio of the universal screening strategy compared with no screening was $186,917 per QALY gained. CONCLUSION Universal HBV screening is cost effective and cheaper for patients receiving anticancer therapy associated with a high reactivation risk. For patients receiving anticancer therapy associated with a lower reactivation risk, universal screening is not cost effective.
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Parthan, A., N. Pruttivarasin, D. Taylor, D. Davies, G. Yang, V. Pawar, and M. C. Weinstein. "CyberKnife for prostate cancer: Is it cost-effective?" Journal of Clinical Oncology 29, no. 7_suppl (March 1, 2011): 87. http://dx.doi.org/10.1200/jco.2011.29.7_suppl.87.
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87 Background: The study assessed the cost-effectiveness of CyberKnife (CK) compared to surgery and radiation therapy for the treatment of prostate cancer (PC) from a third-party and societal perspective. Methods: For patients > 65 yrs with localized PC, a Markov model compared treatment with CK, intensity modulated radiation therapy (IMRT), surgery or proton therapy (PT). Following treatment, patients were at risk of long-term toxicity: genitourinary (GU); gastrointestinal (GI); and sexual dysfunction (SD). Long-term toxicity was defined as adverse events >grade 2 on Radiation Therapy Oncology Group scale occurring at least 12 months following treatment. Markov states included all possible combinations of GI, GU, and SD long-term toxicities, no toxicity, and death. During each year patients remained in the same Markov state or died. Costs and utilities were assigned using published sources. Toxicity probabilities were derived using meta-analytical techniques to pool results from multiple studies. It was assumed that long-term disease control would not differ across treatments. The model projected expected lifetime costs and quality adjusted life years (QALYs) for each treatment and incremental cost-effectiveness of CK vs comparators as cost per QALY gained. Costs from societal perspective included lost productivity. Extensive sensitivity analyses were conducted. Results: Surgery was the least expensive treatment option followed by CK. CK patients had higher expected QALYs (8.11) than other treatment options (7.72- 8.06). From a payer perspective, total lifetime costs were $25,904, $22,295, $38,915, and $58,100 for CK, surgery, IMRT and PT, respectively. Incremental cost per QALY gained for CK versus Surgery was $9,200/QALY. Compared to IMRT and PT, CK was less costly and resulted in higher QALYs (dominance). At a threshold of $50,000/QALY, CK was cost effective in 86%, 79%, and 91% of simulations compared to surgery, IMRT, and PT, respectively. From a societal perspective, CK costs $4,200/QALY compared to surgery and remained dominant vs IMRT and PT. Results were most sensitive to costs of surgery and CK. Conclusions: Initial CK costs are higher than surgery, but CK patients have better quality of life. CK patients have lower lifetime costs and higher QALYs than IMRT and PT patients. [Table: see text]
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Ogoko, Emeka Chima, Stella Amarachi Onyemelukwe, Henrietta Ijeoma Kelle, Ifunanya Iroegbulem, Donard Emeziem, and Adebisi Akinyemi Fagbohun. "Health risk assessment of heavy metals in drinking water from Iponri water treatment plant, Lagos water corporation Nigeria." Ovidius University Annals of Chemistry 34, no. 1 (January 1, 2023): 41–49. http://dx.doi.org/10.2478/auoc-2023-0007.
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Abstract Urban water supplied from treatment plants can constitute public health problems if poorly treated or accidentally contaminated. Water quality and health risk assessment of water supplied from Lagos State water treatment plant was performed. Heavy metal concentration was determined using Atomic Absorption Spectrophotometer. The mean concentrations of Pb, Cu, Zn, Fe, Mn, Cd, Ni, As and Cr were within the standard maximum permissible limits for drinking water quality. The mean estimated daily intake through oral ingestion of drinking water for Pb, Cu, Zn, Fe, Mn, Cd, Ni, As and Cr were 0.00024, 0.00117, 0.00158, 0.00665, 0.00736, 0.000271, 0.00148, 0.000563 and 0.000834 mg/kg bw/day respectively, but were within acceptable tolerable daily intake standards for adult population. The values of hazard quotients for the heavy metal in water samples were below one for adult population. Hazard indices of treated water samples were below the threshold value of one (HI ˂ 1) while hazard indices of untreated and pre-treated water samples exceeded one, indicating possible associated potential health risks as a result of combined effects of the heavy metals through oral consumption water. Incremental life cancer risk values of Cd, Ni, As and Cr in all the three categories of water samples exceeded the safe limit for cancer risk while the cumulative cancer risk (ΣILCR) also exceeded the proposed threshold safe risk limit (> 1x10−4), indicating potential carcinogenic lifetime health risk in adult population through oral consumption of the heavy metal in water. Conclusively, the treated water had lowest levels of heavy metals, hazard quotient, incremental life cancer risks values and unsafe for drinking purposes compared to the untreated and pre-treated water.
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Skedgel, C., D. Rayson, and T. Younis. "Cost-utility of adjuvant trastuzumab in Her-2/neu positive breast cancer: A Canadian perspective." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6574. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6574.
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6574 Background: Recent RCTs have demonstrated a significant disease-free and overall survival advantage with adjuvant trastuzumab (aTZ) compared to chemotherapy alone in women with Her2/neu positive breast cancer. However, as aTZ is also associated with considerable costs and an increased risk of cardiotoxicity, an economic evaluation was undertaken to estimate the cost-utility (CU) of aTZ in terms of cost per quality-adjusted life year (QALY) gained relative to chemotherapy alone. Methods: A Markov model was developed to calculate the incremental costs and outcomes of 12 months of aTZ following chemotherapy in a hypothetical cohort of 1,000 women with Her2/neu positive breast cancer over a lifetime horizon. The model consisted of four broad health states: 1) disease-free, 2) local recurrence, 3) distant recurrence and 4) death. Each survival state was stratified as experienced with or without cardiotoxicity. The baseline rate of recurrence, the hazard ratio (HR) of recurrence with aTZ and the rate of adverse cardiac events were taken from recent RCTs. Age-sex specific background mortality, based on Statistics Canada life tables, was also incorporated. The cost of aTZ was based on our previous cost study (Drucker et al, ASCO 2006). Costs of local and distant cancer recurrence were derived from the literature, with an adjustment for the cost of palliative TZ (Potvin et al, ASCO 2005). Utility weights were taken from the literature. The model took a direct payer perspective, with costs reported in 2006 Canadian dollars (CDN$). Costs and QALYs were both discounted by 3% annually. The primary analysis assumed 5 years of benefit with aTZ therapy and an HR=1.0 over the remainder of the horizon. Results: Per 1,000 treated patients, aTZ was associated with a lifetime gain of 1,267 QALYs and an incremental cost of CDN$38.8 million. Lifetime CU was CDN$30,630 per QALY gained. aTZ met a CDN$50,000/QALY threshold at year 17. CU results were particularly sensitive to changes in the analysis horizon and assumptions regarding the long-term HR of aTZ. Conclusions: The lifetime CU of aTZ appears reasonable. However, further clinical follow-up is required to clarify the long-term outcomes of aTZ and confirm these CU estimates. No significant financial relationships to disclose.
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Rakowska, Joanna, Marzena Rachwał, and Agata Walczak. "Health Exposure Assessment of Firefighters Caused by PAHs in PM4 and TSP after Firefighting Operations." Atmosphere 13, no. 8 (August 10, 2022): 1263. http://dx.doi.org/10.3390/atmos13081263.
