S. Cordier et al., Ecological analysis of digestive cancer mortality related to contaminationby diarrhetic shellfish poisoning toxins along the coasts of France, ENVIR RES, 84(2), 2000, pp. 145-150
Shellfish consumers are exposed to the risk of diarrhea from, among other c
ontaminants, algae that produce diarrhetic shellfish poisoning (DSP) toxins
, such as Dinophysis spp. These illnesses have been effectively prevented s
ince 1984, when a phycotoxin monitoring network was set up along the coasts
of France. There is nonetheless concern that residual levels of okadaic ac
id, a known tumor promoter that is the main toxin present in French coastal
waters, might increase the risk of cancer among regular shellfish consumer
s. To test this hypothesis, we conducted an ecological study linking digest
ive cancer mortality rates with a proxy measure of contamination by DSP tox
ins in 59 coastal areas. Observed and expected numbers of deaths (using nat
ional rates as the reference) were computed by sex, cause of death, and are
a for two time periods: 1984-1988 and 1989-1993. The level of contamination
in each area was estimated by the total number of weeks since monitoring b
egan that production was shut down because of DSP toxin contamination. Usin
g both Poisson regressions and test for trends of standardized mortality ra
tios across four exposure categories, we found some evidence of association
s for several digestive cancer sites (esophagus, stomach, colon, liver, and
total digestive cancers for men; stomach and pancreatic cancers for women)
. Among men, the only statistically significant result that remained after
taking possible confounding by alcohol use into account involved colon canc
er. The conclusions provided by this analysis are very tentative; they need
to be reproduced and interpreted in the light of additional information on
the potential long-term effects of DSP toxins. In the absence of human dat
a, they provide some indication of a possible association between exposure
to DSP toxins and digestive cancers. (C) 2000 Academic Press.