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

Literature Information ​

DOI10.3322/caac.21632
PMID32964460
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2020
Times Cited231
Keywordsbreast cancer, cancer survival, lung cancer, particulate matter
Literature TypeJournal Article, Review
ISSN0007-9235
AuthorsMichelle C Turner, Zorana J Andersen, Andrea Baccarelli, W Ryan Diver, Susan M Gapstur, C Arden Pope, Diddier Prada, Jonathan Samet, George Thurston, Aaron Cohen

TL;DR ​

This study underscores the significant global health threat posed by outdoor air pollution, particularly particulate matter, which is linked to increased lung cancer incidence and mortality, with hundreds of thousands of deaths attributed to it annually. The report highlights the need for comprehensive public health policies and interventions to mitigate pollution's impact and calls for further research into its association with other cancers and cancer survival rates.

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breast cancer · cancer survival · lung cancer · particulate matter

Abstract ​

Outdoor air pollution is a major contributor to the burden of disease worldwide. Most of the global population resides in places where air pollution levels, because of emissions from industry, power generation, transportation, and domestic burning, considerably exceed the World Health Organization's health-based air-quality guidelines. Outdoor air pollution poses an urgent worldwide public health challenge because it is ubiquitous and has numerous serious adverse human health effects, including cancer. Currently, there is substantial evidence from studies of humans and experimental animals as well as mechanistic evidence to support a causal link between outdoor (ambient) air pollution, and especially particulate matter (PM) in outdoor air, with lung cancer incidence and mortality. It is estimated that hundreds of thousands of lung cancer deaths annually worldwide are attributable to PM air pollution. Epidemiological evidence on outdoor air pollution and the risk of other types of cancer, such as bladder cancer or breast cancer, is more limited. Outdoor air pollution may also be associated with poorer cancer survival, although further research is needed. This report presents an overview of outdoor air pollutants, sources, and global levels, as well as a description of epidemiological evidence linking outdoor air pollution with cancer incidence and mortality. Biological mechanisms of air pollution-derived carcinogenesis are also described. This report concludes by summarizing public health/policy recommendations, including multilevel interventions aimed at individual, community, and regional scales. Specific roles for medical and health care communities with regard to prevention and advocacy and recommendations for further research are also described.

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Primary Questions Addressed ​

  1. What are the specific types of outdoor air pollutants that have been most strongly linked to cancer incidence?
  2. How do the health effects of outdoor air pollution differ between urban and rural populations?
  3. What interventions have been most effective in reducing outdoor air pollution and subsequently cancer rates in affected communities?
  4. How does outdoor air pollution impact cancer treatment outcomes and patient survival rates?
  5. What are the gaps in current research regarding the relationship between outdoor air pollution and types of cancer other than lung cancer?

Key Findings ​

Research Background and Objectives ​

Outdoor air pollution is a significant global health issue, contributing to a range of diseases, including cancer. This report aims to provide an overview of the current evidence linking outdoor air pollution, particularly particulate matter (PM), to cancer incidence and mortality. It also discusses public health recommendations and policy interventions necessary to mitigate these risks.

Main Methods/Materials/Experimental Design ​

The authors conducted a comprehensive review of epidemiological studies and meta-analyses focusing on the relationship between outdoor air pollution and cancer, particularly lung cancer. They evaluated the sources and types of air pollutants, their health impacts, and the biological mechanisms of air pollution-related carcinogenesis.

Technical Route ​

Mermaid diagram

Key Results and Findings ​

  1. Lung Cancer and PM Exposure: There is strong evidence linking PM exposure to increased lung cancer incidence and mortality. Meta-analyses indicate a 9% increase in lung cancer risk per 10 µg/m³ increase in PM2.5.
  2. Global Burden: An estimated 265,267 lung cancer deaths globally in 2017 were attributable to PM2.5, representing 14.1% of all lung cancer deaths.
  3. Other Cancers: Evidence linking outdoor air pollution to other cancers, such as bladder and breast cancer, is less robust but suggestive of increased risks.
  4. Biological Mechanisms: Air pollution may cause cancer through mechanisms including oxidative stress, inflammation, and DNA damage.

Main Conclusions/Significance/Innovation ​

The report underscores the urgent need for public health interventions to reduce outdoor air pollution, as it is a modifiable risk factor for cancer. It calls for coordinated efforts across individual, community, and policy levels to implement effective strategies aimed at improving air quality and reducing cancer risk.

Research Limitations and Future Directions ​

  • Limited Evidence for Other Cancers: More research is needed to establish clearer links between outdoor air pollution and other cancer types beyond lung cancer.
  • Need for Longitudinal Studies: Future studies should focus on long-term exposure assessments and consider the effects of specific air pollutants on various cancer histologies.
  • Public Health Strategies: There is a need for more comprehensive public health policies that address air pollution at multiple levels, particularly in low- and middle-income countries where pollution levels are often highest.