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Among the many different chemicals in the air, polycyclic aromatic hydrocarbons (PAHs) pose a serious threat to human health. Firefighters are exposed to them both during fire suppression and in fire vehicles and fire stations due to inhalation of the fumes from contaminated clothing and personal protective equipment. This study aimed to estimate the exposure and cancer risk caused by suspended particulate matter and PAHs present in these particles. Air samples were collected for 4 months in a garage of the fire station in a small town, located in an urban–rural area. PAH concentrations were measured using the gas chromatography method with mass spectrometry (GC/MS). The concentration of PM4 (particulate matter with a diameter below 4µm) and TSP (total suspended particulate) in the fire station garage was 7 and 9 times higher than outside, respectively. The calculated values of health hazard risks associated with the exposure to PAHs in PM4 and TSP are: a toxic equivalent (TEQ) up to 10.36 and 23.3, incremental lifetime cancer risk (ILCR) up to 3.45 and 4.65 and hazard quotient (HQ) up to 0.42 and 0.57, respectively. A significantly increased risk of cancers in the professional group of firefighters was found.
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Li, Edward C., Dylan Mezzio, Andrew Spargo, Kimberley J. Campbell, and Gary H. Lyman. "Cost-effectiveness of filgrastim-sndz as primary prophylaxis (PP) versus secondary prophylaxis (SP) to prevent chemotherapy-induced febrile neutropenia (FN) in non-small cell lung cancer (NSCLC) patients at intermediate risk." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19401-e19401. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19401.
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e19401 Background: Patients with nonmetastatic NSCLC receiving platinum-based chemotherapy are at an intermediate risk (10-20%) of developing FN; clinical practice guidelines recommend assessing whether these patients have FN risk factors before considering myeloid growth factor (MGF) prophylaxis. Most NSCLC patients receiving chemotherapy have ≥1 FN risk factors, and while PP leads to lower rates of FN across all cycles, it is more costly compared to SP. This study evaluates the cost-effectiveness of PP vs. SP using a biosimilar MGF, filgrastim-sndz, in NSCLC patients at intermediate risk of FN. Methods: A Markov model with a lifetime horizon was constructed to evaluate the total costs and clinical outcomes of using filgrastim-sndz as PP vs. SP in NSCLC patients 61 years old receiving adjuvant carboplatin/paclitaxel every 3 weeks for 4 cycles. Separate analyses were conducted for patients with 0 FN risk factors (0RF) and with ≥1 FN risk factors (1+RF), representing 11.3% and 18% baseline FN risk, respectively. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a United States payer perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results: For patients with 0RF, use of filgrastim-sndz as PP vs. SP provided an additional 0.056 QALYs (0.079 LYS) at an incremental cost of $3,266. The ICERs were $46,815, $41,555, and $58,531 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. For patients with 1+RF, PP vs. SP added 0.090 QALYs (0.127 LYS) at an incremental cost of $1,605. The ICERs were $13,970, $12,644, and $17,805 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. In the PSA, the likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per QALY gained was 31.7% for patients with 0RF and 96.6% for 1+RF. Conclusions: For NSCLC patients at intermediate risk of FN receiving adjuvant carboplatin/paclitaxel with 1+RF, PP with filgrastim-sndz compared to SP is cost-effective based on a WTP threshold of $50,000/QALY. [Table: see text]
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Al-Nasir, Farh, Tahani J. Hijazin, Mutaz M. Al-Alawi, Anwar Jiries, Amal Mayyas, Saddam A. Al-Dalain, Rasha Al-Dmour, Abdalrahim Alahmad, Osama Y. Al-Madanat, and Mufeed I. Batarseh. "Accumulation, Source Identification, and Cancer Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Different Jordanian Vegetables." Toxics 10, no. 11 (October 27, 2022): 643. http://dx.doi.org/10.3390/toxics10110643.
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The accumulation of polyaromatic hydrocarbons in plants is considered one of the most serious threats faced by mankind because of their persistence in the environment and their carcinogenic and teratogenic effect on human health. The concentrations of sixteen priority polycyclic aromatic hydrocarbons (16 PAHs) were determined in four types of edible vegetables (tomatoes, zucchini, eggplants, and cucumbers), irrigation water, and agriculture soil, where samples were collected from the Jordan Valley, Jordan. The mean total concentration of 16 PAHs (∑16PAHs) ranged from 10.649 to 21.774 µg kg−1 in vegetables, 28.72 µg kg−1 in soil, and 0.218 µg L−1 in the water samples. The tomato samples posed the highest ∑16PAH concentration level in the vegetables, whereas the zucchini samples had the lowest. Generally, the PAHs with a high molecular weight and four or more benzene rings prevailed among the studied samples. The diagnostic ratios and the principal component analysis (PCA) revealed that the PAH contamination sources in soil and vegetables mainly originated from a pyrogenic origin, traffic emission sources, and biomass combustion. The bioconcentration factors (BCF) for ∑16PAHs have been observed in the order of tomatoes > cucumbers and eggplants > zucchini. A potential cancer risk related to lifetime consumption was revealed based on calculating the incremental lifetime cancer risk of PAHs (ILCR). Therefore, sustainable agricultural practices and avoiding biomass combusting would greatly help in minimizing the potential health risk from dietary exposure to PAHs.
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Li, Edward, Dylan J. Mezzio, David Campbell, Kim Campbell, and Gary H. Lyman. "Primary Prophylaxis With Biosimilar Filgrastim for Patients at Intermediate Risk for Febrile Neutropenia: A Cost-Effectiveness Analysis." JCO Oncology Practice 17, no. 8 (August 2021): e1235-e1245. http://dx.doi.org/10.1200/op.20.01047.
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PURPOSE: Temporary COVID-19 guideline recommendations have recently been issued to expand the use of colony-stimulating factors in patients with cancer with intermediate to high risk for febrile neutropenia (FN). We evaluated the cost-effectiveness of primary prophylaxis (PP) with biosimilar filgrastim-sndz in patients with intermediate risk of FN compared with secondary prophylaxis (SP) over three different cancer types. METHODS: A Markov decision analytic model was constructed from the US payer perspective over a lifetime horizon to evaluate PP versus SP in patients with breast cancer, non–small-cell lung cancer (NSCLC), and non-Hodgkin lymphoma (NHL). Cost-effectiveness was evaluated over a range of willingness-to-pay thresholds for incremental cost per FN avoided, life year gained, and quality-adjusted life year (QALY) gained. Sensitivity analyses evaluated uncertainty. RESULTS: Compared with SP, PP provided an additional 0.102-0.144 LYs and 0.065-0.130 QALYs. The incremental cost-effectiveness ranged from $5,660 in US dollars (USD) to $20,806 USD per FN event avoided, $5,123 to $31,077 USD per life year gained, and $7,213 to $35,563 USD per QALY gained. Over 1,000 iterations, there were 73.6%, 99.4%, and 91.8% probabilities that PP was cost-effective at a willingness to pay of $50,000 USD per QALY gained for breast cancer, NSCLC, and NHL, respectively. CONCLUSION: PP with a biosimilar filgrastim (specifically filgrastim-sndz) is cost-effective in patients with intermediate risk for FN receiving curative chemotherapy regimens for breast cancer, NSCLC, and NHL. Expanding the use of colony-stimulating factors for patients may be valuable in reducing unnecessary health care visits for patients with cancer at risk of complications because of COVID-19 and should be considered for the indefinite future.
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Ogu, Gideon, Beatrice O. Ojiego, Zainab Bello, Madu Josephine, Kalen E. Audu, Shauibu A. Abdullah, Ibrahim M. K. Gadzama, and Paul Bolorunduro. "Health risk of some metals in maize grains cultivated close to Gosa and Gwagwalada solid waste dumpsites." Andalasian International Journal of Applied Science, Engineering and Technology 2, no. 03 (November 1, 2022): 159–71. http://dx.doi.org/10.25077/aijaset.v2i03.59.
