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Berg CD, Schiller JH, Boffetta P, Cai J, Connolly C, Kerpel-Fronius A, Kitts AB, Lam DCL, Mohan A, Myers R, Suri T, Tammemagi MC, Yang D, Lam S. Air Pollution and Lung Cancer: A Review by International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2023; 18:1277-1289. [PMID: 37277094 DOI: 10.1016/j.jtho.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The second leading cause of lung cancer is air pollution. Air pollution and smoking are synergistic. Air pollution can worsen lung cancer survival. METHODS The Early Detection and Screening Committee of the International Association for the Study of Lung Cancer formed a working group to better understand issues in air pollution and lung cancer. These included identification of air pollutants, their measurement, and proposed mechanisms of carcinogenesis. The burden of disease and the underlying epidemiologic evidence linking air pollution to lung cancer in individuals who never and ever smoked were summarized to quantify the problem, assess risk prediction models, and develop recommended actions. RESULTS The number of estimated attributable lung cancer deaths has increased by nearly 30% since 2007 as smoking has decreased and air pollution has increased. In 2013, the International Agency for Research on Cancer classified outdoor air pollution and particulate matter with aerodynamic diameter less than 2.5 microns in outdoor air pollution as carcinogenic to humans (International Agency for Research on Cancer group 1) and as a cause of lung cancer. Lung cancer risk models reviewed do not include air pollution. Estimation of cumulative exposure to air pollution exposure is complex which poses major challenges with accurately collecting long-term exposure to ambient air pollution for incorporation into risk prediction models in clinical practice. CONCLUSIONS Worldwide air pollution levels vary widely, and the exposed populations also differ. Advocacy to lower sources of exposure is important. Health care can lower its environmental footprint, becoming more sustainable and resilient. The International Association for the Study of Lung Cancer community can engage broadly on this topic.
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Affiliation(s)
| | - Joan H Schiller
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and National Health Commission Key Lab of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Casey Connolly
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Anna Kerpel-Fronius
- Department of Radiology National Korányi Institute for Pulmonology, Budapest, Hungary
| | | | - David C L Lam
- University Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Renelle Myers
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Tejas Suri
- Department of Pulmonary Medicine, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Martin C Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital Fudan University, Shanghai, People's Republic of China
| | - Stephen Lam
- Department of Medicine, British Columbia Cancer Agency and The University of British Columbia, Vancouver, British Columbia, Canada
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Ataei Y, Sun Y, Liu W, S. Ellie A, Dong H, Ahmad UM. Health Effects of Exposure to Indoor Semi-Volatile Organic Compounds in Chinese Building Environment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:678. [PMID: 36613006 PMCID: PMC9819628 DOI: 10.3390/ijerph20010678] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
People spend a considerable portion of their lives indoors; thus, the quality of the indoor environment is crucial. Semi-volatile organic compounds (SVOCs) are among the primary indoor pollutants responsible for various health risks. This paper systematically reviews the impact of SVOC exposure on human health in Chinese built environments. Based on a set of criteria, we judged 12 publications as providing sufficient information on both SVOC exposure and health effects to inform the relationship. Out of six studies on polycyclic aromatic hydrocarbons (PAHs), three observed a positive association between PAH exposure and lung cancer. Out of six studies of phthalate exposure, two studies reported a significant positive association between DEP and DiBP and asthma, between DEP and DEHP and dry cough among children, and between DBP and rhinitis among younger adults. The results of this review suggest that there might be a link between phthalate exposure and asthma and allergies, as well as a link between PAH exposure and lung cancer. However, due to the limited number of studies conducted, more evidence is necessary to definitively guide the establishment of standards for SVOC control in China.
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Affiliation(s)
- Yeganeh Ataei
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yuexia Sun
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Wei Liu
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Agnes S. Ellie
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Hui Dong
- Centre for Environmental Policy, Imperial College London, South Kensington, London SW7 2AZ, UK
| | - Umme Marium Ahmad
- Tianjin Key Laboratory of Indoor Air Environmental Quality Control, School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
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Cheng ES, Chan KH, Weber M, Steinberg J, Young J, Canfell K, Yu XQ. Solid Fuel, Secondhand Smoke, and Lung Cancer Mortality: A Prospective Cohort of 323,794 Chinese Never-Smokers. Am J Respir Crit Care Med 2022; 206:1153-1162. [PMID: 35616543 PMCID: PMC9704832 DOI: 10.1164/rccm.202201-0114oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: Household air pollution and secondhand tobacco smoke are known carcinogens for lung cancer, but large-scale estimates of the relationship with lung cancer mortality are lacking. Objectives: Using the large-scale cohort China Kadoorie Biobank, we prospectively investigated associations between these two risk factors and lung cancer death among never-smokers. Methods: The Biobank recruited 512,715 adults aged 30-79 years from 10 regions in China during 2004-2008. Self-reported never-smoking participants were followed up to December 31, 2016, with linkage to mortality data. Total duration of exposure to household air pollution was calculated from self-reported domestic solid fuel use. Exposure to secondhand tobacco smoke was ascertained using exposure at home and/or other places. Hazard ratios and 95% confidence intervals for associations between these two exposures and lung cancer death were estimated using Cox regression, adjusting for key confounders. Measurements and Main Results: There were 979 lung cancer deaths among 323,794 never-smoking participants without a previous cancer diagnosis during 10.2 years of follow-up. There was a log-linear positive association between exposure to household air pollution and lung cancer death, with a 4% increased risk per 5-year increment of exposure (hazard ratio = 1.04; 95% confidence interval = 1.01-1.06; P trend = 0.0034), and participants with 40.1-50.0 years of exposure had the highest risk compared with the never-exposed (hazard ratio = 1.53; 95% confidence interval = 1.13-2.07). The association was largely consistent across various subgroups. No significant association was found between secondhand smoke and lung cancer death. Conclusions: This cohort study provides new prospective evidence suggesting that domestic solid fuel use is associated with lung cancer death among never-smokers.
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Affiliation(s)
- Elvin S. Cheng
- Sydney School of Public Health and
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Ka Hung Chan
- Oxford British Heart Foundation Centre of Research Excellence and
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and
| | - Marianne Weber
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Julia Steinberg
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Jane Young
- Sydney School of Public Health and
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Karen Canfell
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Xue Qin Yu
- the Daffodil Centre, the University of Sydney, Sydney, New South Wales, Australia
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Lung cancer incidence and mortality in China: Updated statistics and an overview of temporal trends from 2000 to 2016. JOURNAL OF THE NATIONAL CANCER CENTER 2022. [DOI: 10.1016/j.jncc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Veith M, McAlarney D, Xue X, Rohan TE, Hosgood HD. Characterizing Trends in Lung Cancer Mortality Attributable to Airborne Environmental Carcinogens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413162. [PMID: 34948771 PMCID: PMC8701182 DOI: 10.3390/ijerph182413162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
Tracheal, bronchus, and lung (TBL) cancer is the leading cause of cancer death globally, but trends in TBL mortality attributable to tobacco, ambient particulate matter pollution (APMP), and household air pollution (HAP) were unequally distributed within global population subgroups over the last three decades. We used data from the Global Burden of Disease 2019 study to quantify the impact of sex, time, sociodemographic development index (SDI), and age for each exposure from 1990–2019. During that interval, tobacco dominated the TBL cancer mortality landscape, with its minimum global age-adjusted death rate of 16.71 deaths/100,000 (95% Uncertainty Interval (UI): 15.27–18.13) outstripping maximums of 3.85 deaths/100,000 (UI: 2.82–4.83) and 2.54 deaths/100,000 (UI: 1.69–3.54) for APMP and HAP, respectively. In 2019, tobacco male TBL death rates exceeded female rates by a factor of 4.4:1. Ratios of 1.9:1 for APMP and 2.1:1 for HAP were seen. Our analysis indicates that both-sex middle SDI and female low, low-middle, and high-middle SDI populations are suffering increasing tobacco TBL burden. Efforts producing successful global reductions in HAP-associated TBL mortality should continue, with attention to low SDI female death rate increases. Finally, except for high SDI populations, global APMP-attributable TBL cancer burden is increasing and represents a major health concern.
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Zhang Y, Meliefste K, Hu W, Li J, Xu J, Ning B, Yang K, Chen Y, Liu D, Wong J, Rahman M, Rothman N, Huang Y, Cassee F, Vermeulen R, Lan Q, Downward GS. Household air pollution from, and fuel efficiency of, different coal types following local cooking practices in Xuanwei, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 290:117949. [PMID: 34438166 DOI: 10.1016/j.envpol.2021.117949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
The domestic combustion of smoky (bituminous) coal in the Chinese counties of Xuanwei and Fuyuan, are responsible for some of the highest rates of lung cancer in the world. Cancer rates vary between coal producing regions (deposits) in the area, with coals from Laibin exhibiting particularly high risks and smokeless (anthracite) coal exhibiting lower risks. However, little information is available on the specific burning characteristics of coals from throughout the area. We conducted an extensive controlled burning experiment using coal from multiple deposits in either a traditional firepit or ventilated stove, accompanied by a detailed examination of time-weighted and real-time size-aggregated particle concentrations. Smoky coal caused higher particle concentrations of all sizes than smokeless coal, with variations observed by geological source. Virtually all particle emissions were in the PM2.5 fraction (98% - mass based), and 75% and 46% were in the PM1 and PM0.3 fraction respectively. Real-time concentrations of PM1 and PM0.1 peaked after coal was added and declined afterwards. Ventilation reduced particle concentrations by up to 15-fold and increased the coal burning rate by 1.9-fold. These findings may provide valuable insight for reducing exposure and adverse health effects associated with domestic coal combustion.
