Fluent Essays

DPH 432 – Introduction to Epidemiology Article Reviews Read the article by Sarah Lowry and Noel Weiss (2016), titled “Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA”,  and answer the following critique questions. Type your response to each question using complete sentences, double spaced, 11 pt Arial font, 1 in margins, and number each question so I can easily identify your answer. Be sure to include your name at the top of every page and include page numbers. Include a proper citation in either APA or AMA format at the end of your critique, along with citations for any other articles you reference. Critique questions: 1. What is the purpose of this article? a. The purpose of an article is very rarely “to inform the audience.” Most will be “to determine factors,” “to display a relationship between,” or something of that nature. Articles are certainly written to inform, but most articles written about studies are primarily to report on an investigation of certain features of the data. 2. What type of study design was used in this article? a. This will be some kind of study that we cover in this class. Cross-sectional, ecological, cohort, case-control, experimental, randomized controlled trial, etc. Most of the investigators will tell you in the abstract what kind of study design was used. 3. List several general advantages and disadvantages for this type of study design. a. This is not referring to the advantages/disadvantages of this particular study. For example, if this is a cross-sectional study I only want the general strengths/weaknesses of all cross-sectional studies, not what this one study did well or poorly. 4. What is the outcome under investigation? How is it defined? a. In this case, the “outcome under investigation” refers to what they’re trying to determine with their actual questionnaires. Outcome under investigation does not necessarily refer to the end result of the entire study, but the outcome that they’re testing for in their experiment/data collection method. So think “what were the researchers trying to determine/confirm/identify” and don’t think about what conclusions they drew from that information. For instance, if a researcher is investigating an e-coli outbreak, their final goal may be to determine what caused the outbreak, but their outcome under investigation may simply be “presence of e-coli as confirmed by laboratory analysis”. Just something to keep in mind, and feel free to contact me if this is giving you a hard time. 5. What other variables were measured or assessed in the study? 6. Describe the sample and the sampling strategies used in the study. a. Consider the following - Who are the participants? Were the specific inclusion or exclusion criteria? Where was the sample drawn from? How did the participants know about the study? 7. What types of bias should you be aware of when reading a study of this type? What type of bias is evidenced in the article, if any? a. Note that bias in research doesn’t just mean intentional favoritism or prejudice. Bias can also happen unintentionally or be an inherent pitfall of a particular study design that must be considered when interpreting the results. 8. What were the major results? 9. What is the “take-home” message? How can the results from this study inform or enhance your practice as a health professional? 10. Include a citation of the article using either AMA or APA style. a. For more information on AMA style citation, consult the following website: https://owl.english.purdue.edu/owl/resource/1017/01/ B R I E F R E P O R T Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA Sarah J. Lowry1 • Noel S. Weiss1 Received: 8 April 2016 / Accepted: 25 October 2016 / Published online: 3 November 2016 � Springer International Publishing Switzerland 2016 Abstract Purpose Exposure to asbestos is thought to cause the large majority of pleural mesotheliomas in the USA. It is unknown whether asbestos exposure plays a role in the etiology of rarer forms of mesothelioma, e.g., those located in the pericardium or in the tunica vaginalis of the testis. In order to address this question, we sought to determine whether geographic patterns of incidence of these mesotheliomas have paralleled those of pleural mesotheliomas. Methods We used age-adjusted incidence data from the nine populations served by the National Cancer Institute’s Surveillance, Epidemiology, and End Results program during 1973–2011. Among men ages C50 years, we compared the incidence of pericardial and paratesticular mesotheliomas, respectively, with the incidence of pleural mesothelioma across the nine populations. Results The rate of pleural mesothelioma was approxi- mately twice as high in the