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Chronic Disease Epidemiology Group

Risk Factors for Chronic Disease

Dale P. Sandler, Ph.D.
Dale P. Sandler, Ph.D.
Principal Investigator and Chief

Tel (919) 541-4668
Fax (919) 541-2511

Curriculum Vitae (  Download Adobe Reader
P.O. Box 12233
Mail Drop A3-05
Research Triangle Park, North Carolina 27709
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Research Summary

The Chronic Disease Epidemiology Group uses the core tools of epidemiology to study a wide range of chronic diseases and conditions, including risk factors for chronic kidney disease, leukemia, lung cancer, breast cancer and women's health problems, and health effects of radon and agricultural exposures. The group is responsible for two large prospective cohort studies that also serve as resources for research by other research groups within the Epidemiology Branch.  The Agricultural Health Study (AHS), a study of licensed pesticide applicators and spouses, is co-directed by Staff Scientist Jane Hoppin, Sc.D., and the Sister Study is co-directed by Staff Scientist Lisa DeRoo, Ph.D.  In addition, the group provides support to the National Toxicology Program for evaluation of epidemiologic evidence through Staff Scientist Freya Kamel, Ph.D. who serves as liaison to that program.  Dale P. Sandler, Ph.D., is head of the Chronic Disease Epidemiology Group.

Sandler’s research on chronic kidney disease focused on the association between use of pain medications including phenacetin, acetaminophen—the major ingredient in many aspirin-free products—and nonsteroidal anti-inflammatory drugs and risk of chronic kidney disease. The study also demonstrated that obesity, a history of kidney stones and consumption of cola beverages may increase risk of developing kidney disease. Sandler’s current work explores the influence of occupational exposures on kidney disease risk.

In a study of acute leukemia and myelodyspastic syndromes, Sandler was among the first to focus on cytogenetic subgoups of leukemia. She reported that smoking cigarettes may cause leukemia, and that a family history of breast cancer or hematopoeitic cancers including leukemia may enhance a person’s risk of these illnesses.  Other results included the suggestion that hair dye and certain occupational exposures increased a person’s risk of developing acute leukemia.  Current analyses focus on whether exposure to solvents and other chemicals and the use of medications increases a person’s risk for acute leukemia.

Current Projects:

  • Sandler partnered with the National Cancer Institute and the Environmental Protection Agency to develop the Agricultural Health Study, a prospective study of the health of licensed pesticide applicators and their spouses.
  • Sandler is Principal Investigator of The Sister Study, a prospective study of 50,000 sisters of women who have had breast cancer.  The study is designed to identify environmental and genetic causes of breast cancer and other diseases in women. 
  • Two population-based studies focus on cancer risk from radon exposure.  A case-control study in Utah and Connecticut focuses on residential radon exposure and other risk factors for lung cancer.  Incidence of leukemia, lung cancer and other cancers is being studied on a prospective study of over 16,000 uranium miners from the Czech Republic.

Sandler is chief of the Epidemiology Branch in the Division of Intramural Research at NIEHS, and head of the Chronic Disease Epidemiology Group. She is adjunct professor of Epidemiology at the University of North Carolina at Chapel Hill, an editor of the journal, Epidemiology, and a past president of the American College of Epidemiology.  Sandler has authored more than 150 articles in peer-reviewed journals.  She received an M.P.H. from Yale University in 1975 and a Ph.D. in Epidemiology from The Johns Hopkins University in 1979.


The Agricultural Health Study (AHS)


The AHS explores a wide range of health outcomes among licensed pesticide applicators, their spouses and children potentially exposed to pesticides and other agricultural hazards.  The study includes nearly 5,000 commercial pesticide applicators from Iowa, 52,000 private pesticide applicators, mostly farmers, from Iowa and North Carolina and 32,000 spouses of private applicators who have been followed since enrollment in 1993–1997.