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Affiliation(s)
- Yongliang Zhang
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands.
| | - Kees Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Wei Hu
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jihua Li
- Xuanwei Center of Disease Control, No.6, Longbao Rd, Xuanwei, Qujing, Yunnan, 655400, PR China
| | - Jun Xu
- Department of Community Medicine, School of Public Health, The University of Hongkong, Hong Kong
| | - Baofu Ning
- Xuanwei Center of Disease Control, No.6, Longbao Rd, Xuanwei, Qujing, Yunnan, 655400, PR China
| | - Kaiyun Yang
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, 650118, PR China
| | - Ying Chen
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, 650118, PR China
| | - Dingyu Liu
- National Institute for Public Health and the Environment (RIVM), the Netherlands
| | - Jason Wong
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Mohammad Rahman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Nathaniel Rothman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Yunchao Huang
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, 650118, PR China
| | - Flemming Cassee
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; National Institute for Public Health and the Environment (RIVM), the Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - George S Downward
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Cheng ES, Weber M, Steinberg J, Yu XQ. Lung cancer risk in never-smokers: An overview of environmental and genetic factors. Chin J Cancer Res 2021; 33:548-562. [PMID: 34815629 PMCID: PMC8580800 DOI: 10.21147/j.issn.1000-9604.2021.05.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 01/22/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality globally, accounting for 1.8 million deaths in 2020. While the vast majority are caused by tobacco smoking, 15%-25% of all lung cancer cases occur in lifelong never-smokers. The International Agency for Research on Cancer (IARC) has classified multiple agents with sufficient evidence for lung carcinogenesis in humans, which include tobacco smoking, as well as several environmental exposures such as radon, second-hand tobacco smoke, outdoor air pollution, household combustion of coal and several occupational hazards. However, the IARC evaluation had not been stratified based on smoking status, and notably lung cancer in never-smokers (LCINS) has different epidemiological, clinicopathologic and molecular characteristics from lung cancer in ever-smokers. Among several risk factors proposed for the development of LCINS, environmental factors have the most available evidence for their association with LCINS and their roles cannot be overemphasized. Additionally, while initial genetic studies largely focused on lung cancer as a whole, recent studies have also identified genetic risk factors for LCINS. This article presents an overview of several environmental factors associated with LCINS, and some of the emerging evidence for genetic factors associated with LCINS. An increased understanding of the risk factors associated with LCINS not only helps to evaluate a never-smoker's personal risk for lung cancer, but also has important public health implications for the prevention and early detection of the disease. Conclusive evidence on causal associations could inform longer-term policy reform in a range of areas including occupational health and safety, urban design, energy use and particle emissions, and the importance of considering the impacts of second-hand smoke in tobacco control policy.
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Affiliation(s)
- Elvin S Cheng
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Marianne Weber
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Julia Steinberg
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
| | - Xue Qin Yu
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW 2011, Australia
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Characterization of outdoor air pollution from solid fuel combustion in Xuanwei and Fuyuan, a rural region of China. Sci Rep 2020; 10:11335. [PMID: 32647370 PMCID: PMC7347641 DOI: 10.1038/s41598-020-68229-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Outdoor air pollution is a growing public health concern, particularly in urban settings. However, there are limited epidemiological data on outdoor air pollution in rural areas with substantial levels of air pollution attributed to solid fuel burning for household cooking and heating. Xuanwei and Fuyuan are rural counties in China where the domestic combustion of locally sourced bituminous (“smoky”) coal has been associated with the highest lung cancer rates in China. We previously assessed indoor and personal air pollution exposures in this area; however, the influence of indoor coal combustion and household ventilation on outdoor air pollution has not been assessed. Therefore, we measured outdoor fine particulate matter (PM2.5), species of polycyclic aromatic hydrocarbons (PAHs) including naphthalene (NAP) and the known carcinogen benzo(a)pyrene (BaP), sulfur dioxide (SO2), and nitrogen dioxide (NO2) over two consecutive 24-h sampling periods in 29 villages. Just over half of the villages were revisited two to nine months after the initial sampling period to repeat all measurements. The overall geometric mean (GM) of outdoor PM2.5, BaP, NAP, and NO2 were 45.3 µg/m3, 9.7 ng/m3, 707.7 ng/m3, and 91.5 µg/m3, respectively. Using linear mixed effects models, we found that burning smoky coal was associated with higher outdoor BaP concentrations [GM ratio (GMR) = 2.79] and lower outdoor SO2 detection rates (GMR = 0.43), compared to areas burning smokeless coal. Areas with predominantly ventilated stoves (> 50% of stoves) had higher outdoor BaP (GMR = 1.49) compared to areas with fewer ventilated stoves. These results show that outdoor air pollution in a rural region of China was associated with the type of coal used for cooking and heating indoors and the presence of stove ventilation. Our findings suggest that efforts of household stove improvement to reduce indoor air pollution have resulted in higher outdoor air pollution levels. Further reducing adverse health effects in rural villages from household coal combustion will require the use of cleaner fuel types.
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Woolley K, Bartington SE, Pope FD, Price MJ, Thomas GN, Kabera T. Biomass cooking carbon monoxide levels in commercial canteens in Kigali, Rwanda. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:75-85. [PMID: 32400286 DOI: 10.1080/19338244.2020.1761279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carbon monoxide (CO) is harmful to human health, yet there is limited evidence concerning emissions associated with biomass fuel cooking in occupational settings. Real-time 48-hour monitoring of CO concentrations at breathing height, was undertaken in staff and student kitchen and serving areas of two commercial canteens. We characterized two diurnal CO peaks coinciding with cooking activities. Peak CO concentrations of 255.5 ppm and 1-hour average of 76.3 ppm (IQR: 57.8-109.0 ppm) were observed in the student kitchen; the staff kitchen levels were 208.5 ppm, and 76.3 ppm (IQR: 52.5-114.0 ppm), respectively. High magnitude CO concentrations (8-hour average: 40.7 ppm SD: 40.0 ppm) which exceed World Health Organisation (WHO) Indoor Air Quality standards were observed. Further investigation of personal exposure and health impacts among kitchen staff is required, to inform interventions in this setting.
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Affiliation(s)
- Katherine Woolley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Telesphore Kabera
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
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Abstract
This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana 47405, USA;
| | - Keith J Zullig
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia 26506, USA;
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana 47405, USA;
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Hosgood HD, Mongodin EF, Wan Y, Hua X, Rothman N, Hu W, Vermeulen R, Seow WJ, Rohan T, Xu J, Li J, He J, Huang Y, Yang K, Wu G, Wei F, Shi J, Sapkota AR, Lan Q. The respiratory tract microbiome and its relationship to lung cancer and environmental exposures found in rural china. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2019; 60:617-623. [PMID: 30942501 PMCID: PMC8259386 DOI: 10.1002/em.22291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/30/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
We previously reported that bacterial diversity in sputum samples from never-smoking women in rural China varied by lung cancer status and household air pollution (HAP) exposure type. Here, we expand on our associations between environmental exposures and respiratory tract microbiota with an additional 90 never-smoking women from Xuanwei, China. DNA from sputum samples of cases (n = 45) and controls (n = 45) was extracted using a multistep enzymatic and physical lysis, followed by a standardized clean up. V1-V2 regions of 16S rRNA genes were Polymerase chain reaction (PCR) amplified. Purified amplicons were sequenced by 454 FLX Titanium pyrosequencing and high-quality sequences were evaluated for diversity and taxonomic membership. In our population of never-smokers, increased risk of lung cancer was associated with lower alpha diversity compared to higher alpha diversity (Shannon: ORhigh = 1.00 [reference], ORmedium = 3.84 [1.02-14.48], ORlow = 3.78 [1.03-13.82]; observed species: ORhigh = 1.00 [reference], ORmedium = 2.37 [0.67-8.48], ORlow = 2.01 [0.58-6.97]; Phylogenetic Diversity (PD) whole tree: ORhigh = 1.00 [reference], ORmedium = 3.04 [0.85-10.92], ORlow = 2.53 [0.72-8.96]), as well as a decreased relative abundance of Fusobacteria (ORhigh = 1.00 [reference], ORmedium = 1.24 [0.42-3.66], ORlow = 2.01 [0.63-6.44], ptrend = 0.03). Increasing alpha diversity was associated with smoky coal use compared to clean fuel use among all subjects (observed species, P = 0.001; PD whole tree, P = 0.006; Shannon, P = 0.0002), as well as cases (observed species, P = 0.02; PD whole tree, P = 0.03; Shannon, P = 0.03) and controls (observed species, P = 0.01; PD whole tree, P = 0.05; Shannon, P = 0.002). Increased diversity was also associated with presence of livestock (observed species, P = 0.02; PD whole tree, P = 0.02; Shannon, P = 0.03) in the home for cases. Our study is the first to report that decreased microbial diversity is associated with risk of lung cancer. Larger studies are necessary to elucidate the direct and indirect effects attributed to the disease-specific, HAP-specific, and animal-specific associations. Environ. Mol. Mutagen. 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Emmanuel F. Mongodin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Yunhu Wan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Xing Hua
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Wei Jie Seow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jun Xu
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jihua Li
- Qujing Center for Diseases Control and Prevention, Qujing, China
| | - Jun He
- Qujing Center for Diseases Control and Prevention, Qujing, China
| | - Yunchao Huang
- Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming, China
| | - Kaiyun Yang
- Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming, China
| | - Guoping Wu
- China National Environmental Monitoring Center, Beijing, China
| | - Fusheng Wei
- China National Environmental Monitoring Center, Beijing, China
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Amy R. Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, Maryland
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Hosgood HD, Klugman M, Matsuo K, White AJ, Sadakane A, Shu XO, Lopez-Ridaura R, Shin A, Tsuji I, Malekzadeh R, Noisel N, Bhatti P, Yang G, Saito E, Rahman S, Hu W, Bassig B, Downward G, Vermeulen R, Xue X, Rohan T, Abe SK, Broët P, Grant EJ, Dummer TJB, Rothman N, Inoue M, Lajous M, Yoo KY, Ito H, Sandler DP, Ashan H, Zheng W, Boffetta P, Lan Q. The establishment of the Household Air Pollution Consortium (HAPCO). ATMOSPHERE 2019; 10:10.3390/atmos10070422. [PMID: 32064123 PMCID: PMC7021252 DOI: 10.3390/atmos10070422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Household air pollution (HAP) is of public health concern with ~3 billion people worldwide (including >15 million in the US) exposed. HAP from coal use is a human lung carcinogen, yet the epidemiological evidence on carcinogenicity of HAP from biomass use, primarily wood, is not conclusive. To robustly assess biomass's carcinogenic potential, prospective studies of individuals experiencing a variety of HAP exposures are needed. We have built a global consortium of 13 prospective cohorts (HAPCO: Household Air Pollution Consortium) that have site- and disease-specific mortality and solid fuel use data, for a combined sample size of 587,257 participants and 57,483 deaths. HAPCO provides a novel opportunity to assess the association of HAP with lung cancer death while controlling for important confounders such as tobacco and outdoor air pollution exposures. HAPCO is also uniquely positioned to determine the risks associated with cancers other than lung as well as non-malignant respiratory and cardiometabolic outcomes, for which prospective epidemiologic research is limited. HAPCO will facilitate research to address public health concerns associated with HAP-attributed exposures by enabling investigators to evaluate sex-specific and smoking status-specific effects under various exposure scenarios.
