Fine Particulate Matter Air Pollution and Mortality among Pediatric, Adolescent, and Young Adult Cancer Patients

Abstract

◥Background: Air pollution is a carcinogen and causes pulmonary and cardiac complications. We examined the association of fine particulate matter pollution (PM 2.5 ) and mortality from cancer and all causes among pediatric, adolescent, and young adult (AYA) patients with cancer in Utah, a state with considerable variation in PM 2.5 .Methods: We followed 2,444 pediatric (diagnosed ages 0-14) and 13,459 AYA (diagnosed ages 15-39) patients diagnosed in 1986-2015 from diagnosis to 5 and 10 years postdiagnosis, death, or emigration. We measured average monthly PM 2.5 by ZIP code during follow-up. Separate pediatric and AYA multivariable Cox models estimated the association of PM 2.5 and mortality. Among AYAs, we examined effect modification of PM 2.5 and mortality by stage while controlling for cancer type.Results: Increases in PM 2.5 per 5 mg/m 3 were associated with cancer mortality in pediatric lymphomas and central nervous system (CNS) tumors at both time points, and all cause mortality in lymphoid leukemias [HR 5-year ¼ 1.32 (1.02-1.71)]. Among AYAs, PM 2.5 per 5 mg/m 3 was associated with cancer mortality in CNS tumors and carcinomas at both time points, and all cause mortality for all AYA cancer types [HR 5-year ¼ 1.06 (1.01-1.13)]. PM 2.5 ≥12 mg/m 3 was associated with cancer mortality among breast [HR 5-year ¼ 1.50 (1.29-1.74); HR 10-year ¼ 1.30 (1.13-1.50)] and colorectal cancers [HR 5-year ¼ 1.74 (1.29-2.35); HR 10-year ¼ 1.67 (1.20-2.31)] at both time points. Effect modification by stage was significant, with local tumors at highest risk.Conclusions: PM 2.5 was associated with mortality in pediatric and AYA patients with specific cancers.Impact: Limiting PM 2.5 exposure may be important for young cancer patients with certain cancers.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations

“…140 Finally, a Utah study reported significant adverse PM 2.5 cancer mortality associations among pediatric patients with lymphoma and CNS tumors as well as among adolescent and young adult patients with CNS tumors, carcinomas, melanomas, breast cancers, and colorectal cancers. 141 Further research of mortality among patients with childhood cancer is needed.…”

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“… PM 2.5 Mexico 2007 - 2011 509 mothers Increased the risk of Postpartum depression and neuropsychological dysfunction in mothers Niedzwiecki et al (2020) 10. PM 2.5 Utah 1986 - 2015 2,444 pediatric patients and 13,459 young adult patients with cancer Increases cancer mortality in pediatric lymphomas and CNS tumors Ou et al (2020a) 11. PM 2.5 Barcelona 2012 - 2014 186 participants Decreased corpus callosum volume in pre-adolescent children and behavior problems Mortamais et al (2019) 12.…”

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“…The risk for respiratory events was significantly higher among childhood cancer survivors than population comparisons without a cancer history (OR 1.84, 95% CI: 1.13-3.00 per 10 µg/m 3 ) [48]. PM 2.5 exposure from diagnosis through 5 and 10 years after diagnosis was also associated with all cause and cancer mortality among pediatric, adolescent, and young adult survivors (AYA) with certain diagnoses [49].…”