Agricultural Health Study: African-American Farmers and Farm Workers

As an adjunct to the Agricultural Health Study, approximately 1,100 African-American farmers and farm workers from eastern North Carolina were recruited through churches in four counties.  This group was followed for mortality and cancer incidence along with the main study.  In 1999, a questionnaire and blood sample was collected from the men in this group to study links between DDE and steroid hormones and markers of immune function.

Chronic Renal Disease Study

Risk factors for chronic renal disease were studied using 548 hospital cases and 514 community controls from four medical centers in North Carolina. Telephone interviews obtained information on past use of analgesic medications, occupational and environmental exposures, lifestyle factors and medical history.

Czech Uranium Miners Study

Cancer incidence related to radon exposure was studied in a cohort of over 16,000 underground uranium miners from the Czech Republic followed from 1977–1996.

Growth and Puberty Study (GAP)

The GAP study is exploring the use of more sensitive hormonal measures of puberty onset and exploring factors associated with timing of puberty in children of licensed applicators from Iowa enrolled in the Agricultural Health Study.

Leukemia Study

A case-control study of risk factors for acute leukemia in adults was carried out with collaboration from Cancer and Leukemia Group B, a cooperative cancer treatment group.  Newly diagnosed cases were recruited at the time of diagnosis and classified by FAB type, cytogenetic abnormalities and immunophenotype.    Community controls were selected through random telephone screening.  Telephone interviews obtained data on occupational and environmental   exposures, hair dye, lifestyle factors and medical history.

Radon Study

A case-control study involving 1,475 incident lung cancer cases aged 40–79 from Connecticut, Utah and southern Idaho. Population controls were carried out on 1,811 cases to evaluate the risk associated with residential exposure to radon.  Complete residential histories and information on known and potential lung cancer risk factors were obtained by in-person and telephone interviews. Radon was measured on multiple levels of past and current homes using 12-month alpha-track etch detectors.

The Sister Study(

The Sister Study will prospectively examine environmental and familial risk factors for breast cancer and other diseases in a cohort of 50,000 sisters of women who have had breast cancer. The study should enhance the group’s ability to understand the interplay of genes and environment in breast cancer risk and to identify potentially preventable risk factors.

Menstrual and Reproductive Health Study

The Menstrual and Reproductive Health Study examines the association between menstrual and reproductive factors and morbidity and mortality resulting from chronic diseases including heart disease, diabetes and osteoporosis. The cohort consisted of 997 white college-educated women who prospectively recorded menstrual cycle data for as many as 50 years, beginning in 1934.  Information on lifestyle factors and medical history was obtained through a mail survey conducted in the early 1990s.