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Affiliation(s)
- H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Madelyn Klugman
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Keitaro Matsuo
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute; Nagoya, 464-8681, Japan
| | - Alexandra J. White
- Epidemiology Branch, National Institute of Environmental
Health Science, Research Triangle Park, NC 27709, United States
| | - Atsuko Sadakane
- Department of Epidemiology, Radiation Effects Research
Foundation, Hiroshima 732-0815, Japan
| | - Xiao-Ou Shu
- Vanderbilt Institute for Global Health, Vanderbilt
University School of Medicine, Nashville, TN 37203-1738, United States
| | - Ruy Lopez-Ridaura
- National Institute of Public Health, Cuernavaca, Morelos,
62100, Mexico
| | - Aesun Shin
- Department of Preventative Medicine, Seoul National
University College of Medicine, Seoul 03080, Korea
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics
and Public Health, Tohoku University Graduate School of Medicine, Miyagi 980-8575,
Japan
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of
Medical Sciences, Tehran, 14117, Iran
| | - Nolwenn Noisel
- CARTaGENE, Centre de Recherche du CHU Sainte-Justine,
Montreal, Quebec, H3T 1C5, Canada
| | | | - Gong Yang
- Center for Health Services, Vanderbilt University School
of Medicine, Nashville, TN, 37203-1738, United States
| | - Eiko Saito
- Division of Cancer Statistics and Integration, Center for
Cancer Control and Information Services, National Cancer Center, Tokyo, 104-0045,
Japan
| | - Shafiur Rahman
- Department of Global Health Policy, Graduate School of
Medicine, University of Tokyo, Tokyo, 113-8654, Japan
| | - Wei Hu
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - Bryan Bassig
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - George Downward
- Institute for Risk Assessment Services, Utrecht
University, Utrecht, 3508, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Services, Utrecht
University, Utrecht, 3508, The Netherlands
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, 10461, United States
| | - Sarah K Abe
- Epidemiology and Prevention Group, Center for Public
Health Sciences, National Cancer Center, Tokyo, 104-0045, Japan
| | - Philippe Broët
- CARTaGENE, Centre de Recherche du CHU Sainte-Justine,
Montreal, Quebec, H3T 1C5, Canada
| | - Eric J. Grant
- Department of Epidemiology, Radiation Effects Research
Foundation, Hiroshima 732-0815, Japan
| | - Trevor J. B. Dummer
- School of Population and Public Health, University of
British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Nat Rothman
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public
Health Sciences, National Cancer Center, Tokyo, 104-0045, Japan
| | - Martin Lajous
- National Institute of Public Health, Cuernavaca, Morelos,
62100, Mexico
- Department of Global Health and Population, Harvard T.H.
Chan School of Public Health, Boston, MA
| | - Keun-Young Yoo
- Department of Preventative Medicine, Seoul National
University College of Medicine, Seoul 03080, Korea
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer
Center Research Institute; Nagoya, 464-8681, Japan
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental
Health Science, Research Triangle Park, NC 27709, United States
| | - Habib Ashan
- Department of Health Sciences, The University of Chicago,
Chicago, IL, 60637, United States
| | - Wei Zheng
- Center for Health Services, Vanderbilt University School
of Medicine, Nashville, TN, 37203-1738, United States
| | - Paolo Boffetta
- The Tisch Cancer Institute, Mount Sinai School of
Medicine, New York, NY 10029-6574, United States
- Department of Medical and Surgical Sciences, University
of Bologna, Bologna, 40126, Italy
| | - Qing Lan
- Occupational and Environmental Epidemiology Branch,
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
20892-7240
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13
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Li J, Ran J, Chen LC, Costa M, Huang Y, Chen X, Tian L. Bituminous coal combustion and Xuan Wei Lung cancer: a review of the epidemiology, intervention, carcinogens, and carcinogenesis. Arch Toxicol 2019; 93:573-583. [PMID: 30649585 DOI: 10.1007/s00204-019-02392-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
Indoor air pollution from bituminous coal combustion has been linked to the extremely high lung cancer rates of nonsmoking women in Xuan Wei County, Yunnan Province, China. Venting the smoke outdoors by installing chimneys was found to be effective at reducing the lung cancer risk in a cohort study of 21,232 farmers in central Xuan Wei. However, the lung cancer mortality rates in all 1.2 million residents of Xuan Wei have been increasing dramatically over the last four decades. It was higher than that in Yunnan Province and China overall, with significant heterogeneities in the geographic patterns of Xuan Wei. Intervention measures targeting certain types of coal or certain carcinogenic components in coal smoke need to be explored. To inform targeted intervention policies, it is essential to pinpoint the specific substance (particulate matter, organic extract, PAHs, free radicals, crystalline silica, and inorganic matter) that might account for the carcinogenicity of bituminous coal smoke. Exploring the underlying carcinogenesis mechanisms would also contribute to the intervention and control of the lung cancer epidemic in Xuan Wei, China. Here we review the suspected carcinogens and carcinogenesis mechanisms and discuss future research directions towards a better understanding of the etiology of lung cancer in Xuan Wei, China.
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Affiliation(s)
- Jinhui Li
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China.,Department of Environmental Medicine, New York University, New York, USA
| | - Jinjun Ran
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Lung-Chi Chen
- Department of Environmental Medicine, New York University, New York, USA
| | - Max Costa
- Department of Environmental Medicine, New York University, New York, USA
| | - Yunchao Huang
- Cancer Research Institute of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, People's Republic of China
| | - Xiao Chen
- Cancer Research Institute of Yunnan Province, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, People's Republic of China
| | - Linwei Tian
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Wong JYY, Bassig BA, Hu W, Seow WJ, Shiels MS, Ji BT, Downward GS, Huang Y, Yang K, Li J, He J, Chen Y, Hildesheim A, Vermeulen R, Lan Q, Rothman N. Household coal combustion, indoor air pollutants, and circulating immunologic/inflammatory markers in rural China. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:411-421. [PMID: 31084278 PMCID: PMC6594692 DOI: 10.1080/15287394.2019.1614500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The study aim was to investigate whether household bituminous ("smoky") coal use and personal exposure to combustion emissions were associated with immunologic/inflammatory marker levels. A cross-sectional study of healthy never-smoking women from rural Xuanwei and Fuyuan, China was conducted, which included 80 smoky coal and 14 anthracite ("smokeless") coal users. Personal exposure to fine particulate matter (PM2.5) and benzo[a]pyrene (BaP) was assessed using portable devices, while 67 circulating plasma immunologic/inflammatory markers were measured using multiplex bead-based assays. Multivariable linear regression models were employed to estimate associations between smoky coal versus smokeless coal use, indoor air pollutants, and immunologic/inflammatory markers. Six markers were altered among smoky coal users compared to smokeless coal, including significantly decreased interferon-inducible T-cell alpha chemoattractant (CXCL11/I-TAC), and increased serum amyloid P component (SAP). CXCL11/I-TAC was previously found to be reduced in workers exposed to high levels of diesel engine exhaust, which exhibits similar constituents as coal combustion emissions. Further, there was evidence that elevated PM2.5 and BaP exposure was associated with significantly diminished levels of the serum amyloid A (SAA); however, the false discovery rates (FDRs) were >0.2 after accounting for multiple comparisons. Inflammatory processes may thus mediate the carcinogenic effects attributed to smoky coal emissions.
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Affiliation(s)
- Jason Y Y Wong
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Bryan A Bassig
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Wei Hu
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Wei Jie Seow
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Meredith S Shiels
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Bu-Tian Ji
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - George S Downward
- b Division of Environmental Epidemiology , Utrecht University, Institute for Risk Assessment Sciences , Utrecht , The Netherlands
| | - Yunchao Huang
- c Department of Cardiothoracic Surgery , Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital) , Kunming , China
| | - Kaiyun Yang
- c Department of Cardiothoracic Surgery , Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital) , Kunming , China
| | - Jihua Li
- d Sanjiangdadao , Qujing Center for Diseases Control and Prevention , Qujing , Yunnan , China
| | - Jun He
- d Sanjiangdadao , Qujing Center for Diseases Control and Prevention , Qujing , Yunnan , China
| | - Ying Chen
- c Department of Cardiothoracic Surgery , Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital) , Kunming , China
| | - Allan Hildesheim
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Roel Vermeulen
- b Division of Environmental Epidemiology , Utrecht University, Institute for Risk Assessment Sciences , Utrecht , The Netherlands
| | - Qing Lan
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
| | - Nathaniel Rothman
- a Division of Cancer Epidemiology and Genetics , National Cancer Institute - National Institutes of Health , Rockville , MD , USA
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15
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Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, van Schayck OCP, Been JV. Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis. Thorax 2018; 73:1026-1040. [PMID: 29925674 DOI: 10.1136/thoraxjnl-2017-210952] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 05/07/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs). DESIGN Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation. SETTING LMICs PARTICIPANTS: Women and children INTERVENTIONS: Improved biomass cookstoves MAIN OUTCOME MEASURES: Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women. RESULTS We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women. CONCLUSION Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact. REGISTRATION PROSPERO: CRD42016033075.