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Maize is a vital nutritional cereal for the infants, young children and adults. The environment which they are cultivated in Africa could expose to metal accumulations from soils, thereby posing health risks to the consumers. The objectives of this study were determine metal accumulations in maize grains (Zea mays L.) cultivated close to Gosa and Gwagwalada solid waste dumpsites and their health risks via consumption. A total of 36 soil samples (12 each from dumpsite soil, farmland soil and maize grains) were collected and analyzed for some metals [cadmium (Cd), lead (Pb), zinc (Zn), cobalt (Co), copper (Cu), chromium (Cr), nickel (Ni) and mercury (Hg)] using standard atomic adsorption spectrophotometer. The transfer factors and metal health risks in adults (60 kg; 22-48.9 years), young children (35 kg; 6-15 years) and infants (15 kg; 1-6 years) were evaluated using mathematical models. The ranges of metal (mg/kg) detected were 10114.00 to 0.52, 10.45 to 0.001 and 13.62 to 0.001 for dumpsite, farmland and maize grains, respectively. Though, within FAO/WHO and EU safe limits, Zn was significantly (p<0.05) highest in both locations, while Cd, Cr and Hg (0.001 mg/kg) were the least. Only Zn had transfer factor value below 0.5, which indicates possibilities of anthropogenic elevations. The estimated daily intake from consumption of maize grains (57 g) were generally high for Zn and low for Ni, Cd, and Hg in exposed individuals. The hazard index was below 1, which indicates no significant non-carcinogenic risks in exposed populations. The incremental lifetime cancer risks was below 10-6 and this suggest potential lifetime cancer risks in the order infants ? children ? adults. This study concluded that daily consumption of maize cultivated closed to dumpsites poses potential lifetime cancer concern and thus maize farming around dumpsites needs to be discouraged for safety reasons.
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Le Ha, Vo Thi. "HUMAN HEALTH HAZARD OF POLYCYCLIC AROMATIC HYDROCARBON IN ROAD DUST IN HA NOI METROPOLIS." Vietnam Journal of Science and Technology 54, no. 2A (March 19, 2018): 27. http://dx.doi.org/10.15625/2525-2518/54/2a/11906.
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This study investigates PAHs content in road dust of Hanoi metropolis, Vietnam. The samples were colected from the roads around city and analyzed by gas chromatography mass spectrometry (GC/MS). The total PAHs mass concentration ranges from 33.88 μg/kg to 5588,16 μg/kg, with the mean of 356,24 μg/kg in which HMW accounted up 70 % and LMW made up 30 %. The toxic equivalence factors (TEFs), mutagenic potency equivalent factors (MEFs) and the incremental lifetime cancer risk (ILCR) methodologies were applied to evaluate human exposure to carcinogenic PAHs sources. Carcinogenic equivalents (BaP-TEQ) and mutagenic equivalents (BaP-MEQ) were calculated from the potency relative to BaP (TEF) and BaP (MEF). The value of BaP-TEQ for 8 PAHs varied from 1.13 μg/kg to 195.23 μg/kg with mean of 24.34 μg/kg, while the value of BaP-MEQ ranged 1.45 μg/kg to 123.15 μg/kg with mean of 19.96 μg/kg. Basing on ILCRs model, the total cancer risk for children and adults was up to 1.6×10-5 and 3.9×10-5, posing a moderate potential cancer risk, respectively.
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Yaradua, A. I., J. I. Bungudu, L. Shuaibu, A. Nasir, A. Usman, I. H. Kankia, N. U. Matazu, et al. "Health Risk Assessment of Heavy Metals in a Vegetable Cultivated on Land Polluted through Illegal Mining." Archives of Current Research International 23, no. 3 (March 14, 2023): 16–25. http://dx.doi.org/10.9734/acri/2023/v23i3561.
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The risk of exposure to the population from heavy metals in an area that have witnessed a surge in illegal mining activities, cattle rustling and banditry were evaluated in the current study. Lettuce leaves sample from Gadirge village, Jibia local Government area, Katsina State, Nigeria was evaluated for the presence of heavy metals using Atomic Absorption Spectrophotometry. The health risks of the evaluated heavy metals in the sample to the population were assessed using the Target Hazard Quotient (THQ) and Health Risk Index (HRI)) to assess the possible non-carcinogenic effect and the Incremental Lifetime Cancer Risk (ILCR) for the cancer risks. The result of the mean concentration values of the evaluated heavy metals Fe and Pb from the sample falls above the Maximum Allowable Concentrations (MAC) of heavy metals in leafy vegetables. The concentrations of the other metals including Cu, Zn, Ni, Mn and Cd evaluated in the sample were within the permissible values. The result of the Target Hazard Quotient (THQ) associated with the evaluated heavy metals exposure through consumption of the sample for adults and children were all lower than 1, with exception of the THQ for the heavy metals Fe and Mn in the adults and children population that was above 1. The combined health risks for all the metals in the sample for the adults and children population represented as the HRI were higher than 1, the result of the Incremental Life Cancer Risk (ILCR) for both the adult and children population has revealed that the heavy metal Ni was beyond the threshold of the safety limit for cancer risk. There is a health risk concern from consumption of the sample as the vegetable may contribute to the disease burden of the population.
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Yaradua, A. I., J. I. Bungudu, L. Shuaibu, A. Nasir, A. Usman, I. H. Kankia, N. U. Matazu, et al. "Health Risk Assessment of Heavy Metals in Vegetable: The Contribution of Illegal Mining and Armed Banditry to Heavy Metal Pollution in Katsina State, Nigeria." Journal of Scientific Research and Reports 29, no. 5 (April 24, 2023): 19–27. http://dx.doi.org/10.9734/jsrr/2023/v29i51744.
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The health risk to the population from exposure to heavy metals in an area that have witnessed a surge in illegal mining activities, cattle rustling and banditry were evaluated in the current study. Moringa leaves sample from Jabiyawa village, Jibia local Government area, Katsina State, Nigeria was evaluated for the presence of heavy metals using Atomic Absorption Spectrophotometry. The health risks of the evaluated heavy metals in the sample to the population were assessed using the Target Hazard Quotient (THQ) and Health Risk Index (HRI)) to assess the possible non-carcinogenic effect and the Incremental Lifetime Cancer Risk (ILCR) for the cancer risks. The result of the mean concentration values of the evaluated heavy metals Fe, Cu and Pb from the sample falls above the Maximum Allowable Concentrations (MAC) of heavy metals in leafy vegetables. The concentrations of the other metals including Zn, Ni, Mn and Cd evaluated in the sample were within the permissible values The results of the Target Hazard Quotient (THQ) associated with the evaluated heavy metals exposure through consumption of the sample for adults and children were below 1, with exception of the THQ for the heavy metal Cu in the children population that was above 1. The combined health risks for all the metals in the sample for the adults and children population represented as the HRI were above 1. The result of the Incremental Life Cancer Risk (ILCR) for both the adults and children population shows that the heavy metal Ni is beyond the threshold of the safety limit for cancer risk. There is a health risk concern from consumption of the sample as the vegetable may contribute to the disease burden of the population.
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Buha-Markovic, Jovana, Ana Marinkovic, Jasmina Savic, Aleksandar Krstic, Andrija Savic, and Mirjana Ristic. "Health risk assessment of potentially harmful substances from fly ashes generated by coal and coal waste combustion." Journal of the Serbian Chemical Society, no. 00 (2023): 48. http://dx.doi.org/10.2298/jsc220130048m.
