Sarolta Gundy

Numerical and structural chromosomal abnormalities are the hallmarks of cancer. Whereas the structural chromosome aberrations got more substantial attention for cancer risk assessment in a healthy population, the role of aneuploidy is much less understood in this respect. We analysed the frequency of numerical (and structural) aberrations in peripheral blood lymphocytes of 2145 healthy individuals between 1989 and 2010, taking into account different biological- and exposure-conditions. We also studied to what extent chromosome gains or losses may predict the probability of cancer. The average frequency of all aneuploid cells was 1.78±0.06% in the entire study population, which increased linearly with age. Gender and smoking did not influence the values, however, occupational exposures did. The highest frequency of aneuploidy was found in chemical industry-workers (1.89±0.05%) compared with the lowest value of medical radiation workers (1.44±0.10%), respectively. No correlation was found between numerical and structural chromosomal aberrations. Cancer incidence followed for 1−23 years after the chromosome analysis showed a 1.26-fold relative risk (confidence interval: 1.02–1.58; P = 0.04) for those with higher frequency of aneuploid cells (1.82% vs. 1.44% in controls). Hypodiploidy had higher impact on the cancer risk than hyperdiploidy (1.72% vs. 0.10%). Our findings on the frequency of numerical aberrations in a healthy cohort represent the largest cytogenetic database from one laboratory with an unchanged mechanistic scoring method during a 30-year period, and provide basic information not only for genotoxicological studies but also confirm the association between numerical aberrations and cancer risk.

The author provides a comprehensive picture on introduction and application of chromosome biodosimetry in Hungary for measuring and estimation of biological doses of ionizing radiation. She describes different mathematical equations existing between the frequencies of dicentric and ring chromosome aberrations, and the different radiation doses of various radiation sources which form the basis of the method. She presents examples for estimation of biological doses received at radiation accidents, or cumulated during residential and occupational exposures in Hungary. The method of chromosome dosimetry is also offered to be used in radiotherapy because it allows the calculation of whole-body equivalent biological doses, and the determination of individual radiosensitivity as well, which cannot be fully informative by sole physical dose measurements. Dose-effect relationship in partial body irradiation might be affected by not only therapeutic doses, but also the localization and the volume of irradiated area of the body. In case of the same radiation therapy protocols and clinical features of the patients up to 2.5-fold differences in individual radiosensitivity may occur. Finally, the author analyzes the future state of biological dosimetry, the advantages and disadvantages of the methods to ensure determination of individual radiosensitivity, thereby administration of individualized radiotherapy.

Aneuploidy plays very important role in tumor development as the consequence of either congenital or acquired mutations. In order to evaluate the adverse effects of various aneugens, the knowledge of the spontaneous frequency of numerical chromosome abnormalities in healthy population is fundamental. In our study we analyzed the spontaneous rate of numerical and structural chromosome aberrations in peripheral blood lymphocytes of 2145 healthy individuals, with special attention to the influence of biological (gender, age) and life-style factors (smoking, different occupational exposure). Correlation between aneuploidy and risk of cancer development were investigated according to National Cancer Registry data followed for 1-23 years. In the whole population the average frequency of aneuploid cells was 1.77±0.06%. This value increased by age linearly (r2=0.81) regardless of occupational exposures. Gender (biological factor) or smoking (life style factor) did not influence the values, however, the occupation of individuals modified the frequency of numerical aberrations. Individuals who worked at workplaces with radiation hazard had the lowest (1.44±0.10%), and those working in the chemical industry had the highest (1.89±0.05%) values of aneuploidy, respectively. We could not find any correlation between numerical and structural chromosome aberrations. In our population studied 97 individuals developed cancer and only those who had ≤2% aneuploidy survived more than 12 years in good health conditions. To our knowledge, this study has the highest case number investigated up to now. Our results support that aneuploidy, similarly to structural chromosomal aberrations, might be an additional cytogenetic biomarker of the genetic instability.