San Francisco–Oakland (SFO) and Seattle–Puget Sound (SPS) areas compared to the other regions. In contrast, rates of paratesticular and pericardial mesotheliomas were not elevated in SFO (n = 3 parates- ticular, 1 pericardial) or SPS (n = 4 paratesticular, 1 pericardial) relative to other regions. Conclusions The results of this ecologic study do not sup- port a role for asbestos exposure in the etiologies of either pericardial or paratesticular mesotheliomas; however, this study was limited by small numbers and was unable to directly ascertain asbestos exposure. Keywords Mesothelioma � Asbestos � Pericardial mesothelioma � Paratesticular mesothelioma � SEER Introduction Occupational exposure to asbestos is a well-established cause of mesothelioma of the pleura [1–3]. However, no doubt due to their relative rarity, the etiologies of pericar- dial, and paratesticular mesotheliomas (which arise in the tunica vaginalis, spermatic cord, epididymis, and tunica albuginea [4]) has received little attention. It has been sug- gested that asbestos may play a role in these mesotheliomas as well [5, 6]. We hypothesized that if the incidence of either (or both) paratesticular or pericardial mesothelioma was strongly related to asbestos exposure, their incidence would have been highest in the parts of the USA in which the incidence of pleural mesothelioma has been highest. Methods We conducted an ecologic study using nine registries of the National Cancer Institute’s (NCI) Surveillance, Epidemi- ology, and End Results program (SEER) to compare geo- graphic patterns of the different types of mesothelioma. Because the majority of pleural mesotheliomas are thought to be caused by asbestos exposure [1–3], we hypothesized that the regional patterns in incidence of paratesticular and pericardial mesotheliomas would parallel those of pleural mesotheliomas if in fact occupational asbestos exposure causes those rarer types as well. & Sarah J. Lowry [email protected] 1 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262, Box 357236, Seattle, WA 98195, USA 123 Cancer Causes Control (2016) 27:1487–1489 DOI 10.1007/s10552-016-0825-3 http://crossmark.crossref.org/dialog/?doi=10.1007/s10552-016-0825-3&domain=pdf http://crossmark.crossref.org/dialog/?doi=10.1007/s10552-016-0825-3&domain=pdf The nine population-based SEER cancer registries included in this study were established between 1973 and 1975 in San Francisco–Oakland, Seattle–Puget Sound, Connecticut, Detroit (metropolitan area), Hawaii, Iowa, New Mexico, Utah, and Atlanta (metropolitan area). Each registry seeks to include data on every cancer diagnosed within the specified region, as well as data on age, sex, race, year, and specific details on diagnosis. Previous studies have reported the SEER registries to be approxi- mately 97\% complete [7, 8]. We limited our study popu- lation to men aged C50 years at diagnosis, because most occupational exposure to asbestos has historically occurred in men. Also, risk of pleural mesothelioma increases with age and tends to occur many years after the earliest exposure to asbestos [2]. We used ICD-O-3 histology codes 9050/3–9053/3 to identify cases of mesothelioma. To distinguish mesothe- liomas of specific anatomic sites of interest, we used the collaborative staging (CS) designation in the SEER registry (CS v. 02.04, which corresponds to the 7th edition of the AJCC Cancer Staging manual) [9]. The SEER*Stat soft- ware (version 8.1.5) [10] was used to generate age-adjusted rates and 95\% confidence intervals (CIs) based on the US 2000 standard population, for each of the nine SEER regions. Results Among men C50 years old, the annual incidence of pleural mesothelioma was approximately 99 per million in the Seattle–Puget Sound region and 76 per million in the San Francisco–Oakland region, compared to between 31 and 55 cases per million in the remaining seven geographic regions (Table 1). Higher rates observed in the Seattle– Puget Sound and San Francisco–Oakland regions have previously been attributed to the fact that a larger fraction of the population had been employed in the shipbuilding industry, which historically had high levels of exposure to asbestos [11]. There were four and three cases of parates- ticular mesothelioma that were reported among residents of the Seattle–Puget Sound and San Francisco–Oakland populations during the period of the study, corresponding to rates of 0.29 and 0.15 cases per million person-years, respectively. The range of incidence among the remaining seven SEER populations was 0.16–1.03 per million person- years. Similarly for pericardial mesothelioma, the one case diagnosed in the Seattle–Puget Sound population and the one in the San