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Lignite and coal waste used as feed fuels in thermal power plants (TPPs) and semi-industrial fluidized bed boiler (FBB), as well as their representative fly ashes (FAs), were examined. Fly ashes were compared employing anions and cations content in correspondent water extracts, trace elements and polycyclic aromatic hydrocarbon concentrations, as well as health risk assessments of substances known to be of concern for public health. Fluoride and sulfate contents in water extracted FAs are far below the legislation limits for waste, classifying all investigated FAs as non-hazardous. Among investigated trace elements, Cd content is the lowest, while Mn content is the highest. The highest enrichment ratios are noticed for As, Pb, Hg, Cu, V and Cr. The results indicate that total PAHs content is elevated in FA from the combustion of coal waste (AFB), with fluoranthene prevailing. The cancer risk of As and the non-cancer risk of As and Ni in some FAs surpass their respective permissible limits. The incremental lifetime cancer risk of an adult population indicates a potential PAHs risk in AFB, whereas all other fly ashes are within safe limits.
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Montuori, Paolo, Elvira De Rosa, Pellegrino Cerino, Antonio Pizzolante, Federico Nicodemo, Alfonso Gallo, Giuseppe Rofrano, Sabato De Vita, Antonio Limone, and Maria Triassi. "Estimation of Polycyclic Aromatic Hydrocarbons in Groundwater from Campania Plain: Spatial Distribution, Source Attribution and Health Cancer Risk Evaluation." Toxics 11, no. 5 (May 6, 2023): 435. http://dx.doi.org/10.3390/toxics11050435.
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The aim of this study was to evaluate the concentrations of polycyclic aromatic hydrocarbons (PAHs) in 1168 groundwater samples of the Campania Plain (Southern Italy), taken using a municipal environmental pressure index (MIEP), and to analyze the distribution of these compounds to determine source PAHs using ratios of isomers diagnostic. Lastly, this study also aimed to estimate the potential health cancer risk in groundwaters. The data indicated that the highest concentration of PAHs was found in groundwater from Caserta Province and the contents of BghiP, Phe, and Nap were detected in the samples. The spatial distribution of these pollutants was evaluated using the Jenks method; moreover, the data indicated that incremental lifetime cancer risk ILCRingestion ranged from 7.31 × 10−20 to 4.96 × 10−19, while ILCRdermal ranged from 4.32 × 10−11 to 2.93 × 10−10. These research findings may provide information about the Campania Plain’s groundwater quality and aid in the development of preventative measures to lessen PAH contamination in groundwater.
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Royce, Trevor Joseph, Rinaa S. Punglia, Sagar Anil Patel, Katherine Anne Thornton, Chandrajit P. Raut, and Elizabeth H. Baldini. "Cost effectiveness of surveillance for distant recurrence in extremity soft tissue sarcoma." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 11021. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.11021.
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11021 Background: Optimal surveillance strategies for extremity soft tissue sarcoma (STS) are unknown. We performed a cost-effectiveness analysis of competing imaging modalities performed at National Cancer Comprehensive Network guideline-specified intervals. Methods: We developed a Markov model simulating lifetime outcomes for 54-year-old patients after definitive treatment for Stage II-III extremity STS using four surveillance strategies: watchful waiting (WW), chest x-ray (CXR), chest computed tomography (CCT) and positron emission tomography-computed tomography (PET/CT) performed every 3-6 months for the first 3 years, every 6 months until year 5, and then annually. We used probabilities, utilities and costs extracted from the literature and Medicare claims to determine incremental cost-effectiveness ratios (ICER). Results: While the model showed that CCT is the most effective strategy, CXR is the most cost-effective strategy at a societal willing-to-pay (WTP) of $100,000/quality-adjusted life year (QALY). The ICER is $14,306/QALY for CXR versus $117,683/QALY for CCT while PET/CT is never cost effective (Table). Sensitivity analyses demonstrated CCT becomes the preferred imaging modality as the lifetime risk of DR increases beyond 38% or as the societal WTP increases beyond $130,000/QALY. Conclusions: Optimal DR surveillance imaging for Stage II-III extremity STS should be individualized based on patients’ risks for DR. CXR, or CCT at more protracted intervals, may be preferred for lower risk patients (i.e. DR risk less than 38%), whereas CCT may be preferred for higher risk patients (i.e. DR risk greater than 38%). These findings can help refine guidelines to reduce resource overutilization during surveillance of sarcoma patients. [Table: see text]
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Kawichai, Sawaeng, and Susira Bootdee. "Health Risk Assessment on Exposure to PM2.5-bound PAHs from an Urban-industrial Area in Rayong City, Thailand." Open Access Macedonian Journal of Medical Sciences 10, E (August 5, 2022): 1–10. http://dx.doi.org/10.3889/oamjms.2022.9977.
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BACKGROUND: A city's industrial area's air quality has become a major priority. PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) are one of the most common pollutants in urban-industrial area, and can be linked to health problems.
AIM: This study aims to 1) investigate PM2.5 and PAHs emitted from roadside area (RS) and industrial estate (IE) in Rayong city 2) assess the inhalation of PM2.5 and PAHs on the human health of the age group.
METHODS: PM2.5-bound PAHs were investigated and thier carcinogenic risk was evalued in this study. PM2.5 samples were collected on quartz filters contained in a mini-volume air sampler and analyzed for PAHs by GC-MS.
RESULTS: The average PM2.5 concentrations at RS and IE were 43.3±26.8 and 40.4±21.7 µg/m3, while the values of total PAHs in both sites were 1.68±1.53 and 1.34±1.22 ng/m3, respectively. However, it was found that the PM2.5 and PAHs values were not significantly different (p>0.05). The results revealed that the individual lifetime cancer risk (Ric) of PM2.5 values for children and adults at both sites indicated acceptable cancer risk (10-6 to10-4). According to the incremental lifetime cancer risk (ILCR) values of PAHs for different age groups, exposure to PAHs in PM2.5 through the inhalation pathway was a negligible (<10-6).
CONCLUSION: As a result, the PM2.5 concentrations have substantial implications for Rayong city’s environmental management and protection, relating to car emissions and coal combustion.
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Wei, Xia, Samuel Oxley, Michail Sideris, Ashwin Kalra, Li Sun, Li Yang, Rosa Legood, and Ranjit Manchanda. "Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review." Cancers 14, no. 24 (December 12, 2022): 6117. http://dx.doi.org/10.3390/cancers14246117.
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Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for BRCA1/2, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies.
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Benamouzig, Robert, Stéphanie Barré, Jean-Christophe Saurin, Henri Leleu, Alexandre Vimont, Sabrine Taleb, and Frédéric De Bels. "Cost-effectiveness analysis of alternative colorectal cancer screening strategies in high-risk individuals." Therapeutic Advances in Gastroenterology 14 (January 2021): 175628482110023. http://dx.doi.org/10.1177/17562848211002359.
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Background and aims: Current guidelines recommend colonoscopy every 3–5 years for colorectal cancer (CRC) screening of individuals with a familial history of CRC. The objective of this study was to compare the cost effectiveness of screening alternatives in this population. Methods: Eight screening strategies were compared with no screening: fecal immunochemical test (FIT), Stool DNA and blood-based screening every 2 years, colonoscopy, computed tomography colonography, colon capsules, and sigmoidoscopy every 5 years, and colonoscopy at 45 years followed, if negative, by FIT every 2 years. Screening test and procedures performance were obtained from the literature. A microsimulation model reproducing the natural history of CRC was used to estimate the cost (€2018) and effectiveness [quality-adjusted life-years (QALYs)] of each strategy. A lifetime horizon was used. Costs and effectiveness were discounted at 3.5% annually. Results: Compared with no screening, colonoscopy and sigmoidoscopy at a 30% uptake were the most effective strategy (46.3 and 43.9 QALY/1000). FIT at a 30 µg/g threshold with 30% uptake was only half as effective (25.7 QALY). Colonoscopy was associated with a cost of €484,000 per 1000 individuals whereas sigmoidoscopy and FIT were associated with much lower costs (€123,610 and €66,860). Incremental cost-effectiveness rate for FIT and sigmoidoscopy were €2600/QALY ( versus no screening) and €3100/QALY ( versus FIT), respectively, whereas it was €150,000/QALY for colonoscopy ( versus sigmoidoscopy). With a lower threshold (10 µg/g) and a higher uptake of 45%, FIT was more effective and less costly than colonoscopy at a 30% uptake and was associated with an incremental cost–effectiveness ratio (ICER) of €4240/QALY versus no screening. Conclusion: At 30% uptake, current screening is the most effective screening strategy for high-risk individuals but is associated with a high ICER. Sigmoidoscopy and FIT at lower thresholds (10 µg/g) and a higher uptake should be given consideration as cost-effective alternatives. Plain Language Summary Cost-effectiveness analysis of colorectal cancer screening strategies in high-risk individuals Fecal occult blood testing with an immunochemical test (FIT) is generally considered as the most cost-effective alternative in colorectal cancer screening programs for average risk individuals without family history. Current screening guidelines for high-risk individuals with familial history recommend colonoscopy every 3–5 years. Colonoscopy every 3–5 years for individuals with familial history is the most effective strategy but is associated with a high incremental cost–effectiveness ratio. Compared with colonoscopy, if screening based on FIT is associated with a higher participation rate, it can achieve a similar effectiveness at a lower cost.
