Open Access Open Badges Research article

Risk of classic Kaposi sarcoma with exposures to plants and soils in Sicily

James J Goedert1*, Giuseppe Calamusa2, Carmelo Dazzi3, Anna Perna2, Colleen Pelser4, Lesley A Anderson5, Camille Madsen16, Liliana R Preiss7, Matt Airola8, Barry I Graubard1, Angelo Messina9, Carmela Lauria10 and Nino Romano2

Author Affiliations

1 Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA

2 Dipartimento di Igiene e Microbiologia 'Giuseppe D'Alessandro', Università degli Studi di Palermo, Palermo, Italy

3 Dipartimento di Agronomia Ambientale e Territoriale (DAAT), Facoltà di Agraria, Universitá degli Studi di Palermo, Palermo, Italy

4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA

5 Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland

6 Department of Health Science, Brigham Young University, USA

7 RTI International, Rockville, Maryland, USA

8 Westat, Rockville, Maryland, USA

9 Dipartimento di Scienze Biomediche, Università degli Studi di Catania, Catania, Italy

10 Lega Italiana per la Lotta Contro i Tumori-Sez Ragusa, Ragusa, Italy

For all author emails, please log on.

Infectious Agents and Cancer 2010, 5:23  doi:10.1186/1750-9378-5-23

Published: 2 December 2010



Ecologic and in vitro studies suggest that exposures to plants or soil may influence risk of Kaposi sarcoma (KS).


In a population-based study of Sicily, we analyzed data on contact with 20 plants and residential exposure to 17 soils reported by 122 classic KS cases and 840 sex- and age-matched controls. With 88 KS-associated herpesvirus (KSHV) seropositive controls as the referent group, novel correlates of KS risk were sought, along with factors distinguishing seronegatives, in multinomial logistic regression models that included matching variables and known KS cofactors - smoking, cortisone use, and diabetes history. All plants were summed for cumulative exposure. Factor and cluster analyses were used to obtain scores and groups, respectively. Individual plants and soils in three levels of exposure with Ptrend ≤ 0.15 were retained in a backward elimination regression model.


Adjusted for known cofactors, KS was not related to cumulative exposures to 20 plants [per quartile adjusted odds ratio (ORadj) 0.96, 95% confidence interval (CI) 0.73 - 1.25, Ptrend = 0.87], nor was it related to any factor scores or cluster of plants (P = 0.11 to 0.81). In the elimination regression model, KS risk was associated with five plants (Ptrend = 0.02 to 0.10) and with residential exposure to six soils (Ptrend = 0.01 to 0.13), including three soils (eutric regosol, chromic/pellic vertisol) used to cultivate durum wheat. None of the KS-associated plants and only one soil was also associated with KSHV serostatus. Diabetes was associated with KSHV seronegativity (ORadj 4.69, 95% CI 1.97 - 11.17), but the plant and soil associations had little effect on previous findings that KS risk was elevated for diabetics (ORadj 7.47, 95% CI 3.04 - 18.35) and lower for current and former smokers (ORadj 0.26 and 0.47, respectively, Ptrend = 0.05).


KS risk was associated with exposure to a few plants and soils, but these may merely be due to chance. Study of the effects of durum wheat, which was previously associated with cKS, may be warranted.