Francisco–Oakland population did not correspond to an elevated rate relative to that in the other seven SEER populations. Discussion Prior literature on the relationship between asbestos exposure and pericardial and paratesticular mesotheliomas is limited. A study based on a national mesothelioma registry in Denmark reported that the incidence of pleural mesothelioma in men steadily increased between 1943 and 2009, rising from \0.1 to 1.76 cases per 100,000 person- years, whereas incidence of pericardial mesothelioma remained at a relatively constant low level of incidence (\0.1 cases per 100,000 person-years) over that period Table 1 Incidence of pleural, paratesticular, and pericardial mesothelioma in nine SEER regions of the USA among males C50 years Person-years Pleural Paratesticular Pericardial Cases Rate a (95\% CI) Cases Rate a (95\% CI) Cases Rate a (95\% CI) US Region b San Francisco–Oakland SMSA 18,041,379 1,188 76.40 (72.02–80.97) 3 0.15 (0.03–0.46) 1 0.08 (0–0.39) Seattle (PS) 16,285,389 1,370 99.19 (93.88–104.72) 4 0.29 (0.07–0.75) 1 0.11 (0.00–0.50) Connecticut 16,768,718 821 54.70 (50.95–58.65) 7 0.43 (0.17–0.91) 0 0.00 (0.00–0.25) Detroit (Metr.) 18,595,840 764 48.28 (44.82–51.95) 3 0.21 (0.04–0.63) 2 0.12 (0.01–0.44) Hawaii 5,576,302 206 39.94 (34.59–45.88) 1 0.16 (0.00–1.01) 2 0.49 (0.06–1.67) Iowa 15,027,083 574 39.55 (36.35–42.95) 6 0.43 (0.16–0.94) 1 0.07 (0.00–0.40) New Mexico 7,459,983 352 51.42 (46.05–57.24) 5 0.69 (0.22–1.66) 7 0.98 (0.38–2.07) Utah 6,978,251 318 51.57 (45.92–57.72) 2 0.37 (0.04–1.28) 3 0.51 (0.10–1.48) Atlanta (Metr.) 8,347,185 196 30.85 (26.39–35.83) 7 1.03 (0.37–2.26) 1 0.09 (0.00–0.78) Sites of mesothelioma defined according to a diagnosis with mesothelioma (ICD-O-3 histology code of 9050–9055, and with CS Schema v 0204 categories assigned as follows: Pleura includes CS Schema v 0204 sites ‘‘Pleura’’ and ‘‘Lung.’’ Paratesticular includes ‘‘Testis,’’ ‘‘Scrotum,’’ and ‘‘Genital Male Other.’’ Pericardial includes ‘‘Heart’’. Metr. metropolitan, P Puget Sound, CI confidence interval) a Rates are age adjusted to the 2000 US population ages 50 ? years and are expressed as number of cases per 1,000,000 person-years b All 1973–2011 except Atlanta (1975–2011) and Seattle (Puget Sound) (1974–2011) 1488 Cancer Causes Control (2016) 27:1487–1489 123 [12]. Additionally, some prior studies have used national or regional mesothelioma registries which include data on cases’ history of possible asbestos exposure; however, such studies have been somewhat limited by data missingness, inconsistencies in exposure ascertainment approaches across regions, and/or lack of exposure data on non-cases [13–15]. Other studies of mesothelioma incidence which include mention of pericardial or paratesticular disease include no more than one or two cases of these types of mesothelioma [16, 17]. This study found no association between the incidence of either pericardial or paratesticular mesothelioma and that of pleural mesothelioma, across nine regions of the USA. This is, however, an ecologic study based on very small numbers of cases, which was unable to directly ascertain asbestos exposure, and thus, the strength of evidence is limited. The absence of a correlation in this study suggests that the association between asbestos exposure and these rarer forms of mesothelioma, if there is one, may not be as strong as the association with pleural mesotheliomas. Acknowledgments This manuscript was supported by the National Cancer Institute Training Grant 2T32CA009168-36. References 1. Robinson BW, Musk AW, Lake RA (2005) Malignant mesothelioma. Lancet 366(9483):397–408 (PMID: 16054941) 2. Selikoff IJ, Lilis R, Nicholson WJ (1979) Asbestos disease in United States shipyards. Ann N Y Acad Sci 330:295–311 (PMID: 294180) 3. 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J Cancer Res Clin Oncol 136(11):1755–1759. doi:10.1007/ s00432-010-0834-7 (PMID: 20213099) Cancer Causes Control (2016) 27:1487–1489 1489 123 http://dx.doi.org/10.1097/PAP.0b013e3181c66fbc http://dx.doi.org/10.1097/PAP.0b013e3181c66fbc http://dx.doi.org/10.1111/j.1464-410X.2012.10932.x http://dx.doi.org/10.1111/j.1464-410X.2012.10932.x http://www.ncra-usa.org/files/public/PartISection1and2v02.04.pdf http://www.ncra-usa.org/files/public/PartISection1and2v02.04.pdf http://www.seer.cancer.gov/seerstat http://www.seer.cancer.gov/seerstat http://dx.doi.org/10.1136/oem.2009.051466 http://dx.doi.org/10.1111/j.1349-7006.2011.02165.x http://dx.doi.org/10.1007/s00432-010-0834-7 http://dx.doi.org/10.1007/s00432-010-0834-7 Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA Abstract Purpose Methods Results Conclusions Introduction Methods Results Discussion Acknowledgments References