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Toledo, Michele C., Janice S. Lee, Bruno L. Batista, Kelly P. K. Olympio, and Adelaide C. Nardocci. "Exposure to Inorganic Arsenic in Rice in Brazil: A Human Health Risk Assessment." International Journal of Environmental Research and Public Health 19, no. 24 (December 8, 2022): 16460. http://dx.doi.org/10.3390/ijerph192416460.
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In certain populations, rice is the main source of exposure to inorganic arsenic (iAs), which is associated with cancer and non-cancer effects. Although rice is a staple food in Brazil, there have been few studies about the health risks for the Brazilian population. The objective of this study was to assess the risks of exposure to iAs from white rice and brown rice in Brazil, in terms of the carcinogenic and non-carcinogenic effects, and to propose measures to mitigate those risks. The incremental lifetime cancer risk (ILCR) and hazard quotient (HQ) were calculated in a probabilistic framework. The mean ILCR was 1.5 × 10−4 for white rice and 6.0 × 10−6 for brown rice. The HQ for white and brown rice was under 1. The ILCR for white and brown rice was high, even though the iAs concentration in rice is below the maximum contaminant level. The risk for brown rice consumption was lower, which was not expected. Various mitigation measures discussed in this report are estimated to reduce the risk from rice consumption by 5–67%. With the support of public policies, measures to reduce these risks for the Brazilian population would have a positive impact on public health.
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Babashov, V., M. A. Begen, J. Mangel, and G. S. Zaric. "Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma." Current Oncology 24, no. 1 (February 28, 2017): 6. http://dx.doi.org/10.3747/co.24.3369.
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Background We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post–autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer.Methods We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters.Results In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities.Conclusions In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having “weak evidence for adoption and appropriate utilization” in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored.
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Li, Edward C., Dylan Mezzio, Kimberley J. Campbell, Andrew Spargo, and Gary H. Lyman. "Cost-effectiveness of filgrastim-sndz as primary prophylaxis (PP) versus secondary prophylaxis (SP) to prevent chemotherapy-induced febrile neutropenia (FN) in breast cancer patients at intermediate risk." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 73. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.73.
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73 Background: According to clinical practice guidelines, the threshold for routine myeloid growth factor (MGF) PP is a high risk (>20%) of developing FN. However, in response to the COVID-19 pandemic, a recent recommendation expands this threshold for using MGF PP to include patients at intermediate risk (10-20%) of developing FN, with the goal of reducing emergency room and hospital visits. Patients with breast cancer receiving potentially curative chemotherapy consisting of docetaxel or paclitaxel (every 21 days) are at an intermediate risk (10-20%) of developing FN. This study evaluates the cost-effectiveness of PP vs. SP using a biosimilar MGF, filgrastim-sndz, in early-stage breast cancer patients at intermediate risk of FN. Methods: A Markov model with a lifetime horizon was constructed to evaluate the total costs and clinical outcomes when using filgrastim-sndz as PP vs. SP in 56 year old early-stage breast cancer patients receiving adjuvant docetaxel (following doxorubicin/cyclophosphamide) every 3 weeks for 4 cycles. Patients had ≥1 FN risk factor (i.e., recent surgery) without the receipt of anti-HER2 therapy, representing a 16% baseline FN risk. Average Sales Price (ASP) calculated from the Centers for Medicare & Medicaid Services July 2020 ASP Drug Pricing File was used as the filgrastim-sndz cost. Incremental cost-effectiveness ratios (ICERs) were calculated for cost per FN event avoided, life-year saved (LYS), and quality-adjusted life-year (QALY) gained from a United States payer perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results: Filgrastim-sndz as PP vs. SP provided an additional 0.102 FN events avoided, 0.065 LYS, and 0.056 QALYs at an incremental cost of $2,106. The ICERs were $20,656, $32,624 and $37,333 for cost per FN event avoided, cost per LYS, and cost per QALY gained, respectively. In the PSA, the likelihood of cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per QALY gained was 71.3%. Conclusions: For early-stage breast cancer patients at intermediate risk of FN receiving adjuvant docetaxel with 1 or more risk factors, PP with filgrastim-sndz compared to SP is cost-effective based on a WTP threshold of $50,000/QALY. [Table: see text]
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Zhang, Mengyuan, Longyi Shao, Timothy P. Jones, Xiaolei Feng, Jürgen Schnelle-Kreis, Yaxin Cao, and Kelly A. BéruBé. "Concentration, Source, and Health Risk Assessment of Polycyclic Aromatic Hydrocarbons: A Pilot Study in the Xuanwei Lung Cancer Epidemic Area, Yunnan Province, China." Atmosphere 13, no. 10 (October 21, 2022): 1732. http://dx.doi.org/10.3390/atmos13101732.
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Polycyclic aromatic hydrocarbons (PAHs) are toxic and hazardous volatile environmental pollutants that have been studied as possible major causative agents of lung cancer in Xuanwei. In this paper, indoor and outdoor PM2.5 samples were collected from two homes at different time periods in Hutou, the lung cancer epidemic area in Xuanwei. The results showed that PAH pollution levels from coal combustion in Xuanwei lung cancer epidemic area were significant. The mass concentrations of total PAHs, major carcinogenic compounds, and benzo[a]pyrene-based equivalent concentration (BaPeq) were significantly higher in the coal-using home than in the electricity-using home. For the coal-using home, the PAHs were mainly derived from coal combustion. For the electricity-using home, the PAHs might have been a combination of traffic and coal combustion sources. The human health risk due to inhalation exposure to the PAHs was represented by the incremental lifetime cancer risk (ILCR) of the inhalation exposure. The results showed that the indoor cancer risk for the coal-using home in Xuanwei is higher than that of the electricity-using home and much higher than that of Chinese megacities such as Beijing and Tianjin. Long-term exposure to indoor coal-burning environments containing high levels of PAHs may be one of the main reasons for the high incidence of lung cancer in Xuanwei.
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Anh, Van Dieu. "OCCURRENCE OF PAHs IN THE ATMOSPHERE AND INCENSE BURNING AREA IN HA NOI ASSOCIATED WITH HEALTH RISK ASSESSMENT." Vietnam Journal of Science and Technology 55, no. 4C (March 24, 2018): 33. http://dx.doi.org/10.15625/2525-2518/55/4c/12126.
