ArticlesAir pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE)
Introduction
Lung cancer is one of the most common cancers and has a poor prognosis. Active smoking is the main cause, but occupational exposures, residential radon, and environmental tobacco smoke are also established risk factors. Furthermore, lower socioeconomic position has been associated with a higher risk for lung cancer.1 Ambient air pollution, specifically particulate matter with absorbed polycyclic aromatic hydrocarbons and other genotoxic chemicals, is suspected to increase the risk for lung cancer. Results of several epidemiological studies have shown higher risks for lung cancer in association with various measures of air pollution2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and suggested an association mainly in non-smokers4, 12 and never-smokers13, 14 and in individuals with low fruit consumption.4, 13 In developed countries, overall lung cancer incidence rates have stabilised during the past few decades, but major shifts have been recorded in the frequencies of different histological types of lung cancer, with substantial relative increases in adenocarcinomas and decreases in squamous-cell carcinomas.15 Changes in tobacco blends15 and ambient air pollution16, 17 might have contributed to these shifts.
Within the European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to analyse data from 17 European cohort studies with a wide range of exposure levels to investigate the following hypotheses: that ambient air pollution at the residence (specifically particulate matter) is associated with risk for lung cancer; that the association between air pollution and risk for lung cancer is stronger for non-smokers and people with low fruit intake; and that the association with air pollution is stronger for adenocarcinomas and squamous-cell carcinomas than for all lung cancers combined.
Section snippets
Study design and participants
This study is a prospective analysis of data obtained by ESCAPE—an investigation into the long-term effects of exposure to air pollution on human health in Europe—which included 36 European areas in which air pollution was measured, land-use regression models were developed, and cohort studies were located. The present study included 17 cohort studies, located in 12 areas, from which information about incident lung cancer cases and the most important potential confounders could be obtained, and
Results
The 17 cohorts in nine European countries that contributed to this study contained 312 944 cohort members and contributed 4 013 131 person-years at risk and 2095 incident lung cancer cases that developed during follow-up (average follow-up was 12·8 years). More details of each cohort, including characteristics of the participants, available variables, and their distribution are provided in the appendix (pp 2–18). Most of the cohort studies recruited participants in the 1990s (appendix, pp 2–18
Discussion
This analysis of 17 European cohort studies shows associations between residential exposure to particulate matter air pollution at enrolment and the risk for lung cancer. The associations were stronger for adenocarcinomas of the lung and in participants who lived at their enrolment address throughout follow-up.
The strengths of our study include the use of 17 cohort studies in several locations in Europe with very different air pollution exposure levels and also the use of standardised protocols
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