Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study

Abstract

BackgroundThere are a few epidemiological studies that (1) link increased ambient air pollution (AP) with an increase in lung cancer incidence rates and (2) investigate whether residing in green spaces could be protective against cancer. However, it is completely unclear whether other forms of cancer are also affected by AP and if residential green spaces could lower cancer incidence rates in general. Therefore, the objective was to estimate whether AP and green space are associated with several cancer types.MethodsThe analysis was based on routine health care data from around 1.9 million people from Saxony who were free of cancer in 2008 and 2009. Incident cancer cases (2010–2014) of mouth and throat, skin (non-melanoma skin cancer - NMSC), prostate, breast, and colorectum were defined as: (1) one inpatient diagnosis, or (2) two outpatient diagnoses in two different quarters within one year and a specific treatment or death within two quarters after the diagnosis. Exposures, derived from freely available 3rd party data, included particulate matter with aerodynamic diameter of less than 10 μm (PM10) and nitrogen dioxide (N02) as well as green space (Normalized Difference Vegetation Index - NDVI). Associations between air pollutants, green space, and cancer incidence were assessed by multilevel Poisson models. Age, sex, physician contacts, short- and long-term unemployment, population density, and having an alcohol-related disorder were considered as potential confounders.ResultsThree thousand one hundred seven people developed mouth and throat cancer, 33,178 NMSC, 9611 prostate cancer, 9577 breast cancer, and 11,975 colorectal cancer during the follow-up period (2010–2014). An increase in PM10 of 10 μg/m3 was associated with a 53% increase in relative risk (RR) of mouth and throat cancer and a 52% increase in RR of NMSC. Prostate and breast cancer were modestly associated with PM10 with an increase in RR of 23 and 19%, respectively. The associations with N02 were in the same direction as PM10 but the effect estimates were much lower (7–24%). A 10% increase in NDVI was most protective of mouth and throat cancer (− 11% RR) and of NMSC (− 16% RR). Colorectal cancer was not affected by any of the exposures.ConclusionsIn addition to the studies carried out so far, this study was able to provide evidence that higher ambient AP levels increase the risk of mouth and throat cancer as well as of NMSC and that a higher residential green space level might have a protective effect for NMSC in areas with low to moderate UV intensity. Nevertheless, we cannot rule out residual confounding by socioeconomic or smoking status.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5615-2) contains supplementary material, which is available to authorized users.

Impact of air pollution on breast cancer incidence and mortality: a nationwide analysis in South Korea

“…NO 2 and PM 10 concentrations were significantly and positively associated with the breast cancer incidence rate in South Korean female population. This result is consistent with previous studies that reported significantly higher risk of breast cancer incidence 5,7,9,11 , and is partly consistent with studies that reported suggestive 6,8,10,12,14,15,27 or null 11,[21][22][23]28 associations between air pollutants and breast cancer. Our study adds evidence of a significant positive association to the aforementioned studies.…”

“…Incorporating more cases or expanding the cohort population may clarify the evidence, though such efforts would demand resources. There also were ecological studies on the association between breast cancer and air pollution 5,7,9 . Chen et al 5 and Wei et al 9 aggregated air pollutant emission data and age-adjusted breast cancer incidence rates in Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute that covered 199 counties and approximately 100,000 or less female population and found positive correlations.…”

“…Chen et al 5 and Wei et al 9 aggregated air pollutant emission data and age-adjusted breast cancer incidence rates in Surveillance, Epidemiology, and End Results Program of the United States National Cancer Institute that covered 199 counties and approximately 100,000 or less female population and found positive correlations. Datzman et al 7 found significant positive associations between NO 2 , PM 10 , and breast cancer incidence by using healthcare data from a local insurance corporation in Germany that covers approximately 1,000,000 female population and 9,577 incidences.…”

Dietary Intake of Acrylamide and Risk of Breast, Endometrial, and Ovarian Cancers: A Systematic Review and Dose–Response Meta-analysis

“…In addition, we accounted for major established or putative risk factors such as body weight, smoking habits, hormone replacement therapy/oral contraceptive use, and partially lack of physical activity, and alcohol intake (64-67) by using the most adjusted estimates from included studies. However, we acknowledge that unmeasured confounding may still have influenced these findings, with reference to environmental risk factors such as cadmium (68)(69)(70), pesticides (71)(72)(73) or air pollution (74)(75)(76)(77). Moreover, food frequency questionnaires used for acrylamide intake estimation in the included studies did not generally collect information about cooking methods, potentially affecting the reliability of exposure assessment (78) and contributing to heterogeneity in results.…”

Richtwerte für Stickstoffdioxid (NO2) in der Innenraumluft

“…Der Endpunkt Kanzerogenität wurde auch in epidemiologischen Studien und Metaanalysen analysiert [113][114][115][116][117]. Auch in diesen Studien ist die NO 2 -Konzentration als Marker für Verkehrsemissionen zu verstehen, so dass die zum Teil gefundenen signifikanten Assoziationen zu erhöhten NO 2 -Konzentrationen für die ursächliche Bewertung nicht herangezogen werden können.…”