Summary Table of Key Points ​

AspectDetails
Main PollutantsPM2.5, NO2, SO2, O3
Cancer Types StudiedLung, bladder, breast, colorectal, and childhood cancers
Evidence LevelStrong for lung cancer; limited for others
Public Health ImplicationsUrgent need for interventions to reduce air pollution
Future Research NeedsFocus on other cancer types, long-term exposure studies

References ​

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  4. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. - Michelle C Turner;Daniel Krewski;C Arden Pope;Yue Chen;Susan M Gapstur;Michael J Thun - American journal of respiratory and critical care medicine (2011)
  5. Chronic long-term exposure to cadmium air pollution and breast cancer risk in the French E3N cohort. - Amina Amadou;Delphine Praud;Thomas Coudon;Aurélie M N Danjou;Elodie Faure;Karen Leffondré;Muriel Le Romancer;Gianluca Severi;Pietro Salizzoni;Francesca Romana Mancini;Béatrice Fervers - International journal of cancer (2020)
  6. Comparison of air pollution exposures in active vs. passive travel modes in European cities: A quantitative review. - Audrey de Nazelle;Olivier Bode;Juan Pablo Orjuela - Environment international (2017)
  7. Ambient air pollution and primary liver cancer incidence in four European cohorts within the ESCAPE project. - Marie Pedersen;Zorana J Andersen;Massimo Stafoggia;Gudrun Weinmayr;Claudia Galassi;Mette Sørensen;Kirsten T Eriksen;Anne Tjønneland;Steffen Loft;Andrea Jaensch;Gabriele Nagel;Hans Concin;Ming-Yi Tsai;Sara Grioni;Alessandro Marcon;Vittorio Krogh;Fulvio Ricceri;Carlotta Sacerdote;Andrea Ranzi;Ranjeet Sokhi;Roel Vermeulen;Kees de Hoogh;Meng Wang;Rob Beelen;Paolo Vineis;Bert Brunekreef;Gerard Hoek;Ole Raaschou-Nielsen - Environmental research (2017)
  8. Local action on outdoor air pollution to improve public health. - Sotiris Vardoulakis;Rachel Kettle;Paul Cosford;Paul Lincoln;Stephen Holgate;Jonathan Grigg;Frank Kelly;David Pencheon - International journal of public health (2018)
  9. Cellular Pliancy and the Multistep Process of Tumorigenesis. - Alain Puisieux;Roxane M Pommier;Anne-Pierre Morel;Fabrice Lavial - Cancer cell (2018)
  10. Association between ambient air pollution and breast cancer risk: The multiethnic cohort study. - Iona Cheng;Chiuchen Tseng;Jun Wu;Juan Yang;Shannon M Conroy;Salma Shariff-Marco;Lianfa Li;Andrew Hertz;Scarlett Lin Gomez;Loïc Le Marchand;Alice S Whittemore;Daniel O Stram;Beate Ritz;Anna H Wu - International journal of cancer (2020)

Literatures Citing This Work ​

  1. Nanocarrier-Based Drug Delivery for Melanoma Therapeutics. - Mingming Song;Chang Liu;Siyu Chen;Wenxiang Zhang - International journal of molecular sciences (2021)
  2. Determination of Genotoxicity Attributed to Diesel Exhaust Particles in Normal Human Embryonic Lung Cell (WI-38) Line. - Joong Won Lee;Hee Jae Lee;Young-Joo Lee;Yong-Beom Lim;Woo Jong Sim;Ji-Hye Jang;Hye-Ryeon Heo;Hyun Joung Lim;Ji-Won Jung;Jin Sik Kim - Biomolecules (2021)
  3. Recent Application of Zebrafish Models in Atherosclerosis Research. - Dandan Tang;Fang Geng;Chunxiao Yu;Ruilin Zhang - Frontiers in cell and developmental biology (2021)
  4. Self-assembled polymeric nanocarrier-mediated co-delivery of metformin and doxorubicin for melanoma therapy. - Mingming Song;Wentao Xia;Zixuan Tao;Bin Zhu;Wenxiang Zhang;Chang Liu;Siyu Chen - Drug delivery (2021)
  5. A bibliometric and visualized analysis of research progress and frontiers on health effects caused by PM2.5. - Ming Han;Fengxia Yang;Haifeng Sun - Environmental science and pollution research international (2021)
  6. Incidence trends in bladder and lung cancers between Denmark, Finland and Sweden may implicate oral tobacco (snuff/snus) as a possible risk factor. - Kari Hemminki;Asta Försti;Akseli Hemminki;Börje Ljungberg;Otto Hemminki - BMC cancer (2021)
  7. Exposure to metals and morbidity at eight years follow-up in women of childbearing age. - Isabella Karakis;Yael Baumfeld;Daniella Landau;Roni Gat;Nofar Shemesh;Maayan Yitshak-Sade;Ofir Tirosh;Batia Sarov;Lena Novack - Scientific reports (2021)
  8. Role of sex hormones in lung cancer. - Nathalie Fuentes;Miguel Silva Rodriguez;Patricia Silveyra - Experimental biology and medicine (Maywood, N.J.) (2021)
  9. The Association between Polluted Neighborhoods and TP53-Mutated Non-Small Cell Lung Cancer. - Loretta Erhunmwunsee;Sam E Wing;Jenny Shen;Hengrui Hu;Ernesto Sosa;Lisa N Lopez;Catherine Raquel;Melissa Sur;Pilar Ibarra-Noriega;Madeline Currey;Janet Lee;Jae Y Kim;Dan J Raz;Arya Amini;Sagus Sampath;Marianna Koczywas;Erminia Massarelli;Howard L West;Karen L Reckamp;Rick A Kittles;Ravi Salgia;Victoria L Seewaldt;Susan L Neuhausen;Stacy W Gray - Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology (2021)
  10. Commute patterns, residential traffic-related air pollution, and lung cancer risk in the prospective UK Biobank cohort study. - Jason Y Y Wong;Rena R Jones;Charles Breeze;Batel Blechter;Nathaniel Rothman;Wei Hu;Bu-Tian Ji;Bryan A Bassig;Debra T Silverman;Qing Lan - Environment international (2021)

... (221 more literatures)

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