Identification of geographic clustering and regions spared by cutaneous T‐cell lymphoma in Texas using 2 distinct cancer registries

Abstract

Background Cutaneous T-Cell Lymphomas (Mycosis Fungoides and its leukemic variant, Sézary Syndrome) are rare malignancies. Reports of occurrence of Mycosis Fungoides in married couples and families raise the possibility of an environmental trigger for this cancer. While it was suggested that CTLC arises from inappropriate T cell stimulation, currently no preventable trigger has been identified. Methods We analyzed by region, zip code, age, sex and ethnicity the demographic data of 1047 patients from Texas, who were seen in a CTCL clinic at the MD Anderson Cancer Center during 2000-2012 (the MDACC database) and 1990 patients that were recorded in the population-based Texas Cancer Registry (TCR) between 1996-2010. Subsequently data from both databases was cross analyzed and compared. Results Our findings, based on the MDACC database, document geographic clustering of patients in three communities within the Houston metropolitan area, where CTCL incidence rates were 5-20 times higher than the expected population rate. Analysis of the TCR database defined the CTCL population rate for the state to be 5.8 [95% CI 5.5, 6.0] cases per million individuals per year, confirmed the observations from the MDACC database and further highlighted additional areas of geographic clustering and regions spared by CTCL in Texas. Conclusions Our study documents geographic clustering of CTCL cases in Texas and argues for the existence of yet unknown external causes/triggers for this rare malignancy.

The Use of Transcriptional Profiling to Improve Personalized Diagnosis and Management of Cutaneous T-cell Lymphoma (CTCL)

“…Recent studies also revealed that CTCL may occur in married couples(4) and cluster in families(5). Recent investigations demonstrated geographic clustering of CTCL cases, therefore implying possible existence of an environmental trigger for this malignancy (6) though this remains to be confirmed.…”

Clustering of cutaneous T‐cell lymphoma is associated with increased levels of the environmental toxins benzene and trichloroethylene in the state of Georgia

“…Clues pointing to attribution of environmental exposure include the concomitant rise in CTCL cases with industrial expansion, increased incidence in nonblood‐related relatives, and known associations of occupational chemicals with other hematologic malignancies . Clustering has been identified in several studies across the globe, including Sweden, Canada, Pittsburgh, Pennsylvania, and Texas . The analysis in Texas found 3 communities in metropolitan Houston with rates of CTCL that were between 5 and 20 times higher than the expected population rate .…”

“…Clustering has been identified in several studies across the globe, including Sweden, Canada, Pittsburgh, Pennsylvania, and Texas . The analysis in Texas found 3 communities in metropolitan Houston with rates of CTCL that were between 5 and 20 times higher than the expected population rate . Each of these studies of geographic clustering of CTCL had proposed environmental and occupational exposures as inciting factors, but further analysis of toxic exposures had not previously been performed.…”

Malignant inflammation in cutaneous T‐cell lymphoma—a hostile takeover

“…Demographic patterns in the incidence of CTCL have been reported, but no environmental triggers have yet been identified [16, 17]. Likewise, no convincing evidence showing an etiologic role of infectious agents in CTCL has been provided, albeit infections may aggravate the disease [18].…”