A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies.
PURPOSE
Establishing a causal relationship between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and risk of specific lymphoid cancers, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM), would be useful for risk assessment.


METHODS
This article systematically and critically reviews epidemiologic studies of the association between exposure to TCDD or TCDD-contaminated herbicides and risk of lymphoid malignancies. These include studies of military, industrial, accidental environmental, and general environmental exposure to Agent Orange or TCDD.


RESULTS
Collectively, the epidemiologic evidence from industrial cohorts suggests a positive association with NHL mortality, but results are not consistent across other studies, a clear exposure-response gradient is not evident, and data are insufficient to conclude that the association is causal. Furthermore, available studies provide little information on NHL incidence or specific NHL subtypes. Epidemiologic studies do not show an association of TCDD exposure with HL, whereas the indication of a positive association with MM in a limited number of studies, but not others, remains to be confirmed in additional research. Exposure classification error and small numbers are important limitations of the available epidemiologic studies.


CONCLUSIONS
Overall, a causal effect of TCDD on NHL, HL, MM, or subtypes of these lymphoid malignancies has not been established.
['Chang|Ellen T|ET|', 'Boffetta|Paolo|P|', 'Adami|Hans-Olov|HO|', 'Mandel|Jack S|JS|']
D015085:2,4,5-Trichlorophenoxyacetic Acid D015084:2,4-Dichlorophenoxyacetic Acid D000075182:Agent Orange D006540:Herbicides D006689:Hodgkin Disease D006801:Humans D008228:Lymphoma, Non-Hodgkin D008232:Lymphoproliferative Disorders D009101:Multiple Myeloma D000072317:Polychlorinated Dibenzodioxins
Epidemiology Agent Orange Lymphoma Multiple myeloma Lymphoma, Hodgkin Lymphoma, Non-Hodgkin Tetrachlorodibenzodioxin