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The presence of polycyclic aromatic hydrocarbon compounds (PAHs) was investigated through the particulate matter of samples air samples collected in the ambient air and the incense burning area in Ha Noi. The concentration of PAHs in the incense burning area was higher than that in the ambient air. The mixture of PAHs in both sites was predominantly composed of PAHs 4 and more than 4 aromatic rings. Benzo(a)pyrene, (BaP), regarded one of the most toxic PAHs, was found in all samples, with the concentrations higher than the maximum concentrations defined by several EU Countries. The health risk assessment was conducted using the toxic equivalent factor (TEF) that was obtained by comparing the toxicity of individual PAHs to BaP. Derma contact was the main routes of exposure in the studied area. The incremental lifetime cancer risk (ILCR) model was used to find the risk level for human. The ILCR was higher than 10-3, indicating high health risk to community. The incense burning activity increases the risk to exposure human.
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Alghamdi, Mansour A., Salwa K. Hassan, Noura A. Alzahrani, Marwan Y. Al Sharif, and Mamdouh I. Khoder. "Classroom Dust-Bound Polycyclic Aromatic Hydrocarbons in Jeddah Primary Schools, Saudi Arabia: Level, Characteristics and Health Risk Assessment." International Journal of Environmental Research and Public Health 17, no. 8 (April 17, 2020): 2779. http://dx.doi.org/10.3390/ijerph17082779.
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Data concerning polycyclic aromatic hydrocarbons (PAHs) in Jeddah’s schools, Saudi Arabia, and their implications for health risks to children, is scarce. Classroom air conditioner filter dusts were collected from primary schools in urban, suburban and residential areas of Jeddah. This study aimed to assess the characteristics of classroom-dust-bound PAHs and the health risks to children of PAH exposure. Average PAH concentrations were higher in urban schools than suburban and residential schools. Benzo (b)fluoranthene (BbF), benzo(ghi)perylene (BGP), chrysene (CRY) and Dibenz[a,h]anthracene (DBA) at urban and suburban schools and BbF, BGP, fluoranthene (FLT) and indeno (1, 2, 3, −cd)pyrene (IND) at residential schools were the dominant compounds in classroom dust. PAHs with five aromatic rings were the most abundant at all schools. The relative contribution of the individual PAH compounds to total PAH concentrations in the classroom dusts of schools indicate that the study areas do share a common source, vehicle emissions. Based on diagnostic ratios of PAHs, they are emitted from local pyrogenic sources, and traffic is the significant PAH source, with more significant contributions from gasoline-fueled than from diesel cars. Based on benzo[a]pyrene equivalent (BaPequi) calculations, total carcinogenic activity (TCA) for total PAHs represent 21.59% (urban schools), 20.99% (suburban schools), and 18.88% (residential schools) of total PAH concentrations. DBA and BaP were the most dominant compounds contributing to the TCA, suggesting the importance of BaP and DBA as surrogate compounds for PAHs in this schools. Based on incremental lifetime cancer risk (ILCingestion, ILCRinhalation, ILCRdermal) and total lifetime cancer risk (TLCR)) calculations, the order of cancer risk was: urban schools > suburban schools > residential schools. Both ingestion and dermal contact are major contributors to cancer risk. Among PAHs, DBA, BaP, BbF, benzo(a)anthracene (BaA), benzo(k)fluoranthene (BkF), and IND have the highest ILCR values at all schools. LCR and TLCR values at all schools were lower than 10−6, indicating virtual safety. DBA, BaP and BbF were the predominant contributors to cancer effects in all schools.
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Di Duca, Fabiana, Paolo Montuori, Ugo Trama, Armando Masucci, Gennaro Maria Borrelli, and Maria Triassi. "Health Risk Assessment of PAHs from Estuarine Sediments in the South of Italy." Toxics 11, no. 2 (February 13, 2023): 172. http://dx.doi.org/10.3390/toxics11020172.
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Increased concerns about the toxicities of Polycyclic Aromatic Hydrocarbons (PAHs), ubiquitous and persistent compounds, as well as the associated ecotoxicology issue in estuarine sediments, have drawn attention worldwide in the last few years. The levels of PAHs in the Sele, Sarno, and Volturno Rivers sediments were evaluated. Moreover, the cancerogenic risk resulting from dermal and ingestion exposure to PAHs was estimated using the incremental lifetime cancer risk (ILCR) assessment and the toxic equivalent concentration (TEQBaP). For Sele River, the results showed that the total PAH concentration ranged from 632.42 to 844.93 ng g−1 dw, with an average value of 738.68 ng g−1 dw. ∑PAHs were in the range of 5.2–678.6 ng g−1 dw and 434.8–872.1 ng g−1 dw for the Sarno and Volturno River sediments, respectively. The cancerogenic risk from the accidental ingestion of PAHs in estuarine sediments was low at all sampling sites. However, based on the ILCRdermal values obtained, the risk of cancer associated with exposure by dermal contact with the PAHs present in the sediments was moderate, with a mean ILCRdermal value of 2.77 × 10−6. This study revealed the pollution levels of PAHs across the South of Italy and provided a scientific basis for PAH pollution control and environmental protection.
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Liu, Qing, Pinggu Wu, Pingping Zhou, and Pengjie Luo. "Levels and Health Risk Assessment of Polycyclic Aromatic Hydrocarbons in Vegetable Oils and Frying Oils by Using the Margin of Exposure (MOE) and the Incremental Lifetime Cancer Risk (ILCR) Approach in China." Foods 12, no. 4 (February 14, 2023): 811. http://dx.doi.org/10.3390/foods12040811.
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A total of 139 vegetable oils and 48 frying oils produced in China were tested for the levels of 15 Environmental Protection Agency-regulated polycyclic aromatic hydrocarbons (PAHs). The analysis was completed by high-performance liquid chromatography-fluorescence detection (HPLC-FLD). The limit of detection and limit of quantitation were ranged between 0.2–0.3 and 0.6–1 μg/kg, respectively. The average recovery was 58.6–90.6%. The highest mean of total PAHs was found in peanut oil (3.31 μg/kg), while the lowest content was found in olive oil (0.39 μg/kg). In brief, 32.4% of vegetable oils exceeded the European Union maximum levels in China. The detected level of total PAHs in vegetable oils was lower than the frying oils. The mean dietary exposure to PAH15 ranged from 0.197 to 2.051 ng BaPeq/kg bw/day. The margin of exposure values was greater than 10,000, and the cumulative probabilities of the incremental lifetime cancer risk of different age groups were less than the priority risk level (10−4). Therefore, there was no potential health concern for specific populations.
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Sopian, Nor Ashikin, Juliana Jalaludin, Suhaili Abu Bakar, Titi Rahmawati Hamedon, and Mohd Talib Latif. "Exposure to Particulate PAHs on Potential Genotoxicity and Cancer Risk among School Children Living Near the Petrochemical Industry." International Journal of Environmental Research and Public Health 18, no. 5 (March 4, 2021): 2575. http://dx.doi.org/10.3390/ijerph18052575.
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This study aimed to assess the association of exposure to particle-bound (PM2.5) polycyclic aromatic hydrocarbons (PAHs) with potential genotoxicity and cancer risk among children living near the petrochemical industry and comparative populations in Malaysia. PM2.5 samples were collected using a low-volume sampler for 24 h at three primary schools located within 5 km of the industrial area and three comparative schools more than 20 km away from any industrial activity. A gas chromatography–mass spectrometer was used to determine the analysis of 16 United States Environmental Protection Agency (USEPA) priority PAHs. A total of 205 children were randomly selected to assess the DNA damage in buccal cells, employing the comet assay. Total PAHs measured in exposed and comparative schools varied, respectively, from 61.60 to 64.64 ng m−3 and from 5.93 to 35.06 ng m−3. The PAH emission in exposed schools was contributed mainly by traffic and industrial emissions, dependent on the source apportionment. The 95th percentiles of the incremental lifetime cancer risk estimated using Monte Carlo simulation revealed that the inhalation risk for the exposed children and comparative populations was 2.22 × 10−6 and 2.95 × 10−7, respectively. The degree of DNA injury was substantially more severe among the exposed children relative to the comparative community. This study reveals that higher exposure to PAHs increases the risk of genotoxic effects and cancer among children.
