Section of Environment and Radiation, International Agency for Research on Cancer (IARC/World Health Organization), Lyon, France.
S Afr Med J. 2019 Apr 29;109(5):340-346. doi: 10.7196/SAMJ.2019.v109i5.13538.
South Africa (SA) has a long history of goldmining that has resulted in locally high levels of environmental contamination from uranium and its decay products (radium-226 and radon-222) from the mine tailings. Populations living around mine tailings of the Witwatersrand goldfields may be exposed through various pathways, raising concern about potential health risks associated with haematological malignancies (HMs), for which evidence is inconclusive.
We designed a prospective case-series study of HMs at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, the major public hospital in the area, to describe demographic and clinical characteristics, lifetime residential history and potential environmental uranium exposure pathways.
All patients, male and female, aged ≥18 years and newly diagnosed with any form of leukaemia, lymphoma or myeloma at the CHBAH Haematology Unit in 2014 and 2015 were considered for inclusion in the study. Information on uranium exposure pathways and lifetime residential history was recorded from interviewer-administered questionnaires. These characteristics were described overall and according to subtypes of HM.
Of 556 patients with HMs diagnosed in 2014 and 2015 at CHBAH, 189 patients aged 18 - 90 years were interviewed, mainly with non-Hodgkin's lymphoma (NHL) (37.6%), leukaemia (32.8%) and Hodgkin's lymphoma (HL) (13.8%). HIV status was positive for 39.2% of the patients, mostly with NHL and HL. Potential environmental uranium exposure pathways were identified. Working on goldmines was reported by 12 patients (6.3%). Consumption of soil (geophagia) was a habit of 51 patients (27.0%), particularly during pregnancy. Drinking water was mainly piped water (76.6% in childhood and 97.9% in adulthood). Animal products and vegetables were most frequently obtained from stores (82.0% and 68.7%, respectively, in childhood and 96.3% and 83.6% in adulthood). Patients were referred to CHBAH by government clinic doctors (44.4%), referral hospitals (24.3%) and private doctors (20.1%). Most participants had been born and lived in Gauteng Province and Soweto (94.7% and 58.2%, respectively), and reported two lifetime places of residence on average and living at their current residence for ≥20 years (49.2%).
We identified potential environmental uranium exposure pathways (occupational, lifestyle related and domestic) among patients with HMs that could have resulted in increased uranium exposure. HIV is common among patients with HMs. Together with the results from a previous retrospective case series of HMs at CHBAH (2004 - 2013), our findings suggest that further research on environmental uranium exposure in mining areas and HM risk in residents is warranted.
南非（SA）有着悠久的金矿开采历史，导致其矿尾中的铀及其衰变产物（镭-226 和氡-222）在当地造成了严重的环境污染。居住在兰德金矿矿尾附近的人群可能通过各种途径接触到这些物质，这引发了人们对与血液系统恶性肿瘤（HMs）相关的潜在健康风险的担忧，但目前还没有确凿的证据。
我们设计了一项在约翰内斯堡 Chris Hani Baragwanath 学术医院（CHBAH）进行的血液系统恶性肿瘤病例系列前瞻性研究，该医院是该地区的主要公立医院，旨在描述血液系统恶性肿瘤患者的人口统计学和临床特征、终身居住史以及潜在的铀环境暴露途径。
所有在 2014 年和 2015 年在 CHBAH 血液科新诊断为任何形式白血病、淋巴瘤或骨髓瘤的 18 岁及以上的男性和女性患者均被考虑纳入研究。通过访谈员管理的问卷记录铀暴露途径和终身居住史的信息。这些特征总体上和根据血液系统恶性肿瘤的亚型进行了描述。
在 2014 年和 2015 年在 CHBAH 诊断的 556 例血液系统恶性肿瘤患者中，有 189 例年龄在 18-90 岁的患者接受了访谈，主要患有非霍奇金淋巴瘤（NHL）（37.6%）、白血病（32.8%）和霍奇金淋巴瘤（HL）（13.8%）。39.2%的患者 HIV 检测呈阳性，主要是 NHL 和 HL 患者。确定了潜在的环境铀暴露途径。有 12 名患者（6.3%）报告曾在金矿工作。51 名患者（27.0%）有食用土壤（食土癖）的习惯，尤其是在怀孕期间。饮用水主要是管道水（儿童期为 76.6%，成年期为 97.9%）。动物产品和蔬菜主要从商店购买（儿童期为 82.0%和 68.7%，成年期为 96.3%和 83.6%）。患者由政府诊所医生（44.4%）、转诊医院（24.3%）和私人医生（20.1%）转介到 CHBAH。大多数参与者出生和居住在豪登省和索韦托（分别为 94.7%和 58.2%），报告平均有两个终身居住地，并且目前居住的地方居住时间≥20 年（49.2%）。
我们确定了血液系统恶性肿瘤患者中潜在的环境铀暴露途径（职业、与生活方式相关和家庭），这些途径可能导致铀暴露增加。HIV 在血液系统恶性肿瘤患者中很常见。结合之前在 CHBAH 进行的血液系统恶性肿瘤病例系列回顾性研究（2004-2013 年）的结果，我们的研究结果表明，有必要进一步研究矿区环境铀暴露和居民血液系统恶性肿瘤风险。