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Affiliation(s)
- Megha Thakur
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Paulien A W Nuyts
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther A Boudewijns
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Flores Kim
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Timor Faber
- Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Giridhara R Babu
- Public Health Foundation of India, Indian Institute of Public Health-Hyderabad, Bangalore, India
| | - Onno C P van Schayck
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Jasper V Been
- Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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16
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Challenges and future direction of molecular research in air pollution-related lung cancers. Lung Cancer 2018; 118:69-75. [DOI: 10.1016/j.lungcan.2018.01.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/29/2017] [Accepted: 01/21/2018] [Indexed: 02/07/2023]
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17
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Quansah R, Semple S, Ochieng CA, Juvekar S, Armah FA, Luginaah I, Emina J. Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis. ENVIRONMENT INTERNATIONAL 2017; 103:73-90. [PMID: 28341576 DOI: 10.1016/j.envint.2017.03.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Cookstove intervention programs have been increasing over the past two (2) decades in Low and Middle Income Countries (LMICs) across the globe. However, there remains uncertainty regarding the effects of these interventions on household air pollution concentrations, personal exposure concentrations and health outcomes. OBJECTIVES The primary objective was to determine if household air pollution (HAP) interventions were associated with improved indoor air quality (IAQ) in households in LMICs. Given the potential impact of HAP interventions on health, a secondary objective was to evaluate the effectiveness of HAP interventions to improve health in populations receiving these interventions. DATA SOURCES OVID Medline, Ovid Embase, SCOPUS and PubMED were searched from their inception until December 2015 with no restrictions on study design. The WHO Global database of household air pollution measurements and Members' archives were also reviewed together with the reference lists of identified reviews and relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION We considered randomized controlled trials, or non-randomized control trials, or before-and-after studies; original studies; studies conducted in a LMIC (based on the United Nations Human Development Report released in March 2013 (World Bank, 2013); interventions that were explicitly aimed at improving IAQ and/or health from solid fuel use; studies published in a peer-reviewed journal or student theses or reports; studies that reported on outcomes which was indicative of IAQ or/and health. There was no restriction on the type of comparator (e.g. household receiving plancha vs. household using traditional cookstove) used in the intervention study. STUDY APPRAISAL AND SYNTHESIS METHODS Five review authors independently used pre-designed data collection forms to extract information from the original studies and assessed risk of bias using the Effective Public Health Practice Project (EPHPP). We computed standardized weighted mean difference (SMD) using random-effects models. Heterogeneity was computed using the Q and I2-statistics. We examined the influence of various characteristics on the study-specific effect estimates by stratifying the analysis by population type, study design, intervention type, and duration of exposure monitoring. The trim and fill method was used to assess the potential impact of missing studies. RESULTS Fifty-five studies met our a priori inclusion criteria and were included in the systematic review. Fifteen studies provided 43 effect estimates for our meta-analysis. The largest improvement in HAP was observed for average particulate matter (PM) (SMD=1.57) concentrations in household kitchens (1.03), followed by daily personal average concentrations of PM (1.18), and carbon monoxide (CO) concentrations in kitchens. With respect to personal PM, significant improvement was observed in studies of children (1.26) and studies monitoring PM for ≥24h (1.32). This observation was also noted in terms of studies of kitchen concentrations of CO. A significant improvement was also observed for kitchen levels of PM in both adult populations (1.56) and in RCT/cohort designs (1.59) involving replacing cookstoves without chimneys. Our findings on health outcomes were inconclusive. LIMITATIONS, CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS We observed high statistical between study variability in the study-specific estimate. Thus, care should be taken in concluding that HAP interventions - as currently designed and implemented - support reductions in the average kitchen and personal levels of PM and CO. Further, there is limited evidence that current stand-alone HAP interventions yield any health benefits. Post-intervention levels of pollutants were generally still greatly in excess of the relevant WHO guideline and thus a need to promote cleaner fuels in LMICs to reduce HAP levels below the WHO guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER The review has been registered with PROSPERO (registration number CRD42014009768).
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Affiliation(s)
- Reginald Quansah
- Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana; Department of Immunology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Sean Semple
- Respiratory Intervention Group, Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland
| | | | - Sanjar Juvekar
- KEM Hospital Research Centre, Pune, India; INDEPTH Network, Accra, Ghana
| | | | - Isaac Luginaah
- Department of Geography, Western University, Ontario, Canada
| | - Jacques Emina
- INDEPTH Network, Accra, Ghana; Department of Population and Development Studies, University of Kinshasa, Kinshasa, People's Republic of Congo
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18
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Guan WJ, Zheng XY, Chung KF, Zhong NS. Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action. Lancet 2016; 388:1939-1951. [PMID: 27751401 DOI: 10.1016/s0140-6736(16)31597-5] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 12/17/2022]
Abstract
In China, where air pollution has become a major threat to public health, public awareness of the detrimental effects of air pollution on respiratory health is increasing-particularly in relation to haze days. Air pollutant emission levels in China remain substantially higher than are those in developed countries. Moreover, industry, traffic, and household biomass combustion have become major sources of air pollutant emissions, with substantial spatial and temporal variations. In this Review, we focus on the major constituents of air pollutants and their impacts on chronic respiratory diseases. We highlight targets for interventions and recommendations for pollution reduction through industrial upgrading, vehicle and fuel renovation, improvements in public transportation, lowering of personal exposure, mitigation of the direct effects of air pollution through healthy city development, intervention at population-based level (systematic health education, intensive and individualised intervention, pre-emptive measures, and rehabilitation), and improvement in air quality. The implementation of a national environmental protection policy has become urgent.
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Affiliation(s)
- Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xue-Yan Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Kian Fan Chung
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK; NIHR Respiratory Biomedical Research Unit, Royal Brompton NHS Foundation Trust, London, UK
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
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19
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Downward GS, Hu W, Rothman N, Reiss B, Wu G, Wei F, Xu J, Seow WJ, Brunekreef B, Chapman RS, Qing L, Vermeulen R. Outdoor, indoor, and personal black carbon exposure from cookstoves burning solid fuels. INDOOR AIR 2016; 26:784-95. [PMID: 26452237 PMCID: PMC4826638 DOI: 10.1111/ina.12255] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/04/2015] [Indexed: 05/03/2023]
Abstract
Black carbon (BC) emissions from solid fuel combustion are associated with increased morbidity and mortality and are important drivers of climate change. We studied BC measurements, approximated by particulate matter (PM2.5 ) absorbance, in rural Yunnan province, China, whose residents use a variety of solid fuels for cooking and heating including bituminous and anthracite coal, and wood. Measurements were taken over two consecutive 24-h periods from 163 households in 30 villages. PM2.5 absorbance (PMabs ) was measured using an EEL 043 Smoke Stain Reflectometer. PMabs measurements were higher in wood burning households (16.3 × 10(-5) /m) than bituminous and anthracite coal households (12 and 5.1 × 10(-5) /m, respectively). Among bituminous coal users, measurements varied by a factor of two depending on the coal source. Portable stoves (which are lit outdoors and brought indoors for use) were associated with reduced PMabs levels, but no other impact of stove design was observed. Outdoor measurements were positively correlated with and approximately half the level of indoor measurements (r = 0.49, P < 0.01). Measurements of BC (as approximated by PMabs ) in this population are modulated by fuel type and source. This provides valuable insight into potential morbidity, mortality, and climate change contributions of domestic usage of solid fuels.
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Affiliation(s)
- G S Downward
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands.
| | - W Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - N Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - B Reiss
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - G Wu
- China National Environmental Monitoring Centre, Beijing, China
| | - F Wei
- China National Environmental Monitoring Centre, Beijing, China
| | - J Xu
- Hong Kong University, Hong Kong, China
| | - W J Seow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - B Brunekreef
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - R S Chapman
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - L Qing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - R Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
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20
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21
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Lung Cancer Mortality and Topography: A Xuanwei Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050473. [PMID: 27164122 PMCID: PMC4881098 DOI: 10.3390/ijerph13050473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/10/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022]
Abstract
The epidemic of lung cancer in Xuanwei City, China, remains serious despite the reduction of the risk of indoor air pollution through citywide stove improvement. The main objective of this study was to characterize the influences of topography on the spatiotemporal variations of lung cancer mortality in Xuanwei during 1990-2013. Using the spatially empirical Bayes method, the smoothed mortality rate of lung cancer was obtained according to the mortality data and population data collected from the retrospective survey (1990-2005) and online registration data (2011-2013). Spatial variations of the village-level mortality rate and topographic factors, including the relief degree of land surface (RDLS) and dwelling conditions (VDC), were characterized through spatial autocorrelation and hotspot analysis. The relationship between topographic factors and the epidemic of lung cancer was explored using correlation analysis and geographically weighted regression (GWR). There is a pocket-like area (PLA) in Xuanwei, covering the clustered villages with lower RDLS and higher VDC. Although the villages with higher mortality rate (>80 per 10⁵) geographically expanded from the center to the northeast of Xuanwei during 1990-2013, the village-level mortality rate was spatially clustered, which yielded a persistent hotspot area in the upward part of the PLA. In particular, the epidemic of lung cancer was closely correlated with both RDLS and VDC at the village scale, and its spatial heterogeneity could be greatly explained by the village-level VDC in the GWR model. Spatiotemporally featured lung cancer mortality in Xuanwei was potentially influenced by topographic conditions at the village scale.