Red mud is an industrial waste produced in the process of alumina extraction from bauxite with concentrated NaOH. When the red mud-containing reservoir collapsed in Ajka Alumina Plant Hungary in October 2010, the most serious immediate effects were caused by the high alkalinity (pH ≥13) of the flood. Many persons suffered burn-like damage to tissues and contact with caustic desiccated ultra-fine dust with traces of toxic metals also caused irritation of upper respiratory tract and eyes. This catastrophe was unique from the point of view of genotoxic effects as well. Therefore cytogenetic examinations were carried out on inhabitants, either with burns (17 persons) or on those inhaling desiccated caustic dust (42 persons). Chromosomal aberration (CA) analysis and bleomycin (BLM)-sensitivity assays, as possible markers of effects, were studied in peripheral blood lymphocytes of persons within 4–6 weeks following the catastrophe. Controls were matched for age, sex and smoking habits, and also places of residence with different constituents of air pollution either from rural (59 persons), or from urban environments (59 persons). Neither spontaneous rate of CAs (1.47% vs. 1.69%) nor BLM-induced in vitro chromosomal breakage (0.79 vs. 0.83 break/cell) showed elevated rates when cytogenetic biomarkers of genotoxicity were compared between controls and exposed persons. Time spent in cleaning did not affect cytogenetic changes either (R² = 0.04). BLM-induced mutagen sensitivity was similar in exposed and control persons (27.1% vs. 30.5%). It seems that the red mud exposure does not appear to pose an immediate genotoxic hazard on residents when measured with cytogenetic methods. We recommend, however, that those involved in clean-up activities should be followed closely not only for overall health, but also for further genotoxic risk assessment, because the long-term hazards of ultra-fine fugitive dust particles with alkalinity of residual NaOH in red mud are still unknown.

Applicability of alcohol- and smoking-related cancer-risk biomarkers might be modified by several factors. Among those, reality of self-reports on alcohol consumption of alcoholic patients with different diseases and extreme high mutagen hypersensitivity of Hungarians, as well as the immunologic role of peripheral lymphocytes as experimental objects of cytogenetic biomarkers seem to be new viewpoints of interest. To clarify these problems, 432 head and neck cancer patients (HNCP), 62 alcoholics with alcoholic hepatitis (ALCL), and 101 disease-free chronic alcoholics (ALC) were examined. Despite clinically confirmed alcohol-related diagnoses (and GGT and MCV values) only about half of HNCPs and ALCLs reported about any alcohol consumption, in contrast to the realistic self-reports of ALCs. In cytogenetic case control investigations no difference between the spontaneous rate of chromosomal aberrations (CAs) of healthy controls and ALCs was found, however, genetic instability expressed as a 40-50% elevation rate of CAs in HNCPs and ALCLs might be associated with systemic inflammatory reaction of lymphocytes. Bleomycin sensitivity assay showed the highest break/cell (b/c) values not in HNCPs (1.06 b/c) as it was reported earlier, but in "healthy" ALCs (1.52 b/c). This phenomenon can be related to the local effect of genotoxins (alcohol, smoking, and in particular the diet), which probably reflects merely a reaction of mucosal immune system. Nearly 50% of mutagen-hypersensitive Hungarian controls, in contrary to the expected 10-20% ones, might also be explained by this. Similarly, HNCPs with oral cancer, where the local mutagen effect was the most intensive, had the highest b/c values. In conclusion, when cytogenetic biomarkers of alcoholism are examined, the subjective character of self-reports at epidemiologic level and immunologic role of lymphocyte subpopulations as genetic confounders must also be taken into consideration.

The author deals with the effects of environmental chemical-, and physical carcinogens playing predominant role in nearly 90% of the cancer development. Different steps of chemical carcinogenesis, classification and evaluation of carcinogens according to the criteria of International Agency for Research on Cancer, and the most important biological markers of genotoxic exposures are presented. Among physical agents the carcinogenic effects of ionizing and nonionizing radiations are demonstrated, including limited, inadequate or proved carcinogenic action of UV, microwave, static and low-frequency electric and magnetic fields.

