Hodgkin's disease, work, and the environment. A review

Hodgkin's disease (HD), a lymphoma with an annual incidence in the United States of approximately 7500 cases, primarily affects the lymph nodes, spleen, and liver. The point of this article is to critically review the literature regarding the purported relationships between HD, certain occupations, and exposure to chemical agents. Attention will also be focused on recent advances in molecular genetics in the etiology of this ailment. A MEDLINE search was conducted to assess case-control and mortality evaluations that investigated links between HD and certain occupations and exposure to designated hazards. A review of citations in the Silver Platter Occupational and Environmental Medicine CD-ROM database was also conducted to ensure that all pertinent reports were obtained. Of the industries evaluated, woodworking showed the most consistent link between an increased risk of HD (relative risk, 1.8 to 7.2), but not all studies conducted showed positive associations. Although certain chemicals (ie, chlorophenols, pesticides) were reported as risks, no chemical was consistently and unambiguously linked with HD. Recent investigative work, however, points to a major etiological role for the Epstein-Barr virus (EBV), genetic fragments of which have been noted in Reed-Sternberg cells, the classic malignant cells of HD. The occupation most consistently associated with HD appears to be woodworking, although no specific chemical has been consistently linked with this lymphoma. The most persuasive evidence regarding the cause of HD arises from recent studies, including epidemiological, clinical, and genetic studies, that point to a major role by the EBV.