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Chen Y, Xiao Y, Yang Y, Duan J, Xu W. Decomposing contribution of age and non-age factors to rapid growth of lung cancer in Xuanwei over past 30 years. BMC Public Health 2015; 15:1116. [PMID: 26563138 PMCID: PMC4643511 DOI: 10.1186/s12889-015-2482-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND From 1973 to 2005, the lung cancer mortality in Xuanwei had increased constantly. Effect analysis of age and non-age factors on lung cancer is important for local policy-making. METHODS Demographic and death data was collected and used. Factors of lung cancer were classified into age and non-age factors. The contribution of the two factors to lung cancer was evaluated by method of decomposing the differences of mortality rate. RESULTS For males, the non-age factors were the major contributor to growth of lung cancer mortality, and 78.46% of all growth was attributed to non-age factors. For females, the non-age factors were the absolute contributor to growth of lung cancer in 1973-1992. From 1992 to 2005, the contribution proportion had reduced to 75.39%. CONCLUSIONS Aging was one of risk factors for lung cancer in Xuanwei, but not the main factor. It was supposed that multiple environmental risk factors were related with high growth of lung cancer in Xuanwei. Policy-making should focus on the non-age factors.
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Affiliation(s)
- Yang Chen
- Department of Chronic disease, Yunnan center for disease control and prevention, Dongsi Street, Kunming, China.
| | - Yize Xiao
- Department of Chronic disease, Yunnan center for disease control and prevention, Dongsi Street, Kunming, China.
| | - Yongfang Yang
- Department of Chronic disease, Yunnan center for disease control and prevention, Dongsi Street, Kunming, China.
| | - Jing Duan
- Department of Chronic disease, Yunnan center for disease control and prevention, Dongsi Street, Kunming, China.
| | - Wen Xu
- Department of Chronic disease, Yunnan center for disease control and prevention, Dongsi Street, Kunming, China.
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Wang TW, Vermeulen RCH, Hu W, Liu G, Xiao X, Alekseyev Y, Xu J, Reiss B, Steiling K, Downward GS, Silverman DT, Wei F, Wu G, Li J, Lenburg ME, Rothman N, Spira A, Lan Q. Gene-expression profiling of buccal epithelium among non-smoking women exposed to household air pollution from smoky coal. Carcinogenesis 2015; 36:1494-501. [PMID: 26468118 DOI: 10.1093/carcin/bgv150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022] Open
Abstract
In China's rural counties of Xuanwei and Fuyuan, lung cancer rates are among the highest in the world. While the elevated disease risk in this population has been linked to the usage of smoky (bituminous) coal as compared to smokeless (anthracite) coal, the underlying molecular changes associated with this exposure remains unclear. To understand the physiologic effects of smoky coal exposure, we analyzed the genome-wide gene-expression profiles in buccal epithelial cells collected from healthy, non-smoking female residents of Xuanwei and Fuyuan who burn smoky (n = 26) and smokeless (n = 9) coal. Gene-expression was profiled via microarrays, and changes associated with coal type were correlated to household levels of fine particulate matter (PM2.5) and polycyclic aromatic hydrocarbons (PAHs). Expression levels of 282 genes were altered with smoky versus smokeless coal exposure (P < 0.005), including the 2-fold increase of proinflammatory IL8 and decrease of proapoptotic CASP3. This signature was more correlated with carcinogenic PAHs (e.g. Benzo[a]pyrene; r = 0.41) than with non-carcinogenic PAHs (e.g. Fluorene; r = 0.08) or PM2.5 (r = 0.05). Genes altered with smoky coal exposure were concordantly enriched with tobacco exposure in previously profiled buccal biopsies of smokers and non-smokers (GSEA, q < 0.05). This is the first study to identify a signature of buccal epithelial gene-expression that is associated with smoky coal exposure, which in part is similar to the molecular response to tobacco smoke, thereby lending biologic plausibility to prior epidemiological studies that have linked this exposure to lung cancer risk.
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Affiliation(s)
- Teresa W Wang
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA, Bioinformatics Program, Boston University, Boston, MA 02215, USA
| | - Roel C H Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Gang Liu
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Xiaohui Xiao
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Yuriy Alekseyev
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jun Xu
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Boris Reiss
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Katrina Steiling
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA, Bioinformatics Program, Boston University, Boston, MA 02215, USA
| | - George S Downward
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Debra T Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Fusheng Wei
- China National Environmental Monitoring Center, Beijing, China and
| | - Guoping Wu
- China National Environmental Monitoring Center, Beijing, China and
| | - Jihua Li
- Qujing Center for Diseases Control and Prevention, Qujing, China
| | - Marc E Lenburg
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA, Bioinformatics Program, Boston University, Boston, MA 02215, USA, Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| | - Avrum Spira
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, MA 02118, USA, Bioinformatics Program, Boston University, Boston, MA 02215, USA, Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA,
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
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Hosgood HD, Song M, Hsiung CA, Yin Z, Shu XO, Wang Z, Chatterjee N, Zheng W, Caporaso N, Burdette L, Yeager M, Berndt SI, Landi MT, Chen CJ, Chang GC, Hsiao CF, Tsai YH, Chien LH, Chen KY, Huang MS, Su WC, Chen YM, Chen CH, Yang TY, Wang CL, Hung JY, Lin CC, Perng RP, Chen CY, Chen KC, Li YJ, Yu CJ, Chen YS, Chen YH, Tsai FY, Kim C, Seow WJ, Bassig BA, Wu W, Guan P, He Q, Gao YT, Cai Q, Chow WH, Xiang YB, Lin D, Wu C, Wu YL, Shin MH, Hong YC, Matsuo K, Chen K, Wong MP, Lu D, Jin L, Wang JC, Seow A, Wu T, Shen H, Fraumeni JF, Yang PC, Chang IS, Zhou B, Chanock SJ, Rothman N, Lan Q. Interactions between household air pollution and GWAS-identified lung cancer susceptibility markers in the Female Lung Cancer Consortium in Asia (FLCCA). Hum Genet 2015; 134:333-41. [PMID: 25566987 PMCID: PMC5537621 DOI: 10.1007/s00439-014-1528-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
We previously carried out a multi-stage genome-wide association study (GWAS) on lung cancer among never smokers in the Female Lung Cancer Consortium in Asia (FLCCA) (6,609 cases, 7,457 controls) that identified novel susceptibility loci at 10q25.2, 6q22.2, and 6p21.32, and confirmed two previously identified loci at 5p15.33 and 3q28. Household air pollution (HAP) attributed to solid fuel burning for heating and cooking, is the leading cause of the overall disease burden in Southeast Asia, and is known to contain lung carcinogens. To evaluate the gene-HAP interactions associated with lung cancer in loci independent of smoking, we analyzed data from studies participating in FLCCA with fuel use information available (n = 3; 1,731 cases; 1,349 controls). Coal use was associated with a 30% increased risk of lung cancer (OR 1.3, 95% CI 1.0-1.6). Among the five a priori SNPs identified by our GWAS, two showed a significant interaction with coal use (HLA Class II rs2395185, p = 0.02; TP63 rs4488809 (rs4600802), p = 0.04). The risk of lung cancer associated with coal exposure varied with the respective alleles for these two SNPs. Our observations provide evidence that genetic variation in HLA Class II and TP63 may modify the association between HAP and lung cancer risk. The roles played in the cell cycle and inflammation pathways by the proteins encoded by these two genes provide biological plausibility for these interactions; however, additional replication studies are needed in other non-smoking populations.
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Affiliation(s)
- H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave. Belfer 1309, 10461, Bronx, NY, USA,
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Downward GS, Hu W, Rothman N, Reiss B, Wu G, Wei F, Chapman R, Portengen L, Qing L, Vermeulen R. Polycyclic aromatic hydrocarbon exposure in household air pollution from solid fuel combustion among the female population of Xuanwei and Fuyuan counties, China. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2014; 48:14632-41. [PMID: 25393345 PMCID: PMC4270388 DOI: 10.1021/es504102z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 05/19/2023]
Abstract
Exposure to polycyclic aromatic hydrocarbons (PAHs) from burning "smoky" (bituminous) coal has been implicated as a cause of the high lung cancer incidence in the counties of Xuanwei and Fuyuan, China. Little is known about variations in PAH exposure from throughout the region nor how fuel source and stove design affects exposure. Indoor and personal PAH exposure resulting from solid fuel combustion in Xuanwei and Fuyuan was investigated using repeated 24 h particle bound and gas-phase PAH measurements, which were collected from 163 female residents of Xuanwei and Fuyuan. 549 particle bound (283 indoor and 266 personal) and 193 gas phase (all personal) PAH measurements were collected. Mixed effect models indicated that PAH exposure was up to 6 times higher when burning smoky coal than smokeless coal and varied by up to a factor of 3 between different smoky coal geographic sources. PAH measurements from unventilated firepits were up to 5 times that of ventilated stoves. Exposure also varied between different room sizes and season of measurement. These findings indicate that PAH exposure is modulated by a variety of factors, including fuel type, coal source, and stove design. These findings may provide valuable insight into potential causes of lung cancer in the area.
