臨床医学に環境・労働の観点を

・本日も乳癌のお話。下のような論文を見つけました。

Occupation and Breast Cancer
A Canadian Case–Control Study

Ann. N.Y. Acad. Sci. 1076: 765–777 (2006). C
2006 New York Academy of Sciences.
doi: 10.1196/annals.1371.019

http://www.nomorebreastcancer.org.uk/assets/NYAS_1076_765_777_final.pdf

抄録が↓

ABSTRACT: Alocal collaborative process was launched in Windsor, Ontario,
Ｃanada to explore the role of occupation as a risk factor for cancer.
An initial hypothesis-generating study found an increased risk for breast cancer among women aged 55 years or younger who had ever worked in farming. On the basis of this result, a 2-year case–control study was undertaken to evaluate the lifetime occupational histories of women with breast cancer. The results indicate that women with breast cancer were nearly three times more likely to have worked in agriculture
when compared to the controls (OR = 2.80 [95% CI, 1.6–4.8]).
The risk for those who worked in agriculture and subsequently worked
in automotive-related manufacturing was further elevated (OR = 4.0
[95% CI, 1.7–9.9]). The risk for those employed in agriculture and subsequently employed in health care was also elevated (OR = 2.3 [95% CI, 1.1–4.6]). Farming tended to be among the earlier jobs worked, often during adolescence. While this article has limitations including the small sample size and the lack of information regarding specific exposures,
it does provide evidence of a possible association between farming and breast cancer. The findings indicate the need for further study to determine which aspects of farming may be of biological importance and to better understand the significance of timing of exposure in terms of cancer risk.

・本文で、私が、大事だな/おもしろいなと思ったところ↓

Increasing
evidence suggests that synthetic chemicals, particularly those that mimic estrogen
(xenoestrogens),may increase risk by acting as endocrine disruptors. Such
exogenous chemicals include organochlorine pesticides, polycyclic aromatic
hydrocarbons, organic solvents, and plastics. Animal bioassays have identified over 200 chemical substances that trigger breast cancer.

Canada and the existence of carcinogens in occupational environments, there
remain no registries or systematic methods to record the occupational histories of cancer patients in general, nor breast cancer patients in particular.  

The failure to document lifetime occupational histories and corresponding
workplace exposures results in an underestimation of occupationally
related cancers and a corresponding lack of substantive prevention-related activity.

・私がいつも言っている、職業・環境性疾患が、低く見積もられているということが、ここにも書かれています。

・環境と乳がんの論文読んでみて、おもしろいなと思うのは、化学物質が、いわゆる内分泌攪乱物質のように、ホルモンの異常を起こして乳がんを発生させやすくしているというメカニズムです。（そういえば、最近「環境ホルモン」の話題をとんと聞きませんが、どうなったのでしょう？）

以下日記

・本日、いろんな患者さんがいるなあと改めて実感。（今回、悪い意味でのいろんな患者さん）①一人は、入院費を会社に借りに言って、支払いせずに行方不明に。②ひとりは、待ち時間が長いと外来で大声をだす。その人曰く、待てるのは３分。③そして、酸素療法をしているのに、禁煙せず、酸素をせずに動き周り、結局呼吸困難がひどくなり、時間外に受診。なんか、 今日一日で疲れます。まあ、こういうこともあるわなと思いますが。（三番目の人は、一定おつきあいがあって憎めないんですがね．．．）

・今朝病院に着いたのが、７時１５分頃、病院でたのが、２１時３０分。明日は、お祭りなのに、うまくおどれるかな？（踊りの練習１回しかするまがなかったです）22時前に帰宅、まずは入浴し、夕食は、ホルモンうどん。だれが、このメニューを考え出したのでしょう？表彰ものです。このうどん食べながら、ＴＶで途中から、『サマーウォーズ』見ました。なんか、昔のアニメのパクリか、パルディーか、はたまたオマージュか？なんか、ごった煮でしたね。（そもそも途中から見て、シテュエーションがようわかりませんでしたが。