Identificatie van indicatoren voor impact van endocrien verstorende stoffen /hormonale stoorstoffen (in het Engels) Identification of indicators for the impact of endocrine/hormone disrupting substances Studie uitgevoerd door Universiteit Gent en Katholieke Universiteit Leuven Mahmoud A., Comhaire F., Van Larebeke N. (University Ghent) Van Kersschaever G. (Catholic University Leuven) In opdracht van For AMINAL (Administratie Milieu,- Natuur-, Land- en Waterbeheer) Project number DTG/OL200300064/3185/M&G Endocrine disrupters, Mahmoud et al 2005 for AMINAL 1 Acknowledgments The generous exchange of information by many clinicians and national as well as international organizations has significantly contributed to the realization of this work. We are especially grateful to organizations that follow an open policy and make their data available in an interactive form on their websites such as MINECO and EUROCAT. This facilitated the recalculation of some data for the present work. The authors would like to thank the members of the steering committee for their expert advice and critical comments. The authors Endocrine disrupters, Mahmoud et al 2005 for AMINAL 2 Summary Based on the evidence we gathered on the possible health impacts of endocrine disruption, we generated a list of pathologies possibly related to endocrine disruptors. The availability of medical data on the relevant pathologies in Flanders was then explored through contacts with many organizations and experts. A suggested strategy was developed for the retrieval of these data and linking them to data on environmental pollution. The relevant pathologies were then ranked according to the evidence available and the relevance to the Flemish situation in a descending order of priority (see below). Rank Pathology 1 Breast cancer (female) 2 Female infertility 3 Male infertility 4 Non-Hodgkin lymphomas 5 Prostate cancer 6 Delayed puberty 7 Sex ratio 8 Congenital anomalies (in general) 9 Intrauterine growth retardation 10 Prematurity 11 Testicular cancer 12 Disturbances in mental and psychomotor development 13 Cryptorchidism 14 Hypospadias 15 Precocious puberty 16 Thyroid gland diseases 17 Immune system diseases (immunosuppression) 18 Endometriosis 19 Time to pregnancy Endocrine disrupters, Mahmoud et al 2005 for AMINAL 3 Table of contents 1 Abbreviations.......................................................................................... 8 2 Simplified definitions of some medical terms ...................................... 10 3 Introduction.......................................................................................... 12 4 Materials and methods ......................................................................... 12 5 Pathologies possibly related to endocrine disruption (literature review) 13 5.1 Intra-uterine growth and pregnancy outcome...........................................................13 5.2 Congenital anomalies .............................................................................................13 5.2.1 Congenital anomalies in general ...........................................................................14 5.2.2 Hypospadias and cryptorchidism...........................................................................14 5.3 Development and health during childhood and adolescence .......................................15 5.3.1 Mental and Psychomotor development ..................................................................15 5.3.2 Thyroid function ..................................................................................................16 5.3.3 Immunosuppression ............................................................................................16 5.3.4 Other health effects .............................................................................................16 5.4 Puberty .................................................................................................................16 5.4.1 Precocious puberty ..............................................................................................17 5.4.2 Delayed puberty..................................................................................................17 5.5 Infertility ...............................................................................................................17 5.5.1 Male infertility .....................................................................................................18 5.5.2 Female infertility .................................................................................................19 5.6 Sex ratio (male to female ratio at birth) ...................................................................20 5.7 Endometriosis and endometrial cancer.....................................................................20 5.8 Breast cancer (female) ...........................................................................................20 5.9 Prostate cancer......................................................................................................22 5.10 Testicular cancer....................................................................................................23 5.11 Thyroid gland diseases in adults ..............................................................................23 5.12 Pancreatic diseases ................................................................................................24 5.13 Immunosuppression in adults .................................................................................24 5.14 Other diseases and abnormalities ............................................................................25 6 Clinical indicators specific to relevant pathologies .............................. 28 6.1 Intrauterine growth retardation ...............................................................................28 6.2 Prematurity ...........................................................................................................28 6.3 Congenital anomalies .............................................................................................29 6.3.1 Congenital anomalies in general ...........................................................................29 6.3.2 Hypospadias .......................................................................................................29 6.3.3 Cryptorchidism....................................................................................................30 6.4 Disturbances in mental and psychomotor development .............................................31 6.5 Puberty .................................................................................................................32 6.5.1 Precocious puberty ..............................................................................................32 6.5.2 Delayed puberty..................................................................................................33 6.6 Male infertility and sperm quality.............................................................................33 6.7 Female infertility ....................................................................................................34 6.8 Time to pregnancy .................................................................................................35 6.9 Sex ratio ...............................................................................................................35 6.10 Endometriosis........................................................................................................35 6.11 Breast cancer (female) ...........................................................................................36 6.12 Prostate cancer......................................................................................................37 6.13 Testicular cancer....................................................................................................37 6.14 Thyroid gland diseases ...........................................................................................38 6.15 Immune system diseases (immunosuppression) .......................................................39 Endocrine disrupters, Mahmoud et al 2005 for AMINAL 4 6.16 Non-Hodgkin lymphomas .......................................................................................39 7 Relevant pathologies: Which data are available for Flanders? ............ 41 7.1 Sources of data......................................................................................................41 7.1.1 Study center for perinatal epidemiology (Studiecentrum voor Perinatale Epidemiologie, SPE) ............................................................................................41 7.1.2 The EUROCAT Register of congenital anomalies .....................................................41 7.1.3 Centers for guiding pupils (Centra voor Leerlingenbegeleiding, CLB) ........................41 7.1.4 Cancer registries .................................................................................................42 7.1.5 Health interviews.................................................................................................42 7.1.6 Electronic medical file ..........................................................................................42 7.1.7 Global medical file (Globaal Medisch Dossier).........................................................43 7.1.8 The National Institute for Sickness and Invalidity Insurance (RIZIV) ........................43 7.1.9 The intermutuality agency (InterMutualistisch Agentschap,