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Affiliation(s)
- George S. Downward
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3512 JE, The Netherlands
- Phone: +31
30 253 2578; e-mail:
| | - Wei Hu
- Division
of Cancer Epidemiology, Genetics, National
Cancer Institute, NIH, DHHS, Bethesda, Maryland 20892, United States
| | - Nat Rothman
- Division
of Cancer Epidemiology, Genetics, National
Cancer Institute, NIH, DHHS, Bethesda, Maryland 20892, United States
| | - Boris Reiss
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3512 JE, The Netherlands
| | - Guoping Wu
- China National Environmental
Monitoring Centre, Beijing 100062, China
| | - Fusheng Wei
- China National Environmental
Monitoring Centre, Beijing 100062, China
| | - Robert
S. Chapman
- College
of Public Health Sciences, Chulalongkorn
University, Bangkok 10330, Thailand
| | - Lutzen Portengen
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3512 JE, The Netherlands
| | - Lan Qing
- Division
of Cancer Epidemiology, Genetics, National
Cancer Institute, NIH, DHHS, Bethesda, Maryland 20892, United States
| | - Roel Vermeulen
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3512 JE, The Netherlands
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Hosgood HD, Sapkota AR, Rothman N, Rohan T, Hu W, Xu J, Vermeulen R, He X, White JR, Wu G, Wei F, Mongodin EF, Lan Q. The potential role of lung microbiota in lung cancer attributed to household coal burning exposures. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2014; 55:643-51. [PMID: 24895247 PMCID: PMC4217127 DOI: 10.1002/em.21878] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/16/2014] [Indexed: 05/04/2023]
Abstract
Bacteria influence site-specific disease etiology and the host's ability to metabolize xenobiotics, such as polycyclic aromatic hydrocarbons (PAHs). Lung cancer in Xuanwei, China has been attributed to PAH-rich household air pollution from burning coal. This study seeks to explore the role of lung microbiota in lung cancer among never smoking Xuanwei women and how coal burning may influence these associations. DNA from sputum and buccal samples of never smoking lung cancer cases (n = 8, in duplicate) and controls (n = 8, in duplicate) in two Xuanwei villages was extracted using a multi-step enzymatic and physical lysis, followed by a standardized clean-up. V1-V2 regions of 16S rRNA genes were PCR-amplified. Purified amplicons were sequenced by 454 FLX Titanium pyrosequencing and high-quality sequences were evaluated for diversity and taxonomic membership. Bacterial diversity among cases and controls was similar in buccal samples (P = 0.46), but significantly different in sputum samples (P = 0.038). In sputum, Granulicatella (6.1 vs. 2.0%; P = 0.0016), Abiotrophia (1.5 vs. 0.085%; P = 0.0036), and Streptococcus (40.1 vs. 19.8%; P = 0.0142) were enriched in cases compared with controls. Sputum samples had on average 488.25 species-level OTUs in the flora of cases who used smoky coal (PAH-rich) compared with 352.5 OTUs among cases who used smokeless coal (PAH-poor; P = 0.047). These differences were explained by the Bacilli species (Streptococcus infantis and Streptococcus anginosus). Our small study suggests that never smoking lung cancer cases have differing sputum microbiota than controls. Further, bacteria found in sputum may be influenced by environmental exposures associated with the type of coal burned in the home.
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Affiliation(s)
- H. Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Amy R. Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, Maryland
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Jun Xu
- School of Public Health, The University of Hong Kong
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Netherlands
| | - Xingzhou He
- Institute of Environmental Health and Engineering, Chinese Center for Disease Control and Prevention, Beijing, China
| | - James Robert White
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Guoping Wu
- China National Environmental Monitoring Center, Chaoyang District, Beijing, China
| | - Fusheng Wei
- China National Environmental Monitoring Center, Chaoyang District, Beijing, China
| | - Emmanuel F. Mongodin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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28
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Seow WJ, Hu W, Vermeulen R, Hosgood Iii HD, Downward GS, Chapman RS, He X, Bassig BA, Kim C, Wen C, Rothman N, Lan Q. Household air pollution and lung cancer in China: a review of studies in Xuanwei. CHINESE JOURNAL OF CANCER 2014; 33:471-5. [PMID: 25223911 PMCID: PMC4198749 DOI: 10.5732/cjc.014.10132] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky (i.e., bituminous) coal use compared to smokeless (i.e., anthracite) coal use. The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.
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Affiliation(s)
- Wei Jie Seow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA.
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Household ventilation may reduce effects of indoor air pollutants for prevention of lung cancer: a case-control study in a Chinese population. PLoS One 2014; 9:e102685. [PMID: 25019554 PMCID: PMC4097600 DOI: 10.1371/journal.pone.0102685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/23/2014] [Indexed: 11/19/2022] Open
Abstract
Background Although the International Agency for Research on Cancer (IARC) has classified various indoor air pollutants as carcinogenic to humans, few studies evaluated the role of household ventilation in reducing the impact of indoor air pollutants on lung cancer risk. Objectives To explore the association between household ventilation and lung cancer. Methods A population-based case-control study was conducted in a Chinese population from 2003 to 2010. Epidemiologic and household ventilation data were collected using a standardized questionnaire. Unconditional logistic regression was employed to estimate adjusted odds ratios (ORadj) and their 95% confidence intervals (CI). Results Among 1,424 lung cancer cases and 4,543 healthy controls, inverse associations were observed for good ventilation in the kitchen (ORadj = 0.86, 95% CI: 0.75, 0.98), bedroom (ORadj = 0.90, 95% CI: 0.79, 1.03), and both kitchen and bedroom (ORadj = 0.87, 95% CI: 0.75, 1.00). Stratified analyses showed lung cancer inversely associated with good ventilation among active smokers (ORadj = 0.85, 95% CI: 0.72, 1.00), secondhand smokers at home (ORadj = 0.77, 95% CI: 0.63, 0.94), and those exposed to high-temperature cooking oil fumes (ORadj = 0.82, 95% CI: 0.68, 0.99). Additive interactions were found between household ventilation and secondhand smoke at home as well as number of household pollutant sources. Conclusions A protective association was observed between good ventilation of households and lung cancer, most likely through the reduction of exposure to indoor air pollutants, indicating ventilation may serve as one of the preventive measures for lung cancer, in addition to tobacco cessation.
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Kim C, Chapman RS, Hu W, He X, Hosgood HD, Liu LZ, Lai H, Chen W, Silverman DT, Vermeulen R, Tian L, Bassig B, Shen M, Zhang Y, Ma S, Rothman N, Lan Q. Smoky coal, tobacco smoking, and lung cancer risk in Xuanwei, China. Lung Cancer 2014; 84:31-5. [PMID: 24506909 DOI: 10.1016/j.lungcan.2014.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/12/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Lung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used. MATERIALS AND METHODS We conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95% confidence interval (CI) for tobacco use was calculated by conditional logistic regression. RESULTS Use of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0-3 tons: OR: 1.09; 95% CI: 1.03-1.17; >3 tons: OR: 0.99; 95% CI: 0.95-1.03). Among more hazardous coal users, attenuation occurred at even low levels of usage (>0-3 tons: OR: 1.02; 95% CI: 0.91-1.14; >3 tons: OR: 0.94; 95% CI: 0.97-1.03). CONCLUSION We found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere.
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Affiliation(s)
- Christopher Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States; School of Public Health, Yale University, New Haven, CT 06520, United States.
| | - Robert S Chapman
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States
| | - Xingzhou He
- Institute of Environmental Health and Engineering, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States; Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Larry Z Liu
- Weill Medical College of Cornell University, New York, NY 10021, United States
| | - Hong Lai
- Department of Radiology and Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Wei Chen
- Forest Laboratories, Inc., Jersey City, NJ 07311, United States
| | - Debra T Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States
| | - Roel Vermeulen
- Institute for Risk Assessment, Utrecht University, Utrecht, The Netherlands
| | - Linwei Tian
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Bryan Bassig
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States; School of Public Health, Yale University, New Haven, CT 06520, United States
| | - Min Shen
- Interfaith Medical Center, Brooklyn, NY 11213, United States
| | - Yawei Zhang
- School of Public Health, Yale University, New Haven, CT 06520, United States
| | - Shuangge Ma
- School of Public Health, Yale University, New Haven, CT 06520, United States
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States
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Hu W, Downward GS, Reiss B, Xu J, Bassig BA, Hosgood HD, Zhang L, Seow WJ, Wu G, Chapman RS, Tian L, Wei F, Vermeulen R, Lan Q. Personal and indoor PM2.5 exposure from burning solid fuels in vented and unvented stoves in a rural region of China with a high incidence of lung cancer. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2014; 48:8456-64. [PMID: 25003800 PMCID: PMC4123931 DOI: 10.1021/es502201s] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 05/19/2023]
Abstract
The combustion of biomass and coal is the dominant source of household air pollution (HAP) in China, and contributes significantly to the total burden of disease in the Chinese population. To characterize HAP exposure related to solid fuel use and ventilation patterns, an exposure assessment study of 163 nonsmoking female heads of households enrolled from 30 villages was conducted in Xuanwei and Fuyuan, two neighboring rural counties with high incidence of lung cancer due to the burning of smoky coal (a bituminous coal, which in health evaluations is usually compared to smokeless coal--an anthracite coal available in some parts of the area). Personal and indoor 24-h PM2.5 samples were collected over two consecutive days in each household, with approximately one-third of measurements retaken in a second season. The overall geometric means (GM) of personal PM2.5 concentrations in Xuanwei and Fuyuan were 166 [Geometric Standard Deviation (GSD):2.0] and 146 (GSD:1.9) μg/m(3), respectively, which were similar to the indoor PM2.5 air concentrations [GM(GSD):162 (2.1) and 136 (2.0) μg/m(3), respectively]. Personal PM2.5 was moderately highly correlated with indoor PM2.5 (Spearman r = 0.70, p < 0.0001). Burning wood or plant materials (tobacco stems, corncobs etc.) resulted in the highest personal PM2.5 concentrations (GM:289 and 225 μg/m(3), respectively), followed by smoky coal, and smokeless coal (GM:148 and 115 μg/m(3), respectively). PM2.5 levels of vented stoves were 34-80% lower than unvented stoves and firepits across fuel types. Mixed effect models indicated that fuel type, ventilation, number of windows, season, and burning time per stove were the main factors related to personal PM2.5 exposure. Lower PM2.5 among vented stoves compared with unvented stoves and firepits is of interest as it parallels the observation of reduced risks of malignant and nonmalignant lung diseases in the region.
