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"...endometriosis is a serious condition that can adversely affect the quality of a woman’s life, yet we still do not have a clear understanding of why endometriosis develops in some women but not in others. Our study provides another piece of the puzzle.” Victoria Holt

Endometriosis risk linked to two pesticides

The Fred Hutchinson Cancer Research Center has found that two organochlorine pesticides are associated with an increased risk of endometriosis, a condition that affects up to 10 percent of reproductive-age women.

Specifically, researchers observed that women with higher exposures to two such pesticides, beta-hexachlorocyclohexane and mirex, had a 30- to 70-percent increase in endometriosis risk.

The findings are published online ahead of the print issue of Environmental Health Perspectives, a journal of the National Institute of Environmental Health Sciences, part of the National Institutes of Health.

Endometriosis is a noncancerous condition that occurs when the tissue that lines the inside of the uterus, or womb, grows outside of the organ and attaches to other structures or organs.

The condition most often affects the ovaries, fallopian tubes and lining of the pelvic cavity. The most common symptoms include chronic pelvic pain, painful menstrual periods and infertility.

“For many women, the symptoms of endometriosis can be chronic and debilitating, negatively affecting health-related quality of life, personal relationships and work productivity,” explains lead and corresponding author Kristen Upson, Ph.D., a predoctoral research fellow in epidemiology at Fred Hutch and the University of Washington when the study was conducted. Today, a postdoctoral fellow at the Epidemiology Branch of the NIEHS.

“Since endometriosis is an estrogen-driven condition, we were interested in investigating the role of environmental chemicals that have estrogenic properties, such as organochlorine pesticides, on the risk of the disease,” she said.

“This research is important, as endometriosis is a serious condition that can adversely affect the quality of a woman’s life, yet we still do not have a clear understanding of why endometriosis develops in some women but not in others. Our study provides another piece of the puzzle.”

Victoria Holt, Ph.D., study principal investigator, former joint member of the Epidemiology Research Unit, Public Health Sciences Division, Fred Hutch, and professor of epidemiology at the University of Washington School of Public Health.

The study was conducted among members of Group Health Cooperative, a Seattle-based nonprofit health care system. The study involved 248 women newly diagnosed with endometriosis and, for comparison, 538 women without the disease.

Upson: “We found it interesting that despite organochlorine pesticides being restricted in use or banned in the U.S. for the past several decades, these chemicals were detectable in the blood samples of women in our study and were associated with increased endometriosis risk.

"The take-home message from our study is that persistent environmental chemicals, even those used in the past, may affect the health of the current generation of reproductive-age women with regard to a hormonally driven disease.”

Organochlorine pesticides have generally demonstrated estrogenic properties in laboratory studies of human tissue and adverse reproductive effects in laboratory studies of other model organisms, altering the function of the uterus and ovaries, as well as hormone production.

“Given these actions, it’s plausible that organochlorine pesticides could increase the risk of an estrogen-driven disease such as endometriosis,” Upson added. “We hope our findings will help inform current global policymaking to reduce or eliminate their use.”

Abstract
Background: Endometriosis is considered an estrogen-dependent disease. Persistent environmental chemicals that exhibit hormonal properties, such as organochlorine pesticides (OCPs), may affect endometriosis risk.

Objectives: We investigated endometriosis risk in relation to environmental exposure to OCPs.

Methods: We conducted the current analyses using data from the Women’s Risk of Endometriosis (WREN) study, a population-based case-control study of endometriosis conducted among 18-49 year old female enrollees of a large healthcare system in western Washington State. OCP concentrations were measured in sera from surgically confirmed endometriosis cases (n=248) first diagnosed between 1996 and 2001 and population-based controls (n=538). We estimated odds ratios (OR) and 95% confidence intervals (CI) using unconditional logistic regression, adjusting for age, reference date year, serum lipids, education, race/ethnicity, smoking, and alcohol intake.

Results: Our data suggested increased endometriosis risk associated with serum concentrations of β-hexachlorocyclohexane (HCH) (third vs. lowest quartile: OR 1.7; 95% CI: 1.0, 2.8; highest vs. lowest quartile OR 1.3; 95% CI: 0.8, 2.4) and mirex (highest vs. lowest category: OR 1.5; 95% CI: 1.0, 2.2). The association between serum β-HCH concentrations and endometriosis was stronger in analyses restricting cases to those with ovarian endometriosis (third vs. lowest quartile: OR 2.5; 95% CI: 1.5, 5.2; highest vs. lowest quartile: OR 2.5; 95% CI: 1.1, 5.3).

Conclusions: In our case-control study of women enrolled in a large healthcare system in the U.S. Pacific Northwest, serum concentrations of β-HCH and mirex were positively associated with endometriosis. Extensive past use of environmentally persistent OCPs in the United States or present use in other countries may impact the health of reproductive-age women.

Data for the study was provided by the Women’s Risk of Endometriosis Study, which was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Environmental Protection Agency and the National Institute of Nursing Research also provided funds for the research, which involved co-investigator Delia Scholes, Ph.D., a senior investigator at Group Health Research Institute, and scientists at the University of Washington, Seattle Children’s Research Institute and Emory University.

At Fred Hutchinson Cancer Research Center, home to three Nobel laureates, interdisciplinary teams of world-renowned scientists seek new and innovative ways to prevent, diagnose and treat cancer, HIV/AIDS and other life-threatening diseases. Fred Hutch’s pioneering work in bone marrow transplantation led to the development of immunotherapy, which harnesses the power of the immune system to treat cancer with minimal side effects. An independent, nonprofit research institute based in Seattle, Fred Hutch houses the nation’s first and largest cancer prevention research program, as well as the clinical coordinating center of the Women’s Health Initiative and the international headquarters of the HIV Vaccine Trials Network. Private contributions are essential for enabling Fred Hutch scientists to explore novel research opportunities that lead to important medical breakthroughs. For more information visit www.fredhutch.org or follow Fred Hutch on Facebook, Twitter or YouTube.

Original press release:http://www.fhcrc.org/en/news/releases/2013/11/endometriosis-risk-linked-to-two-pesticides.html