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Tong, K. B., E. Chen, G. Brink, R. Bender, F. de Snoo, and J. Malin. "Cost-effectiveness of targeting chemotherapy with the 70-gene prognostic signature in early-stage breast cancer (ESBC) patients." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6570. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6570.
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6570 Background: The 70-gene microarray test (MammaPrint) has been shown to provide additional prognostic information to clinicopathologic risk assessment for women ESBC; however, the cost-effectiveness of this strategy is not well understood. Methods: The objective of this analysis was to estimate the incremental benefits, costs, and cost-effectiveness of the treatments guided by the 70-gene signature versus Adjuvant! Software (AS) to decide on the use of adjuvant chemotherapy for women ≤61 years with lymph node negative, HER-2 negative ESBC with estrogen receptor (ER) positive or negative disease. A Markov model with a lifetime horizon and three health states (alive without recurrence, death from cancer and death from other causes) was constructed using TreeAge Pro software. Risk classification and patient outcomes data were based on a multi-center 70-gene signature validation study. Efficacy of chemotherapy derived from published meta-analysis of clinical trials. Costs and health utilities were obtained from the literature. Costs and benefits were discounted 3%/year. Results: Compared to AS, the 70-gene signature strategy resulted in 35% of patients being reassigned to a different risk classification and avoided chemotherapy in 9% of patients. In the base case, the 70-gene signature strategy was cost neutral (lifetime costs per patient: $178,811 versus $178,893 for the 70-gene signature and AS strategy). Moreover the 70-gene signature strategy was associated with an increase of 0.13 life years (LYs) and 0.16 quality adjusted life years (QALYs). The model results were sensitive to the cost of 70-gene signature test, cost of adjuvant chemotherapy, and relative risk reduction associated with chemotherapy; however, the 70-gene strategy remained cost-effective across a wide range of assumptions. Conclusions: In this analysis, the 70-gene signature was associated with a reduction in chemotherapy use and an increase in life expectancy. The 70-gene signature appears to be a cost-effective strategy for obtaining additional information to guide the decision to use adjuvant chemotherapy in patients with lymph node negative ESBC. [Table: see text]
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Thong, Alan E., Justin K. Lee, Sigrid V. Carlsson, and Behfar Ehdaie. "Cost-effectiveness analysis of initial management strategies for low-risk prostate cancer." Journal of Clinical Oncology 34, no. 2_suppl (January 10, 2016): 58. http://dx.doi.org/10.1200/jco.2016.34.2_suppl.58.
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58 Background: A proportion of men with low-risk prostate cancer managed expectantly with active surveillance (AS) go on to definitive treatment in part due to initial understaging during transrectal ultrasound (TRUS) guided biopsy. Newer diagnostic tools including genomic tumor profiling, magnetic resonance (MR) imaging, and MR-ultrasound fusion biopsy have been advocated as effective strategies to risk-stratify men prior to entry into AS. We developed a decision analytic model to determine the cost-effectiveness of various initial management options for low-risk prostate cancer. Methods: A decision tree was constructed with repeat TRUS guided biopsy, MR imaging, genomic tumor profiling, and radical prostatectomy as initial management options with downstream Markov nodes to model annual recurring risks of continued AS, definitive treatment, and death from other causes. Value was optimized from the societal perspective over a lifetime horizon. We evaluated model heterogeneity and assumptions on the probability of understaging and test performance characteristics using Monte Carlo microsimulation and probabilistic sensitivity analysis. Results: At a willingness-to-pay (WTP) threshold of $100,000 per quality adjusted life year (QALY), immediate radical prostatectomy and genomic tumor profiling were dominated strategies with higher costs and lower effectiveness. MR imaging with MR-ultrasound fusion biopsy when targetable lesions are identified was the optimal strategy across 93% of simulations with an incremental cost-effectiveness ratio of $1,096 per QALY. Eliminating uncertainty in our model would lead to cost savings and increased effectiveness. This expected value of perfect information was $516 per patient. Conclusions: With multiple initial management options for low-risk prostate cancer, clinical decision-making can be challenging. Cost-effectiveness analysis demonstrates that image-guided biopsy techniques deliver optimal value from both a patient and societal perspective. However, given the prevalence of low-risk prostate cancer, there is value to be obtained from additional research to optimize management strategies.
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Krajian, Hour. "Estimation of the dietary exposure of polycyclic aromatic hydrocarbons in Syria and their health risks assessment." International Journal of Food Studies 9, no. 2 (October 18, 2020): 332–45. http://dx.doi.org/10.7455/ijfs/9.2.2020.a6.
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In this work, the exposure of people, through their diet, to polycyclic aromatic hydrocarbons (PAHs) has been assessed for the urban, rural, and general populations in Syria. The food categories consumed have been divided into major groups, and the health risk assessment on dietary exposure of PAHs determined in each food category. For this purpose, two approaches were used: incremental lifetime cancer risk (ILCR) and margin of exposure approach (MOE). The results showed that each of the following food categories: oils and fats, meat and meat products, vegetables, and cereals dominantly contribute in the dietary exposure of PAHs. Also their MOE values are the lowest. Additionally, they have higher ILCR values. Therefore, these groups are a main risk source to health. On the other hand, the dietary exposure of PAHs in each of urban, rural and general populations was of low health concern, whereas their ILCR values reached to 10E-05 in total food categories, nevertheless it remains lower than serious risk level (ILCR>10E-04). This work is the first study that is dealing with dietary exposure of PAHs and their health risk assessment in Syria.
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Goudarzi, Gholamreza, Zeynab Baboli, Maliheh Moslemnia, Meimanat Tobekhak, Yaser Tahmasebi Birgani, Abdolkazem Neisi, Kamal Ghanemi, et al. "Assessment of incremental lifetime cancer risks of ambient air PM10-bound PAHs in oil-rich cities of Iran." Journal of Environmental Health Science and Engineering 19, no. 1 (January 12, 2021): 319–30. http://dx.doi.org/10.1007/s40201-020-00605-6.
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Noble, Sian M., Kirsty Garfield, J. Athene Lane, Chris Metcalfe, Michael Davis, Eleanor I. Walsh, Richard M. Martin, et al. "The ProtecT randomised trial cost-effectiveness analysis comparing active monitoring, surgery, or radiotherapy for prostate cancer." British Journal of Cancer 123, no. 7 (July 16, 2020): 1063–70. http://dx.doi.org/10.1038/s41416-020-0978-4.
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Abstract Background There is limited evidence relating to the cost-effectiveness of treatments for localised prostate cancer. Methods The cost-effectiveness of active monitoring, surgery, and radiotherapy was evaluated within the Prostate Testing for Cancer and Treatment (ProtecT) randomised controlled trial from a UK NHS perspective at 10 years’ median follow-up. Prostate cancer resource-use collected from hospital records and trial participants was valued using UK reference-costs. QALYs (quality-adjusted-life-years) were calculated from patient-reported EQ-5D-3L measurements. Adjusted mean costs, QALYs, and incremental cost-effectiveness ratios were calculated; cost-effectiveness acceptability curves and sensitivity analyses addressed uncertainty; subgroup analyses considered age and disease-risk. Results Adjusted mean QALYs were similar between groups: 6.89 (active monitoring), 7.09 (radiotherapy), and 6.91 (surgery). Active monitoring had lower adjusted mean costs (£5913) than radiotherapy (£7361) and surgery (£7519). Radiotherapy was the most likely (58% probability) cost-effective option at the UK NICE willingness-to-pay threshold (£20,000 per QALY). Subgroup analyses confirmed radiotherapy was cost-effective for older men and intermediate/high-risk disease groups; active monitoring was more likely to be the cost-effective option for younger men and low-risk groups. Conclusions Longer follow-up and modelling are required to determine the most cost-effective treatment for localised prostate cancer over a man’s lifetime. Trial registration Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
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Gereslassie, Tekleweini, Ababo Workineh, Xiaoning Liu, Xue Yan, and Jun Wang. "Occurrence and Ecological and Human Health Risk Assessment of Polycyclic Aromatic Hydrocarbons in Soils from Wuhan, Central China." International Journal of Environmental Research and Public Health 15, no. 12 (December 5, 2018): 2751. http://dx.doi.org/10.3390/ijerph15122751.