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Affiliation(s)
- Wei Hu
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
| | - George S. Downward
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3508 TD, The Netherlands
| | - Boris Reiss
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3508 TD, The Netherlands
| | - Jun Xu
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
| | - Bryan A. Bassig
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
| | - H. Dean Hosgood
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
| | - Linlin Zhang
- China
National Environmental Monitoring Center, Beijing 100029, People’s Republic of China
| | - Wei Jie Seow
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
| | - Guoping Wu
- China
National Environmental Monitoring Center, Beijing 100029, People’s Republic of China
| | - Robert S. Chapman
- College
of Public Health Sciences, Chulalongkorn
University, Bangkok 10330, Thailand
| | - Linwei Tian
- Chinese
University of Hong Kong, Hong Kong, People’s Republic of China
| | - Fusheng Wei
- China
National Environmental Monitoring Center, Beijing 100029, People’s Republic of China
| | - Roel Vermeulen
- Institute
for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht 3508 TD, The Netherlands
- Phone: +31 30 253 9448; fax: +31 30 253 9449; e-mail:
| | - Qing Lan
- Division
of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health
and Human Service, Rockville, Maryland 20850, United States
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Hosgood HD, Pao W, Rothman N, Hu W, Pan YH, Kuchinsky K, Jones KD, Xu J, Vermeulen R, Simko J, Lan Q. Driver mutations among never smoking female lung cancer tissues in China identify unique EGFR and KRAS mutation pattern associated with household coal burning. Respir Med 2013; 107:1755-62. [PMID: 24055406 DOI: 10.1016/j.rmed.2013.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/31/2013] [Accepted: 08/22/2013] [Indexed: 01/30/2023]
Abstract
Lung cancer in never smokers, which has been partially attributed to household solid fuel use (i.e., coal), is etiologically and clinically different from lung cancer attributed to tobacco smoking. To explore the spectrum of driver mutations among lung cancer tissues from never smokers, specifically in a population where high lung cancer rates have been attributed to indoor air pollution from domestic coal use, multiplexed assays were used to detect >40 point mutations, insertions, and deletions (EGFR, KRAS, BRAF, HER2, NRAS, PIK3CA, MEK1, AKT1, and PTEN) among the lung tumors of confirmed never smoking females from Xuanwei, China [32 adenocarcinomas (ADCs), 7 squamous cell carcinomas (SCCs), 1 adenosquamous carcinoma (ADSC)]. EGFR mutations were detected in 35% of tumors. 46% of these involved EGFR exon 18 G719X, while 14% were exon 21 L858R mutations. KRAS mutations, all of which were G12C_34G>T, were observed in 15% of tumors. EGFR and KRAS mutations were mutually exclusive, and no mutations were observed in the other tested genes. Most point mutations were transversions and were also found in tumors from patients who used coal in their homes. Our high mutation frequencies in EGFR exon 18 and KRAS and low mutation frequency in EGFR exon 21 are strikingly divergent from those in other smoking and never smoking populations from Asia. Given that our subjects live in a region where coal is typically burned indoors, our findings provide new insights into the pathogenesis of lung cancer among never smoking females exposed to indoor air pollution from coal.
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Affiliation(s)
- H Dean Hosgood
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA; Division of Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA.
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Alberg AJ, Brock MV, Ford JG, Samet JM, Spivack SD. Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e1S-e29S. [PMID: 23649439 DOI: 10.1378/chest.12-2345] [Citation(s) in RCA: 452] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Ever since a lung cancer epidemic emerged in the mid-1900 s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research. METHODS A detailed literature search provided the basis for a narrative review, identifying and summarizing key reports on population patterns and factors that affect lung cancer risk. RESULTS Established environmental risk factors for lung cancer include smoking cigarettes and other tobacco products and exposure to secondhand tobacco smoke, occupational lung carcinogens, radiation, and indoor and outdoor air pollution. Cigarette smoking is the predominant cause of lung cancer and the leading worldwide cause of cancer death. Smoking prevalence in developing nations has increased, starting new lung cancer epidemics in these nations. A positive family history and acquired lung disease are examples of host factors that are clinically useful risk indicators. Risk prediction models based on lung cancer risk factors have been developed, but further refinement is needed to provide clinically useful risk stratification. Promising biomarkers of lung cancer risk and early detection have been identified, but none are ready for broad clinical application. CONCLUSIONS Almost all lung cancer deaths are caused by cigarette smoking, underscoring the need for ongoing efforts at tobacco control throughout the world. Further research is needed into the reasons underlying lung cancer disparities, the causes of lung cancer in never smokers, the potential role of HIV in lung carcinogenesis, and the development of biomarkers.
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Affiliation(s)
- Anthony J Alberg
- Hollings Cancer Center and the Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
| | - Malcolm V Brock
- Department of Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jean G Ford
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jonathan M Samet
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Simon D Spivack
- Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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HosgoodIII HD, Chapman RS, He X, Hu W, Tian L, Liu LZ, Lai H, Chen W, Rothman N, Lan Q. History of lung disease and risk of lung cancer in a population with high household fuel combustion exposures in rural China. Lung Cancer 2013; 81:343-346. [PMID: 23891511 DOI: 10.1016/j.lungcan.2013.06.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/20/2013] [Accepted: 06/28/2013] [Indexed: 11/28/2022]
Abstract
History of chronic lung diseases and household coal use for heating and cooking are established risk factors of lung cancer; however, few studies have been able to explore these risk factors simultaneously. Xuanwei, China, has some of the highest rates of lung cancer in China and most residents experience substantial in-home coal smoke exposures. Using a population-based case-control study of 498 lung cancer cases and 498 age-matched controls, we evaluated the risk of lung cancer in relation to coal smoke exposure and history of chronic lung diseases, including chronic obstructive pulmonary disease (COPD), asthma, tuberculosis (TB), chronic bronchitis, and emphysema. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by conditional logistic regression adjusting for potential confounders. We observed an increased risk of lung cancer with history of any chronic lung disease among males (OR = 14.2; 95%CI = 4.3-46.9), females (OR = 2.6; 95%CI = 1.1-6.3), smokers (OR = 12.7; 95%CI = 3.5-45.8), and nonsmokers (OR = 2.6; 95%CI = 1.1-6.4). Specifically, TB (OR = 83.7; 95%CI = 11.0-634.7), COPD (OR = 3.2; 95%CI = 1.7-6.0), and emphysema and chronic bronchitis (OR = 3.3; 95%CI = 1.7-6.4) were associated with increased risks. These findings suggest that history of chronic lung diseases may also increase risk of lung cancer in populations with indoor coal smoke exposures.
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Affiliation(s)
- H Dean HosgoodIII
- Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA; Division of Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Robert S Chapman
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Xingzhou He
- Institute of Environmental Health and Engineering, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA
| | - Linwei Tian
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
| | - Larry Z Liu
- Department of Public Health, Weill Medical College of Cornell University, New York, NY, USA
| | - Hong Lai
- The Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Wei Chen
- Forest Laboratories, Inc., Harborside Financial Center, Jersey City, NJ, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, MD, USA
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Reid BC, Ghazarian AA, DeMarini DM, Sapkota A, Jack D, Lan Q, Winn DM, Birnbaum LS. Research opportunities for cancer associated with indoor air pollution from solid-fuel combustion. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1495-8. [PMID: 22846419 PMCID: PMC3556624 DOI: 10.1289/ehp.1204962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 07/30/2012] [Indexed: 05/04/2023]
Abstract
BACKGROUND Indoor air pollution (IAP) derived largely from the use of solid fuels for cooking and heating affects about 3 billion people worldwide, resulting in substantial adverse health outcomes, including cancer. Women and children from developing countries are the most exposed populations. A workshop was held in Arlington, Virginia, 9-11 May 2011, to better understand women's and children's potential health effects from IAP in developing countries. Workshop participants included international scientists, manufacturers, policy and regulatory officials, community leaders, and advocates who held extensive discussions to help identify future research needs. OBJECTIVES Our objective was to identify research opportunities regarding IAP and cancer, including research questions that could be incorporated into studies of interventions to reduce IAP exposure. In this commentary, we describe the state of the science in understanding IAP and its associations with cancer and suggest research opportunities for improving our understanding of the issues. DISCUSSION Opportunities for research on IAP and cancer include studies of the effect of IAP on cancers other than lung cancer; studies of genetic factors that modify susceptibility; studies to determine whether the effects of IAP are mediated via germline, somatic, and/or epigenetic changes; and studies of the effects of IAP exposure via dermal and/or oral routes. CONCLUSIONS IAP from indoor coal use increases the risk of lung cancer. Installing chimneys can reduce risk, and some genotypes, including GSTM1-null, can increase risk. Additional research is needed regarding the effects of IAP on other cancers and the effects of different types of solid fuels, oral and dermal routes of IAP exposure, genetic and epigenetic mechanisms, and genetic susceptibility.
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Affiliation(s)
- Britt C Reid
- Modifiable Risk Factors Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA.
