The impact of endocrine disruption: A consensus statement on the state of the science

Perspectives | Editorial The Impact of Endocrine Disruption: A Consensus Statement on the State of the Science doi:10.1289/ehp.1205448 Ake Bergman, 1 Jerrold J. Heindel, 2,a Tim Kasten, 3,b Karen A. Kidd, 4 Susan Jobling, 5 Maria Neira, 6,c R. Thomas Zoeller, 7 Georg Becher, 8 Poul Bjerregaard, 9 Riana Bornman, 10 Ingvar Brandt, 11 Andreas Kortenkamp, 5 Derek Muir, 12 Marie-Noel Brune Drisse, 6,c Roseline Ochieng, 13 Niels E. Skakkebaek, 14 Agneta Sunden Bylehn, 3,b Taisen Iguchi, 15 Jorma Toppari, 16 and Tracey J. Woodruff 17 1 Department of Materials and Environmental Chemistry, Stockholm University, Stockholm, Sweden; 2 National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; 3 United Nations Environment Programme (UNEP), Geneva, Switzerland; 4 Department of Biology & Canadian Rivers Institute, University of New Brunswick, Saint John, New Brunswick, Canada; 5 Institute for the Environment, Brunel University, Uxbridge, Middlesex, United Kingdom; 6 Department of Public Health and Environment, World Health Organization, Geneva, Switzerland; 7 Biology Department, Morrill Science Center, University of Massachusetts, Amherst, Massachusetts, USA; 8 Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; 9 Institute of Biology, University of Southern Denmark, Odense, Denmark; 10 Department of Urology, School of Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa; 11 Department of Environmental Toxicology, Uppsala University, Uppsala, Sweden; 12 Aquatic Ecosystems Protection Research Division, Water Science & Technology Directorate, Environment Canada, Burlington, Ontario, Canada; 13 Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya; 14 University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark; 15 Department of Bioenvironmental Science, Okazaki Institute for Integrative Bioscience, National Institute for Basic Biology, National Institutes of Natural Sciences, Okazaki Aichi, Japan; 16 Departments of Physiology and Paediatrics, University of Turku, Turku, Finland; 17 Department of Obstetrics, Gynecology and Reproductive Sciences, Institute for Health Policy Studies, University of California San Francisco, Oakland, California, USA In 2002, the joint International Programme on Chemical Safety (IPCS) of the World Health Organization (WHO), the United Nations Environment Programme (UNEP), and the International Labour Organisation (ILO) published a report titled Global Assessment of the State-of-the-Science of Endocrine Disruptors (http://www.who.int/ ipcs/publications/new_issues/endocrine_disruptors/en/). Since 2002, intense scientific work has improved our understanding of the impacts of endocrine-disrupting chemicals (EDCs) on human and wildlife health, such that in 2012, the UNEP and WHO, in collaboration with international experts, have produced an updated document on EDCs, State of the Science of Endocrine Disrupting Chemicals - 2012 (http:// www.who.int/ceh/publications/endocrine/en/index.html) that includes scientific information on human and wildlife impacts and lists key concerns for decision makers and others concerned about the future of human and wildlife health. The basis for these key concerns is described in the State of the Science of Endocrine Disrupting Chemicals - 2012 (http://www.who. int/ceh/publications/endocrine/en/index.html) and includes extensive references to the science behind the concerns. A shorter summary, primarily for decision makers, elabo­rates on the key concerns listed below and and also on suggested considerations related to EDCs (State of the Science of Endocrine Disrupting Chemicals - 2012: Summary for Decision-Makers; http://www.who.int/ceh/publications/endocrine/en/ index.html). The key concerns noted in the State of the Science of Endocrine Disrupting Chemicals - 2012 (http://www.who.int/ceh/publications/ endocrine/en/index.html) are as follows: • Human and wildlife health depends on the ability to reproduce and develop normally. This is not possible without a healthy endocrine system. • Three strands of evidence fuel concerns over endocrine disruptors: ǹ ǹ The high incidence and the increasing trends of many endocrine- related disorders in humans; ǹ ǹ Observations of endocrine-related effects in wildlife populations; ǹ ǹ The identification of chemicals with endocrine disrupting proper- ties linked to disease outcomes in laboratory studies. • Many endocrine-related diseases and disorders are on the rise. ǹ ǹ Large proportions (up to 40%) of young men in some countries have low semen quality, which reduces their ability to father children. ǹ ǹ The incidence of genital malformations, such as non-descending testes (cryptorchidisms) and penile malformations (hypospadias), in baby boys has increased over time or levelled off at unfavour- ably high rates. ǹ ǹ The incidence of adverse pregnancy outcomes, such as preterm birth and low birth weight, has increased in many countries. ǹ ǹ Neurobehavioural disorders associated with thyroid disruption affect a high proportion of children in some countries and have increased over past decades. ǹ ǹ Global rates of endocrine-related cancers (breast, endometrial, ovarian, prostate, testicular and thyroid) have been increasing over the past 40–50 years. ǹ ǹ There is a trend towards earlier onset of breast development in young girls in all countries where this has been studied. This is a risk factor for breast cancer. ǹ ǹ The prevalence of obesity and type 2 diabetes has dramatically increased worldwide over the last 40 years. WHO estimates that 1.5 billion adults worldwide are overweight or obese and that the number with type 2 diabetes increased from 153 million to 347 million between 1980 and 2008. • Close to 800 chemicals are known or suspected to be capable of inter- fering with hormone receptors, hormone synthesis or hormone con- version. However, only a small fraction of these chemicals have been investigated in tests capable of identifying overt endocrine effects in intact organisms. ǹ ǹ The vast majority of chemicals in current commercial use have not been tested at all. ǹ ǹ This lack of data introduces significant uncertainties about the true extent of risks from chemicals that potentially could disrupt the endocrine system. • Human and wildlife populations all over the world are exposed to EDCs. ǹ ǹ There is global transport of many known and potential EDCs through natural processes as well as through commerce, leading to worldwide exposure. ǹ ǹ Unlike 10 years ago, we now know that humans and wildlife are exposed to far more EDCs than just those that are POPs [persis- tent organic pollutants]. ǹ ǹ Levels of some newer POPs in humans and wildlife are still increasing, and there is also exposure to less persistent and less bioaccumulative, but ubiquitous, chemicals. Address correspondence to A. Bergman, Department of Materials and Environmental Chemistry, Stockholm University, SE-10691 Stockholm, Sweden. E-mail: ake.bergman@mmk.su.se United Nations Environment Programme (UNEP) address: 13 chemin des Anemones, CH-1219 Chatelaine, Geneva, Switzerland. a The author is an employee of the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH); any statements, opinions, or conclusions contained herein do not necessar- ily represent the statements, opinions, or conclusions of the NIEHS, NIH, or the U.S. government. b The authors are staff members of the United Nations Environment Programme (A.S.B. is now retired). The authors alone are responsible for the views expressed in this article, and they do not necessarily represent the decisions or policies of the United Nations Environment Programme. c The authors are staff mem- bers of the World Health Organization (WHO). The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the views, decisions, or policies of the WHO. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. The WHO does not endorse any specific organization or products. Any reproduction of this article cannot include the use of the WHO logo. The authors declare they have no actual or potential competing ­financial interests. A 104 Environmental Health Perspectives volume 121 | number 4 | April 2013 •