Abstract
Modern molecular and cellular biology have provided powerful new approaches to study cancer in the research laboratory, but these techniques have not been used extensively in field studies or in screening of high-risk occupational cohorts. The primary objective of this study was to demonstrate the use of cellular and molecular methods in combination with medical and epidemiologic methods to identify cancer cases, risk factors, and markers in a previously identified and defined cohort of Chinese workers exposed to benzidine. The screening of exposed workers included occupational medical, and smoking histories to identify exogenous risk factors, a limited physical examination, Papanicolaou (PAP) urinary cytology, measurement of urine pH, quantitative fluorescence image analysis (QFIA) cytology to detect DNA hyperploidy, and quantitative fluorescence to detect expression of a low-grade bladder tumor-associated antigen by exfoliated urothelial cells and elevated expression of the neu oncogene product (p185). Detailed analysis of the accuracy of epidemiologic data and the adequacy of samples and accuracy of molecular techniques was carried out. Three groups were included in this study: group 1 included 23 bladder cancer cases who had previously been exposed to benzidine and served as two surrogates for late-emerging disease; group 2 consisted of 20 subjects with previous exposure history but not previously diagnosed with bladder cancer; and group 0 was the nonexposure and nonbladder cancer controls. The results showed that accurate questionnaire data and urine samples can be obtained at remote sites. Among the 20 group 2 subjects, two displayed abnormal findings by both QFIA cytology and p300 expression and were later confirmed to have bladder cancer. Other positive findings suggest that premalignant changes related to exposure to benzidine are detectable as well. This study demonstrates the feasibility of performing molecular marker field studies to define risks in exposed-worker cohorts.