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Barone-Adesi F, Chapman RS, Silverman DT, He X, Hu W, Vermeulen R, Ning B, Fraumeni JF, Rothman N, Lan Q. Risk of lung cancer associated with domestic use of coal in Xuanwei, China: retrospective cohort study. BMJ 2012; 345:e5414. [PMID: 22936785 PMCID: PMC3431444 DOI: 10.1136/bmj.e5414] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To estimate the risk of lung cancer associated with the use of different types of coal for household cooking and heating. SETTING Xuanwei County, Yunnan Province, China. DESIGN Retrospective cohort study (follow-up 1976-96) comparing mortality from lung cancer between lifelong users of "smoky coal" (bituminous) and "smokeless coal" (anthracite). PARTICIPANTS 27,310 individuals using smoky coal and 9962 individuals using smokeless coal during their entire life. MAIN OUTCOME MEASURES Primary outcomes were absolute and relative risk of death from lung cancer among users of different types of coal. Unadjusted survival analysis was used to estimate the absolute risk of lung cancer, while Cox regression models compared mortality hazards for lung cancer between smoky and smokeless coal users. RESULTS Lung cancer mortality was substantially higher among users of smoky coal than users of smokeless coal. The absolute risks of lung cancer death before 70 years of age for men and women using smoky coal were 18% and 20%, respectively, compared with less than 0.5% among smokeless coal users of both sexes. Lung cancer alone accounted for about 40% of all deaths before age 60 among individuals using smoky coal. Compared with smokeless coal, use of smoky coal was associated with an increased risk of lung cancer death (for men, hazard ratio 36 (95% confidence interval 20 to 65); for women, 99 (37 to 266)). CONCLUSIONS In Xuanwei, the domestic use of smoky coal is associated with a substantial increase in the absolute lifetime risk of developing lung cancer and is likely to represent one of the strongest effects of environmental pollution reported for cancer risk. Use of less carcinogenic types of coal could translate to a substantial reduction of lung cancer risk.
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Affiliation(s)
- Francesco Barone-Adesi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Blv, EPS 8015, Bethesda, MD 20892-7240, USA.
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Abstract
Limited data suggest that outdoor air pollution (such as ambient air pollution or traffic-related air pollution) and indoor air pollution (such as second-hand smoking and biomass fuel combustion exposure) are associated with the development of chronic obstructive pulmonary disease (COPD), but there is insufficient evidence to prove a causal relationship at this stage. It also appears that outdoor air pollution is a significant environmental trigger for acute exacerbation of COPD, leading to increasing symptoms, emergency department visits, hospital admissions and even mortality. Improving ambient air pollution and decreasing indoor biomass combustion exposure by improving home ventilation are effective measures that may substantially improve the health of the general public.
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Affiliation(s)
- Fanny W S Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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Prevalence and causes of air pollution and lung cancer in Xuanwei City and Fuyuan County, Yunnan Province, China. Front Med 2012; 6:217-20. [PMID: 22573219 DOI: 10.1007/s11684-012-0192-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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Hosgood HD, Chapman RS, Wei H, He X, Tian L, Liu LZ, Lai H, Engel LS, Chen W, Rothman N, Lan Q. Coal mining is associated with lung cancer risk in Xuanwei, China. Am J Ind Med 2012; 55:5-10. [PMID: 21987405 DOI: 10.1002/ajim.21014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Xuanwei, China, experiences some of the highest rates of lung cancer in China. While lung cancer risk has been linked to the household use of bituminous coal, no study has comprehensively evaluated the risk of lung cancer associated with the mining of this coal in Xuanwei. In Xuanwei, coal is typically extracted from underground mines, without ventilation, and transported to the surface using carts powered by manpower or electricity. METHODS We evaluated the risk of lung cancer and working as a coal miner, in the absence of diesel exhaust exposure, in a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls with information on occupational histories. Odds ratios (ORs) and 95% confidence intervals (CIs) for working as a coal miner and years of working as a coal miner were calculated by conditional logistic regression, adjusting for potential confounders, such as smoking and household coal use. RESULTS We observed an increased risk of lung cancer among coal miners (OR = 2.7; 95%CI = 1.3-5.6) compared to noncoal miners. Further, a dose-response relationship was observed for the risk of lung cancer and the number of years working as a coal miner (P(trend) = 0.02), with those working as miners for more than 10 years experiencing an almost fourfold increased risk (OR = 3.8; 95%CI = 1.4-10.3) compared to noncoal miners. CONCLUSIONS These findings suggest that coal mining in Xuanwei may be a risk factor for lung cancer.
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Affiliation(s)
- H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Bethesda, Maryland 20892-7240, USA.
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Hosgood HD, Wei H, Sapkota A, Choudhury I, Bruce N, Smith KR, Rothman N, Lan Q. Household coal use and lung cancer: systematic review and meta-analysis of case-control studies, with an emphasis on geographic variation. Int J Epidemiol 2011; 40:719-28. [PMID: 21278196 DOI: 10.1093/ije/dyq259] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Emissions from household coal combustion associated with cooking and heating are an important public health issue, particularly in China where hundreds of millions of people are exposed. Although coal emissions are a known human carcinogen, there is still uncertainty about the level of risk for lung and other cancers. METHODS We performed a meta-analysis on 25 case-control studies (10,142 cases and 13,416 controls) to summarize the association between household coal use and lung cancer risk, and to explore the effect modification of this association by geographical location. RESULTS Using random-effects models, household coal use was found to be associated with lung cancer risk among all studies throughout the world [odds ratio (OR) = 2.15; 95% confidence interval (CI) = 1.61-2.89, N(studies) = 25], and particularly among those studies carried out in mainland China and Taiwan (OR = 2.27; 95% CI = 1.65-3.12, N(studies) = 20). Stratification by regions of mainland China and Taiwan found a variation in effects across the regions, with south/southeastern (OR = 3.27; 95% CI = 1.27-8.42, N(studies) = 3) and southwestern China (OR = 2.98; 95% CI = 1.18-7.53, N(studies) = 3) experiencing the highest risk. The elevated risk associated with coal use throughout Asia was also observed when stratifying studies by gender, smoking status, sample size, design (population vs hospital case-control) and publication language. No significant publication bias was found (p(Begg's) = 0.15). CONCLUSIONS Our results provide evidence that although the carcinogenic effect of coal use varies by location, coals from many locations exhibit elevated lung cancer risks.
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Affiliation(s)
- H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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Hosgood HD, Boffetta P, Greenland S, Lee YCA, McLaughlin J, Seow A, Duell EJ, Andrew AS, Zaridze D, Szeszenia-Dabrowska N, Rudnai P, Lissowska J, Fabiánová E, Mates D, Bencko V, Foretova L, Janout V, Morgenstern H, Rothman N, Hung RJ, Brennan P, Lan Q. In-home coal and wood use and lung cancer risk: a pooled analysis of the International Lung Cancer Consortium. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:1743-7. [PMID: 20846923 PMCID: PMC3002194 DOI: 10.1289/ehp.1002217] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 09/15/2010] [Indexed: 05/04/2023]
Abstract
BACKGROUND Domestic fuel combustion from cooking and heating is an important public health issue because roughly 3 billion people are exposed worldwide. Recently, the International Agency for Research on Cancer classified indoor emissions from household coal combustion as a human carcinogen (group 1) and from biomass fuel (primarily wood) as a probable human carcinogen (group 2A). OBJECTIVES We pooled seven studies from the International Lung Cancer Consortium (5,105 cases and 6,535 controls) to provide further epidemiological evaluation of the association between in-home solid-fuel use, particularly wood, and lung cancer risk. METHODS Using questionnaire data, we classified subjects as predominant solid-fuel users (e.g., coal, wood) or nonsolid-fuel users (e.g., oil, gas, electricity). Unconditional logistic regression was used to estimate the odds ratios (ORs) and to compute 95% confidence intervals (CIs), adjusting for age, sex, education, smoking status, race/ethnicity, and study center. RESULTS Compared with nonsolid-fuel users, predominant coal users (OR = 1.64; 95% CI, 1.49-1.81), particularly coal users in Asia (OR = 4.93; 95% CI, 3.73-6.52), and predominant wood users in North American and European countries (OR = 1.21; 95% CI, 1.06-1.38) experienced higher risk of lung cancer. The results were similar in never-smoking women and other subgroups. CONCLUSIONS Our results are consistent with previous observations pertaining to in-home coal use and lung cancer risk, support the hypothesis of a carcinogenic potential of in-home wood use, and point to the need for more detailed study of factors affecting these associations.
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Affiliation(s)
- H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892-7240, USA.
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Hosgood HD, Cawthon R, He X, Chanock S, Lan Q. Genetic variation in telomere maintenance genes, telomere length, and lung cancer susceptibility. Lung Cancer 2009; 66:157-61. [PMID: 19285750 DOI: 10.1016/j.lungcan.2009.02.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 02/05/2009] [Accepted: 02/07/2009] [Indexed: 01/13/2023]
Abstract
Telomeres are responsible for the protection of the chromosome ends and shortened telomere length has been associated with risk of multiple cancers. Genetic variation in telomere-related genes may alter cancer risk associated with telomere length. Using lung cancer cases (n=120) and population-based controls (n=110) from Xuanwei, China, we analyzed telomere length separately and in conjunction with single nucleotide polymorphisms in the telomere maintenance genes POT1, TERT, and TERF2, which we have previously reported were associated with risk of lung cancer in this study. POT1 rs10244817, TERT rs2075786, and TERF2 rs251796 were significantly associated with lung cancer (p(trend)< or =0.05). The shortest tertile of telomere length was not significantly associated with risk of lung cancer (OR=1.58; 95% CI=0.79-3.18) when compared to the longest tertile of telomere length. When stratified by genotype, there was a suggestion of a dose-response relationship between tertiles of telomere length and risk of lung cancer among the POT1 rs10244817 common variant carriers (OR (95% CI)=1.33 (0.47-3.75), 3.30 (1.14-9.56), respectively) but not among variant genotype carriers (p(interaction)=0.05). Our findings provide evidence that telomere length and genetic variation in telomere maintenance genes may be associated with risk of lung cancer susceptibility and warrant replication in larger studies.
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Affiliation(s)
- H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States.
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