Iowa and Minnesota (Brown et al., 1990), and on leukemia associated with NHL in eastern Nebraska (Zahm et al., 1990).

Case–control studies have been conducted in various US populations for other cancers, including NHL (Cantor, 1982; Cantor et al., 1992; Tatham et al., 1997; Zahm et al., 1993); multiple myeloma (Boffetta et al., 1989; Brown et al., 1993; Morris et al., 1986); cancers of the stomach, prostate, NHL, and multiple myeloma (Burmeister et al., 1983); STS, HD, and NHL (Hoar et al., 1986); NHL and HD (Dubrow et al., 1988); and STS and NHL (Woods and Polissar, 1989; Woods et al., 1987).

Other studies outside the United States have examined ovarian cancer in the Piedmont region of Italy (Donna et al., 1984); brain gliomas in two hospitals in Milan, Italy (Musicco et al., 1988); STS and other cancers in the 15 regional cancer registries that constitute the National Cancer Register in England (Balarajan and Acheson, 1984); STS and malignant lymphomas in the Victorian Cancer Registry of Australia (Smith and Christophers, 1992); lymphoid cancer in Milan, Italy (LaVecchia et al., 1989); STS among rice weeders in northern Italy (Vineis et al., 1986); primary lung cancer among pesticide users in Saskatchewan (McDuffie et al., 1990); and renal-cell carcinoma in the Denmark Cancer Registry (Mellemgaard et al., 1994). Nanni et al. (1996) conducted a population-based case–control study, based on the work of Amadori et al. (1995), of occupational and chemical risk factors for lymphocytic leukemia and NHL in northeastern Italy.

Non-cancer endpoints also have been investigated in case–control studies: spontaneous abortion (Carmelli et al., 1981); congenital malformations (García et al., 1998); immunosuppression and subsequent decreased host resistance to infection among AIDS patients with Kaposi’s sarcoma (Hardell et al., 1987); mortality in US Department of Agriculture extension agents (Alavanja et al., 1988, 1989); spina bifida in offspring associated with paternal occupation (Blatter et al., 1997); mortality from neurodegenerative diseases associated with occupational risk factors (Schulte et al., 1996); Parkinson’s disease (PD) associated with occupational and environmental risk factors (Liou et al., 1997); PD associated with various rural factors, including exposure to herbicides and wood preservatives (Seidler et al., 1996); PD associated with occupational risk factors (Semchuk et al., 1993); and birth defects in offspring of agriculture workers (Nurminen et al., 1994). Those studies are discussed in detail in VAO, Update 1996, and Update 1998. No new case–control studies of agriculture and forestry workers have been published since Update 2000.

Workers in the paper and pulp industry can be exposed to TCDD and other dioxins that can be generated by the bleaching process during the production and treatment of paper and paper products. VAO describes studies of pulp and paper

Front Matter (R1-R16)

Executive Summary (1-10)

1 Introduction (11-19)

2 Evaluating the Evidence (20-32)

3 Toxicology (33-117)

4 Epidemiology (118-164)

5 Exposure Assessment (165-200)

6 Cancer (201-353)

7 Reproductive and Developmental Effects (354-403)

8 Neurologic Disorders (404-435)

9 Other Health Effects (436-490)

10 Research Recommendations (491-494)

Appendix A: Epidemiologic Tables for Chapter 4 (495-568)

Appendix B: Agendas of Public Meetings (569-570)

Appendix C: International Classification of Diseases (ICD-9) Codes for Cancers of Interest (571-574)

Appendix D: Committee and Staff Biographies (575-579)

Index (580-664)