In the aetiology of head and neck squamous cell carcinoma (HNSCC), smoking and heavy alcohol consumption are the main environmental risk factors. The bleomycin (BLM) sensitivity assay is believed to measure environment-related cancer risks, mainly of HNSCC. Previously, we have shown that this method is only moderately sensitive to identify individuals at high risk for developing HNSCC, due to broad overlap of BLM-induced chromatid breaks per cell (b/c) between cancer patients and controls, and alcoholics with liver diseases. In the present study, we evaluated whether the differences between patients and controls are more manifested when the risks according to localization of HNSCC are examined. BLM sensitivity in lymphocytes of 278 patients with HNSCC at four different anatomical sites, and that of 356 frequency-matched controls was studied. There was a significant difference in BLM-induced b/c values between patients (1.11 b/c) and controls (0.97 b/c); however, considering all HNSCC cases, only 58.3% of patients and 43.3% of controls were mutagen sensitive. When the patients were distributed according to tumour sites, mutagen sensitivity of those with cancer of oral cavity, oropharynx and hypopharynx was significantly higher than that of the frequency-matched controls (1.12–1.14 b/c versus 1.00 b/c), while laryngeal tumour patients (1.05 b/c) did not differ from controls (1.00 b/c). When the associations between BLM sensitivity and the risk of HNSCC sites were examined, it was expressed mostly in patients with tumours of the oral cavity and oropharynx (OR = 1.97 and OR = 1.90), and not in patients with tumours of the hypopharynx and larynx. Though the mutagen sensitivity decreased from the oral cavity down to the larynx, indicating that the site-specific risks may differ, the BLM assay shows weak and controversial associations between mutagen sensitivity and cancer risk of patients even at specific HNSCC sites.

Cancer susceptibility was examined in first-degree relatives of 293 testicular tumor patients (TTPs) and 586 age-matched healthy males. Significantly increased risk was found in the families of TTPs (OR: 1.4; CI: 1.08–1.79), however, except for testicular cancer of 7 brothers (OR: 11.7; CI: 1.42–256.5), and 6 various childhood tumors (bilateral Wilms’ tumor, neuroblastoma, medulloblastoma, ALL, histiocytosis-X, testicular tumor) of 200 offspring (OR: 12.9; CI: 1.54–286.2), no association with other malignancies was observed. No differences were seen between the fertility of patients and controls when occupational or socio-economic status of the families was taken into account. However, the majority of the controls (85%) fathered the first child between 20–30 years of age, while only 61% of TTPs had the first child in the same age group. TTPs fathered more girls than boys (P=0.009), and the lower male-higher female ratio of index children was also identical, irrespective of the conception taking place before or after the father’s treatment. Occupations did not, but smoking might have influenced cancer susceptibility of the patients. Aggregation of fraternal testicular tumors, and both dramatically increased cancer risk and altered sex ratio of the offspring indicate a remarkable role of hereditary factors in tumorigenesis and later consequences of a certain portion of testicular malignancies, which must be refined by molecular studies.

To investigate the clinical outcome of HNSCC patients, and their hormonal status. The liver function (GGT), hypophysis gonadotrop hormone (FSH, LH, prolactin) and sexsteroid hormone serum levels were examined in 130 male HNSCC patients. Clinical parameters for age, primary tumor site and clinical tumor stage were also recorded. The survival was disadvantageously influenced by the following parameters: age, the presence of lymph node metastasis, advanced tumor stage, the lower than normal testosterone and the higher than normal FSH serum levels. Elevated FSH and decreased testosterone serum levels showed significant correlation with the survival of head and neck cancer patients. The better understanding of their exact role in the biology of HNSCC requires further investigations.

In the second half of 2002, IARC for Central and Eastern European countries targeted studies on the relationship between chromosomal aberrations (CAs) and cancer risk. For these purposes we preliminarily investigated, under identical methodological circumstances, the base-line level of CAs in peripheral blood lymphocytes of 1414 healthy Hungarian persons between 1986 and 2001. The age and sex as biological, and smoking habit and residency (Budapest, industrial- and agricultural settlements) as environmental confounding factors were evaluated. Previously, people were not exposed to any known potential mutagens. The overall frequencies of aberrant cells (1.60+/-0.05%) were not influenced by sex, age and residency, but the smoking habits (1.84+/-0.09%) had significant impact on the elevation of aberrant cells. Aneuploidy, exchange-type dicentric chromosomes and the total of aberrations increased significantly with the age of the donors. The individual frequency of aberrant cells ranged between 0-12%. No aberrant cells were detected in 35% of individuals, and 1 aberrant cell was found in 23% of the total population, while 42% of the examined persons were characterized with aberrant cell rates between 2-12%. The initial value of 0.85% of aberrant cells doubled by the end of the examined 16-year period, following 2-4-fold fluctuations. None of the investigated biological or environmental factors was responsible for the elevation of the CAs. The causes of the elevation of CA-level can be explained more precisely when these data will be compared to cancer registry database of these persons.