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Polycyclic aromatic hydrocarbons are large groups of ubiquitous environmental pollutants composed of two or more fused aromatic rings. This study was designed to evaluate the distribution, potential sources, and ecological and cancer risks of eleven polycyclic aromatic hydrocarbons from Huangpi soils in Wuhan, central China. The soil samples for this study were taken from 0–10 cm and 10–20 cm soil depths. A modified matrix solid-phase dispersion extraction method was applied to extract analytes from the soil samples. A gas chromatograph equipped with a flame ionization detector was used to determine the concentrations of the compounds. The sum mean concentrations of the polycyclic aromatic hydrocarbons were 138.93 and 154.99 µg kg−1 in the 0–10 cm and 10–20 cm soil depths, respectively. Benzo[a]pyrene and fluorene were the most abundant compounds in the 0–10 cm and 10–20 cm soil depths, respectively. The quantitative values of the pyrogenic index, total index, and diagnostic ratio used in this study showed that the polycyclic aromatic hydrocarbons have a pyrogenic origin. The negligible and maximum permissible concentrations values for naphthalene, acenaphthylene, acenaphthene, phenanthrene, anthracene, pyrene, benz[a]anthracene, and benzo[a]pyrene indicated a moderate ecological risk. The incremental lifetime cancer risk values for adults and children showed a low and moderate cancer risk, respectively.
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Abdullahi, S., and M. S. Musa. "HEALTH RISK ASSESSMENT OF SOME HEAVY METALS IN SOIL SAMPLES AROUND IDENTIFIED METAL WORKSHOPS." FUDMA JOURNAL OF SCIENCES 7, no. 2 (April 30, 2023): 240–45. http://dx.doi.org/10.33003/fjs-2023-0702-1745.
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Soil properties may change due to climate change, but in recent times, the changes occur as a result of anthropogenic activities such as metal workshop operations. This study was conducted to assess the impact of metal contamination on human health due operating activities of metal workshops. In this research work which was carried out to estimated human health risk due to heavy metal contamination around metal workshops, five different workshops, Garejin Oga Abdul (GOA), Nakowa Welding Construction (NWC), Garejin Da’awa (GDH), Garejin Adamu Salisu (GAS) and Garejin Iliya Maina (GIM) all in Potiskum town, Yobe State were sampled for the study and analyzed for eight heavy metals (Pb, Zn, Cr, Cd, Co, Mn, Ni and Cu) levels using Atomic Absorption Spectrophotometer (AAS). Results from this study revealed that Cr (2.37E-01) and Co (5.77E-04) recorded the highest and lowest hazard quotient and the trend of total hazard quotient of all the heavy metals analyzed is Cr > Pb > Mn > Cu > Cd > Ni > Zn > Co. The hazard Quotients (HQ) and Hazard Index (HI) deduced from the workshops fall below the acceptable level indicating unlikelihood of non-carcinogenic health risks. However, GDH, GIM and GOA workshops were estimated to pose medium cancer risks with Incremental Lifetime Cancer Risk (ILCR) values of 8.195 x 10-5, 6.313 x 10-5 and 7.443 x 10-5 respectively.
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Yousefi, Mohammad Hashem, Esmaeel Abbasi, Milad Hadidi, Seyedenayat Hashemi, Amir Hossein Ghadimi, Saeed Yousefinejad, Hossein Arfaeinia, et al. "Simultaneous Analysis of Mycotoxins, Potentially Toxic Elements, and Pesticides in Rice: A Health Risk Assessment Study." Toxins 15, no. 2 (January 20, 2023): 102. http://dx.doi.org/10.3390/toxins15020102.
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Rice is a widely consumed food worldwide; however, it can be a source of pollutants, such as potentially toxic elements (PTEs), mycotoxins, and pesticides. Sixty rice samples imported from Pakistan (PAK), India (IND), and Thailand (THAI), as well as domestic Iranian (IRN) rice, were collected from Bushehr, Iran, and investigated for the contamination of PTEs, including arsenic (As), lead (Pb), cadmium (Cd), and nickel (Ni); pesticides, including chlorpyrifos, trichlorfon, diazinon, fenitrothion, and chlorothalonil; mycotoxins, such as aflatoxin B1 (AFB1), zearalenone (ZEN), ochratoxin A (OTA), and deoxynivalenol (DON); and molds. Estimated daily intake (EDI) and hazard quotient (HQ) of pollutants and hazard index (HI) and incremental lifetime cancer risk (ILCR) of rice types for the Iranian adult population were calculated. The content of PTEs in Iranian rice was not higher than Iran’s national standard limits. In contrast, other types of rice (imported) had at least one PTE above the permissible level. OTA content was below the detection limit, and all other mycotoxins were within the allowable range in all rice types. Thai rice was the only group without pesticides. The HI order of rice types was as follows: HIPAK = 2.1 > HIIND = 1.86 > HIIRN = 1.01 > HITHAI = 0.98. As was the biggest contributor to the HI of Iranian and Thai rice, and diazinon in the HI of Pakistani and Indian rice. The calculation of ILCR confirmed that the concentrations of Ni and Pb in Pakistani and Ni and As in Indian, Thai, and Iranian rice were not acceptable in terms of lifetime carcinogenic health risks.
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Asphaug, Lars, and Hans Olav Melberg. "The Cost-Effectiveness of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer in Norway." MDM Policy & Practice 4, no. 1 (January 2019): 238146831882110. http://dx.doi.org/10.1177/2381468318821103.
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Background. Expansion of routine genetic testing for hereditary breast and ovarian cancer from conventional BRCA testing to a multigene test could improve diagnostic yield and increase the opportunity for cancer prevention in both identified carriers and their relatives. We use an economic decision model to assess whether the current knowledge on non- BRCA mutation prevalence, cancer risk, and patient preferences justifies switching to a multigene panel for testing of early-onset breast cancer patients. Methods. We evaluated routine testing by BRCA testing, a 7-gene panel, and a 14-gene panel using individual-level simulations of annual health state transitions over a lifetime perspective. Breast and ovarian cancer incidence is reduced and posttreatment survival is improved when high-risk mutations are detected and risk-reducing treatment offered. Most model inputs were synthesized from published literature. Intermediate health outcomes included breast and ovarian cancer incidence rates, along with organ-specific cancer mortality. Cost-effectiveness outcomes were health sector costs and quality-adjusted life years. Results. Intermediate health outcomes improved by testing with multigene panels. At a cost-effectiveness threshold of $77,000, a 7-gene panel test with five non- BRCA genes was the optimal strategy with an incremental cost-effectiveness ratio of $53,310 per quality-adjusted life year compared to BRCA-only testing. Limitations. Unable to stratify carriers to specific mutations within genes, we can only make predictions on the gene level, with combined risk estimates for known variants. As mutation prevalence is the absolute upper bound of returns to more expansive testing, the rarity of modelled mutations makes analysis outcomes sensitive to model implementation. Conclusions. A 7-gene panel to diagnose hereditary breast and ovarian cancer in early-onset breast cancer patients can be a cost-effective alternative to current BRCA-only testing in Norway.