Selected Publications

  1. Sandler DP, Smith JC, Weinberg CR, Buckalew VM, Dennis V, Blythe W, Burgess WP. Analgesic use and chronic renal disease. N Engl J Med 320: 1238-1243, 1989. [Abstract] Exit NIEHS(
  2. Sandler DP, Shore DL, Anderson JR, Davey FR, Silver RT, Aisner J, Canellos GP, Weiss RB, Trump DL, Arthur D, Wurster-Hill D, McIntyre OR, Bloomfield CD. Cigarette smoking and risk of acute leukemia: Associations with morphology and cytogenetic abnormalities in bone marrow. J Natl Cancer Inst 85: 1994-2003, 1993. [Abstract] Exit NIEHS(
  3. Rauscher GH, Sandler DP, Shore D, Poole C, Olshan AF. Is family history of breast cancer a marker of susceptibility to exposures in the incidence of de novo adult acute leukemia? Cancer Epid Biom Prev 12: 289-294, 2003. [Abstract] Exit NIEHS( [Full Text] Exit NIEHS( [download the PDF] Exit NIEHS(
  4. Rauscher GH, Shore DS, Sandler DP. Hair dye use and risk of adult acute leukemia. Amer J Epidemiol 160: 19-25, 2004. [Abstract] Exit NIEHS( [Full Text] Exit NIEHS( [download the PDF] Exit NIEHS(
  5. De Roos AJ, Cooper GS, Alavanja MC, Sandler DP.  Rheumatoid arthritis among women in the Agricultural Health Study:  Risk associated with farming activities and exposures.  Ann Epidemiol 15: 762-770, 2005. [Abstract] Exit NIEHS(
  6. Rericha V, Kulich M, Rericha R, Shore DL, Sandler DP.  Incidence of leukemia and other lymphatic and haematopoietic neoplasms in Czech uranium miners: A case-cohort study.  Environ Health Perspect 114: 818-822, 2006. [Abstract] Exit NIEHS(
  7. Sandler DP, Weinberg CR, Shore DL, Archer VE, Bishop Stone M, Lyon JL, Rothney-Kozlak L, Shepherd M, Stolwijk JAJ. Indoor radon and lung cancer risk in Connecticut and Utah. J Tox Env Health Part A 69: 633-54, 2006. [Abstract] Exit NIEHS(
  8. Flower KB, Hoppin JA, Shore DL, Lynch CF, Blair A, Knott C, Alavanja MCR, Sandler DP. Causes of mortality and risk factors for injury mortality among children in the Agricultural Health Study. Journal of Agromedicine 3/4: 47-59, 2006. [Abstract] ( Exit NIEHS
  9. Saldana TM, Basso O, Hoppin HA, Baird DD, Knott C, Blair A, Alavanja MCR, Sandler DP.  Pesticide exposure and gestational diabetes in the Agricultural Health Study.  Diabetes Care 30: 529-34, 2007. [Abstract] Exit NIEHS(
  10. Mahajan R , Blair A , Coble J , Lynch CF , Hoppin JA , Sandler DP , Alavanja MCR. Carbaryl exposure and incident cancer in the Agricultural Health Study. International journal of cancer. Journal International du Cancer 8: 1799-1805, 2007. [Abstract] ( Exit NIEHS
  11. Chen H , Richards M , Sandler DP , Umbach DM , Kamel F. Head injury and amyotrophic lateral sclerosis. American Journal of Epidemiology 7: 810-816, 2007. [Abstract] ( Exit NIEHS
  12. Hoppin JA, Valcin M, Henneberger PK, Kullman GJ, Umbach DM, London SJ, Alavanja MCR, Sandler DP. Pesticide use and chronic bronchitis among farmers in the Agricultural Health Study. American journal of industrial medicine 2007 50(12):969-979. [Abstract] ( Exit NIEHS
  13. Koutros S, Cross AJ, Sandler DP, Hoppin JA, Ma X, Zheng T, Alavanja MCR, Sinha R. Meat and meat mutagens and risk of prostate cancer in the Agricultural Health Study. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology 2008 17(1):80-87. [Abstract] ( Exit NIEHS
  14. Montgomery MP, Kamel F, Saldana TM, Alavanja MCR, Sandler DP. Incident diabetes and pesticide exposure among licensed pesticide applicators: Agricultural Health Study 1993 - 2003. American journal of epidemiology 2008 167(10):1235-1246. [Abstract] ( Exit NIEHS
  15. Kamel F, Umbach DM, Stallone L, Richards M, Hu H, Sandler DP, . Association of lead exposure with survival in Amyotrophic Lateral Sclerosis (ALS). Neurology 2008 116(7):943-947. [Abstract] ( Exit NIEHS
  16. Crawford JM, Hoppin JA, Alavanja MCR, Blair A, Sandler DP, Kamel F. Hearing loss in licensed pesticide applicators. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 2008 50(7):817-826. [Abstract] ( Exit NIEHS
  17. De Roos AJ, Cooper GS, Alavanja MC, Sandler DP. Personal and family medical history correlates of rheumatoid arthritis. Annals of epidemiology 2008 18(6):433-439. [Abstract] ( Exit NIEHS

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